April 26, 1994

Susan Stapel, R.N.
Whitley County Memorial Hospital
353 North Oak Street
Columbia City, Indiana 46725

Dear Ms. Stapel:

This is in response to your letter received November 29, 1993, regarding 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.

Specifically, you asked whether a physician's order is required before performing blood testing on a source individual after consent is obtained, or whether the hospital may state in its policy that tests shall be performed following the patient's consent.

You also state that you understand that consent must be obtained from the source individual. This is the situation in some states. However, in others, the third sentence in Section (f)(3)(ii)(A) applies. This sentence states, "When the source individual's consent is not required by law, the source individual's blood, if available, shall be tested and the results documented." This stipulation was included for employee protection. That is, in some states, if an employee has been exposed to blood, the employee has the right to know the infectious status of the source person. Such knowledge enables the employee to make informed treatment decisions. The blood of such a source individual is to be tested even without consent in those circumstances. The Indiana Board of Health Office of Legal Affairs (telephone (317) 633-8540) should be able to assist you in this determination.

A separate physician's order is not required before testing a source individual's blood. It is permissible for the hospital policy to simply state that such testing will be performed after consent is obtained, unless the hospital is located in a state where consent is not required. In that case, such a statement by the hospital would not be in compliance with OSHA's Bloodborne pathogens standard.

Thank you for your interest occupational safety and health.

Sincerely,



Ruth E. McCully, Director
Office of Health Compliance Assistance




Ms. Patricia Clark
Director of Compliance Affairs
Occupational Safety & Health Administration
Room N-3409
200 Constitution Avenue, NW
Washington, D.C. 20210

Dear Ms. Clark:

I am writing in hope that you can shed some light on the subject of "Post-Exposure Evaluation & Follow-Up" as it pertains to the OSHA Bloodborne Pathogens Rule.

Section (f)(3)(ii)(A) states: The source individual's blood shall be tested as soon as feasible and after consent is obtained in order to determine HBV & HIV infectivity, etc., etc.,.

Understanding that consent must be obtained from the source individual, my question is: Is a physician's order required to do this test, or can the hospital state in its policy and procedure that the tests shall be done following the patients consent?

Thank you for your attention to this matter.

Sincerely,



Susan Stapel, R.N.
Infection Control Coordinator

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