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OSHA targets AIDS in the workplace.

IN AN ATTEMPT to protect more than 5.6 million workers, prevent more than 200 deaths and 9,200 bloodborne infections annually, and quell hysteria about worker-to-patient transmission of AIDS-causing human immunodeficiency virus (HIV), the U.S. Occupational Safety and Health Administration (OSHA) promulgated a new workplace standard this past December. The OSHA standard on bloodborne pathogens--microorganisms in human blood that can cause disease in humans, including the potentially deadly hepatitis B virus (HBV), as well as HIV--went into effect on March 6, 1992.

Despite not having a standard that was designed precisely to reduced occupational exposure to bloodborne pathogens in the past, OSHA did have several regulations on the books that applied to this hazard. On the most basic level, the General Duty Clause of the Occupational Safety and Health Act, section 5(a)(1), requires that each employer "furnish to each of his employees employment and a place of employment which are free from recognized hazards causing or likely to cause death or serious physical harm." More specifically, previous standards required employers to furnish personal protective equipment and accident prevention tags to warn of biological hazards. Furthermore, in 1983, OSHA issued a set of voluntary guidelines designed to reduce the risk of occupational exposure to HBV.

Despite a reduction in occupational exposure to bloodborne pathogens over the last several years as a result of a stepped-up OSHA enforcement program, the agency determined that significant risks stil remained. Thus, as stated in the standard's preamble, OSHA concluded that a new standard would "much more efficiently reduce these risks [that] can be minimized or eliminated using a combination of engineering and work practice controls, personal protective clothing and equipment, training, medical follow-up of exposure incidents, vaccination and other provisions."

The scope and application of the standard applies to all employees who could be "reasonably anticipated" to come into bodily "contact with blood and other potentially infectious materials" as a result of performing their job duties. Other infectious materials include such body fluids as semen, vaginal secretions, and saliva; any body fluid visibly contaminated with blood; and all body fluids involved in situations where it is difficult or impossible to differentiate between body fluids.

Also covered under the standard are unifixed human tissue or organs and HIV- and HBV-containing cell, tissue, and organ cultures and/or mediums and solutions, as well as infected blood, organs, or other tissues from experimental animals. Thus, OSHA is now taking the "universal precautions" approach to infection control where "all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens."

"A lot of our clients," notes Jack Kester, national accounts executive of National Loss Control Service Corporation, a Kemper Risk Management Services division in Long Grove, Illinois, "are concerned about the standard because they are not sure how it applied to them, who it applies to, and what they have to do to comply with the standard." OSHA estimates that over 500,000 establishments and nearly 5.6 million workers will be affected by the standard. Administration studied also estimate "that 78 percent of these workers are employed in health care occupations."

Although the standard does not list those occupations where exposures are likely to occur, OSHA did identify in its regulatory impact analysis 24 industry sectors and activities where workers would be affected. They include physician and dentists' offices, medical and dental labs and equipment repair facilities, hospitals, nursing homes, residential care and government outpatient facilities, dialysis centers, home health care, blood collections and processings, health clinics in industrial plants, personnel services, funeral homes and crematories, research, labs, linen services, law enforcement, fire and rescue, correctional institutions, hospices, schools for the mentally retarded, lifesaving, and handlers of regulated waste.

Broad Implications

IT MAY NEVER have occurred to some people that certain industries cited by OSHA would have fallen under the new standard's purview. But, as Mr. Kester contends, though "the health care fields have much more exposure to blood and therefore bloodborne pathogens than other professions, there are also areas such as police services, emergency response teams, fire departments, and linen services that service the hospitals or the health care industry, which have employees with some serious concerns." To drive this point home, Mr. Kester notes that "it is not uncommon for a linen service to find a hypodermic needle in among the sheets that they are laundering. When you get that far removed from the original use of the needle, you don't know where it's coming from."

But the 22 percent of affected workers not employed in health care occupations could be located in any organization. "Somebody in a factory or production plant who has been given the responsibility to respond to emergencies or administer first aid would be expected in certain circumstances to be exposed to blood, especially in an industry like metal stamping, where it's common to have finger or hand cuts." Thus, concludes Mr. Kester, "It looks like almost all of our clients, the majority of which are not in the health care industry, will be impacted because of the first aid/CPR providers in the plants." Under the standard, employers will have to provide the required protective equipment and training.

Violations of the regulatory requirements set out in the bloodborne pathogen standard can result in fines of up to $70,000 for each offense. These violations can also expose an employer to devastating lawsuits filed by the injured party.

At a recent RIMS Western Carolina Chapter meeting, Ronald J. Graves, vice president for loss control at Hewitt, Coleman and Associates, in Greenville, South Carolina, presented several cases of major lawsuits and OSHA-assessed fines over the past year that relate to the new standard. One of the most publicized cases was that of Dr. Veronica Prego who, having contracted AIDS by means of a needkestick, won a $1.3 million lawsuit against King's County Hospital in New York. It was determined that the hospital failed to provide adequate training to staff and to enforce strict infection control protocol, which contributed to one of its intern leaving a "contaminated needle in a bundle of gauze and wrappers on the bed of an AIDS patient after taking a blood culture."

The February issue of the "Medical Liability Monitor" reported research suggesting that 88 percent of needlesticks are preventable. This finding simply further demonstrates the added necessity for an enforceable standard.

Required Response

MR. GRAVES POINTS out that any workers' compensation claim of an OSHA-recordable illness or injury can snowball from employee hysteria and local and national publicity, to serious illness or death and an OSHA visit, followed by a "mega-fine." But what constitutes an OSHA-recordable injury or illness? As clarified by Mary Lynn, a Denver-based OSHA Region VIII senior industrial hygienist, needlesticks and blood exposure incidents are recordable if there is loss of consciousness, restriction of work or motion, job transfer, post-exposure provision of HBV vaccinations or prescription medications, or a testing positive for HIV or HBV by an employee as a result of an exposure. It any one of these five criteria is met, the accident becomes recordable to OSHA.

By May 5, 1992, employers will be required to establish a written exposure control plan that identifies tasks and procedures where occupational exposure to bloodborne pathogens is likely to occur, and specifies a schedule for the means of implementation for other provisions of the standard. Other provisions include making HBV vaccinations available at no cost to employees with occupational exposure, and offering post-exposure evaluation and follow-up to those employees who have had an exposure incident.

An employee does have the right to refuse HBV vaccination treatment, but must sign a declination form. Should that employee change his or her mind at a later date, the employer must still make that vaccination available at no cost to the employee. The plan must be accessible to employees and available to OSHA.

Provisions for information, training and recordkeeping take effect on June 4, 1992. Hazard communication (signs and labels), "house" cleaning and maintenance, and laundry procedural requirements will take effect as of July 6, 1992. The standard also calls for employers to maintain confidential medical records for each employee subject to occupational exposure "for at least the duration of employment plus 30 years." States that operate their own OSHA programs (23 in all) are required to adopt a comparable standard within six months of the federal standard's effective date.
COPYRIGHT 1992 Risk Management Society Publishing, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992 Gale, Cengage Learning. All rights reserved.

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Author:Kurland, Orin M.
Publication:Risk Management
Date:Apr 1, 1992
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