Hepatitis B vaccination for collateral-duty first aiders

May 16, 2011

Ms. Diane Walker, RN, MS

Griswold International, LLC

[Recipient address omitted]

Dear Ms. Walker:

Thank you for your January 26, 2011, letter to the Occupational Safety and Health Administration's (OSHA) Directorate of Enforcement Programs requesting clarification of an employer's responsibility for providing the hepatitis B vaccine to companion-sitters who may provide first aid as a collateral duty. Your inquiry requests further clarification of a letter of interpretation previously written to Ms. Patricia O'Malley and dated April 17, 1997. Our response to you constitutes OSHA's interpretation only of the requirements herein, and may not be applicable to any situation not delineated within your original correspondence. Your paraphrased questions are below, followed by our replies.

Question 1: What is a "first-aid provider" in the workplace?

Reply: In the OSHA publication, Best Practices Guide: Fundamentals of a Workplace First-Aid Program (OSHA 3317-06N 2006), the term "first-aid provider" is defined as someone who is trained in the delivery of initial medical emergency procedures using a limited amount of equipment to perform a primary assessment and intervention while awaiting arrival of emergency medical service personnel.

Question 2: Must employers offer the pre-exposure hepatitis B vaccine series to companion-sitters when their only anticipated exposure to blood or other potentially infectious materials is when they render first aid only as a duty collateral to their normal job functions?

Reply: Each employer having employees with occupational exposure to blood or other potentially infectious materials (OPIM) must comply with the Bloodborne Pathogens Standard at 29 CFR 1910.1030. Designated first aiders are generally regarded as covered by the standard, as explained in OSHA's compliance directive, CPL 02-02-069, Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens, section XIII.A.2. In addition to the other protections afforded by the standard, such employees must be offered the hepatitis B vaccination series, as required by paragraph (f)(2) of the standard. It must be provided according to recommendations of the U.S. Public Health Service. 29 CFR 1910.1030(f)(1)(ii)(D).

In addition, OSHA's CPL 02-02-069 provides a de minimis policy, wherein employers will not be issued a citation for not offering the pre-exposure hepatitis B vaccine series to employees if specific conditions are met. CPL 02-02-069, section XIII.F.8. The specific conditions stated in the compliance directive are:

• The primary job assignment of such a designated first-aid provider is not the rendering of first aid or other medical assistance, and

• 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.

• 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."

This de minimis policy may be applicable in your case, where you have stated that your workers are trained in first aid and their only exposure to blood or OPIM would occur when rendering first aid as a collateral duty to their normal job function. We are attaching a copy of our CPL 02-02-069 as a reference.

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 continue to consult OSHA's Web site at www.osha.gov. If you have any further questions, please feel free to contact the Office of Health Enforcement at 202-693-2190.

Sincerely,

Thomas Galassi, Director

Directorate of Enforcement Programs

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