Blood Borne Pathogen Exposure Control Plan-Necessary?

AnaC · November 2003

I have an agency that is in place specifically to provide assistance (not medical in nature) to HIV/AIDS infected clients, counseling etc., and although they do provide for testing, but not by drawing blood, but using the cotton swab, small amount of saliva method, and they don't have an onsite lab so the swabs are sent out for testing. They do not have first aid responders, and they are instructed to dial 911 for any emergencies that might occur.

They feel that under the OSHA regs on this topic, they are reasonably occupationally exposed and they should have in place the whole BBPathogen Standard Requirement, i.e. policy, annual training etc. The attorney who is providing services to them feels that they are not reasonably, but only remotely exposed and they don't have to have this in place. I feel that they would be safer to have it just based on the nature of their business. I was hoping to hear some expert, and maybe totally differnet opinions on this topic.

Thanks,
Ana

rad · November 2003

Not expert but past experience - when I was teaching preschool we had a full protection gear kit - face mask with eye protector sheild, thick heavy rubber gloves, smock with tight writs cuffs, the whole deal. The idea was that if a child is spurting blood we are to put all this gear on and then tend to the child while someone else calls 911. We received annual training on how to handle bleeding emergencies. Our concern was HIV as well as hepatitis which is common in inner city and underprivileged communities. So while I am not sure whether the training I received is the same as the training you mention, it sounds like I was at even less risk for exposure and was still adequately trained.

TN HR · November 2003

I had the Red Cross add an instruction period on BBP to our annual CPR and First Aid training program. The cost is minimal, it only adds a small amount of time to the training day and it gets you compliant with OSHA standards.

Gene

Parabeagle · November 2003

I would say they have a reasonable expectation of exposure, especially if they're dealing with customers already identified as HIV positive. I would implement a full-blown exposure control plan. In my company, everyone receives BBP training who has even a minimal risk of exposure. I would rather err on the side of doing too much rather than too little.

AnaC · November 2003

Thank you all for your responses. Let me ask you this then....Under the full blown OSHA Standard it states that everyone that has a reasonable exposure potential must be offered for free, the Hep B Vaccine series, or a chance to decline with signatures, so how many of your staff members were offered this? I feel that this still would be cheaper in the long run, plus the vaccines last for 5 or 6 years I believe, than to face a lawsuit down the road.

Thanks again for this wonderful forum! It is one of the most valuable tools any HR person could have.

Sincerely,
Ana

Don D · November 2003

I would disagree with the attorney. There is in fact a reasonable likelihood or possibility that the employees could or might be exposed. And that's the OSHA criteria for having a BBP program in place. If he feels this is 'remote', I wonder what his 'reasonable' might be. Ask him this, "Can you think of any reason why we would NOT want to have a BBP program in place?"

AnaC · November 2003

Don

He agrees with a general BBPath policy in place and any safety measures such as proper equipment etc. being available, but he feels that stating and identifying in the policy the list of employees with reasonable exposure (which he feels do not truly have reasonble exposure based on the methods of testing used on the clients, and the fact that they do not have first aid responders)is going to cost this little nonprofit agency a lot of potentially unnecessary money due to the requirement by the Standard to provide Hep B vaccines, if in fact those employees are not TRULY reasonably exposed (in his opinion) since there is no blood drawing going on, needles being used etc. So that's his issue right there.

Parabeagle · November 2003

Our employees who have a reasonable expectation of exposure are housekeepers and maintenance people in our hotels. I would venture to guess they are probably at less risk of exposure than your employees simply because the bodily fluids with which they come into contact are, usually, dried. However, we have insisted on Hep B vaccines or waivers for all of our housekeepers and maintenance staff and even offer the vaccinations to front desk personnel who are only marginally exposed. Ask your attorney if he would be willing to pay the noncompliance fine on your behalf and pay to remedy the violation.

mwild31 · November 2003

Okay - here's a dumb question - blast away at me folks for it may be totally from left field, but I like to think that I don't ask too many of these x;-).

AnaC - Are you sure it's his only issue? If these folks (employees) work for your agency & you guys are citing OSHA references - do you think the attorney may also being looking at this situation from a cost/benefit ratio? It seems to me that the OSHA fines for each case would only be, what is it UP to $7500 or is it $10,000 now - and that's your minimum risk for monetary damages compare that to the initial training & on-going training costs as well as the vaccines. Is he betting on no one getting infected (hence skipping the fines & even then they're small) so there's no need for the expense?

Go with the program - it's the right thing to do - employee safety should be first and foremost.

LindaS · November 2003

The issue that you need to remember is that there are other infectious diseases in addition to HIV/AIDS and many of them are transmitted through bodily fluids other than the blood. You have individuals working with saliva that have the potential to infect individuals as well. I would recommend putting a full blown BBP program into place. As far as the Hepatitis B vaccine, we vaccinate all first aid responders, any janitorial personnel and anyone else that has a potential to exposure. It is a series of 3 shots (given over a six month span) as well as a titer to determine reactivity. The length of the vaccinations have yet to be determined, as far as I know.

Balloonman · November 2003

Okay lets make sure everyone understands, you have to OFFER the hep b vaccine, if they decline it have them sign a waiver stating they understand they can change their mind at any time etc. etc. and can get it.
3 shots, less than $300.00 per person, my medical folks say like Linda no is for sure how long they last. I finally had one doctor say redo every ten years to be on the safe side. I think that sounds reasonable.
You will find many will not take the vaccine (50%).
As a safety professional if you have individuals working with people who have a known infectious disease, I would consider then at risk. Besides they are working with body fluids.
My $0.02 worth.
DJ The Balloonman

Don D · November 2003

I understand your clarification Ana. Still, it's the appropriate thing to do. The OSHA standard is 'does your analysis reveal that there is a reasonable risk of exposure?' Tell you what; to settle the question, let's see if the attorney will put in writing his advice on letterhead recommending that there be no BBP program in place and that having none will not conflict with OSHA regulations. Tell him you can show that to OSHA upon inspection. Anytime there is a reasonable risk of exposure, the shots should be offered. It is also required that even if a responder declines, once there is an exchange of fluids or exposure to blook, you must then again offer the shot series and document the signed refusal. I would estimate the decliners to be around 85% in my industry, manufacturing. The cost is negligible, the work is basically one-time and the follow-through is also minimal. Fines can snowball and are not minimal. They multiply exponentially by the day, per first responder. The BBP program, once implemented is such a nat in a furball. I don't know why the attorney is even giving it further thought. Tell him you'll be looking for his letter recommending you NOT have the program. If an OSHA inspector comes into your facility, as you have described it, and asks to see your Bloodborne Pathogens Exposure Control Plan, and they will, he will cite you immediately for not having one. My opinion of course.

Blood Borne Pathogen Exposure Control Plan-Necessary?

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