OSHA Bloodborne Pathogen Standard To Be Applied To Governmental Employers

In December, 1991, the Federal Occupational Safety and Health Administration issued its final rules concerning occupational exposure to bloodborne pathogens. While the OSHA rules are applicable only to private sector and federal civilian employees, the Illinois Department of Labor has indicated its intention to adopt the OSHA Standard for state and local government employees.

It appears that the OSHA Standard will be adopted "wholesale" with a currently projected July 1992 effective date. When adopted, the rule will require state and municipal employers to undertake a variety of steps, including preparation of certain written plans, special training for employees, the purchase of protective equipment and the offer of certain medical services. This article discusses the basic provisions of the OSHA standard.

COVERAGE

The Bloodborne Pathogen rule, when adopted, will govern state and local employers which have even one employee. Moreover, volunteer fire departments and EMS services will apparently also be covered. The rule is triggered to the extent that an employee may have "reasonably anticipated" skin, eye, mucous membrane, or parenteral contact with blood or "potentially infectious materials" as a result of the performance of the employee's duties. Thus, employees likely to be affected will include peace officers, firefighters, EMS workers, jail or prison attendants, employees responsible for first aid, school nurses and the like.

WHAT ARE
POTENTIALLY INFECTIOUS MATERIALS?

The OSHA Standard defines "potentially infectious materials" as the following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva, any body fluid visibly contaminated with blood, together with body fluids in situations where it is difficult or impossible to differentiate between body fluids. Further, the definition includes unfixed tissues or organs, other than intact skin, from a living or dead human, cell or tissue cultures containing human immunodeficiency virus (HIV) or hepatitis B virus. Also covered are liquid, semi-liquid or dried blood or other potentially infectious materials which could be released during handling.

WHAT MUST THE EMPLOYER DO?

Written Plans

Exposure Control Plan
Employers who have an employee with occupational exposure to potentially infectious materials must prepare a written exposure control plan. The plan must contain at least the following elements: (1) exposure determination; (2) schedule and method of implementation of necessary elements; and (3) procedure to evaluate exposure incidents. A copy of the exposure plan must be made available to employees.

In order to make the exposure determination the employer must list (1) job classifications in which all employees have exposure, (2) job classifications in which some employees have exposure, (3) together with a list of tasks and procedures in which exposure occurs. Exposure determinations must be made without regard to the wearing of any personal protective equipment.

Cleaning and Decontamination Plan
The employer must also create written cleaning and decontamination schedules relating to equipment and work areas. Further, the employer must keep certain

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employee training and exposure records, which are discussed in more detail below.

Compliance Methods
Employers must adopt certain compliance methods. The preferred method of compliance within the OSHA Standard is referred to as "universal precautions," which means that employees are expected to treat any blood, body fluid or tissue as infected. The employer must also implement suitable engineering and work practice controls to minimize occupational exposure, and regularly examine and maintain such controls. To the extent that employee exposure remains, the employer must provide and require employees to use appropriate protective equipment. The employer must also provide readily accessible hand washing facilities or antiseptic hand cleaner or towelettes.

Work Rules
The employer will be obligated to implement certain work rules. For example, the employer must prohibit eating, drinking, smoking, cosmetic application, lip balm application or handling of contact lenses where there is a reasonable likelihood of exposure and also must enforce rules requiring employees to properly utilize appropriate personal protective equipment. Employers should consider discipline of employees who fail to follow the work rules.

There are specific rules for handling and disposal of "sharps" such as needles or scalpels.

Personal Protective Equipment
All personal protective equipment must be provided by the employer at no cost to the employee. The equipment must be appropriate to the circumstances and must prevent blood or potentially infectious materials from passing through the equipment under normal conditions. The equipment must be readily accessible

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to employees and the employer must clean, launder or dispose of such equipment at no cost to the employee. Protective equipment must be removed by employees prior to leaving the work area and must be placed in designated areas or containers for storage, washing, decontamination or disposal. In many cases, the employer will thus be required to provide and mandate the wearing of gloves, masks, gowns or aprons.

Housekeeping
The employer must maintain a clean, sanitary work site and, as noted above, prepare a written cleaning and decontamination schedule. In this regard, where there is contaminated laundry, it must be handled as little as possible, be bagged or put in a container in the area of its use, transported in labeled or color coded bags or containers, and be placed in containers which prevent leakage or soak-through. To the extent that laundry is shipped off site, it must be tagged or color coded so that laundry workers are aware that there may be infectious materials in the laundry.

Hepatitis B Vaccination
Where there may be occupational exposure to Hepatitis B virus, the employer must offer vaccination at no cost to the employee, at a reasonable time and place. The vaccination must be made available after appropriate required training and within ten days of job assignment in most cases. The employee may decline the vaccination, but if so, must sign a specific written statement. Even then, the employee may change his or her mind and decide upon the vaccination. If there is work related exposure to Hepatitis B, the rule contains detailed medical evaluation and follow-up rules.

Employee Information and Training
All employees with occupational exposure must receive initial training at no cost, during working hours,

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according to a schedule which will be set by the rule. There must be at least annual training thereafter, together with additional training when there are new tasks or procedures which could affect the employee's occupational exposure.

Significantly, the training must be appropriate in language and content to the specific employees being trained, and there must be an opportunity for questions and answers.

The training must contain at least the following elements: (1) the rule and an explanation of its contents; (2) a general explanation of the epidemiology and systems of bloodborne diseases; (3) an explanation of the mode of transmission of bloodborne pathogens; (4) an explanation of the employer's exposure control plan and how the employee may obtain a copy; (5) an explanation of how to recognize tasks and activities in which the employee may be exposed to blood or potentially infectious materials; (6) an explanation of the use and limitations of methods to prevent or limit exposure; (7) detailed information on use, decontamination and disposal of personal protective equipment; (8) how to select personal protective equipment; (9) information on the Hepatitis B vaccine and that the vaccination is offered free; (10) actions to take, and persons to notify, in an emergency involving blood and potentially infectious materials; (11) procedures for an exposure inci-

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dent including medical follow-up; (12) information on required post-exposure evaluation and follow-up provided by the employer; and (13) an explanation of signs, labels and any color coding necessitated by the rule.

Record Keeping
Under the OSHA standard, the employer is obligated to keep records for each employee with occupational exposure with certain required information. These medical records must be maintained in a confidential manner and kept for the duration of employment plus thirty (30) years.

Training records, incorporating specific information, must be kept for three (3) years from the date of the training.

CONCLUSION

The rule is extremely detailed. Affected state and municipal employers should obtain a copy of the complete rule as soon as possible and begin taking steps to come into compliance. Certain of the deadlines set by the rule will occur quickly after its adoption. This article has outlined some of the highlights of the rule, but does not constitute an adequate alternative to careful study of the rule itself or advice from competent counsel. •

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