In November 1999 the federal Occupational Safety and Health Administration (OSHA) issued a major revision of its "compliance directive" for the bloodborne pathogens standard. The new directive makes substantial changes in the way OSHA enforces the law.

Most employers will be required to make big changes in their bloodborne pathogens policy in order to comply with the directive, but making certain that the changes take place will be largely up to employees, because OSHA does not have the resources to inspect all workplaces where workers can expect to be exposed to blood. Workers can use the new directive to make certain that their employers are following policies and using equipment that provides the most effective possible protection from bloodborne pathogens, such as HIV, hepatitis B and hepatitis C.

Unions and workers can familiarize themselves with the new directive and take action whenever they find that their employer is not following the policies that it mandates. For public-sector workers in New York State, the directive is enforced by the Public Employee Safety and Health bureau of the state Department of Labor (PESH).

When an employer is not following the directive, employees can protest to the employer formally or informally, or they can prepare a complaint that they can file with OSHA or PESH. OSHA and PESH are required to investigate any specific complaint about non-compliance, so well-founded complaints should result in citations. If OSHA and PESH issue enough citations for failure to comply with the directive, other employers can be expected to take notice and make efforts to comply in order to avoid a citation. This factsheet explains what is new about OSHA's enforcement policy, and how you can use the compliance directive to help protect yourself and your co-workers.

(To see the complete text of the
new OSHA compliance directive, click here.)

All employees who could be "reasonably anticipated" to face contact with blood and other potentially infectious materials as the result of performing their job duties. In addition to blood, potentially infectious materials include "semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid visibly contaminated with blood and all body fluids in situations where it is difficult or impossible to differentiate between body fluids."

Yes. PESH has adopted the new compliance directive as the basis of its enforcement program. Workers in other states who are under the jurisdiction of a state plan are not necessarily covered by the directive, but all state plans are required to adopt policies that are "at least as effective" as OSHA's.

Yes. In a major change from OSHA's old policy, the new compliance directive requires employers to provide workers with the best available devices, such as safer needles, to eliminate bloodborne pathogen exposure or reduce it to the greatest extent feasible. According to the new directive, an "employer must use engineering and work practice controls that eliminate occupational exposure or reduce it to the lowest feasible extent. . . . Where engineering controls will reduce employee exposure either by removing, eliminating or isolating the hazard, they must be used." -- OSHA Instruction CPL 2-2,44D, Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens (the "BBP Directive,") Section XIII.D.2

Every employer with employees who may be exposed to bloodborne pathogens is required to have an Exposure Control Plan, which describes the methods the employer uses to comply with the standard. Under the new compliance directive, employers are required to familiarize themselves with the devices that are commercially available and document the basis for choosing one device over another in their Exposure Control Plan. At least once a year, all employers must evaluate their Exposure Control Plans, and document the technical basis for deciding to stick with an existing program or change it. The employer's evaluation must conform to OSHA's policy that the use of engineering controls is mandatory if they will reduce exposure. -- BBP Directive, Section XIII.C.5

Yes. Under the new directive, an OSHA or PESH inspector reviews the evaluation of engineering controls in the employer's Exposure Control Plan and the employer's documentation of the basis for it. The inspector is directed to independently confirm the evaluation's accuracy and completeness by comparing the equipment included in the plan with "other devices that are commercially available," and considering "evidence that the other engineering controls would reduce exposure" below the level achieved by the employer's plan. If there are other devices that would protect workers better than the devices in the Exposure Control Plan, it may be a violation. To carry out this section, the inspector is directed to consult with an OSHA official, the Regional Bloodborne Pathogens Coordinator, who is supposed to have up-to-date information about available engineering controls. – BBP Directive, XIII.D.2

Yes. An employee or an employee's representative, such as a union, has a right to obtain a copy of the employer's Exposure Control Plan. -- Bloodborne Pathogens Standard, 1910.1030(c)(1)(iii) If you request a copy of your employer's Exposure Control Plan, the employer must give you a copy of the plan or let you make a copy of it within 15 working days.
-- BBP Directive, XIII.C.1

Workers and unions do not need to wait for an OSHA inspection if an employer's Exposure Control Plan does not comply with the regulations. In that case, an employee or employee representative can file a complaint with OSHA or PESH. Employees can evaluate the Exposure Control Plan in light of the kinds of equipment that are available. For example, retractable needles are generally considered to provide greater protection than needle that must be manually sheathed after use. An employer's decision to use manually sheathed needles could be a violation of the requirement to use equipment that reduces exposure as much as possible. Here are examples of reasons that a plan would not comply with the regulations:

• it does not minimize exposure to bloodborne pathogens to the greatest extent feasible; or
• the employer is not following the procedures called for by the plan; or
• the plan does not include a record showing that it has been "reviewed and updated" during the previous 12 months; or
• the record of review and updating does not "document consideration and implementation of appropriate commercially available and effective engineering controls. . . ."
  -- BBP Directive,XIII.C.5

Under the new policy, an employer must consider, and make a record of considering, using any commercially available engineering controls that came on the market after the last time the plan was reviewed by the employer. New engineering controls are coming on the market at least weekly, so it would not be possible for an employer to review the plan without making a record of having considered using some new equipment. Even if the employer decides to not use any new equipment, the directive requires the employer to make a record of the reasons for not changing equipment. If an employer has not documented such a review, an employee can file a complaint. OSHA or PESH can cite an employer for an Exposure Control Plan that does not include a record of having been reviewed in the past year. -- BBP Directive XIII.C.5 OSHA or PESH can also issue a citation if the employer does not select a device that "would be clearly more effective than the one in use." -- BBP Directive, XIII.D.2

The new OSHA directive includes some requirements that were always part of the standard, but had been omitted from the original directive. According to OSHA, these additions do not represent a change in policy, but are part of an effort to insure that the standard is fully and effectively enforced. Two of these additions to the directive restate the standard's requirements that:

• The employer must provide training to all affected workers that includes an explanation of the uses and limitations of engineering controls, work practices, and personal protective equipment (BBP Directive, XIII.G.6). The old directive's description of mandatory training omitted this requirement.
• The employer must provide personal protective equipment (PPE) called for by the standard at no cost to the employee (BBP Directive, XIII.D.12). The old directive was silent on the question of who paid for PPE.

In addition to these requirements, the new directive underlines the importance of training and employee participation: "OSHA encourages employers to involve employees in the selection of effective engineering controls to improve employee acceptance of the newer devices and to improve the quality of the selection process." – BBP Directive, XIII.D.2

Yes. The Bloodborne Pathogens Standard prohibits the removal of contaminated needles, but the new compliance directive explains the meaning of the prohibition. "Bending, recapping, or removing contaminated needles is prohibited as a general practice. . . . Certain circumstances may exist, however, in which recapping, bending, or removing needles is necessary (e.g., administering incremental doses of a medication such as an anesthetic to the same patient). . . . An acceptable means of demonstrating that no alternative to bending, recapping, or removing contaminated needles is feasible or that such action is required by a specific medical procedure would be a written justification (supported by reliable evidence) included as part of the exposure control plan." -- BBP Directive, XIII.D.5

Yes, in most cases. The directive includes a detailed discussion of the employer/employee status of physicians and people they work with, which concludes that the standard applies to them as either employers or employees in almost all circumstances except when a physician, or physicians who are partners, have no employees and do not work on the premises of a host employer, such as a hospital.-- BBP Directive, XI.D

Home-health service employers are exempted from some of the standard's requirements. They are required to comply with all provisions that the employer directly controls, but they are exempted from complying with provisions that are specific to worksites that are not under their control. For example, a home-health service employer is required to provide all the appropriate safer devices and personal protective equipment, but the employer cannot be cited if a home-health worker does not use the equipment or PPE at a location that is not under the employer's control, such as a private home -- BBP Directive, XI.C

Employees who perform first aid as a normal part of their duties must be provided pre-exposure hepatitis B vaccinations, but if an employer trains an employee in first aid without making first aid a normal duty of that employee, the employer is not required to provide a pre-exposure vaccination -- BBP Directive, XIII.F.8

No. The standard does not apply to workers in the construction, marine terminal or longshore industries (BBP Directive,XIII.A.3). The old compliance directive stated that the standard applied to construction and maritime workers. Under the new directive, a construction or maritime employer who exposes workers to bloodborne pathogens can be cited only under the General Duty Clause of the Occupational Safety and Health Act.

Yes, if your work involves contact with blood, or if your work creates a reasonable potential for contact with blood. Any worker who may come into contact with used needles or other sharps has a reasonable potential for contact with blood. Any worker whose responsibilities include an activity that can be anticipated to result in contact with blood (such as having the responsibility to provide first aid) has a reasonable potential for contact with blood. Employers are required to "make available" to all such employees hepatitis B vaccinations that cost the employee nothing.

If you are exposed to blood that could enter your body through a wound or other route, such as a splash in the eye, it is important to receive treatment to prevent infection as quickly as possible. Most bloodborne pathogens will not infect a person who receives prompt medical care. You should report the exposure to your employer or supervisor immediately. Do not wait until the end of your shift. If you are an employee who is covered by the bloodborne pathogens standard, your employer is required to provide you with confidential medical evaluation and follow-up as soon as possible. Any unnecessary delay in providing you with medical evaluation will increase your risk of infection. If your employer does not immediately provide you with the required care, it is a violation of the bloodborne pathogens standard.

If you are not covered by the bloodborne pathogens standard because your duties do not include exposure to blood or do not create a reasonable potential for exposure to blood (for example, if you are an administrative worker who is exposed to blood when you come to the aid of an injured co-worker), the law does not require your employer to do anything, but OSHA "strongly encourages employers" to offer such workers the same procedures as those required for workers who are covered by the standard.

For a detailed overview of post-exposure prevention prepared by the University of California at San Francisco, click here.

Click here to see the directive. Click here to see the Bloodborne Pathogens Standard (the regulation that the directive is based on).

Background information about OSHA regulations

What is an OSHA standard?
An OSHA standard is a group of regulations concerning one hazard or group of closely related hazards. For example, there is an OSHA standard for asbestos and one for lead. OSHA can issue a citation to an employer for violation of a standard. Even though OSHA standards are about a single hazard, they are lengthy and complicated documents, concerning a wide variety of situations and working environments. Because an OSHA standard includes regulations that cover all the essential aspects of identifying and controlling a hazard, it can have a complexity that can make it difficult to apply in the field.

What is a compliance directive?
OSHA publishes compliance directives, which are official interpretations and clarifications of standards. They are instructions to OSHA staff members, showing how to apply a complicated standard to conditions in a workplace. A compliance directive explains the procedure for enforcing a standard, including specific information about how to conduct an inspection and determine when a violation exists. Compliance directives also include information about technical changes (such as equipment that was developed after a standard was published), judicial precedents and policy decisions that affect a regulation's enforcement.

What is the bloodborne pathogens standard?
To protect workers from HIV, hepatitis and other diseases that are transmitted by blood or other body fluids, in 1991 OSHA published the bloodborne pathogens standard. The standard's 8,000 words fill more than 14 pages of small type. When the standard was first published, OSHA also published a compliance directive, with guidance to OSHA inspectors about specific practices and equipment that complied with or violated the standard. The first compliance directive remained in effect until late November 1999, when OSHA published a heavily revised version.

What are "engineering controls"?
Under OSHA policy, it is mandatory, whenever possible, to design production methods and equipment in such a way that hazards are eliminated or completely separated from workers, rather than to protect workers from hazards that are present in the work environment. For example, a toxic material is not permitted in a workplace if it can be replaced by a non-toxic one. If a toxic material must be used, it must be isolated from the work environment, if possible.

The process of substituting non-toxic materials for toxic ones or designing production methods and equipment to isolate hazards from the work environment is known as using "engineering controls." Any process or equipment that is "engineered" to eliminate a hazard or prevent workers from ever being exposed to it is known as an "engineering control." In the case of bloodborne pathogens, any piece of equipment, such as a needle or a scalpel, that may be contaminated with blood and is sharp enough to puncture the skin is a potential hazard. In many cases there is no way to eliminate the use of a sharp devices (often called "sharps") that may become contaminated with blood, but the hazard can be eliminated by designing the device so it cannot puncture the skin after it has been used once. Some examples of engineering controls for bloodborne pathogens are needleless devices, shielded needle devices, blunt needles and plastic capillary tubes.

The “This page was last updated on” line just below reflects the date on which this page was transferred to this redesigned website. The information in this page (as opposed to the design) was last updated on April 6, 2000.