Eyewash after blood or infectious-material exposure

November 6, 2020

Mr. Robert O. Shumate

[Recipient address omitted]

Dear Mr. Shumate:

Thank you for your letter to the Occupational Safety and Health Administration (OSHA). Your letter was referred to OSHA’s Directorate of Enforcement Programs for a response. You requested clarification on the use of portable eyewash solutions to wash blood or other potentially infectious materials (OPIM) from workers’ eyes. This letter constitutes OSHA’s interpretation only of the requirements discussed and may not be applicable to any questions not delineated within your original correspondence. Your specific question is paraphrased below, followed by OSHA’s response.

Background: In your letter, you state that you are re-writing your South Carolina county government’s Bloodborne Pathogens (BBP) Plan, which will cover deputy sheriffs, emergency medical service (EMS) workers, and fire department employees who are exposed to blood or other potentially infectious materials (OPIM) which has been spat or splattered into their eyes. In doing so, you state that you seek to comply with OSHA Instruction STD 1-8.2, 29 CFR § 1910.151(c), Medical Services and First Aid; 29 CFR § 1926.50 and 51, Medical Service and First Aid, and Sanitation, Respectively; Applicable to Electric Storage Battery Charging and Maintenance Areas, March 8, 19821. You also state that these emergency employees are provided kits containing personal protective equipment and safety supplies, including 4-ounce eyewash bottles with 5-milliliter eyedropper dispensers.

Question: Does OSHA require a minimum volume of portable eyewash solution in areas where workers are exposed to eye hazards from spit or splatter containing blood or OPIM?

Response: As a preliminary matter, it should be noted that the governing standards are those of the South Carolina occupational safety and health agency, as explained more fully in the penultimate paragraph of this letter. South Carolina in all relevant aspects has adopted federal OSHA standards, which must be enforced at least as effectively as federal OSHA enforces its standards. Therefore, the following information about federal OSHA standards is provided. OSHA’s Bloodborne Pathogens standard, 29 CFR § 1910.1030, covers reasonably anticipated work exposure to blood and OPIM (29 CFR § 1910.1030 (a)). When splashes, sprays, splatters, or droplets of blood or OPIM pose a hazard to the eyes, nose, or mouth, personal protective equipment, such as goggles or glasses with solid side shields for eye protection, or chin-length face shields or face masks for coverage of the nose and mouth, must be worn (29 CFR § 1910.1030(d)(3)(x))2. In this regard, the standard prioritizes methods to prevent blood or OPIM from contacting eyes or mucous membranes, but also requires the rapid flushing of mucous membranes with water3. Although the requirements in the BBP standard do not specify a minimum volume of eyewash solution for treating employees whose eyes have been exposed to blood or OPIM, the obvious intent of the standard is that blood or OPIM be removed from the eyes. Therefore, sufficient water must be used to accomplish this goal. Although ANSI standards not incorporated in OSHA standards are not binding, they do provide technical information to help determine sufficiency here. ANSI Z358.1 states that eyewash facilities should deliver flushing fluid to the eyes for not less than 1.5 liters per minute (0.4 gpm), for fifteen minutes4. In light of this guidance, four-ounce bottles are insufficient to meet the requirement that blood or OPIM be flushed from the eyes. The sixteen-ounce bottles you note in your letter may still not be enough to sufficiently flush the eyes for 15 minutes. A one-liter bag of saline or ringers lactate may be more appropriate in areas where an eyewash facility is unavailable, and can be used until there is access to an eyewash facility capable of flushing the eyes for the recommended 15-minute period. Flooding the eye, including under upper and lower eyelids, simply requires more fluids.

Furthermore, the employer must take certain measures after an inadvertent employee exposure incident, i.e., “… a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties” (29 CFR § 1910.1030(b)). The employer of the affected employee must initiate post-exposure and follow-up procedures5 as soon as possible after exposure, per paragraph 29 CFR § 1910.1030(f)(3)6. Those procedures involve a confidential medical evaluation and follow-up which include (1) documentation of exposure route(s) and circumstances; (2) identification and documentation of the source individual when feasible; (3) collection and testing of blood for HBV and HIV serological status; (4) post-exposure prophylaxis, when medically indicated; (5) counseling; and (6) evaluation of reported illnesses.

The OSHA standard you note at the beginning of your letter does not apply here. It applies only to exposure to corrosive materials. 29 CFR § 1910.151(c) specifies that “where the eyes or body of any person may be exposed to injurious corrosive materials, suitable facilities for quick drenching or flushing of the eyes and body shall be provided within the work area for immediate emergency use.”

As you may be aware, South Carolina is one of 26 states, in addition to Puerto Rico and the Virgin Islands, that operates its own occupational safety and health program under a plan approved and monitored by federal OSHA. Employers in South Carolina must comply with state occupational safety and health requirements. As a condition of plan approval, State Plans are required to adopt and enforce occupational safety and health standards that are at least as effective as those promulgated by federal OSHA. A state’s interpretation of its standards must also be as least as effective as federal OSHA interpretations. If you would like additional information regarding South Carolina’s occupational safety and health requirements, you may contact the State agency:

South Carolina Department of Labor, Licensing & Regulation

Division of Occupational Safety and Health

121 Executive Center Dr., Suite 230

P.O. Box 11329

Columbia, SC 29211-1329

Phone: (803) 896-7665

Fax: (803) 896-7670

www.osha.gov/stateplans/sc

Thank you for your interest in occupational safety and health. I hope you find this information helpful. OSHA’s requirements are set by statute, standards, and regulations. Letters of interpretation do not create new or additional requirements but rather explain these requirements and how they apply to particular circumstances. This letter constitutes OSHA’s interpretation of the requirements discussed. From time to time, letters are affected when the agency updates a standard, a legal decision impacts a standard, or changes in technology affect the interpretation. To assure that you are using the correct information and guidance, please consult OSHA’s website at www.osha.gov. If you have additional questions, please feel free to contact the Office of Health Enforcement at (202) 693-2190.

Sincerely,

Patrick J. Kapust, Acting Director

Directorate of Enforcement Programs

[1] See OSHA Instruction, STD 01-08-002, 29 CFR 1910.151(c), Medical Services and First Aid; 29 CFR 1926.50 and 51, Medical Service and First Aid, and Sanitation, Respectively; Applicable to Electric Storage Battery Charging and Maintenance Areas, at www.osha.gov/enforcement/directives/std-01-08-002.

[2] OSHA Publication, Personal Protective Equipment (PPE) Reduces Exposure to Bloodborne Pathogens Fact Sheet (2011), at www.osha.gov/OshDoc/data_BloodborneFacts/bbfact03.pdf.

[3] 29 CFR § 1910.1030(d)(2)(vi) - Employers shall ensure that employees wash hands and any other skin with soap and water, or flush mucous membranes with water immediately or as soon as feasible following contact of such body areas with blood or other potentially infectious materials.

[4] ANSI/ISEA Z358.1-2014 – American National Standard for Emergency Eyewash and Shower Equipment.

[5] OSHA Letter of Interpretation - Bloodborne Pathogens Post-Exposure Evaluation and Follow-up for Emergency Response Employees, at www.osha.gov/laws-regs/standardinterpretations/2017-06-21.

[6] For additional information about OSHA’s BBP program requirements, see OSHA Publication, Bloodborne Pathogens Standard Fact Sheet (2011) www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdf and OSHA Letter of Interpretation - Applicability of Bloodborne Pathogens Standard to emergency responders, decontamination, housekeeping, and good Samaritan acts, at www.osha.gov/laws-regs/standardinterpretations/1992-12-04.