April 1, 1994

Reva Shilmover, Senior M.T.
Santa Teresa Kaiser Hospital
260 International Circle
San Jose, California 95119

Dear Ms. Shilmover:

This is in response to your letter of August 14, concerning the Occupational Safety and Health Administration (OSHA) regulation 29 CFR 1910.1030, "Occupational Exposure to Bloodborne Pathogens." We apologize for the delay in this response.

You wrote on behalf of "all the phlebotomists and medical technologists" at your hospital and others across the country who do not agree with the requirement for the wearing of gloves during routine vena punctures.

You noted that "there is an exemption for the Red Cross" from the requirement to wear gloves during routine phlebotomies. This exemption applies to the Red Cross' volunteer blood donation centers, and was the result of a settlement of a legal challenge filed by the Red Cross during our rulemaking process. At the present time, the regulation has been finalized, and further exemptions cannot be made.

According to your letter, you understand that the requirement is for your protection but asked that "the person drawing the blood make the final decision about glove use." Your reasoning is that "modern phlebotomy is almost always totally free of blood exposure, except for finger and heel sticks."

As you know, the purpose of the bloodborne pathogens standard is to reduce to the full extent possible the number of exposure incidents to blood or other potentially infectious material. The scope of the standard requires that blood and certain other body fluids from all patients be considered potentially infectious and that rigorous infection control precautions be taken to minimize the risk of exposure. This approach is called "universal precautions," and the CDC published this recommendation in its August 1987 guidelines.

It is true that gloves provide only minimal protection from needlesticks, but they provide excellent hand protection from a blood drop on a patient's arm. Because one cannot predict which patients will be more likely to bleed during phlebotomy procedures than the average, we believe that gloves must always be worn when performing vena punctures.

We understand that, for experienced phlebotomists and medical technicians, learning how to perform vena punctures while wearing gloves may present a new challenge. However, for those entering the field, the process is taught from the start using gloves. It would be counter-productive for OSHA to allow phlebotomists and medical technicians to choose not to use gloves. Such a situation would not only keep the experienced phlebotomists from being fully protected from bloodborne pathogens, it would encourage entering healthcare workers to choose not to be fully protected as well. This is inconsistent with the Occupational Safety and Health Act and with the mission of OSHA.

Your letter reflected your concern that you "be taken seriously." Because our purpose is to protect the safety and health of the working people of this country, we do take your concerns seriously. Perhaps your hospital could provide special training sessions for you and your co-workers to practice the vena puncture procedure while wearing gloves so that you become confortable with the process.

We have provided our Federal OSHA interpretation in response to your concerns. However, as you may know, the State of California administers its own occupational safety and health program, which is overseen and monitored by Federal OSHA. State plan regulations must be at least as effective as Federal OSHA regulations, and the state may choose to promulgate and enforce requirements which are stricter than Federal OSHA's. If you would like further information regarding California occupational safety and health requirements, you may contact the California Department of Labor and Industry directly at the following address:

Lloyd W. Aubry, Director
California Department of Industrial Relations
455 Golden Gate Avenue, 4th Floor
San Francisco, California 94102

Telephone: (415) 703-4590

We hope this information has been responsive to your concerns. Thank you for your interest in employee safety and health.

Sincerely,



H. Berrien Zettler, Deputy Director
Directorate of Compliance Programs