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OSHA Clarifies Enforcement of Bloodborne Pathogens Standard for Home Care

Kate Traynor

Inspectors for the Occupational Safety and Health Administration (OSHA) have been instructed not to cite home health agencies that fail to comply with certain provisions in the bloodborne pathogens standard.

The policy resulted from a 1993 U.S. Court of Appeals decision that set limits on OSHA’s enforcement of the bloodborne pathogens standard in the home care industry. Circuit Judge Richard A. Posner recognized in his decision that "the home health and medical personnel not control the sites at which their employees work."

This fact, Posner said, "does affect the ability of the employer to comply with the requirements for protective clothing and equipment, because his employees do not work in his presence. It especially affects the employer's ability to comply with site-specific precautions required by the rule, such as ensuring that the work site is maintained in a clean and sanitary condition and that the worker has convenient access to running water in the event of exposure to blood or other potentially infective materials."

In a directive (PDF) effective Nov. 27, 2001, OSHA noted that Posner’s 1993 decision prevents the agency from issuing citations for unsanitary housekeeping practices in a patient’s private home. Likewise, home health agencies cannot be cited for a household’s failure to use personal protective equipment, properly dispose of regulated waste, or provide running water for hand washing.

OSHA did, however, reiterate that home health agencies are responsible for following other provisions in the bloodborne pathogens standard, such as having an exposure-control plan, providing personal protective equipment to workers, and offering hepatitis B vaccination to workers.

An OSHA document dated May 4, 2000, similarly addressed enforcement of the bloodborne pathogens standard in the home care industry. The letter was a response to an inquiry about the need for home care agencies to purchase "expensive" safety needles to replace less-safe needles bought by patients who are being taught how to inject insulin.

According to OSHA, "the bloodborne pathogens standard does not apply to the protection of home healthcare service employees from syringes purchased by patients and used in the home." Thus, if a patient decides not to buy safety needles for his or her own use, then the home health employer does not have to replace that equipment.