December 3, 2002

Janice Zalen
Director of Special Programs
American Health Care Association
1201 L Street, NW
Washington, DC 20005-4444

Dear Ms. Zalen:

Thank you for your August 22 letter to the Occupational Safety and Health Administration (OSHA). Your letter was forwarded to OSHA's Office of Health Enforcement to answer a specific question regarding the enforcement procedures for the Bloodborne Pathogens Standard in the Nursing and Personal Care Facility National Emphasis Program (NEP). Specifically, you inquired about the direction given to our field staff for evaluating an employer's sharps injury log. Your concern is restated below followed by OSHA's response.

AHCA Concern: The AHCA believes that there is no regulatory requirement that generally prohibits names to appear on the sharps injury log; rather it is circumstances that trigger the requirement to remove personal identities to maintain privacy.

AHCA Suggestion: We encourage OSHA to take quick action to correct its NEP directive to accurately reflect that the sharps injury log may contain names when appropriate.

Response: The sharps injury log is used to track devices that are causing injuries and may need to be replaced; it is not intended to track employees having injuries. The log is a valuable surveillance tool for healthcare facilities to identify departments, devices, and/or procedures where injuries are occurring.

The Bloodborne Pathogens Standard as revised by the Needlestick Safety and Prevention Act (NSPA) sets forth the elements that must be included in the log. These are:

• Type and brand of device, if known;
• Department or work area where exposure occurred; and
• An explanation of how the incident occurred.

OSHA's Compliance Directive for the Bloodborne Pathogens Standard, CPL 2-2.69, at paragraph XIII.H.3, further explains that additional information may be included; however the confidentiality of the injured employee must be maintained [Needlestick Safety and Prevention Act; Pub. L. No. 106-430, Sec. 3, 114 Stat. 1901, 1903 (2000)]. Since neither the NSPA nor the Bloodborne Pathogens Standard specifies the format of the log, OSHA included a sample log in the directive's appendix. You will note that the sample log does not include a column for an employee's name, but rather one for "case/report numbers." This is because OSHA believes the addition of an employee's name jeopardizes that employee's confidentiality and increases his or her hesitancy to report an incident. Also, it does not fulfill the intent of the log.

An establishment may keep sharps logs with employees' names on them. However, if the log is made available to any other persons, the establishment must withhold any information that directly identifies an employee or that could reasonably be used to identify the employee. Therefore, OSHA will direct its compliance staff and the public that if the sharps injury logs include employee names, the names and all other personal identifiers must be removed before the log is made available to others.

As AHCA mentioned in its letter, it is aware of some long-term care facilities that are including names on the log. In order to ensure required confidentiality, facilities must remove names prior to the record being turned over to any other person(s). Employers may keep a separate confidential list of the case numbers and employee names, as suggested by CPL 2-2.69, paragraph XIV.A.

In addition, AHCA suggested that the sharps injury log be maintained, "in the employee's medical file" (and then) "identifiers would not have to be removed." This is not possible, since any "log" containing more than one name could not be maintained in an individual's personal medical file without breaching the confidentiality of any other named individual.

Thank you for your interest in occupational safety and health. We hope this provides the clarification you were seeking and apologize for any earlier confusion. As this letter demonstrates, OSHA's re-examination of an issue may result in clarification or correction of previously stated enforcement guidance. OSHA requirements are set by statute, standards, and regulations. Our 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. Please note that our enforcement guidelines 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 www.osha.gov. If you have any further questions, please feel free to contact the Office of Health Enforcement at 202-639-2190.

Sincerely,



Richard E. Fairfax, Director
Directorate of Enforcement Programs