November 18, 1992

(Name Withheld)

This is in response to your recent inquiries regarding requirements in the Occupational Exposure to Bloodborne Pathogens Standard, 29 CFR 1910.1030.

As you are aware, the personal protective equipment requirements of the standard are performance oriented. That is, it is the employer's responsibility to evaluate the task and type of exposure expected and, based on that determination, select the "appropriate" personal protective equipment in accordance with paragraph (d)(3)(i) of the standard.

At a minimum, gloves must be used where there is reasonable anticipation of employee hand contact with blood, other potentially infectious materials, mucous membranes, or non-intact skin; when performing vascular access procedures; or when handling or touching contaminated surfaces or items.

In general, OSHA agrees with you that gloves are not necessary when giving intramuscular injections as long as hand contact with blood or non-intact skin is not anticipated. However, if the employee administering the vaccine is expected to hold pressure over the site of injection (e.g., with a cotton ball) or apply a bandage to the site, gloves are required since it could be reasonable anticipated that the employee's fingers could contact blood. If the patient receiving the immunization is responsible for applying pressure or a bandage (e.g., patient hold cotton ball and applies pressure as needle is withdrawn), the employee administering the vaccine need not wear gloves. It must be understood, however, that if such an employee is expected to provide assistance to the patient should an adverse reaction occur (e.g., the employee holds pressure on site or provides other assistance if patient loses consciousness), then that employee should be prepared for such an occurrence. Part of such preparation would be the donning of gloves before initiating vaccine administration.

Your second inquiry regarded payment for Hepatitis B vaccine required to be offered by employers. The 3 scenarios you presented are as follows:

1. A dental employee has health coverage through a spouse's health plan, and such plan requires the employee's spouse to contribute a portion of the premium. Such a method would not constitute "at no cost" to the employee.

2. A dental employee has health coverage through a spouse's health plan, and such plan does not require any employee contribution. Regardless of monetary aspects of the spouse's contribution to such a health plan, it is the labor of the spouse which earns the benefits of such a plan, and therefore such a plan cannot be considered noncontributory on the part of the dental employee.

3. A dental employee has health coverage through a health plan which is entirely (100%) paid for by the dentist employer. If the plan is truly non-contributory by the employee (e.g., no premium charge, deductible, copayment, or other form of payment required of the employee), then certainly the dentist employer can use such a plan to cover the vaccination expenses, provided such expenses are part of the plan coverage.

The message in the above examples is clear: It is the employer's responsibility to pay for the Hepatitis B vaccine offered to employees.

Your third concern was the qualifications of trainers for employees under 1910.1030. The language of the standard [section (g)(2)(viii)] is "The person conducting the training shall be knowledgeable in the subject matter covered by the elements contained in the training program as it relates to the workplace that the training will address."

As explained in the Summary and Explanation of the Standard published in the Federal Register along with the Standard, flexibility has been incorporated into the Standard. The National Institute for Occupational Safety and Health submitted a comment that "the trainer should have expertise in the subject area, as documented by objective evidence such as satisfactory completion of relevant training courses or degree programs". However, the Standard does not suggest completion of particular courses since workplaces where exposure can occur are varied. Rather, the trainer should be knowledgeable in the contents of the training program the employer is required to provide. A dentist or nurse in the dental office certainly should be able to train employees provided he or she gains familiarity with the Standard and understands the topics to be covered in a training program.

I have enclosed a recent OSHA News Release regarding Bloodborne Pathogens training programs for your information.

Please bear in mind that the State of Virginia operates its own occupational safety and health program which may promulgate standards which are more stringent than federal OSHA's. We suggest that you contact them as well at the following address:

                     Virginia Department of Labor 
                     and Industry Powers-Taylor Building
                     13 South 13th Street 
                     Richmond, VA  23219 
                     Telephone (804) 786-2376

I hope this information is helpful to you. Thank you for contacting us. We appreciate your efforts on behalf of dentists and dental employees throughout Virginia,

Sincerely,



Angela C. Presson, MD MPH
Office of Occupational Medicine