May 28, 2003

Benjamin H. Hoffman, M.D., M.P.H
Chief Medical Officer
Waste Management, Inc.
1001 Fannin Street
Suite 4000
Houston, TX 77002

Dear Dr. Hoffman:

Thank you for your January 21 letter to the Occupational Safety and Health Administration (OSHA) regarding the potential exposure to contaminated sharps in the solid waste industry. Your letter is a follow-up to a letter that we wrote to you on January 3 regarding the application of OSHA's bloodborne pathogens standard (29 CFR 1910.1030) to solid waste handlers who may come into contact with medical sharps (e.g., syringes) during their normal job duties. Your inquiry is restated below, followed by OSHA's response. This letter constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to any situation not delineated within your original correspondence.

Statement: We (Waste Management, Inc.) are unaware of any study that supports the conclusion that, as a rule, sharps found in waste streams, such as ours, are "contaminated."

Question: Are there any studies supporting OSHA's conclusion that there is reasonably anticipated contact with blood or other potentially infectious materials (OPIM) by virtue of the fact that needles appear in our waste stream?

Reply: Occupational exposure to blood or other potentially infectious materials (OPIM) is determined by assessing job tasks that may involve a reasonably anticipated exposure to contaminated sharps. This is performed during an employer's exposure determination, as required by the bloodborne pathogens standard [29 CFR 1910.1030(c)(2)(i)].

Paragraph (b) of the standard defines "contaminated" as "… the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface." Also "contaminated sharps" are defined as "any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires." Thus, if a sharp (e.g., syringe, lancet) is found in the waste stream, one must assume that it has been used to inject a medication or drug into a person and, by virtue of that action, is reasonably anticipated to have blood on it; therefore, it is a contaminated sharp. The waste hauler's exposure determination would need to reflect this assessment in the employer's written exposure control plan.

A steadily increasing number of Americans are self-injecting drugs in their homes and at work. It has been estimated that 8 million syringes are used to administer up to 3 billion injections per year outside of a traditional healthcare facility ("Safe Community Disposal of Needles and Other Sharps," Coalition for Safe Community Syringe Disposal August 2002). Therefore, it is likely that syringes used by millions of self-injectors will be found in the waste stream due to inappropriate disposal practices.

Furthermore, although the coverage of the standard is not triggered by the actual presence of pathogens, but by the presence or reasonably anticipated presence of blood or OPIM, we note the following study dealing with the possibility of infection from syringes. "Operation Red Box," conducted in Baltimore in the mid-1990s, was an attempt by the U.S. Public Health Service to reduce the risk of infection with HIV associated with injection drug use (Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 18 (Suppl. 1): S120-S125, 1998). In that study, used syringes collected in community drop boxes were randomly tested for the presence of HIV. Approximately 10% of those syringes tested positive for HIV. Unfortunately, this study did not test for the presence of the hepatitis B or C viruses, which are more prevalent in the U.S. population. Regardless of actual disease status of the patients using the syringes, the Centers for Disease Control and Prevention (CDC) recommended practicing standard precautions, which assume that all blood or body fluids are potentially contaminated with a bloodborne pathogen because diseases are not always identifiable and contaminated materials are not always properly labeled.

You acknowledged in your previous letter to us that Waste Management, Inc. provides the pre-exposure hepatitis B virus vaccination to employees in "locations where there are an unusually high number of needlesticks." We responded, in our January 2, 2003 letter, by stating that it is not enough to offer the vaccine to only employees in those high-incident geographic areas, but also to any employees who may be reasonably anticipated to have exposure to contaminated sharps as part of their job duties, specifically those supervisors or designated responders who are required to pick up a contaminated sharp found in a trash bag or on a conveyer belt.

Thank you for your interest in occupational safety and health. We hope you find this information helpful. 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 http://www.osha.gov. If you have any further questions, please feel free to contact the Office of Health Enforcement at (202) 693-2190.

Sincerely,

Richard E. Fairfax, Director
Directorate of Enforcement Programs