In light of the
current global occupational and public-health challenges and policies in
healthcare, the Occupational Safety and Health Administration (OSHA) has
issued some new and important letters of interpretation regarding the
requirements promulgated in the Bloodborne Pathogens Standard (BPS) (29
CFR 1910.1030). These challenges include occupational safety and health
application to the preparation and preparedness for potential global
pandemics, and the fundamentals of the sharps-injury log and employee
evaluation. This brief article summarizes these newly issued
interpretations and provides some additional compliance guidance.
To begin, it is important to understand the
relevance of the OSHA BPS in context to all of healthcare. It continues
to be the top cited standard in the “health services” industry
classification codes (80XX). In fiscal year 2007-2008, out of 1985 total
citations issued in “health services” in federal OSHA states, there were
754 citations (284 inspections) that included the BPS. The BPS is cited
almost five times more often than the next most frequently cited
standard: Hazard Communication (occupational exposure to hazardous
chemicals) with 157 citations. Even in difficult economic times,
healthcare is booming — resulting in major expansion of existing and new
healthcare facilities and services. Since healthcare facilities are
designed and modeled after miniature cities with free-standing
operational needs in the face of potential disasters, the occupational
safety and health results are hazards that include construction, power
generation, hazardous waste, ergonomics, laboratory safety, maintenance,
pharmacy, warehousing, and radiation, among many others. The fact that
the BPS is continuing to achieve top ranks in OSHA inspections despite
the growing prevalence of other hazards means that employers still have
a long way to go with regard to instituting controls for preventing
occupational exposure to blood and other potentially infectious
materials.
OSHA responds to public compliance inquiries in
the form of “letters of interpretation.” These letters serve as both
regulatory guidance and compliance assistance. Often, new or important
interpretations are published on OSHA's website at
www.osha.gov
and serve as resource tools for all employers and employees. In the past
two years, several important letters have been issued — two major ones
are explored here.
First, with regard to public preparedness for a
potential influenza pandemic, both OSHA and the Department of Health and
Human Services (DHHS) recommend greater healthcare and public-health
focus on pre-pandemic preparations to include stockpiling a wide range
of medical supplies. Once DHHS has a plan in place for vaccine stockpile
and distribution, OSHA reminds employers who will be administering
vaccines that they must evaluate, select, and use sharps with engineered
sharps-injury protections (SESIPs) per 29 CFR 1910.1030 (d)(2)(i)
including either syringes (to be used with vials of vaccine) or safety
needles (to attach to syringes already pre-filled with vaccine). Another
important consideration is planning for a plentiful supply of sharps
collectors. This letter of interpretation (Callison 2007) is available
online:
www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=25744.
Second, OSHA issued a valuable letter of
interpretation (Hyman 2006) on the new requirements of the sharps-injury
log published in the revised 2001 standard with changes mandated by the
Needle stick Safety and Prevention Act:
www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=25340.
Section (h)(5) of the standard — the requirement for employers to
establish and maintain a sharps-injury log — is designed to aid
employers in the evaluation of devices being used in the workplace and
to “quickly identify problem areas in the facility.” The log requires
documentation of the type and brand of device involved in the incident,
the department or work area where the exposure occurred, and an
explanation of how the incident occurred.
OSHA adds that “entries on the sharps log need to
be complete enough for evaluators to determine accurately which
particular product (device) was actually being used when incidents
occurred.” This means that “brand” should include manufacturer's name
and product name. It may also be useful to include information about not
only where the incident occurred but also during what type of procedure
(e.g., blood collection, IV insertion, injection, suturing, and so on).
Selecting a safety device with design and features appropriate for each
clinical procedure is paramount for ensuring safety as well.
Another requirement of the revised 2001 standard
is the inclusion of solicitation from “non-managerial” employees in
evaluating safer medical deviceS in SESIPs (29 CFR 1910.1030 [c][i][5]).
OSHA offers useful compliance assistance and acknowledges that “simple
open request(s) for input (are) adequate.” OSHA continues to offer that
“(m)ethods for soliciting employee input may include joint
labor-management safety committees; involvement of informal
problem-solving groups; participation in safety meetings and audits,
employee surveys, worksite inspections, or exposure-incident
investigations; using a suggestion box or other effective methods for
obtaining written employee comments; and participation in the evaluation
of devices through pilot testing.” In interpreting the requirement in
such a broad-sweeping and comprehensive manner, OSHA allows employers
the opportunity to engage in a variety of feedback media best suited to
their needs and capabilities.
Keep updated and informed by logging on to OSHA's
Bloodborne Pathogens Safety and Health Topics Webpage at
www.osha.gov/SLTC/bloodbornepathogens/index.html. Another
resource for general compliance in healthcare settings is OSHA's
Hospital and Nursing Home eTools also available online free of charge at
www.osha.gov/SLTC/etools/hospital/engineering/engineering.html.
Amber Hogan Mitchell is a full-time doctoral
student in occupational injury prevention at the University of Texas
School of Public Health in Houston. Before returning to school fulltime,
she was the Manager of Health Affairs for BD. Prior to BD, she was a
senior industrial hygienist and the National Bloodborne Pathogens
Coordinator for the OSHA National Office in Washington, DC.
