Sharps protection for home healthcare workers treating diabetic patients

May 4, 2000

Noreen Coyne, RN, MSN

Tender Loving Care Staff Builders

Home Health Care

[Recipient address omitted]

Dear Ms. Coyne:

Thank you for your December 3, 1999 letter addressed to the Occupational Safety and Health Administration's (OSHA's) Office of Health Compliance Assistance. You have concerns about the sharps protection provisions in Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens, [CPL 02-02-069], as they relate to your home healthcare staff who regularly treat and teach diabetic patients to administer insulin injections in their homes. Your letter asks very important questions about an ever-expanding realm of healthcare, home-based care. Please be aware that this response may not be applicable to any situation not delineated within your original correspondence. Your specific questions are restated below, followed by OSHA's interpretation.

What is OSHA's expectation for the provision of sharps protection to employees in such situations as the diabetic patient [treated and taught at home]...?

Would the employer be held responsible for purchasing the patient's supplies if the patient refuses to buy the more expensive safety devices or would OSHA consider the employer not responsible for this site-specific violation (as noted in section XI (c), Multi-Employer and Related Worksites, Home Health Service of the Enforcement Procedures)?

According to [CPL 02-02-069 XI.C], with regards to home health services, and based on American Dental Association v. Martin, 984 F.2d 823, 829 (7th Cir. 1993), OSHA has determined that “the employer will not be held responsible for the following site-specific violations... ensuring the use of personal protective equipment...ensuring that specific work practices are followed... and ensuring the use of engineering controls [emphasis added].” Thus, the bloodborne pathogens standard does not apply to the protection of home healthcare service employees from syringes purchased by patients and used in the home. However, the home health service must provide to its employees appropriate personal protective equipment and the other protections specifically mentioned in XI.C, i.e., an exposure control plan, hepatitis B vaccinations, post-exposure evaluation and follow-up, recordkeeping, and generic training.

Thank you for your interest in occupational safety and health. We hope you find this information helpful. Please be aware that the enforcement guidance contained in this response represents the views of OSHA at the time the letter was written based on the facts of an individual case, question, or scenario and is subject to periodic review and clarification, amplification, or correction. It could also be affected by subsequent rulemaking; past interpretations may no longer be applicable. In the future, should you wish to verify that the guidance provided herein remains current, you may consult OSHA's website at http://www.osha.gov. If you have any further questions or concerns, please feel free to contact OSHA's [Office of Health Enforcement at (202) 693-2190].

Sincerely,

Richard E. Fairfax, Director

[Directorate of Enforcement Programs]

[Corrected 6/2/2005]