October 29, 2013

Ms. Linda Fairbanks
Executive Director, Association for Linen Management
2161 Lexington Rd., Suite 2
Richmond, KY 40475

Dear Ms. Fairbanks:

Thank you for your June 26, 2013, letter to the Occupational Safety and Health Administration (OSHA) regarding the unintended disposal of contaminated hospital linens as regulated waste when they arrive at laundries in red bags. Your letter was referred to OSHA's Directorate of Enforcement Programs for a response. This letter constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to issues not delineated within your original correspondence. Your paraphrased question and our response are below.

Background:You explained that hospitals are seeking to gain control of the unintended and costly disposal of linens intended for reuse by laundries when blood-contaminated linens are received in red bags. Some hospitals believe they must place the contaminated linens in red bags because of OSHA's Bloodborne Pathogens (BBP) Standard, 29 CFR 1910.1030. Laundry personnel then assume that the bags contain regulated waste. They are instructed not to open the bags in an attempt to determine the contents due to the risks to the employee should they contain regulated waste. (Healthcare laundries frequently, but inappropriately, receive actual medical waste, such as used surgical instruments). The bags are redirected to a waste department for disposal. The Association for Linen Management (ALM) does not believe it was the intent of this OSHA standard to include contaminated linens or other reusable textile product/asset in the definition of regulated waste.

Question: What are the requirements for providing warnings on bags of contaminated linens that are to be laundered?

Response: The definition of "regulated waste" does not include contaminated linens that will be laundered and reused. 29 CFR 1910.1030(b). The word "waste" is defined as "garbage" or "trash." Webster's II New College Dictionary, 1995, p. 1247 (definition 6). Furthermore, "[c]ontaminated [l]aundry" is separately defined in the standard. The definition is "...laundry which has been soiled with blood or other potentially infectious materials [OPIM] or may contain sharps." 29 CFR 1910.1030(b).

However, while red bags are generally used for regulated waste, the BBP standard also permits red bags to be used for contaminated laundry. OSHA's BBP standard provides the requirements for management of regulated waste at paragraph 1910.1030(d)(4)(iii), and contaminated laundry at paragraph 1910.1030(d)(4)(iv). As stated in your letter, to comply with the requirements of 1910.1030(d)(4)(iv)(A)(2) contaminated laundry generally must be placed and transported in bags or containers labeled or color-coded in accordance with 1910.1030(g)(1)(i). That provision generally requires the placement of a specified biohazard label on the container, but it does give employers the option to comply with the requirements specified at 1910.1030(g)(1)(i)(E), which states: "Red bags or red containers may be substituted for labels" (emphasis added).

Accordingly, when a facility utilizes universal precautions in the handling of all soiled laundry, alternative labeling or color-coding is sufficient if it permits all employees to recognize that the containers require universal precautions. 29 CFR 1910.1030(d)(4)(iv)(A)(2). Thus, another label or color may be used for the laundry. CPL 02-02-069, Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens, par. XIII.D.38. This provision was included in the standard because during the rulemaking, OSHA became aware of the problem in the healthcare industry of unintended disposal of red-bagged laundry due to mistaken thinking that the red bags contained infectious waste (56 FR 64004-64149, December 6, 1991). However, there is an exception to this provision. The standard at 29 CFR 1910.1030(d)(4)(iv)(C) provides:

When a facility ships contaminated laundry off-site to a second facility which does not utilize Universal Precautions in the handling of all laundry, the facility generating the contaminated laundry must place such laundry in bags or containers which are labeled or color-coded in accordance with paragraph (g)(1)(i).

Even if a facility distinguishes between "contaminated laundry," i.e., soiled with blood or OPIM or which may contain sharps, and other soiled laundry, it is permissible to add warnings to the bags of "contaminated laundry," (which in this case must be red or have the biohazard label), indicating that the bags contain "contaminated laundry," as long as the additional warnings do not obscure the red coloring of the bags or the biohazard labels. This would also prevent confusing laundry with waste.

In order to alleviate any confusion regarding the handling of soiled laundry, employees of generating facilities and laundries must be trained on the procedures used for handling contaminated laundry. 29 CFR 1910.1030(g)(2)(vii)(F) (explanation of methods to prevent or reduce exposure) and (M) (explanation of signs and labels and/or color coding required by paragraph (g)(1)). Among other things, training must include materials appropriate in content and vocabulary to the educational level, literacy, and language of the employees. 29 CFR 1910.1030(g)(2)(vi).

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 interpretations 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