Bloodborne pathogen precautions in allergy skin testing

NOTICE: This is an OSHA Archive Document, and may no longer represent OSHA Policy. It is presented here as historical content, for research and review purposes only.

July 10, 1995

Gary L. Hein, President
Lincoln Diagnostics, Inc.
[Recipient address omitted]
Dear Mr Hein:

Thank you your letter dated June 22, 1995, concerning allergen testing procedures. Your letter addresses several important points relevant to 29 CFR 1910.1030, Occupational Exposure to Bloodborne Pathogens. Each will be addressed separately.

1. Applicability of 29 CFR 1910.1030 Bloodborne Pathogens. Under paragraph 5(a)(1) of the OSH Act, the employer is responsible to ensure a safe and healthful workplace for all employees. More specifically, the Occupational Exposure to Bloodborne Pathogens standard applies where "... occupational exposure to blood or other potentially infectious materials...can be reasonably anticipated." (p. 64175) OSHA has not attempted to list all the occupations where such exposures have the potential to occur. This listing comprises a portion of the employer's Exposure Control Plan.

As the employer specified in your letter, the allergist is responsible for the provisions of the standard. Procedures performed by the employees in this worksite do include the reasonable anticipation of contact with blood and other potentially infectious materials. This constitutes the definition of "occupational exposure" and OSHA therefore believes the standard is applicable to allergists and their employees who perform allergen test procedures.

2. Feasibility of engineering controls. One of the greatest hazards to workers is from needles and other sharp objects contaminated with blood or other potentially infectious, materials. Of the 25 cases of HIV seroconversion reported in the standard's health effects section, 15 were associated with needlestick injuries. The chance of becoming infected after a single needlestick from a patient infected with Hepatitis B ranges up to 30%. The intent of the Bloodborne Pathogens standard is to minimize or eliminate reasonably anticipated skin and other contacts with blood or other potentially infectious materials. Therefore, OSHA requires the handling of contaminated needles and sharps be dealt with accordingly.

The needles which are used to inject extracts of various allergens either subcutaneously or intradermally are considered to be "contaminated sharps"; that is, they would be reasonably anticipated to involve the presence of blood or other potentially infectious material. The presence of non-visible body fluids would also constitute "contamination."

Employee contact with contaminated articles, specifically the needle or other instrument used for allergen testing, would need to be eliminated or minimized. If contact is required by a specific medical procedure or if no alternative is feasible, engineering controls (i.e., mechanical devices), or work practice controls (i.e., one-handed technique), must be employed. Engineering and work practice controls would need to be evaluated by the employer to facilitate the elimination or minimization of the risk. If engineering and work practice controls do not eliminate or minimize the occupational exposure potential, personal protective equipment shall also be used.

Further, the standard requires each employer to establish an exposure control plan "designed to eliminate or minimize employee exposure." The exposure determination shall be made without regard to the use of personal protective equipment. Clearly, the "prick and wipe" or "scratch and wipe" procedure described in your letter would merit attention from the employer to minimize occupational exposure. If contact with the contaminated needle must be practiced, it must be accomplished through the use of engineering or work practice controls. The exposure control plan must include a provision for the use of these controls in the specific circumstance.

3. Endorsement of products. Your implicit request for OSHA to review and comment on your product, a disposable multi- test skin testing device, is beyond the purview of this agency. OSHA does not review or endorse products as you have requested. The final determination of compliance must take into account all factors pertaining to the use of such devices at a particular worksite. This must include an evaluation through direct observation of employee work practices as well as an evaluation of the equipment or devices alone.

4. Recommendation for specific practice methodologies. Most recent OSHA standards are written as performance rules; they state a general objective to be achieved without stating requirements for accomplishing that goal. OSHA has used this same general approach in the Bloodborne Pathogens standard. Instead of stating precisely which employees should be provided gloves or goggles, or which need more extensive protection, we have essentially required employees be protected through a combination of work practices, engineering controls and personal protective equipment to the extent such protection is necessary dependent upon the extent and type of exposure. This approach requires judgement on the part of employers as to which employees are exposed, how extensively they are exposed, and what protection is necessary.

You expressed the belief that the standard prohibits the performance of the "prick and wipe" or "scratch and wipe" technique of allergy testing. There is nothing in the standard that would prohibit the performance of any medical procedure. The standard simply requires all human blood and certain body fluids be treated as if they were known to be infectious for HIV and HBV; employees with occupational exposure be provided with the protections of the standard, including the implementation of engineering and work practice controls as well as the wearing of appropriate personal protective equipment such as gloves; and, contaminated sharps be appropriately containerized and labeled. The final OSHA rule does not dictate professional practice. This is the responsibility of the profession.

I hope this information is helpful to you. If you have any further questions feel free to contact Elise Handelman, Acting Director, Office of Occupational Health Nursing at (202) 219-7056.

Sincerely,
Charles Adkins, CIH
Director
Directorate of Technical Support

[Requester correspondence and device evaluation reference reproduced on OSHA page; omitted here.]