OSHA Regulations for Incidental Exposure to Blood-Borne Pathogens

Most employers are aware that the Occupational Safety and Health Administration (OSHA) has promulgated regulations designed to protect employees against occupational exposure to bloodborne pathogens. As you would expect, these regulations were enacted in order to regulate the health care industry and other industries where occupational exposure to bloodborne pathogens is reasonably likely to occur. What most employers may not be aware of, however, is that these regulations also provide guidelines for exposure incidents in industries where exposure could not reasonably have been anticipated. In these situations, OSHA has enacted requirements which govern an employer's post-exposure procedures.

Employer Precautions

Initially, an employer must make a Hepatitis B vaccine (HBV) and vaccination series available to any employee who has occupational exposure. By "occupational exposure," OSHA is referring to a working situation where there is a realistic possibility the employee may be exposed to bodily fluids that potentially could transmit an infectious disease; primarily blood, but also, potentially, excrement, saliva, etc. The vaccine must be of no cost to the employee and must occur at a reasonable time and place, within ten (10) working days of the employee's initial assignment.

Medical procedures must be performed by a licensed physician or health care professional and laboratory tests must be conducted by an accredited laboratory. An employer is relieved from the responsibility of providing a HBV vaccine where the employee has previously received the complete HBV vaccination series, where the employee is immune to Hepatitis, or where the vaccine would be a danger to the employee for medical reasons. Likewise, an employee may decline to accept the vaccination by signing a statement acknowledging:

1. that he or she understands that he or she is at risk of acquiring the Hepatitis B virus infection;
2. that he or she has been given the opportunity to be vaccinated at no charge; and
3. that he or she is declining the vaccination at the present time, but understands that if he or she continues to be at risk, he or she will still be able to receive the vaccination series at no charge.

Following an Incident

Following an exposure incident, i.e., an incident of actual exposure to potentially infectious bodily fluids, an employer must immediately make a confidential medical evaluation and follow-up available to the exposed employee. The evaluation and follow-up report must document the route of exposure and state the circumstances under which the exposure incident occurred. The report must identify the individual whose blood or other potentially infectious materials may be a source of the occupational exposure. This "source individual" must be tested as soon as possible, but only after his or her consent has been obtained, so that a determination of human immuno-deficiency virus (HIV) or HBV infectivity can be made. If the source individual does not consent, this must be noted on the exposed employee's report.

An employer must make sure that the health care professional responsible for administering the Hepatitis B vaccination and evaluating employees after exposure incidents is provided the following information:

1. a copy of OSHA's HIV/HBV regulations;
2. a description of the exposed employee's duties;
3. documentation of the route of exposure and circumstances under which exposure occurred;
4. results of the source individual's blood testing, if available; and
5. all medical records relevant to the appropriate treatment of the employee involved in the exposure incident, including his or her vaccination status.

Additionally, employers are required to provide the employee with a copy of the health care professional's written opinion within fifteen (15) days of its completion.

In addition to these procedural requirements, an employer is obligated to establish and maintain accurate records for each employee who has experienced an exposure incident. The record must contain the employee's name and social security number, a copy of the employee's HBV status, a copy of all follow-up procedures and results, the health care professional's written opinion, and a copy of the information the health care professional used to create his or her opinion. Medical records must be maintained for at least the duration of employment plus 30 years. These records must be kept confidential, and may not be disclosed or reported without the employee's express written consent. Finally, OSHA mandates that an employer must provide an employee access to his or her medical records at any time upon his or her request.

Caveat Employer

In summary, even if your employees work in an environment where occupational exposure is not likely to occur, accidents happen. Paper cutters, slippery floors and even workplace violence can all result in exposure to potentially infectious bodily fluids. We hope you never need the foregoing information, but if you do, you should now have the knowledge you need to address such a situation if it arises.