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.
February 28, 1991
The Honorable Sam Nunn
United States Senate
75 Spring Street, S.W.
Atlanta, Georgia 30303
Dear Senator Nunn:
This is in further response to your letter of January 10, which you wrote on behalf of your constituent, Dr. Ron Parsons, of Lilburn, Georgia. Dr. Parsons contacted you regarding his concern that the dentistry industry has been targeted for inspections by the Occupational Safety and Health Administration (OSHA). Dr. Parsons also objected to OSHA enforcement of a number of measures which protect employees from the hazards of bloodborne pathogens.
In 1986, OSHA was petitioned by various unions representing health care employees to develop an emergency temporary standard to protect workers from occupational exposure to bloodborne pathogens. OSHA decided to pursue the development of a standard through regular (not emergency) rulemaking and published a proposed rule on May 30, 1989, on occupational exposure to bloodborne pathogens (enclosed). The Agency believed such a regulation was necessary to prevent the transmission of the hepatitis B virus (HBV) and the human immunodeficiency virus (HIV) to employees whose work involves contact with blood or other potentially infectious body fluids. The public record on OSHA's proposed regulation is one of the largest in the Agency's history. Over 4000 pages of testimony resulted from public hearings that were held in five cities and over 3000 written comments were received.
Based on figures from the Centers for Disease Control (CDC), hepatitis B virus infects about 12,000 health care workers each year and results in the death of approximately 200 to 300 of these employees annually. The CDC has concluded that exposure to blood or other infectious materials (including saliva in dental settings) is the determining factor in the likelihood of contracting these diseases, i.e. it is not the profession but rather the exposure to blood which is of concern. Therefore, an employer with employees who are occupationally exposed to blood or other potentially infectious materials falls under the scope of both the proposed regulation and the Agency's current enforcement activity.
Until the proposed regulation is promulgated, OSHA is enforcing a number of current standards which are applicable to the hazards of bloodborne disease. In addition to several general industry standards, we are also enforcing Section 5(a)(1) of the occupational Safety and Health Act of 1970 (OSH Act), which requires an employer to "furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees." These standards are summarized in OSHA Instruction CPL 2-2.44B, "Enforcement Procedures for Occupational Exposure to Hepatitis B Virus and Human Immunodeficiency Virus" (enclosed)
OSHA Instruction CPL 2-2.44 also established a national emphasis program of inspections of all types of health care facilities, including hospitals, doctors' offices, blood banks, laboratories, and funeral homes, as well as dentists' offices. Dentists, as such, have not been specifically "targeted by OSHA for unannounced inspections", as Dr. Parsons writes; rather the entire health care industry, including dentists, is covered by this Instruction. (For your information, pre-notification of OSHA inspections is forbidden by the OSH Act.)
Lastly, we would like to point out that dental employers, like all other employers in this country, are responsible for ensuring that their workplaces conform to all applicable OSHA health and safety regulations. The hazards associated with "faulty wiring and unchained oxygen tanks" are the same regardless of what type of workplace they are located in and may comprise violations of OSHA standards whether they are found in a machine shop or a dental office.
We appreciate the opportunity to provide you with this information and thank you for your interest in employee safety and health. Please do not hesitate to contact us if we can be of further assistance.