Medical record retention and chemical labels in dental offices

NOTICE: This is an OSHA Archive Document, and may no longer represent OSHA Policy. It is presented here as historical content, for research and review purposes only.

September 25, 1992
The Honorable Christopher J. Dodd
United States Senator
[Recipient address omitted]
Dear Senator Dodd:
This is in further response to your letter of July 24, on behalf of your constituent, Dr. James E Brown, regarding his concerns about the Occupational Safety and Health Administration (OSHA) regulation, 29 CFR 1910.1030, "Occupational Exposure to Bloodborne Pathogens." He expressed concerns about the necessity for the standard, and the standard's requirements and costs.
The Bloodborne Pathogens standard is designed to protect the Nation's workers, particularly health care workers, from exposure to the Hepatitis B Virus (HBV), the Human Immunodeficiency Virus (HIV), and other bloodborne pathogens. Of the diseases caused by these viruses, Hepatitis B is the most common, with 8,700 cases per year among workers in the health care profession. Hepatitis B infection may result in serious illness, long term disability, and death. HIV causes AIDS, for which there currently is no cure and which eventually results in death. These viruses, as well as other organisms that cause bloodborne diseases, are found in human blood and certain other human body fluids. Therefore, employers have a particular responsibility to ensure that employees do not come into direct contact with blood or other potentially infectious materials while performing their job.
The development of this standard by OSHA took more than five years, beginning with close cooperation on the development of a proposed standard with the Centers for Disease Control, Department of Health and Human Services. The proposed standard was based on the scientifically sound infection control practice of "universal precautions" originally established by the CDC for handling of body fluids known to transmit HIV.
Following the publication of the proposed standard the public, particularly the dental and medical communities, submitted approximately 3,000 comments to the official record. In addition, OSHA held 5 public hearings, in Washington, D.C., Chicago, New York City, Miami and San Francisco, where 440 individuals and organizations testified. The comments and testimony underwent extensive review and analysis, and many of the suggested changes were adopted in the final rule. In addition, the U.S. Congress held a series of hearings concerning the proposed Bloodborne Pathogens standard. Many individuals and groups testified at these hearings, including the American Medical Association and the American Dental Association.
Furthermore, Congress attached an "appropriations rider" to the FY 1992 OSHA funding bill which required the agency to finalize the Bloodborne Pathogens standard by December 1, 1991. During debate, members of Congress indicated that the risks to workers were significant and that the possibility of illness and death could no longer be ignored; it therefore used the appropriations rider to encourage the agency to expedite the promulgation of the standard.
During the development of the standard, compliance costs, those costs incurred to meet the requirements, were extensively analyzed. All OSHA workplace safety and health standards undergo a similar, very stringent, review. A key component of this review was a 3,500-facility survey, which included both large and small physicians' and dentists' offices, funeral homes, nursing homes, and blood banks among others. This survey showed that many offices already were complying with many provisions of the standard, including practicing "universal precautions."
For example, disposable gloves were in use by 96% of the direct patient care workers in dentists' offices before the standard became final. The costs for items already being used and procedures already in place were not included in the cost estimates for full compliance with the final standard. Therefore, the costs which were analyzed were the additional costs to those employers not currently providing their workers with items such as disposable gloves.
With respect to Dr. Brown's comments regarding the recordkeeping requirements of the standard, OSHA believes that the 30-year retention period is necessary and not overly burdensome. Paragraph 29 CFR 1910.1030(h) requires employers to establish and maintain for each employee medical records that include hepatitis B vaccination status and evaluation and follow-up of exposure incidents. The records need not be kept at the place of employment but must be maintained in a manner that makes them accessible to OSHA. Some employers may contract with the health care professional or professionals that perform the vaccination or post-exposure follow-up to maintain the records. If the employer does not retain possession of the records, the employer must assure that the records are available to OSHA and make them accessible by identifying where the records are kept and how they may be accessed by OSHA.
Dr. Brown's concern regarding labeling of containers of chemical products such as rubbing alcohol and "white out" with "biohazard labels" appears to be based on a misunderstanding of the definitions and requirements of the rule, and confusion with the labeling requirements of another OSHA standard. To clarify, the OSHA Hazard Communication standard, 29 CFR 1910.1200, addresses labeling of containers of hazardous chemicals to warn employees of chemical hazards, although there are exemptions regarding labeling requirements for certain consumer products and pharmaceuticals. Dr. Brown's presumption of a requirement to label such chemical products as "biohazardous", however, is not correct.
We also understand your constituent's concerns about the increase in medical costs and the effect on health care availability. The standard was designed to protect the lives and health of workers from serious and deadly diseases, such as Hepatitis B and AIDS. OSHA believes that the relatively modest costs necessary to comply with the standard will neither put small, independent physicians and dentists out of business, nor reduce the availability of health care for American families.
In order to explain the general requirements of the standard, OSHA published five fact sheets and six Bloodborne Pathogens compliance assistance booklets, including booklets for acute care facilities, emergency responders, dentists, and nursing homes. OSHA also produced a motivational video titled, "As It Should Be Done". The enclosed sheet lists titles and ordering information for all of these materials and copies of the regulations referenced above.
OSHA has ten regional offices around the United States, each with a Bloodborne Pathogens Coordinator to respond to inquiries about the standard. A listing of telephone numbers and addresses is enclosed. Since December 1991, the OSHA staff in the National, Regional and Area Offices have been conducting extensive outreach, training and education meetings on the Bloodborne Pathogens standard with a wide range of groups, including physicians and dentists. Over 1,000 individual meetings have been held and over 80,000 individuals have participated. This is the largest, most extensive, training and education effort in the 20 year history of OSHA. This effort is ongoing and will continue. Please refer Dr. Brown to the OSHA office in his area to request further assistance.
We understand that the cost of complying with this standard is of concern, and that most American health care professionals follow safe practices; however, the risks of illness and death from HBV and HIV for workers are too great to ignore and they mandate the full employee protection and training required by the standard.
Sincerely,
Roger A. Clark
Acting Director
Directorate of Compliance Programs