December 13, 2010

Catherine Rucker, EMT-1
20 Azalea Place
Novato, CA 94949

Dear Ms. Rucker:

Thank you for your February 19, 2010, letters to the Occupational Safety and Health Administration (OSHA). Your letters were forwarded to the Directorate of Enforcement Programs for a reply. You requested clarification on the applicability of the Bloodborne Pathogens Standard, 29 CFR 1910.1030, to employees who render first aid as a collateral duty. 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 paraphrased scenario and requests are below, followed by our response.

Scenario: Due to budgetary constraints several California school districts have laid off their school nurses. Office staff is now expected to render first aid to the students. However, these additional first aid duties are not listed in the employees' job descriptions, nor are the employees trained to render first aid. The employees are not provided the protections of the Bloodborne Pathogens Standard. Employers are being told that to avoid having their employees covered under the Bloodborne Pathogens Standard they should not designate employees to render first aid.

Request 1: OSHA should clarify that an employee who provides first aid as a collateral duty is actually covered by the Bloodborne Pathogens Standard and must be afforded its protections, but that employers are relieved of their responsibility to offer collateral duty first aiders the pre-exposure hepatitis B vaccination series if specified measures are taken. Collateral duty first aiders and their supervisors should sign statements, saying that they have been designated to provide first aid, that they understand that pre-exposure hepatitis B vaccination is not being provided, that post-exposure hepatitis B vaccination will be provided, and that they have received complete bloodborne pathogens training in accordance with the standard.

Response 1: As a preliminary matter, it should be noted that the lack of first aid training for personnel expected to render first aid may be a violation. The OSHA standard at 29 CFR 1910.151(a) provides in pertinent part: "(a) In the absence of an infirmary, clinic, or hospital in near proximity to the workplace which is used for the treatment of all injured employees, a person or persons shall be adequately trained to render first aid." The OSHA Bloodborne Pathogens standard is applicable to all occupational exposure to blood or other potentially infectious material (OPIM), as defined by the standard. [29 CFR 1910.1030(a).] The term "occupational exposure' is defined as "...reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties." [1910.1030(b).] As clarified in the OSHA directive on the standard, Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens, CPL 2-2.69, par. XIII A.3.c., OSHA interprets the standard to cover "employees who are designated to provide first aid or medical assistance as part of their job duties..." OSHA interprets the directive to say that an employee who routinely provides first aid with the knowledge of the employer may be regarded as so designated. Therefore, you are correct in your interpretation that school office staff members who are "expected" by their employer to provide first aid, whether trained in first aid or untrained, would be covered by the OSHA Bloodborne Pathogens Standard, whether they render first aid to students, employees, or both.

The signed statement you suggest in your letter is not required by the Federal bloodborne pathogens standard. However, as you note, an employee's failure to offer prophylactic hepatitis B vaccinations to personnel expected to render first aid only as a collateral duty is only a de minimis violation, not cited, if the protocol set forth in the directive is followed. CPL 2-2.69, par. XIII F. 8.

Request 2: Can OSHA edit its May 19, 1992 letter of interpretation to Dr. Margery M. Scanlin to clarify the need for all 14 minimally required elements of the bloodborne pathogens standard [1910.1030(g)(2)(vii)(A)-(N)] to be included in a training program for first aiders working at summer camps and conference centers?

The letter states, "Many first aid courses now include materials on universal precautions and procedures for minimizing exposure to bloodborne pathogens. Such a course could be provided as part of the camp's orientation program or could be a required prerequisite for employment as a summer camp counselor... Employees who arrive on the job after having taken a first aid course that includes the elements of universal precautions, would have to be provided with site specific information such as the location of gloves but this could be included in the general employee orientation."

Response 2: You wrote that you find the statement above to be misleading in that readers may interpret this to mean that once an employee has completed "universal precaution" training and a site- specific training, all bloodborne pathogens training requirements would have been met. Our letter was written to convey the importance of training which includes material beyond a discussion of "universal precautions". All the elements of the minimally required training provisions must be covered in a site-specific manner to assure that employees understand the procedures that are in place at their individual worksite. We appreciate your suggestion and will amend the May 19, 1992 letter of interpretation in an effort to further clarify OSHA's policy.

Please be aware, under section 18 of the Occupational Safety and Health Act, States are offered the opportunity to assume responsibility for the adoption and enforcement of occupational safety and health standards under a plan approved by Federal OSHA. Although OSHA does not have jurisdiction over employees of State and local governments, States with OSHA-approved State Plans are required to extend their jurisdiction to these workers. The Division of Occupational Safety and Health in the California Department of Industrial Relations operates such a program which is known as Cal/OSHA. California adopts and enforces standards which often differ, but are at least as effective as the Federal standards. Thus the California bloodborne pathogens standard while not identical to the Federal is applicable to public employees including public school teachers and staff. California's bloodborne pathogens standard may be found on the State's website at http://www.dir.ca.gov/title8/5193.html. The State's enforcement directive is available at http://www.dir.ca.gov/DOSHPol/P&PC14.htm, and a list of Frequently Asked Questions is posted at http://www.dir.ca.gov/dosh/bloodbornefaq.html.

We suggest that you contact Cal/OSHA for more information on the State's bloodborne pathogens standard, its requirements regarding the issues of concern to you, and its applicability in the public schools, or to file a workplace complaint.

Len Welsh, Chief
Division of Occupational Safety and Health
Department of Industrial Relations
1515 Clay Street, Suite 1901
Oakland, CA 94612
PH: (510) 286-7000
FAX: (510 286-7037

You may also wish to contact the School Action for Safety and Health (SASH) program administered by the state's Commission on Health and Safety and Workers' Compensation (CHSWC) in the Department of Industrial Relations. The program provides free training for school district staffers responsible for safety and health, written materials, and problem-solving assistance. The contact information for the CHSWC is:

CHSWC
1515 Clay Street, Room 901
Oakland, CA 94612
PH: (510) 622-3959
FAX: (510) 622-3265

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,

Thomas Galassi, Director
Directorate of Enforcement Programs