Proposed OSHA Regulation Protects Against Blood-Borne Viruses

Proposed OSHA Regulation Protects Against Blood-Borne Viruses

PROTECTION OF PERSONNEL

AN INCREASING number of people in the United States are contracting blood-borne viruses, namely AIDS and Hepatitis B. AIDS (Acquired Immune Deficiency Syndrome) is characterized by a defect in the body’s natural immunity against diseases. The affected person is unable to cope with diseases that normally would not affect us. The virus that causes AIDS is the Human Immunodeficiency Virus (HIV). There were 32,663 cases of AIDS reported to the Center for Disease Control (CDC) in 1988; and that year 18,225 AIDSrelated deaths were reported as well. Hepatitis B is a blood-borne disease that attacks the liver, often leading to cirrhosis and liver cancer. The CDC estimates there were 200,000 cases of new infections in 1987; and 1.5 percent of cases reported to the CDC died in 1987.

These two major diseases are transmitted through blood or blood components, semen, vaginal secretions, saliva, urine, and other body fluids. They cannot be transmitted under such conditions as unbroken skin contact and sharing drinking fountains, telephones, and toilets. In a healthcare setting, the chances of coming in contact with one of these body fluids are greatly increased. Firefighters, too, increase their chances of contact when responding to a call at a healthcare facility or when providing emergency care to victims of the diseases.

To safeguard against the possibility of exposure, the Department of Labor, through the Occupational Safety and Health Administration, has proposed a regulation that would protect healthcare workers and all emergency first responders from the Hepatitis B Virus (HBV), the Human Immunodeficiency Virus, and other blood-borne pathogens. The department, under considerable pressure from Congress and the unions to take emergency action to safeguard healthcare employees, is seeking to enact the following with this new regulation:

  1. Initiation of rule making, with an advanced notice of proposed rule making to be published in the Federal Register.
  2. Invocation on an interim basis of OSHA’s “General Duty” clause. Under this provision, even in the absence of a specific OSHA standard, an employer has an OSHA-enforceable duty to furnish to its employees “employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm…[27 USC 654 (a) (1)]
  3. Enforcement and inspection activities regarding HBV and HIV that focus on existing OSHA and CDC guidelines. Central to these guidelines is the recommendation that healthcare workers and emergency responders take universal blood and body fluid precautions with all patients whenever there is a risk of exposure to blood or other body fluids or tissues
  4. The application of OSHA’s existing Personal Protective Standard (29 CFR PART 1910 subpart I), mandating employer provisions and maintenance of equipment for “eyes, face, head, extremities, and protective clothing.. and protective shields and barriers,” when appropriate.
  5. Collaboration with the Department of Health and Human Services to educate healthcare employees, responders, and employers on the use of universal precautions.

The idea behind OSHA’s proposed regulation is that if all patients and their body fluids are treated as infectious, and if precautions are taken to protect firstaid givers, it will prevent them from contracting HIV, HBV, or any other nosocomial infection (transmitted through a specific source). The proposal is OSHA’s first regulation of occupational exposure to biological hazards. OSHA does have a number of existing regulations that apply to hazards: 29 CFR 1910.132 requires employers to provide personal protection equipment, and 29 CFR 1910.145 (f) requires accident prevention tags to warn of biological hazards (the General Duty clause is included in this regulation). Also, in 1983 OSHA released voluntary guidelines designed to reduce the risk of occupational exposure to the Hepatitis B Virus.

SUMMARY OF REGULATION

The specific details of the proposed OSHA regulation include the following:

  • Definition of exposure. Exposure or exposure potential is not only contact with human tissues, fluids, or blood but also includes fluids in labs that may (Contain HBV or HIV; experimental animals’ embryonated eggs, tissue, and cell cultures; and culture media—what the culture grows in (nutrient solution, etc.).
  • Categories of risk of exposure. Category one tasks arc those that predictably cause exposure or may cause exposure unexpectedly or on short notice. They require protective clothing. This exposure class does not apply to workers who move from one exposure classification to another in the course of their jobs but only to the particular task that is high-risk. An employer evaluating the task should take into account the type of blood fluid, the volume of this fluid, the probable route of exposure, the probability of exposure, and the virus concentration in the fluid. Employers must establish standard operating procedures for this class and use engineering controls, work practices, and protective equipment to minimize exposure.

Category two tasks are lower risks, but employers should evaluate them as they do category one tasks. Employers should still exercise the proper controls to prevent employee exposure.

Category three tasks offer no risk to workers, and employers are not required to provide protective equipment or instruct workers in personal hygiene. They must, however, instruct employees in the risks of HIV and HBV so employees can recognize a potential risk and take appropriate action.

  • Establishing formal procedures.
  • To evaluate the workplace, employers must establish category-of-risk classifications for all tasks and identify all workers who may perform these tasks. They must develop standard operating procedures for category one and two tasks and monitor the effectiveness of these tasks. They must also enforce the use of controls by the employees.
  • Emphasis on training and education. Employers must establish initial and periodic training for employees. Training programs must inform employees of modes of transmission and how to recognize tasks specified in categories one and two. They must also cover work practices as well as control measures and limitations. Employees should also know what actions to take in case of exposure and spills.
  • Healthcare. Employers must provide healthcare and medical counseling for all exposed workers. They must also provide voluntary HBV immunization and monitoring for HBV or HIV antibodies.
  • Recordkeeping. Employers must maintain records for all administrative procedures and standard operating procedures used. They must keep records of training and conditions observed in routine surveillance. They must also document each incident of exposure plus evaluations of conditions and corrective measures to prevent recurrence.

OSHA is currently enforcing existing agency standards to prevent worker exposure to blood-borne diseases while the proposal is pending approval. Until that time, OSHA is using the General Duty clause to protect workers.

The proposed regulation, when put into effect, will greatly increase the health and safety of healthcare workers, firefighters, police, and EMS personnel when giving first aid in the line of duty. Educating first responders about the regulation, the risks, and the viruses will protect them even more. OSHA estimates that compliance with the proposed regulation w ill cost employers of affected workers approximately $852 million. Hearings on the proposal will run through October.

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