June 14, 2007

Ms. Selin Hoboy
Corp VP, Environmental, Safety and Health
Stericycle, Inc.
2333 Waukegan Road
Suite 300
Bannockburn, IL 60015

Dear Ms. Hoboy:

Thank you for your January 22, 2007 letter to the Occupational Safety and Health Administration (OSHA). Your letter has been referred to OSHA's Directorate of Enforcement Programs (DEP) for an answer. You had specific questions regarding the applicability of OSHA's bloodborne pathogens standard to the use of sharps containers on hospital crash carts. This letter constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to any question not delineated within your original correspondence. Your questions were rephrased below followed by OSHA's responses.

Scenario: Crash carts with specialized life-saving equipment are used in emergency response situations in healthcare facilities and are moved throughout the medical facility as needed. In general, each crash cart is equipped with either a disposable or reusable sharps container which is attached in an upright position to the cart to allow for prompt disposal of contaminated sharps in emergency situations. The sharps container is essentially integral to the crash cart in that it remains in position on the crash cart until the container is ready to be replaced.

Question 1: What is considered the "area of use" for a movable crash cart?

Reply 1: With regard to sharps containers, OSHA interprets the area of use to be the location where used sharps are deposited into the containers. In the case of movable crash carts whose contents are only removed or used at the time and location where they are needed, "area of use" is the location where the medical procedure requiring the cart is being performed.

Question 2: Does 29 CFR 1910.1030(d)(4)(iii)(A)(3)(i) mean that a sharps container on a crash cart needs to be closed during transport from one location of use to another within the same hospital?

Reply 2: Yes. The intent of this requirement is to ensure that employees are protected from contaminated sharps that may fall out while sharps containers are being transported from one area of use to another. In order to assure employees' safety, employers must select from the variety of commercially-available sharps containers which are suitable for the intended use, in this case moving safely from one location to another [29 CFR 1910.1030(c)(1)(iv)(B)]. Among available products are portable sharps containers designed with counter-balanced doors and sharps containers equipped with closable flaps for mobile phlebotomy functions. The design features of these containers allow for immediate disposal of sharps and provide an acceptable temporary barrier from spillage of sharp objects during transport. In addition, these types of containers allow users to lock the closures in place once containers are filled and ready to be removed for final disposal.

According to recommendations from the National Institute for Occupational Safety and Health (NIOSH) document, Selecting, Evaluating, and Using Sharps Disposal Containers, the selection of a [sharps] container should be based on a site-specific hazard analysis. One important criterion in the selection of sharps containers is the assessment of containers that accommodate transport or mobility needs.¹ This essentially means that whether containers are being transported on a cart or by hand, employees will be afforded the best protection when employers select sharps containers which are appropriately constructed and will allow for safe transport. Containers located on movable carts should be secured with brackets or other positioning mechanism (s) to minimize the likelihood of the container tipping or becoming overturned and should have a protective barrier over the opening to prevent protrusion of displaced sharps.

Question 3: Allowing the use of sharps containers on crash carts would promote compliance with 29 CFR 1910.1030(d)(4)(iii)(A)(2)(i), "[d]uring use, containers for contaminated sharps shall be: [e]asily accessible to personnel and located as close as is feasible to the immediate area where sharps are used or can be reasonably anticipated to be found. . . " Healthcare facilities, today, do not close these containers. If the containers were closed and reopened after the cart has been moved, would this be a violation of another part of the regulations 1910.1030(d)(4)(iii)(A)(4) regarding opening of sharps containers?

Reply 3: OSHA agrees with your statement that the placement of sharps containers on crash carts is an effective means of meeting the requirement that employees dispose of contaminated sharps as soon as possible after use. With regard to the appropriateness of employers permitting employees to manually reopen reusable sharps containers that have been closed, it is, indeed, a violation to do so. In addition to meeting the requirement for immediate disposal of contaminated sharps, employers have the additional obligation to forbid the opening, emptying, or cleaning of reusable containers manually or in any other manner which would expose employees to the risk of sharps injury [29 CFR 1910.1030(d)(4)(iii)(A)(4)].

However, the use of commercially-available sharps containers which are designed to provide temporary barriers to protect employees during the transport of containers from one area of use to another are often necessary and are permitted. As mentioned above, there are a variety of portable containers produced by more than one manufacturer which are equipped with counter-balanced doors or closable flaps for temporary closure. These containers can provide interim protection from the sharps contained within the container and are suitable for use on mobile carts.

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
Directorate of Enforcement Programs

¹ Selecting, Evaluation, and Using Sharps Containers, U.S. Department of Health and Human Services, Jan. 1998, p. 6. [ back to text ]