Bloodborne pathogen exposure for first aid, cleanup, and hotel housekeeping

December 4, 1992

Mr. W. Valentini
President
Federal Compliance and Reporting Service
[Recipient address omitted]
Dear Mr. Valentini:

This is in further response to your letter of October 14, which was sent to a number of Occupational Safety and Health Administration (OSHA) Regional and Area Offices. Your letters were referred to this office for response.

The Office of Health Compliance Assistance, in this Directorate, is responsible for developing enforcement policy on health issues and for coordinating guidance to both agency field staff and the general public on a variety of health compliance issues, including the Occupational Exposure to Bloodborne Pathogens Standard, 29 CFR 1910.1030. We were therefore concerned to learn that some apparent misinformation may have been provided concerning this important standard.

Following the issuance of this standard, OSHA mounted an unprecedented outreach effort in an attempt to inform the public of the requirements of the standard. This effort included the publication of six booklets detailing the standard's applicability to acute care facilities, emergency responders, dentists, and nursing homes, as well as five fact sheets and the production of a video entitled "As It Should Be Done".

OSHA conducted a two-day train-the-trainer session for its field staff concurrently with the issuance of the standard and has appointed a bloodborne pathogens coordinator in each of its ten regional offices. These coordinators may be contacted for answers to complex inquiries. A list of OSHA publications and the addresses of our regional offices are enclosed for your information.

Lastly, since December 1991, OSHA staff in national, regional, and area offices have been conducting extensive outreach, training and education meetings of the bloodborne pathogens standard with a wide range of groups. Over 1,000 meetings have been held and over 80,000 individuals have participated. This is the largest, most extensive training and education effort in the twenty year history of OSHA.

You requested in your letter that the agency clarify its position with regard to compliance programs offered by private companies to employers. OSHA does not endorse or approve any type of product, including training programs. Staff at the regional or area office level, may, at the discretion of the Regional Administrator or Area Director, offer some assistance in the development of various products. However this in no way constitutes approval or endorsement of the product and the agency's name may not be used to market the product. We are also enclosing a copy of a news release which the agency recently issued concerning training programs.

With regard to the specific scenarios for which you requested an interpretation as to the applicability of the standard, we will address them in the order in which you presented them. Please bear in mind that while OSHA can provide general guidelines, it is the employer's responsibility to determine which particular jobs or groups of specific tasks and procedures constitute occupational exposure at his or her facility.

Scenario 1: "In an industrial facility, with a history of accidents and injuries, where employees, not designated nor trained in first aid, are expected to render first aid to an injured employee. Does this constitute occupational exposure?"

Answer: If an employee is expected, as part of his or her job duties, to render first aid or medical assistance, that employee is covered by the requirements of the standard. Such an expectation would constitute a de facto designation of the employee and OSHA, additionally, would require that such an employee receive the appropriate training. Please refer to the enclosed news release for details on a recent policy decision concerning employees who render first aid as a collateral duty and the pre-exposure hepatitis B vaccine.

Scenario 2: "In an industrial manufacturing facility, with a history of accidents and injuries, where injuries, however small are treated by outside personnel (ambulance personnel, paramedics, EMT's, etc.) but the accident area or the area where first aid was rendered are left to be cleaned up and expected to be cleaned up and decontaminated by company personnel. Does this constitute "occupational exposure"?

Answer: "Occupational exposure" is defined as the reasonable anticipation of contact with blood or other potentially infectious materials as a result of performing one's job duties and is not limited to employees who experience occupational exposure by virtue of the fact that they render certain health care services. An employee whose job includes the cleaning and decontaminating of contaminated areas or surfaces would be considered to have occupational exposure.

Scenario 3: In a typical hotel or motel operations, where housekeepers routinely clean rooms by handling potentially contaminated laundry, cleaning potentially contaminated surfaces, have the reasonable expectation of coming in contact with potentially contaminated sharps such as syringes or broken glass, and have the reasonable expectation to have to clean up blood, vomitus and other potentially infectious materials. Does this constitute "occupational exposure"?

Answer: OSHA does not generally consider housekeeping staff in non-health care facilities to have occupational exposure. However, in keeping with the above mentioned requirement that the employer evaluate each job classification for occupational exposure, employers in the hotel industry would have to take into account all circumstances of potential exposure and determine which, if any, employees may come into contact with blood or OPIM during normal cleaning and handling of laundry. Employees who handle linens soiled with feces, nasal secretions, sputum, sweat, tears, urine, vomitus, or saliva (other than saliva from dental procedures) would not be occupationally exposed during that task as these substances are not included in the standard's definition of "other potentially infectious materials".

An employer may choose to designate specific employees to perform any tasks and procedures (e.g., handling linens soiled with urine that did contain visible blood) that involve occupational exposure and train other employees to defer such tasks to employees designated to perform them.

For enforcement purposes, if OSHA determines on a case-by-case basis that sufficient evidence exists of reasonably anticipated exposure, the employer will be held responsible for providing the protections of 29 CFR 1910.1030 to the employees with occupational exposure. For example, if it can be reasonably anticipated that an employee in a particular hotel will come into contact with contaminated sharps, that employee must be extended the protections of the standard.

Please note that the definition of "contaminated" applies to dry as well as wet material since, as you correctly stated, the hepatitis B virus remains viable in dried material for up to seven days.

Scenario 4: This applies to every workplace and relates to where the line is drawn between "occupational exposure" and "good samaritan acts". A fact sheet, circulated by OSHA, contains the statement "Good samaritan acts such as assisting a co-worker with a nose bleed would not be considered occupational exposure". My question is: "Would a worker assisting a bleeding co-worker with a work related injury still be considered a good samaritan or does the worker have occupational exposure?"

Answer: "Good Samaritan" acts are not covered under the standard regardless of the particular type of injury involved. The work- relatedness of the injury is not the determining factor; rather coverage is invoked when, as stated above, an employee is expected to render assistance as part of his or her job duties.

We hope this information is responsive to your concerns. We appreciate your bringing your concerns to our attention. Thank you for your interest in worker safety and health.

Sincerely,
Roger A. Clark,
Director
Directorate of Compliance Programs

Enclosures

[Requester letter reproduced on OSHA page; omitted here.]