Bloodborne-pathogen rules for a medical practice

May 7, 1996

The Honorable Bob Graham
Unites States Senator
[Recipient address omitted]
Dear Senator Graham:

This is in further response to your letter of January 31, on behalf of your constituent, Dr. David M. Mokotoff, of Bay Area Heart Center concerning the Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogens Standard (29 CFR 1910.1030).

Dr. Mokotoff's employees attended a symposium on OSHA guidelines for medical practices. The information provided in the symposium raised concerns for the doctor. Dr. Mokotoff's concerns center on the designation of appropriate areas for eating, drinking, applying cosmetics or lip balm, and handling contact lenses; handwashing procedures; and information and training requirements for non-employees and employees. Also, the doctor raised concerns about the assessment of penalties for cited violations.

The Bloodborne Pathogens standard, paragraph (d)(2)(ix), prohibits these activities such as eating, drinking, applying cosmetics or lip balm, and handling contact lenses, only in work areas where employees have a reasonably anticipated exposure to blood or other potentially infectious materials (OPIM). The prohibition against food and drink and the use of personal items in such a work area is consistent with other OSHA standards and is good industrial hygiene practice. The employer/practitioner is free to designate an area where it is reasonable to anticipate that occupational exposure will fail to occur, and to allow the consumption of food and drink in those areas.

Dr. Mokotoff has been mistakenly informed that handwashing after patient contact for a bloodpressure check is an OSHA requirement. The bloodpressure check is a non-invasive procedure, and as such, employees would not have a reasonable likelihood of exposure to blood or OPIM. Hence, with bloodpressure checks, there is no requirement for handwashing by employees after patient contact.

In contrast, handwashing becomes a critical concern when the employee has occupational exposure to blood or OPIM, or when occupational exposure can be reasonably anticipated. OSHA recognizes this concern with paragraphs (d)(2)(v) and (d)(2)(vi) of the standard, stating employees must wash their hands after the removal of gloves and other personal protective equipment. Employees must also wash their hands or skin following contact with blood or other potentially infectious materials.

The Occupational Safety and Health Act extends protection only to employees, not to patients. Therefore, the Bloodborne Pathogens standard is applicable only to Dr. Mokotoff's employees. Dr. Mokotoff's concerns regarding this matter are unfounded since employers have no obligation under the Act to provide or implement any protective measures required under this standard, or any other standards to patients.

Dr. Mokotoff also expresses concern regarding training employees who have occupational exposure. Paragraph (g)(2) details employee training requirements, but essentially the standard emphasizes that the employer must provide information and training to those employees that have occupational exposure at the time of initial assignment and at least annually thereafter. Therefore, if the employee's initial assignment occurs on the first day of employment, the employer must provide the required training at that time.

Violations cited under OSHA's standards are classified as willful, serious, other-than-serious, and a notification of de minimis. These violations are assessed penalties based on the gravity of the violations. Each willful violation can carry a penalty of not more than $70,000. Serious and other-than-serious violations can carry a penalty of not more than $7,000. Although these are the maximum penalty amounts OSHA can issue, please bear in mind that OSHA's average penalty for a serious violation is less than $900. Factors such as employer work history and employer size are factored into determination of the penalty.

Thank you for your interest in safety and health and for seeking address to your concerns on OSHA and the Bloodborne pathogens standard. Should you have any further questions, please call [the Office of Health Enforcement at (202) 693-2190].

Sincerely,
John B. Miles, Jr., Director
Directorate of Compliance Assistance

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

[Corrected 12/6/2024]