June 3, 1992

Ms. Leslyn Boese
Medical Innovations
1110 N. Post Oak Road
Suite 140
Houston, Texas 77055

Dear Ms. Boese:

This is in response to your letter of January 30, requesting a clarification regarding the applicability of the training requirements in 29 CFR 1910.1030, "Occupational Exposure to Bloodborne Pathogens," to your nursing personnel service. We apologize for the delay in this response.

You state in your letter that your company is "a very large personnel pool providing hospital staffing and private duty nursing." The Occupational Safety and Health Administration (OSHA) considers personnel providers such as your company, which send their own employees to work at other facilities, to be employers whose employees may be exposed to hazards. Since it is your company, Medical Innovations, which maintains a continuing relationship with its employees, but another employer (your client) who creates and controls the hazard, there is a shared responsibility for assuring that your employees are protected from workplace hazards. The client employer has the primary responsibility for such protection, but the "lessor employer" (Medical Innovations) likewise has a responsibility under the Occupational Safety and Health Act.

In the context of OSHA's standard on bloodborne pathogens, 29 CFR 1910.1030, Medical Innovations would be required to provide generic training in universal precautions and to ensure that employees are provided with the required vaccinations and that proper followup evaluation is provided following an exposure incident. Your clients would be responsible for providing sitespecific training and personal protective equipment and would have the primary responsibility to control potential exposure conditions. The client, of course, may specify what qualifications are required for supplied personnel, including vaccination status. It is certainly in the interest of the lessor employer to ensure that all steps required under the standard have been taken by the client employer to ensure a safe and healthful workplace for the leased employees. To that end, your contracts with your clients should clearly describe the responsibilities of both parties in order to ensure that all requirements of the regulation are met.

The following paragraphs address each of the specific questions you pose:

1) Who is considered the employer of personnel who have signed on with numerous agencies?

All of the employing agencies would be considered to be employers. As a practical matter, OSHA will consider as employers both the client employer as well as the lessor employer who is actually providing the employees at the time of the inspection.

2) Is each nursing agency responsible for training all health care personnel in its "pool?"

This answer to this question is subsumed under the answer to question 1.

3) Are the individual hospitals utilizing this personnel responsible for the training of these health care providers?

See the general discussion at the beginning of this letter.

4) Is there a time limit for completing the required training.

Training must be completed by June 4, 1992 and repeated at least annually. Employees who received training within the year preceding March 6, 1992, must receive information on the sections of the standard which were not included in their training. Employees who begin employment after June 4 must be trained prior to being placed in positions where occupational exposure may occur.

5) Is a self-study module an acceptable format for meeting personnel training requirement?

Self-study modules, videos and interactive computer programs may all be used as part of the training program. However the training must be tailored to the language and educational levels of the employees and trainees must be given an opportunity for interactive questions and answers. It should be pointed out that the training does not have to be provided by the employer's own staff. An agency could make an arrangement with a local hospital to provide the training through its regular in-service educational program.

We hope this information is responsive to your concerns. If you need further information, please contact the Regional bloodborne pathogens coordinator in Dallas at (214) 767-4731.

Sincerely,



Patricia K. Clark, Director
Directorate of Compliance Programs