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OSHA developing protective standard against AIDS, hepatitis B.

OSHA developing protective standard against AIDS, hepatitis B

As a prelude to expanded enforcement activity, the Occupational Safety and Health Administration is now reviewing industry comments as it develops a standard to protect health care workers against AIDS and hepatitis B.

The Government rule-making process began with a Nov. 25 notice in the Federal Register inviting industry input on 12 areas affecting worker protection. The need for such information is great because this is a relatively new assignment for OSHA, a unit of the U.S. Department of Labor.

"We have had very little experience in regulating biological hazards, which require methods somewhat different from those used to protect workers against toxic chemicals,' explains OSHA head John A. Pendergrass. "Therefore we encourage the fullest participation in our efforts to develop a workplace standard to protect workers against bloodborne diseases.'

The urgency of the matter was underscored by a recent OSHA risk assessment showing that about 11,000 of the nation's five million health care workers are infected by the hepatitis B virus each year. Of those infections, 2,000 to 3,000 result in clinical hepatitis, and some are fatal.

Further, 13 health care workers without other risk factors have been identified as having contracted human immunodeficiency virus, the AIDS virus, as a result of occupational exposure. But with more than 40,000 persons in the U.S. diagnosed as having AIDS, and more than 1.5 million infected, OSHA says the potential risk to health care workers "may be greater than the number of those infected may indicate.'

The Labor and Health and Human Services Departments took an intermediate step Oct. 30 when it mailed out a Joint Advisory on precautions addressed in Centers for Disease Control guidelines.

That action had been urged by groups such as the Service Employees International Union, which represents more than 300,000 health care workers.

The Advisory, which was mailed to some 500,000 employers in the health field, instructs facilities to classify work tasks into three categories of risk exposure to blood and body fluids; draft operating procedures for each occupation, including training and equipment requirements; and provide protective equipment specified by the CDC.

The Advisory also requires employers to provide hepatitis B vaccine to those employees who wish to be vaccinated; provide proper needlestick disposal; and develop a method to monitor compliance with the CDC guidelines.

A letter from Labor Secretary William Brock and HHS Secretary Otis Bowen warns: "It is the legal responsibility of employers to provide appropriate safeguards for health care workers who may be exposed to these dangerous viruses.'

OSHA, the lead enforcement agency, currently has no standard designed specifically to reduce occupational exposure to the viruses. Until such a standard is in place, several existing regulations covering personal protective equipment, sanitation, waste disposal, and exposure to biohazards will be applied. Further, a "General Duty Clause' in OSHA's charter says employers must provide "employment and a place of employment that are free from recognized hazards.'

Those are the two broad areas of authority OSHA will use to enforce precautions until specific regulations can be issued.

It's unclear, however, just how aggressive the agency will be in the meantime. A spokesperson said two civil money penalties have thus far been levied against health care facilities, but declined to give specifics on the cases. The law says fines of up to $10,000 can be imposed for willful and repeated violations.

The agency is putting into effect a systematic inspection program of health care facilities to insure compliance, details of which were still being finalized at this writing. A brochure sent out as part of the Joint Advisory says workers whose employers "will not correct hazardous situations' can complain directly to OSHA, which will then begin a special investigation.

Complainants' identities will not be revealed to employers, and OSHA will also investigate complaints of discriminatory action against employees who exercise this right.

In the new information request (known formally as an advance notice of proposed rule making), OSHA asks for scientific and technical data, expert analysis and opinion on the health effects and technological/economic feasibility of a new standard.

Workers identified as having the highest risk include laboratory and blood bank technicians, physicians, nurses, dentists and dental workers, emergency room personnel, phlebotomists, emergency medical technicians, dialysis personnel, paramedics, medical examiners, and morticians.

The following is a breakdown of the areas OSHA is reviewing, along with some of the key questions being asked:

Scope of coverage. Are employees outside the health care industries at risk of HIV and HBV infection? For example, should employees at mortuaries or other facilities be covered, or should it be limited to health care facilities?

Public sector employees. OSHA has no direct jurisdiction over state and municipal employees, but if a standard is enacted, many states will be required to extend coverage to those workers. Therefore, what public sector employees are at risk? What special protective equipment or clothing do they require to reduce risk? What training is needed?

Significant risk. How many people are at risk from work exposure to HBV and/or HIV? What information should be considered to assess potential risk? What data, such as medical records or unpublished studies, should be considered in rule making? Is there evidence that exposure to patients with cytomegalovirus, a potential threat for pregnant women, presents an increased occupational risk?

b Modes of transmission. What is the risk of becoming infected from single or multiple exposures to contaminated blood or body fluids? What tasks place employees at risk of infection with HBV and HIV?

Controlling exposures. What current control technologies, work practices, or precautions are available or in use? How and when are they applied in specific work settings? What other guidelines are available in addition to those published by OSHA, CDC, the American Hospital Association, and the American Occupational Medicine Association? To what extent are they followed?

Personal protective clothing and equipment. What barrier techniques are available to reduce the likelihood of infection? When should gloves, eye protectors, and gowns be used? How often should clothing be changed? Do adequate supplies of this clothing and equipment exist? What is the cost associated with these supplies?

Vaccination programs. What are the current practices for administering HBV vaccine to health care employees? Who should provide it, and who should be vaccinated? How many and what percentage of employees have already received the complete vaccine series? Under what circumstances would administering the vaccine be inadvisable?

Management of needlestick/ splash injuries. What is the appropriate method of handling these common occurrences when they result in exposure to blood from a patient known to be infected with HIV or HBV? If an employee chooses to be tested following an injury, how can confidentiality of test results or other pertinent medical information be protected?

Medical surveillance. Should such programs be established for workers at risk of occupational exposure? How often should surveillance be required? Is there evidence that such surveillance reduces risk?

Training and education. How are employees currently informed of the occupational hazards of HIV and HBV? How should they be trained? Are model training programs available? Should training apply to personal as well as occupational behavior?

Generic standards. Are there diseases other than hepatitis B and AIDS whose transmission and control are similar enough to warrant including them in a "generic standard' for bloodborne diseases? If so, which diseases should be included? What risk do these diseases present to health care workers?

Advances in hazard control. How can the standard be structured to reflect, on a continuing basis, technological advances in control methods? How can OSHA keep its compliance and other activities current with the frequent updating of guidelines such as CDC's? Are there other approaches to protecting workers against these viruses?

Interested laboratorians may respond to any or all of the above areas by writing the OSHA Docket Office, Docket No. H-370, Room N-3670, 200 Constitution Ave. NW, Washington, D.C. 20210. Comments are being accepted through Jan. 20.
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Title Annotation:Occupational Safety and Health Administration
Publication:Medical Laboratory Observer
Date:Jan 1, 1988
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