29 CFR 1910.1030 Bloodborne Pathogens

Rationale

The rationale for the standard is described in the extensive introductory text. While HBV, HCV, and HIV are specifically identified in the standard, the term "bloodborne pathogen" refers to any microorganism that in present in human blood or other potentially infectious material that can infect and cause disease in exposed persons. These microorganisms include but are not limited to HBV, HCV, HIV, human T-lymphotrophic virus Type 1, and pathogens causing malaria, syphilis, babesiosis, brucellosis, leptospirosis, arboviral infections, relapsing fever, Creutzfeldt-Jakob disease, and viral hemorrhagic fever.

In essence, OSHA recognizes that bloodborne pathogens, including (but not limited to) hepatitis B Virus (HBV), hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV), among others, account for significant morbidity and mortality in the workplace. In the preamble to the final standard, OSHA estimates that, "for every 1000 workers with occupational exposure to blood or other potentially infectious material, between 83 and 113 will become infected with HBV over the course their working lifetime because of occupational exposure to the virus. Of these, 21 to 30 will suffer clinical illness and 4 to 6 will need hospitalization. Between 4 and 12 of the cases with clinical illness will become chronic carriers, and 1 to 3 of them will suffer from chronic hepatitis. HBV infection from occupational exposure will lead to the death of 2 to 3 of these 1000 exposed workers."

Application

The standard applies to "...[All] occupational exposure to blood or other potentially infectious materials..." Specifically, "occupational exposure" means, "reasonably anticipated skin, eye, mucous membrane, or parenteral (Situated or occurring outside the intestine); introduced otherwise than by way of the intestines (intravascular) contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties." This means that any fire fighter who may have contact with blood or other materials, either as a first responder or in any other way that is work-related, is subject to the provisions of the standard. In its Regulatory Impact and Regulatory Flexibility Analysis, "...OSHA based its estimate of the population at risk on survey responses which indicated essentially all EMT’s to be exposed (98 percent)...and 80 percent of all fire fighters to be exposed." If there is any doubt, the assumption should be that anyone who could possibly be exposed to bloodborne pathogens should be assumed to be at risk, should be immunized, and should adhere to the other provisions of the standard.

Under the Occupational Safety and Health Act of 1970, federal OSHA has no direct enforcement authority to ensure that state and local governments comply with health and safety standards, such as the OSHA Fire Brigade Standard, for public employees. However, the OSHA law does permit other methods to be utilized in order to maximize the protection of public employees’ health and safety.

In lieu of federal OSHA enforcement of health and safety standards, a state may opt to implement their own enforcement program providing federal OSHA has approved their state safety and health plan. These rules and regulations, 29 CFR 1956, entitled State Plans for the Development and Enforcement of State Standards Applicable to State and Local Government Employees in States Without Approved Private Employee Plans set forth the requirement that states without approved plans must develop a safety and health plan for public employees similar to those required for states with approved plans if they wish to receive federal financial support for public employee safety and health programs. Section 18 of the Occupational Safety and Health Act requires that a state must provide satisfactory assurance that it will establish and maintain an effective and comprehensive occupational safety and health program for all public employees as effective as that contained in the approved state plan covering private employees.

OSHA announced on December 2, 1991 that it would be sending letters to the governors of states which do not yet have approved state plans, "to encourage them to extend the protections of the standard to public sector employees." OSHA has given the State Plan states 6 months from the publication date of the final standard to adopt a comparable standard that is “at least as effective” as the OSHA standard. All fire departments, whether state, county, or municipal, in any of the states or territories where an OSHA State Plan agreement is in effect has the protection of the minimally acceptable health and safety standards promulgated by federal OSHA. Individual states may provide more stringent standards, if they wish to do so.

The following twenty-six states/territories have State OSHA Plans:

  • New York*
  • North Carolina
  • Oregon
  • Puerto Rico
  • South Carolina
  • Tennessee
  • Utah
  • Kentucky
  • Maryland
  • Michigan
  • Minnesota
  • Nevada
  • New Jersey
  • New Mexico
  • Vermont
  • Virginia
  • Virgin Islands
  • Washington
  • Wyoming
  • Alaska
  • Arizona
  • California*
  • Connecticut*
  • Hawaii
  • Indiana
  • Iowa
*For state and local government employees only. OSHA APPROVED STATE PLANS

Finally, Executive Order 12196, issued February 26, 1980 and implemented December 21, 1980 requires that all federal agencies comply with the same safety and health requirements as private employees. Thus, federal fire fighters are protected under federal OSHA safety and health standards.

The coverage of public employees under minimum acceptable standards as promulgated by federal OSHA becomes important when we consider this infection control regulation. This standard is enforceable for all public fire fighters in states with approved federal OSHA plans. However, all U.S. and Canadian fire fighters should consider this to be the minimum acceptable standard for protection from bloodborne pathogens.

Requirments

The following is a summary of the most important parts of the standard applicable to fire fighters. This is not a word-for-word transcription of the standard, and does not contain all of the provisions of the standard. It also does not contain the preamble to the standard, which contains some of OSHA’s explanations for various provisions. Where appropriate, some of these comments have been added. However, this summary should not substitute for the regulatory text itself.

  • Employers must develop comprehensive exposure control plans and review them at least annually. This plan describes how the employer will meet the overall goals of the standard (minimizing employee exposures) and the specific elements of the program.
  • Employers must develop exposure determinations, which list job classifications, activities, and potential for exposures to infectious materials.
  • Universal precautions shall be followed whenever the potential for exposure exists.
  • Engineering and work practice controls shall be used by employers to eliminate or minimize employee exposures. OSHA’s 1999 revision of the standard requires employers to use engineering controls such as safer medical devices. Safer medical devices include equipment like needleless systems, sharps with engineered sharps injury protection, and plastic capillary tubes. Where occupational exposures remain after these controls are instituted, personal protective equipment (PPE) is also to be used. There must be a regular maintenance and replacement schedule for engineering controls.
  • Hand washing facilities will be accessible to all employees, or, where this is not feasible, antiseptic hand cleaner with cloth or paper towels. Hands must be washed after removal of PPE; hands, mucous membranes, or other exposed skin must be washed after exposure to blood or other infectious materials.
  • Sharps may not be bent, recapped, or removed unless there is no feasible alternative. If they must be recapped or removed, it must be through a one-handed technique.
  • Workplace practices are specified, including immediate safe disposal of sharps, prohibition against eating, drinking, or other practices in areas where there is a "reasonable likelihood" of occupational exposure, and a requirement that blood and other potentially infectious materials be handled in a way so as to minimize potential exposures. [Note: In the summary and explanation, OSHA states, "...[The] Agency recognizes that circumstances could arise which would require employees to remain in ambulances for extended periods of time. It is not the Agency’s intent to prohibit these employees from eating or drinking during such extended periods. Therefore, eating and drinking in ambulance cabs is permitted under the final standard provided the employer has implemented procedures to wash up and change contaminated clothing prior to entering the cab. In addition, employers must prohibit the consumption, handling, storage, and transport of food and drink in the rear of the vehicle."]
  • Potentially contaminated equipment must be inspected and decontaminated, if necessary, before servicing or shipping.
  • Personal protective equipment (PPE) shall be provided at no cost to all employees and accessible in situations where there is occupational exposure. The PPE will be considered "appropriate" if it prevents penetration of the potentially infectious material to the employee’s skin, street clothing, or mucous membranes. [Note: In the summary and 23 explanation, OSHA states, "Based upon the information provided in the comments, OSHA has concluded that minimization of mouth-to-mouth resuscitation is prudent practice and that the most effective means to do so is to require ventilation devices be provided for resuscitation. Consequently, these devices have been retained under the requirements for provision of personal protective equipment. In addition…these devices are to be readily accessible to employees who can reasonably be expected to resuscitate a patient."]
  • The employer is responsible for seeing that the employees use the appropriate PPE. The employer may show that the employee “temporarily and briefly” declined to use PPE, if the employee judged that use of the PPE would have prevented the delivery of health care or increased the hazard to the employee or a co-worker; however, the circumstances of the occurrence are supposed to be investigated so as to prevent similar events in the future. [Note: In the summary and explanation, OSHA discusses at length the rationale for providing an exemption to the use of PPE. ". . . The types of circumstances which OSHA envisions may necessitate invocation of the exemption are those which require an on-the-spot decision and would not be conducive to awaiting approval or disapproval of the employer . . . OSHA does not intend to compel an employee to bypass the use of appropriate personal protective equipment against the employee’s will . . . Utilization of the exemption is to occur, as stated in the standard, only in rare and extraordinary circumstances which are unexpected and threaten the life or safety of the patient, worker, or co-worker . . . It should also be understood that the decision not to use personal protective equipment is to be made on a case-by-case basis and in no way is to be generally applied to a particular work area or recurring task .
  • PPE must be accessible at the worksite or issued to employees. For people with sensitivity to the gloves ordinarily provided, alternatives (hypoallergenic gloves or glove liners, for example) must be provided. [Note: In the summary and explanation to the standard, OSHA commented on the need for accessibility in cases where it was not possible to return to a "home base" between emergency calls. "OSHA agrees . . . that . . . 'accessible' would be on-scene, either on an individual’s person or on the vehicle, depending upon the nature of the equipment . . . [The] second set of clothing could be kept on the ambulance or employees could be provided with several sets of replaceable coveralls to be kept on the vehicle. The employer’s responsibility to ensure accessible personal protective equipment for employees at non-fixed worksites cannot be overemphasized."]
  • PPE shall be cleaned, laundered, and disposed of as appropriate by the employer at no cost to employees. It shall also be repaired or replaced at no cost. If penetrated with blood or other potentially infectious materials, the garment shall be removed immediately. PPE must be removed prior to leaving the work area, and placed in a designated area or container for storage, washing, decontamination, or disposal.
  • Gloves shall be worn in all situations where it may be "reasonably anticipated" there may be contact with blood or "other potentially infectious materials, mucous membranes, and non-intact skin; when performing vascular access procedures (except in volunteer blood banks under specified conditions); and when handling or touching contaminated items or surfaces." Disposable gloves must be disposed of after use or if they are contaminated, torn, or punctured; they may not be washed or decontaminated.
  • Masks, eye protection, and face shields shall be used whenever potentially infectious material may be "reasonably anticipated" from splashes, spray, spatter, etc.
  • Gowns, aprons, and other protective body clothing may be used depending on the type of situation.
  • Housekeeping requirements include an appropriate written schedule for cleaning and decontamination of the worksite (based on the activity or potential contamination of the area), cleaning and decontamination of equipment, environmental and working surfaces after contact with blood or other potentially infectious materials; prompt removal of protective coverings (plastic, aluminum foil, or imperviously-backed absorbent paper) immediately if they become contaminated or on a regular schedule; inspection and decontamination of bins, pails, cans, and similar waste receptacles; removal of broken glassware with mechanical means (brush and dustpan, tongs, or forceps); and storage of reusable sharps in such a fashion that employees do not have to reach into a container with their hands.
  • Sharps must be disposed of in appropriate containers. Containers for sharps shall be closable, puncture resistant, leak proof on the sides and bottom, labeled and color-coded, easily accessible, maintained upright, and replaced routinely. When removed from the area of use, the containers must be closed prior to removal, placed in a secondary container if leakage is possible, and may not be reopened in any way that would expose an employee to the risk of an injury.
  • Other regulated waste (materials that have come in contact with or could release infectious material) must be placed in containers that are closable, do not leak, are color-coded, and are closed prior to removal. If the outside of the container is itself contaminated, it must be placed in a secondary container that is similarly constructed.
  • Contaminated laundry must be bagged or containerized at the location where it was used without any sorting or rinsing, and shall be transported in labeled or color-coded containers or bags to the laundry facility. Employees who handle the laundry must wear gloves and other appropriate PPE.
  • Hepatitis B vaccine shall be made available to all employees who have occupational exposures, at no cost to the employees. The vaccine shall be made available "after the employee has received the training required" (see below) and "within 10 working days of initial assignment to all employees who have occupational exposure unless the employee has previously received the complete hepatitis B vaccination series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated for medical reasons." Vaccinations are to be given by or under the supervision of a licensed physician or other health care professional according to the recommendations of the CDC/U.S. Public Health Service. Participation in a prescreening program (a program to screen people for previous exposure to hepatitis B) cannot be made a prerequisite for receiving hepatitis B vaccination. If an employee initially declines vaccination but decides later to get vaccinated, the employer shall make the vaccine available at no cost. If an employee declines to receive the vaccination, he/she must sign a waiver as described in the standard. If at some point the CDC/U.S. Public Health Service recommends that people who have had the vaccination series should receive routine booster doses, they shall be made available to all employees at no cost.
  • Post-exposure evaluations and follow-up, including prophylaxis in the case of exposure, are also to be made immediately available to all employees at no cost and at a reasonable place. After the exposure incident is reported, the employer shall make available to the employee a confidential medical evaluation and follow-up, which includes at least:
    • Documentation of the route of exposure and circumstances under which it occurred;
    • Identification and documentation of the "source individual" (the individual whose blood or body fluids were the source of the exposure) unless that identification is not feasible or is prohibited by state or local law; once the source individual is identified, his blood shall be tested for HIV, HBV, and HCV infectivity (if patient consent for testing is legally required it must be obtained before his blood can be tested; if consent is required but not obtained that must be established by the employer; if consent is not required then the source individual’s blood will be tested and the results documented). Testing is not required if the source individual is already known to be infected with HIV, HBV, or HCV. Once the source individual’s status for HIV, HBV, and HCV infectivity is known, that information is made available to the exposed employee, as well as any "laws or regulations concerning disclosure of the identity and infectious status of the source individual";
    • Testing of the employee for HBV, HVC, and HIV serologic status as soon as feasible after consent is obtained. The employee may consent to give blood but not have HIV serologic testing; if so, the blood must be stored for at least 90 days, so that the employee can later elect to have the sample analyzed;
    • Post-exposure prophylaxis, when medically indicated, as recommended by the CDC/U.S. Public Health Service;
    • Counseling; and
    • Evaluation of reported illnesses.
  • The standard defines information provided to the healthcare professional, including a copy of the regulation for the healthcare professional providing the hepatitis B vaccination, and, for the healthcare professional providing care after an exposure incident, a copy of the regulation, a description of the employee’s duties, documentation of the route(s) and circumstances of the exposure, results of any blood testing on the source.
  • Within 15 days of the completion of the healthcare professional’s evaluation, the employer must obtain and provide to the employee a copy of the healthcare professional’s written opinion, which shall include only:
    • For hepatitis B vaccination, only whether vaccination is indicated and whether the employee has received it;
    • For a post-exposure evaluation, only that the employee has been informed of the results of the evaluation, and that the employee has been told about “any medical conditions resulting from exposure to blood or other potentially infectious materials which require further evaluation or treatment.”
  • Warning labels must be affixed to "containers of regulated waste, refrigerators and freezers containing blood or other potentially infectious material; and other containers used to store, transport or ship blood or other potentially infectious materials"; there are exceptions for red bags or red containers, blood or blood components that have been released for transfusions or other clinical uses, individual containers of blood or other potentially infection materials that are placed within a properly labeled container, or regulated waste that has been decontaminated. The label must include the biohazard legend:
  • A training program must be provided at no cost during working hours to all employees with occupational exposures. Training must be provided at the time an employee is initially assigned to a job where occupational exposure may take place, within 90 days after the effective date of the standard (March 3, 1992) and at least annually thereafter. Employees who have already had some training in bloodborne pathogens in the year prior to the standard only need training on subjects which their previous training did not cover. There must also be training updates when the tasks or procedures done by the employee change or create a new exposure. The training must include at a minimum:
    • A copy and explanation of the standard
    • General explanations of the epidemiology and symptoms of bloodborne diseases, and how bloodborne diseases are transmitted
    • The employer’s exposure control plan and how the employees can obtain a copy
    • How to recognize tasks that may involve exposures to bloodborne pathogens
    • The methods (and limitations of those methods) that will prevent exposures to bloodborne pathogens, including appropriate engineering controls, PPE, and work practices
    • The “types, proper use, location, removal, handling, decontamination and disposal” of PPE
    • The selection of appropriate PPE
    • Information on hepatitis B vaccination, including the benefits and the fact that it is no cost to the employee
    • Actions and procedures to be followed in the event of exposure and a description of the post-exposure evaluation
    • Labeling and signing requirements.
  • The employer is required to maintain records according to the following schedule: medical records (including the employee’s name, social security number, hepatitis B vaccination status, all examinations and evaluations required under the standard, healthcare professionals’ written opinions, and information provided to the healthcare professionals) for the duration of employment plus at least 30 years; and training records for 3 years from the date on which the training occurred. Medical records are confidential and may not be disclosed or reported without the employee’s written consent. Medical records are to be available to employees and to anyone having written consent of the employees upon request. Training records are available to the employee or employee representative upon request.

For more information go to
https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051