Bloodborne Pathogens: Exposure Control Plans, Vaccination, and Training

Human blood and certain other body fluids can carry germs that cause disease, including hepatitis B virus (HBV) and HIV. This standard covers employees who can reasonably be expected to contact those materials on the job. It requires you to write a plan, use safer work methods, offer the hepatitis B vaccine, train employees, and keep records.

Who it applies to

The standard applies to all occupational exposure to blood or other potentially infectious materials (1910.1030(a)). Coverage turns on two definitions (1910.1030(b)):

• Occupational exposure means "reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties."
• Other potentially infectious materials (OPIM) include listed human body fluids, any body fluid visibly contaminated with blood, and unfixed human tissue or organs (other than intact skin).

Paragraph (e) adds requirements for HIV and HBV research laboratories and production facilities, which this guide does not cover (1910.1030(e)(1)).

What the standard requires

A written exposure control plan

If you have an employee with occupational exposure, you must establish a written Exposure Control Plan designed to eliminate or minimize employee exposure (1910.1030(c)(1)(i)). It must contain at least the exposure determination, the schedule and method of implementation for the standard's other paragraphs, and the procedure for evaluating the circumstances surrounding exposure incidents (1910.1030(c)(1)(ii)(A) through (C)).

The exposure determination lists the job classifications in which all or some employees have occupational exposure. For the "some" group, it also lists the tasks and procedures in which exposure occurs (1910.1030(c)(2)(i)(A) through (C)).

The plan must be reviewed and updated at least annually, and whenever necessary to reflect new or modified tasks and procedures that affect occupational exposure and new or revised employee positions with occupational exposure (1910.1030(c)(1)(iv)). A copy must be accessible to employees (1910.1030(c)(1)(iii)).

Universal precautions and controls

• Universal precautions must be observed to prevent contact with blood or OPIM (1910.1030(d)(1)). That means treating all human blood and certain human body fluids as if known to be infectious (1910.1030(b)).
• Engineering and work practice controls must be used to eliminate or minimize employee exposure. Where exposure remains after those controls, personal protective equipment (PPE) must also be used (1910.1030(d)(2)(i)).
• You must provide readily accessible handwashing facilities (1910.1030(d)(2)(iii)). When that is not feasible, you must provide an appropriate antiseptic hand cleanser with clean cloth or paper towels, or antiseptic towelettes. Hands must then be washed with soap and running water as soon as feasible (1910.1030(d)(2)(iv)).

Contaminated sharps

• Contaminated needles and other contaminated sharps must not be bent, recapped, or removed unless you can demonstrate that no alternative is feasible or that the action is required by a specific medical or dental procedure (1910.1030(d)(2)(vii)(A)). Any such bending, recapping, or needle removal must be done with a mechanical device or a one-handed technique (1910.1030(d)(2)(vii)(B)).
• Shearing or breaking contaminated needles is prohibited (1910.1030(d)(2)(vii)).
• Contaminated sharps must be discarded immediately or as soon as feasible in containers that are closable, puncture resistant, leakproof on sides and bottom, and labeled or color-coded (1910.1030(d)(4)(iii)(A)(1)).
• During use, sharps containers must be replaced routinely and not be allowed to overfill (1910.1030(d)(4)(iii)(A)(2)(iii)).

PPE, housekeeping, and waste

• When there is occupational exposure, you must provide appropriate PPE at no cost to the employee (1910.1030(d)(3)(i)).
• All equipment and environmental and working surfaces must be cleaned and decontaminated after contact with blood or OPIM (1910.1030(d)(4)(ii)).
• Regulated waste must be placed in containers that are closable, built to contain all contents and prevent leakage, labeled or color-coded, and closed before removal (1910.1030(d)(4)(iii)(B)(1)).

Hepatitis B vaccination

• You must make the hepatitis B vaccine and vaccination series available to all employees who have occupational exposure (1910.1030(f)(1)(i)), at no cost to the employee (1910.1030(f)(1)(ii)(A)).
• It must be made available after the employee has received the training on the hepatitis B vaccine required by 1910.1030(g)(2)(vii)(I) and within 10 working days of initial assignment. This does not apply if the employee has previously received the complete series, antibody testing shows immunity, or the vaccine is contraindicated for medical reasons (1910.1030(f)(2)(i)).
• You must make sure that employees who decline the vaccination you offer sign the statement in Appendix A (1910.1030(f)(2)(iv)).

Post-exposure evaluation and follow-up

Following a report of an exposure incident, you must make a confidential medical evaluation and follow-up immediately available to the exposed employee (1910.1030(f)(3)), at no cost (1910.1030(f)(1)(ii)(A)). Its required elements include documenting the route and circumstances of the exposure, blood collection and testing, post-exposure prophylaxis when medically indicated, and counseling (1910.1030(f)(3)(i) through (vi)).

You must give the employee a copy of the healthcare professional's written opinion within 15 days of the completion of the evaluation (1910.1030(f)(5)).

Labels

Warning labels must be affixed to containers of regulated waste, to refrigerators and freezers containing blood or OPIM, and to other containers used to store, transport, or ship those materials (1910.1030(g)(1)(i)(A)). Red bags or red containers may be substituted for labels. The text also exempts certain released blood products and individual containers placed inside a labeled container (1910.1030(g)(1)(i)(E) through (G)).

Training

You must train each employee with occupational exposure, at no cost to the employee and during working hours (1910.1030(g)(2)(i)).

• When: at the time of initial assignment to tasks where occupational exposure may take place, and at least annually thereafter (1910.1030(g)(2)(ii)). Annual training must be provided within one year of the previous training (1910.1030(g)(2)(iv)).
• After changes: additional training is required when changes such as modified or new tasks or procedures affect the employee's occupational exposure (1910.1030(g)(2)(v)).
• Content: the standard lists 14 minimum elements. They include a copy of the standard, how bloodborne diseases spread, your exposure control plan, controls and PPE, the hepatitis B vaccine, and exposure incident procedures (1910.1030(g)(2)(vii)(A) through (N)).
• Trainer: the person conducting the training must be knowledgeable in the subject matter as it relates to the workplace the training will address (1910.1030(g)(2)(viii)).

Written programs and records

Besides the written Exposure Control Plan, you must keep:

• Medical records: an accurate record for each employee with occupational exposure (1910.1030(h)(1)(i)). Keep them confidential (1910.1030(h)(1)(iii)(A)) and maintain them for at least the duration of employment plus 30 years (1910.1030(h)(1)(iv)).
• Training records: maintained for 3 years from the date the training occurred (1910.1030(h)(2)(ii)).
• Sharps injury log: a log of percutaneous injuries from contaminated sharps, kept in a way that protects the injured employee's confidentiality. It must record at least the type and brand of device, the department or work area, and how the incident occurred (1910.1030(h)(5)(i)). It is required of any employer who must maintain a log of occupational injuries and illnesses under 29 CFR part 1904 (1910.1030(h)(5)(ii)). Keep it for the period required by 29 CFR 1904.33 (1910.1030(h)(5)(iii)).

Easy-to-miss requirements

• The exposure determination must be made without regard to the use of PPE (1910.1030(c)(2)(ii)).
• The plan review must document annually your consideration and implementation of appropriate commercially available and effective safer medical devices (1910.1030(c)(1)(iv)(B)).
• You must solicit input from non-managerial employees responsible for direct patient care who are potentially exposed to injuries from contaminated sharps when identifying, evaluating, and selecting engineering and work practice controls. You must document that solicitation in the plan (1910.1030(c)(1)(v)).
• Training must include an opportunity for interactive questions and answers with the person conducting the session (1910.1030(g)(2)(vii)(N)).

Related guides

• First aid
• PPE hazard assessment
• Eye and face protection

Source

This guide is based on the text of 29 CFR 1910.1030 as published on osha.gov. The regulation itself always controls. States that run their own OSHA-approved State Plans may have additional or stricter rules.