Michael Karl McNeil has spent most of a working life on the response side of exposure, and the thing I notice when I read an employer’s bloodborne pathogens program is almost never the written plan. The plan is usually there. What is missing is the log.
Section 5193 of Title 8 applies to all occupational exposure to blood or other potentially infectious materials. It does not reach the construction industry, which surprises people, but it reaches every clinic, every laboratory, every correctional infirmary and every agency that puts a medic in the back of a unit. Subsection (c)(1)(A) requires the employer to establish, implement and maintain an effective Exposure Control Plan, and subsection (c)(1)(D) requires that plan to be reviewed and updated at least annually and whenever necessary — when a task changes, when a new technology arrives, when a position is created, after an exposure incident is evaluated, and whenever a deficiency in the plan comes to light. An annual signature on an unchanged document satisfies the calendar and not the standard.
Then there is subsection (c)(2), the Sharps Injury Log. California requires a record of each exposure incident involving a sharp, and subsection (c)(2)(D) puts a clock on it: the entry goes in within fourteen working days of the date the incident is reported. The required content under (c)(2)(A) through (C) is more than a date and a name. It takes the date and time, the type and brand of the sharp, the job classification, the department, the procedure being performed, how the incident occurred, the body part involved, whether the device had engineered protection — and the injured employee’s own opinion about how the incident could have been prevented. That last item is the one I have never once seen filled in, and it is the one that would tell an employer something it does not already know.
The engineering controls in subsection (d)(3)(A) run in a sequence that is worth reading in order. Item 1 requires needleless systems where a needleless alternative exists for withdrawing body fluids after initial access, for administering medication, and for other procedures carrying exposure potential. Item 2 says that where a needleless system is not available, the needle device must have engineered sharps injury protection. Item 3 extends engineered protection to non-needle sharps. Item 4 is the only exit, and it is narrow: the control is not available in the marketplace; a licensed healthcare professional directly responsible for the patient determines that the device would jeopardize patient safety or the success of a medical procedure; the employer can demonstrate the control is less effective; or reliable safety performance information does not yet exist and the employer is actively evaluating the device. Cost is not on that list.
Hepatitis B vaccination sits in subsection (f). The employer makes the vaccine and the vaccination series available to every employee with occupational exposure under (f)(1)(A), and (f)(2)(A) sets the window at ten working days of initial assignment — but only after the employee has had the training described in (g)(2)(G)9. The order matters. Training first, then the offer, then the declination form if the employee declines. An employer that vaccinates on day one and trains in week three has the sequence backwards.
After an exposure, subsection (f)(3) requires a confidential medical evaluation and follow-up to be made immediately available: documentation of the route and circumstances, identification and testing of the source individual where permitted, collection and testing of the employee’s blood, post-exposure prophylaxis where medically indicated, and counseling with evaluation of any reported illness. Subsection (f)(5) then gives the employer fifteen days from completion of the evaluation to obtain the healthcare professional’s written opinion and give the employee a copy.
Training is annual. Subsection (g)(2)(B) requires it at initial assignment and at least annually after that, (g)(2)(D) closes the gap by requiring it within one year of the previous session, and (g)(2)(A) requires it at no cost and during working hours. The content under (g)(2)(G) runs to fourteen elements, and the last of them is an opportunity for interactive questions and answers. A recorded video with no one present to answer a question does not meet it.
The retention periods are where a program’s quality finally shows. Medical records are kept for the duration of employment plus thirty years under (h)(1)(D). Training records go three years under (h)(2)(B). The Sharps Injury Log is kept five years from the date the exposure incident occurred under (h)(3). Thirty years past a termination is longer than most employers keep anything, and it is the obligation most often discovered during a records request rather than before one.
If a program is going to fail an inspection, it rarely fails on the plan. It fails on the log, the fourteen-day entries, and the question nobody asked the injured employee.
Michael Karl McNeil, REP, RIH, EPP, QSD
Leave a Reply