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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.
October 26, 2007
Mr. Michael Lonigro
Advocate Good Samaritan Hospital
3815 Highland Avenue, Tower 2; Suite 206
Downers Grove, IL 60515
Dear Mr. Lonigro:
This is in response to your May 4, 2007 and June 30, 2007, correspondence to the Occupational Safety and Health Administration (OSHA). Your letters were transferred to OSHA's Directorate of Enforcement Programs (DEP) for response. This letter constitutes OSHA's interpretation of only the requirements discussed and may not be applicable to any questions not delineated within your original correspondence. Your letters requested clarification regarding OSHA's Bloodborne Pathogens (BBP) standard, 29 CFR 1910.1030. For clarification, your questions have been paraphrased below, followed by OSHA's responses.
Questions 1: Are lab coats required to be used by skilled phlebotomists during the performance of routine venipunctures in a hospital setting or in a rural outpatient clinic?
Answers 1: As you may know, when there is occupational exposure to blood or other potentially infectious materials (OPIM), the employer is required to provide, at no cost to the employee, appropriate personal protective equipment such as, but not limited to, gloves, gowns, laboratory coats, or other PPE deemed necessary. Occupational exposure is defined by the BBP standard, 29 CFR 1910.1030(b) 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." As a general rule, phlebotomists are considered to have occupational exposure. The performance of routine vascular access procedures by skilled phlebotomists in a hospital or clinic would require, at a minimum, the use of gloves to prevent contact with blood [29 CFR 1910.1030(d)(3)(ix)].
Laboratory coats or work smocks, though commonly worn as part of a phlebotomist's uniform, are not typically needed as personal protective equipment (PPE) during routine venipuncture. Nonetheless, employers must assess the workplace to determine whether certain tasks, workplace situations, or employee skill levels may result in an employee's need for laboratory coats or other PPE to prevent contact with blood.
Please keep in mind that the need for PPE must not be based on geographic location. According to the BBP standard, employers must adhere to the concept of Universal Precautions, the infection and exposure control philosophy which advises that all human blood and certain body fluids are to be treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens [29 CFR 1910.1030(b) and 1910.1030(d)(1)].
Question 2: May an employee who performs venipunctures in a rural outpatient clinic setting wear a personal work smock, and may these smocks be laundered at home by the employee, if there is no visible contamination?
Answer 2: Please see the answer for the first question. This question is also specifically addressed in OSHA Instruction 02-02-069, Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens, paragraph X.III.D.16, which states: ". . . While many employees have traditionally provided and laundered their own uniforms or laboratory coats or the like, if the item's intended function is to act as PPE, then it is the employer's responsibility to provide, clean, repair, replace, and/or dispose of it." The practice of employees laundering their own PPE at home is prohibited by the standard.
If an employee wishes to choose, wear, and maintain his or her uniform or work smock, then he or she would need to don additional employer-handled and employer-controlled PPE when performing tasks where it is reasonable to anticipate exposure which may contact the skin or clothing.
Question 3: May the potential exposure to blood be assessed by the employee (a phlebotomist) on a case-by-case basis, and based on the situational disposition of the patient?
Answer 3: No. It is the employer, and not the employee, who is required to make the occupational exposure determination. As required by 29 CFR 1910.1030(c)(2)(i), the employer must assess each job classification and task. Also, as per 29 CFR 1910.1030(g)(2)(vii)(E) through 1910.1030(g)(2)(vii)(G), the employer is also required to train employees on the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and OPIM. Training must also include an explanation of the use and limitations of personal protective equipment.
Question 4: Does OSHA have a comprehensive list of situations where there exists a reasonable chance of exposure to blood during venipuncture operations?
Answer 4: No. Please see the answers for questions #1 and #3.
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. An in-depth discussion and summary of OSHA's BBP standard, 29 CFR 1910.1030, can be found in the preamble to the standard, Federal Register, Volume 56, December 6, 1991. For further information on this subject, you may go to OSHA's web site at http://www.osha.gov.
Richard E. Fairfax
Directorate of Enforcement Programs