Managing a bloodborne-pathogens exposure plan

October 1, 2012

Mr. James Richardson

[Recipient address omitted]

Dear Mr. Richardson:

Thank you for your April 16, 2012, letter to the Occupational Safety and Health Administration (OSHA). Your letter was referred to the Directorate of Enforcement Programs for a response. You requested an interpretation of OSHA's Bloodborne Pathogens (BBP) standard, 29 CFR 1910.1030, regarding whether there were any specific OSHA qualifications for management of an exposure control plan (ECP). This letter constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to issues not delineated within your original correspondence. Your paraphrased questions and our responses are below.

Question 1: Does OSHA have any specific training or certification requirements for someone to manage an ECP?

Response: OSHA's BBP standard, 29 CFR 1910.1030, is performance-based and does not specify training or certification requirements for managing an ECP. Employers have flexibility in designating who manages their ECPs. Some assign this responsibility to the same individuals who train their employees on BBP. If that is so, 29 CFR 1910.1030(g)(2)(viii) does require that "[t]he person conducting the training shall be knowledgeable in the subject matter covered by the elements contained in the training program as it relates to the workplace that the training will address." OSHA Instruction CPL 02-02-069, Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens, states in Chapter XIII, par. G.9:

Possible trainers include a variety of healthcare professionals such as infection control practitioners, nurse practitioners, registered nurses, occupational health professionals, physician's assistants, and emergency medical technicians. Non-healthcare professionals, such as but not limited to, industrial hygienists, epidemiologists, or professional trainers, may conduct the training provided they are knowledgeable in the subject matter covered by the elements contained in the training program as it relates to the workplace.

Question 2: Does OSHA have any specific training or certification requirements for someone to determine if an exposure incident has/has not occurred?

Response: The BBP standard at section 1910.1030(g)(2), Information and Training, requires the employer to train each employee with occupational exposure in accordance with this section. As part of this training, workers are to be provided with "[a]n explanation of the modes of transmission of bloodborne pathogens" [1910.1030(g)(2)(vii)(C)]; "[a]n explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials" [1910.1030(g)(2)(vii)(E)]; and "[a]n explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident and the medical follow-up that will be made available" [1910.1030(g)(2)(vii)(K)]. With this information occupationally exposed workers will be able to recognize any suspected exposure incidents that they may have and report them for appropriate follow-up.

In addition, the BBP standard at paragraph 1910.1030(f)(1)(ii)(C) requires the employer to ensure that post-exposure evaluation and follow-up, including prophylaxis, are: "Performed by or under the supervision of a licensed physician or by or under the supervision of another licensed healthcare professional." The BBP standard does not specify the training or certification required for the licensed healthcare professional. However, the BBP standard defines this professional as one whose legally permitted scope of practice allows him or her to perform the activities required by paragraph 1910.1030(f), Hepatitis B Vaccination and Post-exposure Evaluation and Follow-up. [1910.1030(b)]

Question 3: The terms "Designated Officer" (DO) or "Infection Control Officer" (ICO) are often used when referring to the BBP standard. Is a DO or ICO required under (or to comply with) an ECP or the BBP standard? If a DO/ICO is required, what training is necessary?

Response: The BBP standard does not require or specify a DO or ICO. Additionally, as we stated in our response to Question 1, OSHA does not specify training or certification requirements for persons managing an ECP.

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