Q Our lab is reviewing the Bloodborne Pathogen
Exposure-Control Plan. We have had few incidents. What concerns should
we keep in mind in revising our protocols?
A Most occupational exposure to bloodborne pathogens
results from a failure to observe precautions or to use appropriate
equipment, and the fact that lab personnel perform inherently risky
procedures. A good exposure-control plan will address all these
concerns, within the context of the overall standards that the
Occupational Safety and Health Administration (OSHA) has set forth for
reducing the risk of occupationally acquired hepatitis and HIV. OSHA
issued the first bloodborne pathogen standards in 1991 and revised them
10 years later. Access the most current versions of the applicable OSHA
rules at
www.osha.gov/SLTC/bloodbornepathogens/standards.html .
Be sure to check the most current provisions of relevant state laws
(nearly half of the states have additional needlestick laws). Reviewing
current regulations is the place to start in overhauling your policy.
Overall lab obligations have not changed greatly in
the 20 years since OSHA enacted the first standard. Employers still must
provide appropriate safety equipment for employees; monitor needlestick
events; offer hepatitis vaccination; provide evaluation/treatment for
employees who sustain a needlestick in the course of employment; keep
records relating to needlestick incidents; and conduct training in
universal precautions. Some details have changed over time, and opinions
have clarified standards. With violations of these standards still an
expensive proposition, totaling thousands of dollars per incident,
additional attention to safety and health management is well worth the
effort.
The revision of the OSHA standards with the
Needlestick Safety and Prevention Act in 2001 imposed an obligation on
employers to reflect advances in safety technology in their
exposure-control plans and practices. At least annually, you are
obligated to assess what technology improvements are available and to
reduce occupational exposure to bloodborne pathogens. Look not only at
what is available in the marketplace but also solicit the advice of “in
the trenches” staff about risks and prevention of injury. Like
everything else in lab medicine, if this process is not documented, it
did not happen, so take time to devise a formal plan for surveying your
staff, doing market research, and rolling the resulting information into
annual recommendations for changes — then follow it. Keep in mind that
the input of your at-risk employees is more important that purchasing
agreements or vendor contracts, under an opinion rendered by OSHA in
2002 (www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=24385&p_text_version=FALSE).
Personal protective equipment (PPE) is a big part of
controlling occupational exposure, but exactly what equipment is
required can be subject to debate. The employer has the obligation to
assess exposure and, thus, to assess and define what constitutes PPE for
staff, and it is prudent to do so for the various activities of lab
personnel. Note that under OSHA standards, lab coats may not be
protective, depending on the job — but if they are, the employer has the
obligation both to provide and to launder them. Defining in policy what
is and is not protective may save costly arguments later.
This is a good time to check how well your response
policy is working. Because needlesticks can occur at any time, your
institution should be prepared to respond rapidly to any exposure to
bloodborne pathogens with appropriate evaluation and, if necessary,
treatment. Check the Internet for sample policies, compare these with
yours, and adapt to offer the most rapid, comprehensive response
possible within your institution’s limits. Make certain that the
prophylaxis guidelines in use are the most current, and that lab testing
to support evaluation and treatment is available. From a lab standpoint,
it is important to remember that standards require source blood to be
tested “as soon as feasible” after exposure. In a 2007 opinion, OSHA
indicated that failure to have and use any of the commercially available
rapid (one-hour) HIV tests would constitute a violation of standard —
which implies that anything less than 24/7 rapid-response testing from
the lab may put the institution at risk of non-compliance.
Make certain all paperwork is in order. Are all
incidents fully recorded? Do you have records of hepatitis vaccinations
or lack thereof for all employees? Employers are obligated to offer
employees (but may not require) a hepatitis vaccination. If an employee
declines, keep a record by way of a declination form that states offered
vaccination was refused. Personnel turnover can mean that contacts named
in the plan are not valid; take time to double-check that those named
still bear designated responsibility.
OSHA’s model exposure-control plan can provide a good
framework against which to check your own policy, including sample forms
and logs:
www.osha.gov/OshDoc/Directive_pdf/CPL-@-2_69_APPD.pdf.
Barbara Harty-Golder is a
pathologist-attorney consultant in Chattanooga, TN. She maintains a law
practice with a special interest in medical law. She writes and lectures
extensively on healthcare law, risk management, and human resource
management.
MLO’s “Liability and
the Lab”is intended to provide risk management and human resource
management education; it is not intended to provide specific legal
advice. If you require legal advice, the services of an attorney should
be sought. Dr. Harty-Golder welcomes your questions, which can be sent
to her at
[email protected] . Unless otherwise noted as “confidential”
by readers, all queries will be considered for publication without
further notice to them. Names, institution, city, and state will be
removed before publication.
