OSHA requirements are set by statute, standards and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult OSHA's website at https://www.osha.gov.
June 27, 1991
- MEMORANDUM FOR:
- ROY CLASON, DIRECTOR
DIRECTORATE OF POLICY - FROM:
- PATRICIA K. CLARK, DIRECTOR
DIRECTORATE OF COMPLIANCE PROGRAMS - SUBJECT:
- ILO QUESTIONNAIRE
The following is our response to the ILO questions you requested that the Directorate of Compliance Programs answer.
6.1 Are public health and medical services covered by occupational health and safety legislation and subject to inspection by labor or occupational health and safety inspectorate in the same way as private sector employers?
Answer: The Occupational Safety and Health Act of 1970 excludes public sector employees from federal OSHA coverage. Therefore, in the states which are covered solely by federal OSHA regulations, public sector employees, such as employees in state or municipal hospitals, are excluded from coverage. Twenty-one states have their own state occupational safety and health programs which are overseen, monitored, and partially funded by federal OSHA. Public sector employees in those states are covered by the state occupational safety and health regulations. Two federally covered states, New York and Connecticut, have partial state plans which cover their public service employees only.
6.3 (a) According to statistics of occupational accidents and
diseases, what are the major hazards facing the staff of health and medical services?
Answer: Approximately 12,000 cases of Hepatitis B infections occur annually in health care workers who have occupational exposure to blood or other potentially infectious body fluids. 500-600 hospitalizations and 200 deaths result each year. Other infectious diseases, including exposure to the tuberculosis bacteria, also pose a risk.
Other hazards to the medical profession include ergonomic hazards (eg. back injuries), radiation hazards, exposure to hazardous chemicals such as ethylene oxide and waste anesthetic gases (potential teratogenic hazards) and cytotoxic drugs, exposure to as yet undetermined hazards from a variety of new treatment agents including aerosolized pentamidine for the human immunodeficiency virus, stress resulting from rotating and prolonged work shifts, and electrical hazards.
(b) What measures have been taken to reduce or eliminate these hazards?
Answer: In 1989, OSHA published a proposed rule on occupational exposure to bloodborne pathogens and began applying a number of general industry standards and the General Duty Clause of the OSH Act to the hazards of bloodborne disease. Federal OSHA has conducted approximately 1000 inspections, mostly in health care facilities, to determine compliance with the Centers for Disease Control recommendations, including the use of universal precautions.
In 1988 the National Institute of Occupational Safety and Health (NIOSH) compiled in one volume all guidelines for protecting the safety and health of healthcare workers. For many hospitals this initiated a concerted effort to develop hospital safety and health programs.
Measures are in the developmental stages to establish methods to deal with ergonomic hazards such as back injuries which are prevalent among health care workers.
6.4 What new hazards have appeared in recent years? Describe any preventive measures, including training, already taken or planned in this context.
Answer: The Human Immunodeficiency Virus is a relatively recent hazard to workers occupationally exposed to blood and other body fluids. Both the proposed regulation and the current enforcement under the General Duty Clause include training employees in the epidemiology and symptoms of HBV and HIV, the modes of transmission of the two diseases, the employer's infection control program including engineering controls and work practices that are to be used, proper selection and use of personal protective equipment, the benefits of the hepatitis B vaccine, procedures to follow if an exposure incident occurs, and the meanings of the various signs, labels, tags, and color coding used to denote biohazards.