Frequently Asked Questions About the Bloodborne Pathogens Standard

  1. Are there any industries exempt from 5193 coverage? Yes. The construction industry (Standard Industrial Classification Codes [SIC] 152-179) is specifically exempted from coverage under 5193, as stated in the Exception to 5193(a). However, construction industry employers still have a regulatory responsibility to protect their employees from bloodborne pathogens.
  2. What responsibilities do employers in the construction industry have under Title 8 standards other than 5193 to protect employees from exposure to bloodborne pathogens? Employees in the construction industry are not necessarily free of potential hazards related to bloodborne pathogens. For example, employees assigned to first aid duties may encounter such hazards. Employers in the construction industry are subject to the Injury and Illness Prevention (IIP) Program requirements of 8 CCR 3203, and to the requirement to provide hygiene facilities and personal protective equipment pursuant to Title 8 sections other than 5193. Pursuant to these other regulatory requirements, construction employers are required to provide appropriate protective measures to employees who may be subject to the hazard of exposure to bloodborne pathogens.
  3. How is coverage under 5193 determined?5193 applies to all occupational exposure to blood or other potentially infectious materials (OPIM) as defined in 5193(b). In 5193(b), the standard defines occupational exposure 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." Some facilities and operations are considered by Cal/OSHA to involve "occupational exposure," as defined in 5193, because the intrinsic nature of the facility or operation is such that contact with blood or OPIM is reasonably anticipated for at least some of the employees involved with the facility or operation. Employers of these facilities or operations have the responsibility to conduct an exposure determination to determine which tasks and procedures involve occupational exposure as a part of complying with the written Exposure Control Plan requirements of 5193(c)(l). Employers whose employees work in facilities other than those that intrinsically involve occupational exposure are still subject to 5193 if the individual circumstances of the facility or operation are such that the employee's activities or tasks place them in contact with blood or OPIM.
  4. What types of facilities and operations are subject to 5193? The facilities and operations subject to 5193 fall into two general categories. Category One consists of those facilities and operations that involve occupational exposure by virtue of the intrinsic nature of the work at the facility or operation. Lack of a history of actual exposure incidents at these facilities and operations does not preclude coverage under 5193. Some examples of facilities and operations or services in Category One are: hospitals, hemodialysis centers, blood banks, plasma donation centers, laundries that serve healthcare or public safety facilities, correctional facilities (jails, prisons, juvenile detention centers), ambulance, emergency or public safety operations, emergency first aid operations, emergency rooms and other medical operations, fire services, lifeguard rescue services, paramedic services, police services, facilities for the developmentally disabled, funeral services, medical equipment service and repair operations, regulated waste operations, tissue bank operations, general dentistry offices and clinics, orthodontics and oral surgery offices, dental hygienists, dental laboratory technicians, dental chairside assistants, hospice facilities, home healthcare services, skilled and long-term nursing care facilities, medical laboratories, nurse practitioner's and physician assistant offices, physicians' offices, outpatient medical clinics, school-based health clinics, and other healthcare facilities where healthcare is provided by employees or independent contractors, or where medications are regularly self-administered with sharps (e.g., residential care facilities and adult day care facilities). Category Two facilities and operations consist of those that involve occupational exposure only because of the specific exposure circumstances in the facility or operation. These specific features are such that employee tasks and activities can reasonably result in anticipated contact with blood or OPIM, although such facilities and operations are not usually thought of as covered by 5193, e.g., laundry facilities and lodging establishments.
  5. Under what circumstances does 5193 cover employers with employees such as housekeepers, laundry attendants, janitorial workers, sanitation workers, plumbers, and other workers not generally thought of as being at risk for exposure to bloodborne pathogens? 5193 applies wherever occupational exposure exists, i.e., where skin, eye, mucous membrane, or parenteral contact with blood or OPIM is reasonably anticipated. In facilities that intrinsically involve occupational exposure, e.g., hospitals, it is obvious that healthcare workers will be covered by 5193. However, operations not commonly understood to involve occupational exposure may involve such exposure if carried out in such a facility. For example, laundry operations are not usually thought of as involving occupational exposure, but laundry workers in hospitals have such exposure because they work with bedding and other laundry and are likely to encounter contaminated sharps from time to time that have been inadvertently discarded or other wise found their way into the laundry. Similarly, if plumbers are required to work on plumbing or sewage systems inside, or directly coming from hospitals or other healthcare facilities, it is "reasonably anticipated" that they would have contact with blood or other potentially infectious material. Therefore, they have occupational exposure are also be covered by 5193. Occupational exposure does not depend only on the nature of the facility in which the operation is conducted. Taking again the example of laundry services, if laundry workers work at a commercial laundry facility rather than a hospital, they will still have occupational exposure if they work with laundry that has come from a hospital or other facility that may contain contaminated sharps. The same may be true of housekeepers or laundry workers who work in short-term or long-term lodging establishments where contact with items such as contaminated hypodermic syringes in bed sheets or in trash receptacles is reasonably anticipated. Even in those situations where the risk of contact with blood or OPIM is not so high as to be "reasonably anticipated," the nature of the work may still require basic protective measures under the provisions of 8 CCR 3203 (IIP Program) to prevent events that could lead to an exposure incident. For example, municipal sanitation workers are at risk of receiving cuts, abrasions, and punctures in the course of their work unless precautions such as using gloves, protective clothing, and specific procedures for handling garbage and refuse are taken. A skin puncture from a contaminated hypodermic syringe could, on occasion, be among these injuries. Therefore, the protections and training that sanitation workers must receive, even if they are not covered by the bloodborne pathogens standard, must be calculated to eliminate exposure to bloodborne pathogens that could arise in the course of their work, if the employer's IIP Program is to be considered "effective" as required by 3203(a).
  6. Are sewage plant and wastewater treatment workers covered by the 5193? These workers are not ordinarily considered to have occupational exposure, since the material they contact is not visibly contaminated with blood. There is no evidence to suggest that sewage plant or wastewater workers are at increased risk for hepatitis B infection. HBV and HIV may be present in wastewater, but only in a non-viable state and in very dilute concentrations which would not be expected to pose a risk to waste water workers or sewage plant workers.
  7. Are workers who use tagging guns in the garment industry and other associated industries covered by 5193? Workers who use tagging guns may be covered by 5193 depending on the individual circumstances of the work. The use of tagging guns can result in workers sustaining a needlestick with a contaminated needle. This happens when one worker accidentally punctures his or her skin with the needle of a tagging gun, and another worker using the same gun later on with the same needle sustains the same type of injury. Under these circumstances, the risk of an exposure incident occurring can be sufficient to invoke coverage of 5193, because parenteral contact with blood is reasonably anticipated. For this reason, Cal/OSHA believes that garment production or processing facilities, where the use of tagging guns is regular, sustained, and very frequent, are covered by 5193. In other facilities that use tagging guns, e.g., retail clothing stores, whether the standard applies will depend on the individual circumstances of the facility. However, if employers at these facilities take simple measures under their IIP Program (8 CCR 3203), they can ensure that contact with blood is not reasonably anticipated. One such measure consists of assigning employees their own tagging guns, implementing and enforcing a policy that forbids employees from using any tagging gun other than the one assigned to them, and training employees on this policy and the potential health consequences of violating the policy.
  8. If I have employees who are designated to render first aid, am I covered by 5193? Yes. Employers with employees who are designated to provide first aid or medical assistance as part of their job duties are subject to 5193. The job classification of these employees must be identified as involving occupational exposure by the employer's exposure control plan pursuant to 5193(c)(3), and the employees in this classification must be protected as required by the applicable subsections of 5193. However, as allowed by the Exception at 5193(f)(1)(a), employees who are assigned to administer first aid only as a duty that is collateral to their routine work assignments are not required to be offered the hepatitis B vaccination prior to exposure. Under this Exception for collateral duty first aid providers, the requirement for provision of the hepatitis B vaccination is triggered by the rendering of assistance in any situation involving the presence of blood or OPIM, regardless of whether an actual exposure incident as defined in the standard occurred. If, under this Exception, an employer chooses not to vaccinate prior to occurrence of exposure and instead elects to vaccinate only after first aid is rendered where blood or OPIM is present, the employee must be provided with a hepatitis B vaccination as soon as possible, but not more than 24 hours, after the rendering of such assistance. The Exception to 5193(f)(1)(A) should be consulted for additional conditions and requirements.
  9. Are employers of emergency response teams covered by 5193? Emergency response teams usually have members who are designated to provide first aid and these members are considered to have occupational exposure under 5193. On this basis, their employers are subject to the standard and must identify the job classification of these employees as one involving occupational exposure pursuant to the exposure control plan requirements of 5193(c)(3). However, if an emergency response team member is not designated to provide first aid as either a primary or collateral duty, the member is not considered to have occupational exposure. If the employer has an emergency response team with no members designated to provide first aid as either a primary or collateral duty, the employer is not subject to 5193, at least to the extent that having an emergency response team may invoke the application of 5193. Examples might include a hazardous materials team or a refinery fire brigade, provided that no members are responsible for administering first aid as either a primary or collateral duty.
  10. Are lifeguards covered by the standard? Yes. Lifeguards are covered by 5193 because they are considered to be primary first aid providers.
  11. Are volunteers covered by 5193? No. 5193, like other Title 8 occupational safety and health standards, applies only to employers and employees. A volunteer is not considered to be an employee. However, to be a volunteer, the individual must not receive compensation of a monetary nature for his or her services. One common example of a volunteer is a student who receives academic credit for his or her services but no remuneration. However, an individual who is not paid, but is allowed to work off a debt, e.g., a monetary fine, is considered to be an employee and not a volunteer.
  12. Are physicians who are not employees of the hospital in which they work subject to 5193? Cal/OSHA has jurisdiction to enforce occupational safety and health standards only with respect to employers and employees. In some cases, physicians are neither employers nor employees. For example, they may be sole proprietors or members of a partnership. However, a sole proprietor or partnership that hires someone to work as an employee becomes an employer subject to Cal/OSHA's jurisdiction. Similarly, if a physician has created an entity such as a corporation or limited liability company, and the entity has identified one or more individuals as employees, the entity is subject to Cal/OSHA's jurisdiction and must comply with 5193 as well as all other standards applicable to the work situation of those employed by the entity. Sometimes, articles of incorporation designate an owner as an employee of the corporation. If a physician is in this position, the corporation will be considered an employer even if the physician is the sole employee of the corporation.
  13. Are there any circumstances under which Cal/OSHA can issue a citation to physicians or other health care professionals who are not considered to be employers? Yes. Existing case law recognizes the concept of the "special employer." A special employer is any entity or person who is not generally considered an employer, but is deemed by law to become an employer by engaging in the supervision of other people who are employed as the employees of someone else. For example, a physician who is not an employer, but works at a hospital, performs a surgical procedure, and supervises those who assist with the procedure can be cited as a "special employer" for violations that occur within the context of that supervision.
  14. Can a hospital be cited by Cal/OSHA if a physician, who is not employed by the hospital and is not subject to Cal/OSHA's enforcement jurisdiction, refuses to comply with the requirements of 5193 and/or other occupational safety and health standards? Yes. The hospital is responsible for the protection of its employees from workplace hazards. If the practices of any person present in the hospital, whether or not he or she is an employee of the hospital, create conditions that expose hospital employees to a hazard, the hospital may be cited for allowing such exposure to occur. It is therefore important that hospitals have in place procedures that ensure to the extent reasonably possible that all individuals working in the hospital follow hospital health and safety rules and comply with applicable occupational safety and health standards.
  15. If my company is a temporary help agency that supplies employees to health care facilities, what are my responsibilities under 5193? Cal/OSHA terms this a "dual employer" situation. This type of situation is discussed in detail in Cal/OSHA's Enforcement Policy & Procedure C-1D. Since your company maintains a continuing employment relationship with its employees, but another employer (your client) directs and supervises these employees, there is a shared responsibility for assuring that your employees are protected from workplace hazards. Your client is considered to be the "secondary employer," and you are considered to be the "primary employer." The secondary employer usually has the most direct responsibility for such protection while the employee is at the secondary employer's worksite, but the primary employer also has responsibility for assuring occupational safety and health protection for its employees as to those issues reasonably under its control. The primary and secondary employer must work together to ensure that the employees receive all protection required by applicable occupational safety and health standards. If the employees are exposed to violations at the secondary employer's worksite, both employers may be cited by Cal/OSHA for failure to protect employees. Primary employers are required to ensure that their employees are provided with all of the required training, personal protective equipment, and medical evaluations, and vaccinations required by the standard. In addition, they are required to do what is reasonably necessary to protect their employees from hazards under their control. Primary employers in the healthcare industry usually discharge this responsibility by providing some of these items directly, and by assuring that the remaining items are covered by the secondary employer. For example, the primary employer typically is the direct provider of general training to employees, who are given site-specific training by the secondary employer when placed at the site of the secondary employer. The secondary employer, of course, may specify what qualifications are required for supplied personnel, including vaccination status. It is clearly in the primary employer's interest to actively ensure that all steps required under 5193 have been taken and continue to be taken by your client, the secondary employer, to ensure safe and healthful work for the employees you have sent to work at your client's worksite.
  16. Are "other potentially infectious materials" or OPIM regulated by 5193 limited to those of human origin? No. While "blood" is defined in 5193(b) as including only "human blood, human blood components, and products made from human blood," the definition of "other potentially infectious material" includes "any of the following, if known or reasonably likely to contain or be infected with HIV, HBV or HCV: (A) cell, tissue or organ cultures from human or experimental animals; (B) blood, organs, or other tissues from experimental animals; or (C) culture medium or other solutions." 5193(b) -- Definitions
  17. Does 5193 define all items that are contaminated with blood or OPIM as "regulated waste," so that they must be disposed of according to the regulated waste requirements of 5193(d)(3)(G)? No. There are some categories of contaminated items that are not considered regulated waste. 5193 uses the term "regulated waste," to refer to the following categories of waste which require, at a minimum, special handling: (1) liquid or semi-liquid blood or other potentially infectious material (OPIM); (2) items contaminated with blood, or OPIM, and which would release these substances in a liquid or semi-liquid state if compressed; (3) items that are caked with dried blood, or OPIM, and are capable of releasing these materials during handling; (4) contaminated sharps; and (5) pathological and microbiological wastes containing blood, or OPIM. In 5193(b), the definition of "regulated waste" makes it clear that some contaminated items may become contaminated with blood or OPIM during the course of their use, but are not within the scope of regulated waste and the disposal provisions of 5193. These include minimally contaminated absorbent items, such as dental drapes, gauze, band-aids, and sanitary napkins, that will dry out and be free of dried blood in quantities that could be considered "caked."

  1. General conditions under which a needle-destruction device may be used. Subject to the caveat in Item (B) below, NDDs may generally be used whenever the specific engineering control measures required by 5193 (d)(3)(A) are not required. This means that one of the four exceptions must apply. See Item (C) below for further discussion of how to determine whether an exception applies. Where a traditional needle is being used with an NDD, the NDD serves as an alternative or a supplement to a traditional sharps container. If the NDD does not completely destroy the needle, the syringe must be placed in a sharps container immediately after destruction of the needle. If the needle is completely destroyed by the device, the syringe need not be disposed of in a sharps container, but must be disposed of as regulated waste. These devices must always be used in accordance with instructions.
  2. Caveat regarding use of needle-destruction devices While NDDs may be used as stated in Item (A) above, the manner in which the device is used must not add a hazard that would not be present if the syringe were to be discarded directly into a sharps container. For example, use of an NDD with a two-handed technique would not be allowed. These devices must not be used in any potentially explosive environment, or where flammable liquids or gases are stored. In addition, since the NDD is serving as an intervening step between use of the syringe and disposal of the syringe into a sharps container, it must, like a sharps container, be positioned so that it is "easily accessible to personnel and located as close as is feasible to the immediate area where sharps are used. "
  3. Applicability of the exceptions to 5193(d)(3)(A). For any of the four exceptions to (d)(3)(A) to apply, employers must be able to show that they have met the terms of the exception. For example, in the case of evaluating whether an employer must use a safety needle, the third exception to (d)(3)(A) will apply:

"if the employer can demonstrate by means of objective product evaluation criteria that [use of the safety needle] is not more effective in preventing exposure incidents than the alternative used by the employer."

Cal/OSHA

Emergency Response