December 4, 1992

The Honorable Bill Clinger
U.S. House of Representatives
Washington, D.C. 20515

Dear Congressman Clinger:

Thank you for your letter of September 24, on behalf of your constituent, Mr. Stephen Hale, Forest County Commissioner, regarding his concerns about the Occupational Safety and Health Administration's (OSHA) Final Standard for Occupational Exposure to Bloodborne Pathogens. Mr. Hale expressed concerns about the necessity for the standard, and the standard's requirements and costs.

The Bloodborne Pathogens standard is designed to protect the Nation's workers, particularly health care workers, from exposure to the Hepatitis B Virus (HBV) and the Human Immunodeficiency Virus (HIV). Of these two diseases Hepatitis B is more common, with 8,700 cases per year among workers in the health care profession. Hepatitis B infection may result in serious illness, potential long term disability and death. HIV causes AIDS, for which there currently is no cure and which eventually results in death. These viruses, as well as other organisms that cause bloodborne disease, are found in human blood and certain other human body fluids. Therefore, employers have a particular responsibility to ensure that workers do not come into direct contact with blood or other potentially infectious materials while performing their job.

The development of this standard by OSHA took more than five years, beginning with close cooperation on the development of a proposed standard with the Centers for Disease Control, Department of Health and Human Services. The proposed standard was based on the scientifically sound infection control practice of "universal precautions" originally established by the CDC for handling of body fluids known to transmit HIV.

Following the publication of the proposed standard the public, particularly the dental and medical communities, submitted approximately 3,000 comments to the official record. In addition, OSHA held 5 public hearings, in Washington, D.C., Chicago, New York City, Miami and San Francisco, where 440 individuals and organizations testified. The comments and testimony underwent extensive review analysis, and many of the suggested changes were adopted in the final rule. In addition, the U.S. Congress held a series of hearings concerning the proposed Bloodborne Pathogens standard. Many individuals and groups testified at these hearings, including the American Medical Association and the American Dental Association.

Furthermore, Congress attached an "appropriations rider" to the FY 1992 OSHA funding bill which required the agency to finalize the Bloodborne Pathogens standard by December 1, 1991. Congress believed the risks to workers were significant and that the possibility of illness and death could no longer be ignored; it therefore used the appropriations rider to encourage the agency to expedite the promulgation of the standard.

During the development of the standard, compliance costs, those costs, incurred to meet the requirements, were extensively analyzed. All OSHA workplace safety and health standards undergo a similar, very stringent, review. A key component of this review was a 3,500-facility survey, which included both large and small physicians' and dentists' offices, funeral homes, nursing homes, and blood banks among others. This survey showed that many offices already were complying with many provisions of the standard, including practicing "universal precautions."

In order to explain the general requirements of the standard OSHA produced a video titled, "As It Should Be Done." It explains in clear, straightforward language most of the key provisions of the standard. In addition, OSHA published five fact sheets and six Bloodborne Pathogens compliance assistance booklets, including booklets for acute care facilities, emergency responders, dentists, and nursing homes. In addition, we are enclosing a booklet pertaining to emergency responders. The enclosed sheet lists titles and ordering information for all of these materials.

OSHA has ten regional offices around the United States, each with a Bloodborne Pathogens Coordinator to respond to inquiries about the standard. A listing of telephone numbers and addresses is enclosed. Since December 1991, the OSHA staff in the National, Regional and Area Offices have been conducting extensive outreach, training and education meetings on the Bloodborne Pathogens standard with a wide range of groups, including physicians and dentists. Over 1,000 individual meetings have been held and over 80,000 individuals have participated. This effort is ongoing and will continue. Please contact the OSHA office in your area to request a speaker or other assistance.

We would like to also address several of Mr. Hale's specific concerns which resulted largely from inaccuracies in the Emmco West memorandum which he quotes. OSHA does permit the use of solutions of 5.25 sodium hypochlorite (household bleach) diluted between 1:10 and 1:100 with water for disinfection of environmental surfaces and for decontamination of sites following initial cleanup of spills of blood or other potentially infectious materials.

The bloodborne pathogens standard requires employers to provide employees with appropriate personal protective equipment for the tasks and procedures which they perform as part of their job duties. An exception is allowed when the employer can show that the employee temporarily and briefly declined to use personal protective equipment when, under rare and extraordinary circumstances, it was the employee's judgement that in the specific instance its use would have prevented the delivery of health care or public safety services. However, since it is reasonable to anticipate that an emergency medical technician will perform mouth-to-mouth resuscitation as part of his or her job duties, the employer is expected to provide the employee with, and ensure the use of, resuscitation devices which protect the employee from occupational exposure.

Lastly, OSHA jurisdiction extends to the employer-employee relationship. While a number of factors may be considered in establishing such a relationship (such as compensation), true volunteers are not currently covered under the OSH Act.

We understand that the cost of complying with this standard is of concern, and that most American health care professionals follow safe practices; however, the risks of illness and death from HBV and HIV for workers are too great to ignore and they mandate the full employee protection and training required by the standard.

Sincerely,



Roger A. Clark,
Director
Directorate of Compliance Programs



August 24, 1992

Congressman William F. Clinger, Jr.
605 Penn
Bank Building
Warren, PA 16365

Dear Bill:

I am writing in regards to recent OSHA regulations concerning infectious disease control requirements and their impact on Emergency Medical Services.

I have enclosed a copy of a memorandum, from EMMCo West Inc. which they sent to the ambulance providers in the seven counties which they cover, to give you some insight into how these regulations can and will effect EMS providers in your district.

I would like to comment briefly on some of the regulations. The first where it addresses cleaning of the inside of an ambulance, OSHA is setting this up to be a Haz-mat incident. I am wondering why, when common household bleach and water will serve the same purpose. I am wondering if the Bureaucrats at OSHA checked with any Infectious Disease Professionals such as Catherine West, before they made up these regulations.

On the part where it states that OSHA does not allow mouth to mouth contact between a rescuer and a victim.

Does this mean that I, as a State Certified EMT, am not allowed to initiate CPR on any victim of a cardiac arrest, motor vehicle accident, electrocution, or drowning that I happen upon if I do not have in my possession a pocket mask with a one way valve.

Does this mean that if I successfully resuscitate a victim of any of the above tragedies and do not use a pocket mask that I am going to be liable to a fine of $70,000.00.

Another issue is the Hepatitis B Immunization that OSHA is requiring hospital workers to have. This regulation is now filtering down to EMS Training. If an EMT student who is a volunteer is required to have a series of three shots of Hepatitis B vaccine at a cost of approximately $180.00, to do their required ten hours of hospital clinical time, this is going to be very detrimental to volunteer EMS providers and to rural EMS Training Program.

Bill, these new OSHA regulations are going to have a profound and detrimental effect on rural volunteer EMS providers.

These Bureaucratic regulations could have the effect of putting rural volunteer ambulance services out of business.

Why should these Bureaucratic regulations be allowed to destroy the rural volunteer EMS network which is now working so well to serve our citizens.

Bill, the time has come to interject some common sense into these government regulations.

Sincerely,



Stephen E. Hale
Forest County Commissioner