Bloodborne pathogens requirements for emergency medical services

NOTICE: This is an OSHA Archive Document, and may no longer represent OSHA Policy. It is presented here as historical content, for research and review purposes only.

December 4, 1992

The Honorable Bill Clinger
U.S. House of Representatives
[Recipient address omitted]

Dear Congressman Clinger:

Thank you for your letter of September 24, on behalf of your constituent, Mr. Stephen Hale, Forest County Commissioner, regarding his concerns about the Occupational Safety and Health Administration's (OSHA) Final Standard for Occupational Exposure to Bloodborne Pathogens. Mr. Hale 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) and the Human Immunodeficiency Virus (HIV). Of these two diseases Hepatitis B is more common, with 8,700 cases per year among workers in the health care profession. Hepatitis B infection may result in serious illness, potential 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 disease, are found in human blood and certain other human body fluids. Therefore, employers have a particular responsibility to ensure that workers 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 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. Congress believed 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."

In order to explain the general requirements of the standard OSHA produced a video titled, "As It Should Be Done." It explains in clear, straightforward language most of the key provisions of the standard. In addition, OSHA published five fact sheets and six Bloodborne Pathogens compliance assistance booklets, including booklets for acute care facilities, emergency responders, dentists, and nursing homes. In addition, we are enclosing a booklet pertaining to emergency responders. The enclosed sheet lists titles and ordering information for all of these materials.

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 effort is ongoing and will continue. Please contact the OSHA office in your area to request a speaker or other assistance.

We would like to also address several of Mr. Hale's specific concerns which resulted largely from inaccuracies in the Emmco West memorandum which he quotes. OSHA does permit the use of solutions of 5.25 sodium hypochlorite (household bleach) diluted between 1:10 and 1:100 with water for disinfection of environmental surfaces and for decontamination of sites following initial cleanup of spills of blood or other potentially infectious materials.

The bloodborne pathogens standard requires employers to provide employees with appropriate personal protective equipment for the tasks and procedures which they perform as part of their job duties. An exception is allowed when the employer can show that the employee temporarily and briefly declined to use personal protective equipment when, under rare and extraordinary circumstances, it was the employee's judgement that in the specific instance its use would have prevented the delivery of health care or public safety services. However, since it is reasonable to anticipate that an emergency medical technician will perform mouth-to-mouth resuscitation as part of his or her job duties, the employer is expected to provide the employee with, and ensure the use of, resuscitation devices which protect the employee from occupational exposure.

Lastly, OSHA jurisdiction extends to the employer-employee relationship. While a number of factors may be considered in establishing such a relationship (such as compensation), true volunteers are not currently covered under the OSH Act.

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,
Director
Directorate of Compliance Programs

[Constituent correspondence reproduced on OSHA page; omitted here.]