Hepatitis B vaccine timing for collateral-duty AED responders

November 1, 2000

John J. Perkner, DO, MSPH

AED Medical Director, FOH

Public Health Service

[Recipient address omitted]

Dear Dr. Perkner:

Thank you for your September 11, 2000 letter to the Occupational Safety and Health Administration (OSHA). Your letter has been referred to OSHA's [Directorate of Enforcement Programs (DEP)] for a response to your questions regarding the hepatitis B virus (HBV) vaccination as it pertains to first aiders and initial responders in federal buildings. Your letter follows several phone conversations you had with members of the [DEP] staff. We hope this letter serves your need for further clarification of this issue. Your question is outlined below, followed by our response. We apologize for the delay. Please be aware that this response may not be applicable to any situation not delineated within your original correspondence.

[Do] certain team members, who perform [emergency response to cardiac events] [and are] voluntarily on a response team, need hepatitis B immunizations as soon as they are on the Automated External Defibrillator (AED) response team or [can] this immunization be given after a potential exposure? The delay in administering the hepatitis B vaccine would only apply to those employees whose place on the AED team was considered collateral work.

In a telephone conversation you had with a member of our staff, you asked that we clarify the role that OSHA has in protecting federal employees with regard to their occupational safety and health. Simply for your information, federal employees are covered by OSHA's congressional mandate. Section 19 of the Occupational Safety and Health Act (OSH Act) of 1970 and Executive Order (EO) 12196 establish that the head of each Federal agency is responsible for ensuring a safe and healthful workplace. In meeting this responsibility, the head of each Federal agency is required to establish and maintain a comprehensive occupational safety and health (OSH) program which is consistent with the standards promulgated under Section 6 of the Act. The Federal Register, 29 CFR 1960, establishes how the head of each agency must operate the Agency's OSH program. The OSH Act, the Federal Register, EO 12196, and all OSHA Regulations are available on our website at http://www.osha.gov.

According to the Bloodborne Pathogens Standard (29 CFR 1910.1030) and OSHA enforcement policy, all employees with occupational exposure to blood and other potentially infectious materials (OPIM) must be covered by the standard. This would include, in addition to all the applicable provisions of the standard, the administration of the hepatitis B virus (HBV) vaccination series prior to employee exposure, as indicated by paragraph (f)(2) of the standard, and provided according to recommendations of the U.S. Public Health Service. In reference to your situation, OSHA has provided an exception in its enforcement policy. According to the compliance directive, [CPL 2-2.69] Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens, employers would not be cited if they have not offered the hepatitis B vaccination series to an employee whose only exposure to blood would be responding to injuries resulting from workplace incidents as long as this was only a collateral duty of the employee and certain other requirements have been met. Members of your AED Team would also fall under this category if the same conditions existed.

The requirements of the exemption stated in the compliance directive are:

["b. Any first aid rendered by such person is rendered only as a collateral duty, responding solely to injuries resulting from workplace incidents, generally at the location where the incident occurred.

NOTE: This exception does not apply to designated first aid providers who render assistance on a regular basis, for example, at a first aid station, clinic, dispensary or other location where injured employees routinely go for assistance; nor does it apply to any healthcare, emergency, or public safety personnel who are expected to render first aid in the course of their work. These employees must be offered the vaccine prior to exposure.

c. The employer's exposure control plan must specifically address the provision of the hepatitis B vaccine to all unvaccinated first aid providers who render assistance in any situation involving the presence of blood or OPIM (regardless of whether an actual "exposure incident" as defined by the standard occurred) and the provision of appropriate post-exposure evaluation, prophylaxis, and follow-up for those employees who experience an "exposure incident." The plan must include:

1) Provision for a reporting procedure that ensures that all first aid incidents involving the presence of blood or OPIM will be reported to the employer before the end of the work shift during which the incident occurred. The report must include the names of all first aid providers who rendered assistance, regardless of whether personal protective equipment was used and must describe the first aid incident, including time and date. The description must include a determination of whether or not, in addition to the presence of blood or other potentially infectious materials, an "exposure incident," as defined by the standard, occurred. This determination is necessary in order to ensure that the proper post-exposure evaluation, prophylaxis, and follow-up procedures required by paragraph (f)(3) of the standard are made available immediately, whenever there has been an "exposure incident" as defined by the standard.

2) A report that lists all such first aid incidents, that is readily available, upon request, to all employees and to the Assistant Secretary.

3) Provision for the bloodborne pathogens training program for designated first aiders to include the specifics of this reporting procedure.

4) Provision for the full hepatitis B vaccination series to be made available as soon as possible, but in no event later than 24 hours, to all unvaccinated first aid providers who have rendered assistance in any situation involving the presence of blood or OPIM, regardless of whether or not a specific "exposure incident," as defined by the standard, has occurred."]

Thank you for your interest in occupational safety and health. We hope you find this information helpful. OSHA requirements are set by statute, standards and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult the OSHA website at http://www.osha.gov. If you have any further questions, please feel free to contact the [Office of Health Enforcement] at (202) 693-2190.

Sincerely,

Richard E. Fairfax, Director

[Directorate of Enforcement Programs]