OSHA's Guidelines for Bloodborne Pathogens, …...OSHA’s Bloodborne Pathogens standard (29 CFR...

OSHA's Guidelines for Bloodborne Pathogens, Waste,

Sharps, and Catheters

Medical Evaluation and Follow-upWhen a worker experiences an exposure incident,the employer must make immediate confidentialmedical evaluation and follow-up available to theworker. This evaluation and follow-up must be:made available at no cost to the worker and at areasonable time and place; performed by or underthe supervision of a licensed physician or otherlicensed healthcare professional; and providedaccording to the recommendations of the U.S.Public Health Service (USPHS) current at the timethe procedures take place. In addition, laboratorytests must be conducted by an accredited labora-tory and also must be at no cost to the worker. Aworker who participates in post-exposure evalua-tion and follow-up may consent to have his or herblood drawn for determination of a baseline infec-tion status, but has the option to withhold consentfor HIV testing at that time. In this instance, theemployer must ensure that the worker's bloodsample is preserved for at least 90 days in casethe worker changes his or her mind about HIVtesting.

Post-exposure prophylaxis for HIV, HBV, and HCV,when medically indicated, must be offered to theexposed worker according to the current recom-mendations of the U.S. Public Health Service. Thepost-exposure follow-up must include counselingthe worker about the possible implications of theexposure and his or her infection status, includingthe results and interpretation of all tests and howto protect personal contacts. The follow-up mustalso include evaluation of reported illnesses thatmay be related to the exposure.

Reporting an Exposure IncidentExposure incidents should be reported immedi-ately to the employer since they can lead to infec-tion with hepatitis B virus (HBV), hepatitis C virus(HCV), human immunodeficiency virus (HIV), orother bloodborne pathogens. When a workerreports an exposure incident right away, thereport permits the employer to arrange for imme-diate medical evaluation of the worker. Earlyreporting is crucial for beginning immediate inter-vention to address possible infection of the work-er and can also help the worker avoid spreadingbloodborne infections to others. Furthermore, theemployer is required to perform a timely evalua-tion of the circumstances surrounding the expo-sure incident to find ways of preventing such asituation from occurring again.

Reporting is also important because part of thefollow-up includes identifying the source individ-ual, unless the employer can establish that identi-fication is infeasible or prohibited by state or locallaw, and determining the source’s HBV and HIVinfectivity status. If the status of the source indi-vidual is not already known, the employer isrequired to test the source’s blood as soon as fea-sible, provided the source individual consents. Ifthe individual does not consent, the employermust establish that legally required consent can-not be obtained. If state or local law allows testingwithout the source individual’s consent, theemployer must test the individual’s blood, if it isavailable. The results of these tests must be madeavailable to the exposed worker and the workermust be informed of the laws and regulationsabout disclosing the source’s identity and infec-tious status.

FactSheetBloodborne Pathogen Exposure Incidents OSHA’s Bloodborne Pathogens standard (29 CFR 1910.1030) requires employers tomake immediate confidential medical evaluation and follow-up available for workerswho have an exposure incident, such as a needlestick. An exposure incident is a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contactwith blood or other potentially infectious materials (OPIM), as defined in the standardthat results from the performance of a worker’s duties.

This is one in a series of informational fact sheets highlighting OSHA programs, policies or standards. It does not impose any new compliance requirements. For a comprehensive list of compliance requirements of OSHA standards or regulations, refer to Title 29 of the Code of FederalRegulations. This information will be made available to sensory-impaired individuals upon request.The voice phone is (202) 693-1999; teletypewriter (TTY) number: (877) 889-5627.

Written OpinionThe employer must obtain and provide the worker with a copy of the evaluating healthcareprofessional’s written opinion within 15 days ofcompletion of the evaluation. According toOSHA’s standard, the written opinion should only include: whether hepatitis B vaccination wasrecommended for the exposed worker; whetheror not the worker received the vaccination, andthat the healthcare provider informed the workerof the results of the evaluation and any medicalconditions resulting from exposure to blood orOPIM which require further evaluation or treatment.Any findings other than these are not to be includedin the written report.

Additional InformationFor more information, go to OSHA’s BloodbornePathogens and Needlestick Prevention Safety andHealth Topics web page at: https://www.osha.gov/SLTC/bloodbornepathogens/index.html.

To file a complaint by phone, report an emergency,or get OSHA advice, assistance, or products, contact your nearest OSHA office under the “U.S.Department of Labor” listing in your phone book, or call us toll-free at (800) 321-OSHA (6742).

Occupational Safetyand Health Administrationwww.osha.gov 1-800-321-6742

For assistance, contact us. We can help. It’s confidential.

DSG 1/2011

pathogens nor is there any chance of developingHBV from the vaccine.

The vaccine must be administered according tothe recommendations of the U.S. Public HealthService (USPHS) current at the time the proceduretakes place. To ensure immunity, it is importantfor individuals to complete the entire course ofvaccination contained in the USPHS recommen-dations.

The great majority of those vaccinated will devel-op immunity to the hepatitis B virus. The vaccinecauses no harm to those who are already immuneor to those who may be HBV carriers. Althoughworkers may desire to have their blood tested for antibodies to see if vaccination is needed,employers cannot make such screening a conditionof receiving vaccination and employers are notrequired to provide prescreening.

Employers must ensure that all occupationallyexposed workers are trained about the vaccineand vaccination, including efficacy, safety, methodof administration, and the benefits of vaccination.They also must be informed that the vaccine andvaccination are offered at no cost to the worker.The vaccination must be offered after the workeris trained and within 10 days of initial assignmentto a job where there is occupational exposure,unless the worker has previously received thevaccine series, antibody testing has revealed thatthe worker is immune, or the vaccine is contra-indicated for medical reasons. The employer mustobtain a written opinion from the licensed health-care professional within 15 days of the completionof the evaluation for vaccination. This writtenopinion is limited to whether hepatitis B vaccina-tion is indicated for the worker and if the workerhas received the vaccination.

Any workers who have reasonably anticipatedcontact with blood or OPIM during performanceof their jobs are considered to have occupationalexposure and to be at risk of being infected.Workers infected with HBV face a risk for liver ailments which can be fatal, including cirrhosis of the liver and primary liver cancer. A small percentage of adults who get hepatitis B neverfully recover and remain chronically infected. Inaddition, infected individuals can spread the virusto others through contact with their blood andother body fluids.

An employer must develop an exposure controlplan and implement use of universal precautionsand control measures, such as engineering controls,work practice controls, and personal protectiveequipment to protect all workers with occupa-tional exposure. In addition, employers mustmake hepatitis B vaccination available to theseworkers. Hepatitis B vaccination is recognized asan effective defense against HBV infection.

HBV Vaccination The standard requires employers to offer the vaccination series to all workers who have occupational exposure. Examples of workers who may have occupational exposure include,but are not limited to, healthcare workers, emergency responders, morticians, first-aid personnel, correctional officers and laundryworkers in hospitals and commercial laundriesthat service healthcare or public safety institutions.The vaccine and vaccination must be offered atno cost to the worker and at a reasonable timeand place.

The hepatitis B vaccination is a non-infectious,vaccine prepared from recombinant yeast cultures,rather than human blood or plasma. There is norisk of contamination from other bloodborne

FactSheetHepatitis B Vaccination ProtectionHepatitis B virus (HBV) is a pathogenic microorganism that can cause potentially life-threatening disease in humans. HBV infection is transmitted through exposure toblood and other potentially infectious materials (OPIM), as defined in the OSHABloodborne Pathogens standard, 29 CFR 1910.1030.


Declining the VaccinationEmployers must ensure that workers who declinevaccination sign a declination form. The purposeof this is to encourage greater participation in thevaccination program by stating that a worker declin-ing the vaccination remains at risk of acquiringhepatitis B. The form also states that if a workerinitially declines to receive the vaccine, but at alater date decides to accept it, the employer isrequired to make it available, at no cost, providedthe worker is still occupationally exposed.


To file a complaint by phone, report an emergency,or get OSHA advice, assistance, or products, con-tact your nearest OSHA office under the “U.S.Department of Labor” listing in your phone book, orcall us toll-free at (800) 321-OSHA (6742).



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Keeping work areas in a clean and sanitary condition reduces employees'risk of exposure to bloodborne pathogens. Each year about 8,700 healthcare workers are infected with hepatitis B virus, and 200 die fromcontracting hepatitis B through their work. The chance of contractinghuman immunodeficiency virus (HIV), the bloodborne pathogen whichcauses AIDS, from occupational exposure is small, yet a goodhousekeeping program can minimize this risk as well.

DECONTAMINATIONEvery employer whose employees are exposed to blood or other potentiallyinfectious materials must develop a written schedule for cleaning eacharea where exposures occur. The methods ofdecontaminating different surfaces must be specified, determined by thetype of surface to be cleaned, the soil present and the tasks or proceduresthat occur in that area.

For example, different cleaning and decontamination measures would beused for a surgical operatory and a patient room. Similarly, hard surfacedflooring and carpeting require separate cleaning methods. More extensiveefforts will be necessary for gross contamination than for minor spattering. Likewise, such varied tasks as laboratory analyses and normal patient carewould require different techniques for clean-up.

Employees must decontaminate working surfaces and equipment with anappropriate disinfectant after completing procedures involving exposure toblood. Many laboratory procedures are performed on a continual basisthroughout a shift. Except as discussed below, it is not necessary to cleanand decontaminate between procedures. However, if the employee leavesthe area for a period of time, for a break or lunch, then contaminated worksurfaces must be cleaned.

Employees also must clean (1) when surfaces become obviouslycontaminated; (2) after any spill of blood or other potentially infectiousmaterials; and (3) at the end of the work shift if contamination might haveoccurred. Thus, employees need not decontaminate the work area aftereach patient care procedure, but only after those that actually result incontamination.

If surfaces or equipment are draped with protective coverings such asplastic wrap or aluminum foil, these coverings should be removed orreplaced if they become obviously contaminated. Reusable receptaclessuch as bins, pails and cans that are likely to become contaminated mustbe inspected and decontaminated on a regular basis. If contamination isvisible, workers must clean and decontaminate the item immediately, oras soon as feasible.

Should glassware that may be potentially contaminated break, workersneed to use mechanical means such as a brush and dustpan or tongs orforceps to pick up the broken glass--never by hand, even when wearinggloves.

Before any equipment is serviced or shipped for repairing or cleaning, itmust be decontaminated to the extent possible. The equipment must belabeled, indicating which portions are still contaminated. This enablesemployees and those who service the equipment to take appropriateprecautions to prevent exposure.

REGULATED WASTE

In addition to effective decontamination of work areas, proper handling ofregulated waste is essential to prevent unnecessary exposure to blood andother potentially infectious materials. Regulated waste must be handledwith great care --i.e., liquid or semi liquid blood and other potentiallyinfectious materials, items caked with these materials, items that wouldrelease blood or other potentially infected materials if compressed,pathological or microbiological wastes containing them and contaminatedsharps.

Containers used to store regulated waste must be closable and suitable tocontain the contents and prevent leakage of fluids. Containers designedfor sharps also must be puncture resistant. They must be labeled or color-coded to ensure that employees are aware of the potential hazards. Suchcontainers must be closed before removal to prevent the contents fromspilling. If the outside of a container becomes contaminated, it must beplaced within a second suitable container.

Regulated waste must be disposed of in accordance with applicable stateand local laws.

LAUNDRY

Laundry workers must wear gloves and handle contaminated laundry aslittle as possible, with a minimum of agitation. Contaminated laundryshould be bagged or placed in containers at the location where it is used,but not sorted or rinsed there.

Laundry must be transported within the establishment or to outsidelaundries in labeled or red color-coded bags. If the facility uses UniversalPrecautions for handling all soiled laundry, then alternate labeling orcolor coding that can be recognized by the employees may be used. If laundry is wet and it might soak through laundry bags, then workersmust use bags that prevent leakage to transport it.

RESEARCH FACILITIES

More stringent decontamination requirements apply to researchlaboratories and production facilities that work with concentrated strainsof HIV and HBV.

________________________________________________________________________________________________________________________This is one of a series of fact sheets that discusses various requirements of the Occupational Safety and Health Adninistration's standard covering exposure tobloodborne pathogens. Single copies of fact sheets are available from OSHA Publications, Room N-3101, 20O Constitution Avenue,N.W., Washington, DC 20210 and

• Implement the use of universal precautions(treating all human blood and OPIM as if knownto be infectious for bloodborne pathogens).

• Identify and use engineering controls. Theseare devices that isolate or remove the blood-borne pathogens hazard from the workplace.They include sharps disposal containers, self-sheathing needles, and safer medical devices,such as sharps with engineered sharps-injuryprotection and needleless systems.

• Identify and ensure the use of work practicecontrols. These are practices that reduce thepossibility of exposure by changing the way atask is performed, such as appropriate practicesfor handling and disposing of contaminatedsharps, handling specimens, handling laundry,and cleaning contaminated surfaces and items.

• Provide personal protective equipment (PPE),such as gloves, gowns, eye protection, andmasks. Employers must clean, repair, andreplace this equipment as needed. Provision,maintenance, repair and replacement are at nocost to the worker.

• Make available hepatitis B vaccinations to allworkers with occupational exposure. This vac-cination must be offered after the worker hasreceived the required bloodborne pathogenstraining and within 10 days of initial assignmentto a job with occupational exposure.

• Make available post-exposure evaluation andfollow-up to any occupationally exposed work-er who experiences an exposure incident. Anexposure incident is a specific eye, mouth,other mucous membrane, non-intact skin, orparenteral contact with blood or OPIM. Thisevaluation and follow-up must be at no cost tothe worker and includes documenting theroute(s) of exposure and the circumstances

Protections Provided by OSHA’sBloodborne Pathogens StandardAll of the requirements of OSHA’s BloodbornePathogens standard can be found in Title 29 of theCode of Federal Regulations at 29 CFR 1910.1030.The standard’s requirements state what employ-ers must do to protect workers who are occupa-tionally exposed to blood or other potentiallyinfectious materials (OPIM), as defined in the stan-dard. That is, the standard protects workers whocan reasonably be anticipated to come into con-tact with blood or OPIM as a result of doing theirjob duties.

In general, the standard requires employers to:

• Establish an exposure control plan. This is awritten plan to eliminate or minimize occupa-tional exposures. The employer must preparean exposure determination that contains a listof job classifications in which all workers haveoccupational exposure and a list of job classifi-cations in which some workers have occupa-tional exposure, along with a list of the tasksand procedures performed by those workersthat result in their exposure.

• Employers must update the plan annually toreflect changes in tasks, procedures, and posi-tions that affect occupational exposure, andalso technological changes that eliminate orreduce occupational exposure. In addition,employers must annually document in the planthat they have considered and begun usingappropriate, commercially-available effectivesafer medical devices designed to eliminate orminimize occupational exposure. Employersmust also document that they have solicitedinput from frontline workers in identifying, eval-uating, and selecting effective engineering andwork practice controls.

FactSheetOSHA’s Bloodborne Pathogens StandardBloodborne pathogens are infectious microorganisms present in blood that cancause disease in humans. These pathogens include, but are not limited to, hepatitis Bvirus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), thevirus that causes AIDS. Workers exposed to bloodborne pathogens are at risk forserious or life-threatening illnesses.

This is one in a series of informational fact sheets highlighting OSHA programs, policies or standards. It does not impose any new compliance requirements. For a comprehensive list of compliance requirements of OSHA standards or regulations, refer to Title 29 of the Code of FederalRegulations. This information will be made available to sensory-impaired individuals upon request.The voice phone is (202) 693-1999; the teletypewriter (TTY) number is (877) 889-5627.

under which the exposure incident occurred;identifying and testing the source individual forHBV and HIV infectivity, if the source individualconsents or the law does not require consent;collecting and testing the exposed worker’sblood, if the worker consents; offering post-exposure prophylaxis; offering counseling; andevaluating reported illnesses. The healthcareprofessional will provide a limited written opin-ion to the employer and all diagnoses mustremain confidential.

• Use labels and signs to communicate hazards.Warning labels must be affixed to containers of regulated waste; containers of contaminatedreusable sharps; refrigerators and freezers containing blood or OPIM; other containersused to store, transport, or ship blood or OPIM;contaminated equipment that is being shippedor serviced; and bags or containers of con-taminated laundry, except as provided in thestandard. Facilities may use red bags or redcontainers instead of labels. In HIV and HBVresearch laboratories and production facilities,signs must be posted at all access doors whenOPIM or infected animals are present in thework area or containment module.

• Provide information and training to workers.Employers must ensure that their workersreceive regular training that covers all elementsof the standard including, but not limited to:information on bloodborne pathogens and dis-eases, methods used to control occupational

exposure, hepatitis B vaccine, and medical eval-uation and post-exposure follow-up procedures.Employers must offer this training on initialassignment, at least annually thereafter, andwhen new or modified tasks or proceduresaffect a worker’s occupational exposure. Also,HIV and HBV laboratory and production facilityworkers must receive specialized initial training,in addition to the training provided to all work-ers with occupational exposure. Workers musthave the opportunity to ask the trainer ques-tions. Also, training must be presented at aneducational level and in a language that work-ers understand.

• Maintain worker medical and training records.The employer also must maintain a sharpsinjury log, unless it is exempt under Part 1904 --Recording and Reporting Occupational Injuriesand Illnesses, in Title 29 of the Code of FederalRegulations.





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they show signs of cracking, peeling, tearing,puncturing, or deteriorating. Non-latex gloves,glove liners, powderless gloves or similar alterna-tives must be provided if workers are allergic tothe gloves normally provided.

Gloves are required for all phlebotomies outsideof volunteer blood donation centers. If an employ-er in a volunteer blood donation center judgesthat routine gloving for all phlebotomies is notnecessary, then the employer is required to peri-odically re-evaluate this policy; make gloves avail-able for workers who want to use them; and can-not discourage their use. In addition, employersmust ensure that workers in volunteer blooddonation centers use gloves (1) when they havecuts, scratches or other breaks in their skin, (2)while they are in training, or (3) when the workerbelieves that hand contamination might occur.

When splashes, sprays, splatters, or droplets ofblood or OPIM pose a hazard to the eyes, nose or mouth, then masks in conjunction with eyeprotection (such as goggles or glasses with solidside shields) or chin-length face shields must beworn. Protection against exposure to the body isprovided by protective clothing, such as gowns,aprons, lab coats, and similar garments. Surgicalcaps or hoods, and shoe covers or boots areneeded when gross contamination is expected,such as during orthopedic surgery or autopsies.

In HIV and HBV research laboratories and produc-tion facilities, laboratory coats, gowns, smocks,uniforms, or other appropriate protective clothingmust be used in work areas and animal rooms.Also, protective clothing must not be worn outsideof the work area and must be decontaminatedbefore being laundered.

One way the employer can protect workersagainst exposure to bloodborne pathogens, suchas hepatitis B virus (HBV), hepatitis C virus (HCV),and human immunodeficiency virus (HIV), thevirus that causes AIDS, is by providing andensuring they use personal protective equipment,or PPE. Wearing appropriate PPE can significantlyreduce risk, since it acts as a barrier againstexposure. Employers are required to provide,clean, repair, and replace this equipment asneeded, and at no cost to workers.

Selecting Personal ProtectiveEquipmentPersonal protective equipment may includegloves, gowns, laboratory coats, face shields ormasks, eye protection, pocket masks, and otherprotective gear. The PPE selected must be appro-priate for the task. This means the level and typeof protection must fit the expected exposure. Forexample, gloves may be the only PPE needed fora laboratory technician who is drawing blood.However, a pathologist conducting an autopsywould need much more protective clothingbecause of the different types of exposure (e.g.,splashes, sprays) and the increased amount ofblood and OPIM that are encountered. PPE mustbe readily accessible to workers and available inappropriate sizes.

If it can be reasonably expected that a workercould have hand contact with blood, OPIM, orcontaminated surfaces or items, the employermust ensure that the worker wears gloves. Single-use gloves cannot be washed or decontaminatedfor reuse. Utility gloves may be decontaminatedif their ability to provide an effective barrier is notcompromised. They should be replaced when

FactSheetPersonal Protective Equipment (PPE)Reduces Exposure to Bloodborne PathogensOSHA’s Bloodborne Pathogens standard (29 CFR 1910.1030) requires employers toprotect workers who are occupationally exposed to blood and other potentiallyinfectious materials (OPIM), as defined in the standard. That is, the standard protectsworkers who can reasonably be anticipated to come into contact with blood orOPIM as a result of doing their job duties.


Exception to Use of Personal ProtectiveEquipmentA worker may choose, temporarily and briefly,under rare and extraordinary circumstances, toforego use of personal protective equipment. Itmust be the worker’s professional judgment thatusing the personal protective equipment wouldprevent the delivery of health care or public safetyservices or would pose an increased hazard to the safety of the worker or coworker. When such a situation occurs, the employer is required toinvestigate and document the circumstances to determine if there is a way to avoid it from happening again in the future. Employers andworkers should be aware that this is not a blanketexemption to the requirement to use PPE. OSHAexpects that this will be an extremely rare occur-rence.

Decontaminating and Disposing ofPersonal Protective EquipmentEmployers must ensure that workers remove personal protective equipment before leaving the

work area. If a garment is penetrated by blood orOPIM, it must be removed immediately or as soonas feasible. Once PPE is removed, it must beplaced in an appropriately designated area or container for storage, washing, decontamination,or disposal. In addition, employers must ensurethat workers wash their hands immediately or assoon as feasible after removal of gloves or otherpersonal protective equipment.





DSG 1/2011

as psychiatric patients or children, from accessingthe sharps. Containers also must be availablewherever sharps may be found, such as in laundries.

Contaminated sharps must never be sheared orbroken. Recapping, bending, or removing needlesis permissible only if there is no feasible alterna-tive or if such actions are required for a specificmedical or dental procedure. If recapping, bend-ing, or removal is necessary, employers mustensure that workers use either a mechanicaldevice or a one-handed technique. The cap mustnot be held in one hand while guiding the sharpinto it or placing it over the sharp. A one-handed"scoop" technique uses the needle itself to pick upthe cap, and then the cap is pushed against a hardsurface to ensure a tight fit onto the device. Also,the cap may be held with tongs or forceps andplaced over the needle. Contaminated brokenglass must not be picked up by hand, but must be cleaned up using mechanical means, such as a brush and dust pan, tongs, or forceps.

Sharps ContainersContainers for contaminated sharps must bepuncture-resistant. The sides and the bottommust be leakproof. They must be appropriatelylabeled or color-coded red to warn everyone thatthe contents are hazardous. Containers for dispos-able sharps must be closable (that is, have a lid,flap, door, or other means of closing the container),and they must be kept upright to keep the sharpsand any liquids from spilling out of the container.

The containers must be replaced routinely and not be overfilled, which can increase the risk ofneedlesticks or cuts. Sharps disposal containersthat are reusable must not be opened, emptied,

A needlestick or a cut from a contaminated sharpcan result in a worker being infected with humanimmunodeficiency virus (HIV), hepatitis B virus(HBV), hepatitis C virus (HCV), and other blood-borne pathogens. The standard specifies measuresto reduce these types of injuries and the risk ofinfection.

Careful handling of contaminated sharps can prevent injury and reduce the risk of infection.Employers must ensure that workers follow thesework practices to decrease the workers’ chancesof contracting bloodborne diseases.

Safer Medical DevicesEmployers are required to consider and use safer medical devices, wherever possible. Thesedevices include those that are needleless or have built-in protection to guard workers againstcontact with the contaminated sharp. In addition,employers must ask non-managerial patient careworkers who could be exposed to contaminatedsharps injuries for their input in identifying, evaluating and selecting effective work practiceand engineering controls, including safer medicaldevices. The employer must document considera-tion and implementation of these devices, and thesolicitation of worker input, in the ExposureControl Plan.

Prompt DisposalEmployers must also ensure that contaminatedsharps are disposed of in sharps disposal contain-ers immediately or as soon as feasible after use.Sharps disposal containers must be readily acces-sible and located as close as feasible to the areawhere sharps will be used. In some cases, theymay be placed on carts to prevent patients, such

FactSheetProtecting Yourself When HandlingContaminated SharpsSharps are objects that can penetrate a worker’s skin, such as needles, scalpels, broken glass, capillary tubes and the exposed ends of dental wires. If blood or other potentially infectious materials (OPIM), as defined in the OSHA BloodbornePathogens standard (29 CFR 1910.1030), are present or may be present on the sharp,it is a contaminated sharp and appropriate personal protective equipment must beworn.


or cleaned manually or in any other manner thatwould expose workers to the risk of sharps injury.Employers also must ensure that reusable sharpsthat are contaminated are not stored or processedin a manner that requires workers to reach byhand into the containers where these sharps havebeen placed.

Handling ContainersBefore sharps disposal containers are removed orreplaced, they must be closed to prevent spillingthe contents. If there is a chance of leakage fromthe disposal container, the employer must ensurethat it is placed in a secondary container that isclosable, appropriately labeled or color-coded red, and constructed to contain all contents andprevent leakage during handling, storage, transport,or shipping.





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catheters, and chest tubes. Engineering controls,such as improved adhesive products and secure-ment devices, may decrease or eliminate the needfor sutures and thus directly reduce needlestickrisk.

For catheters that do not require sutures forsecurement, such as peripheral intravenouscatheters, healthcare workers typically use tape.Careful and thorough catheter securement isessential since ineffective securement may resultin catheter dislodgment. A variety of tapes, adhesive products, and catheter securementdevices are available. Appropriate products andeffective work practices are essential to provideincreased catheter stability. Such products andwork practices may reduce catheter dislodgmentand the necessity of reinsertion with its associatedneedlestick risk.

What OSHA requirements cover medical catheters?OSHA's bloodborne pathogens standard (29 CFR1910.1030) requires that employers of workers withoccupational exposure to blood or other potential-ly infectious materials annually consider andimplement appropriate, available, and effectivesafer medical devices designed to eliminate orminimize that exposure [See 29 CFR 1910.1030(c)(1)(iv)(B)]. Engineering controls that reduce thepotential for needlesticks by eliminating the needto suture medical catheters in place are one optionfor healthcare employers to consider. As part oftheir annual review of methods to reduce needle-sticks, employers must review options for securingmedical catheters and consider appropriate engi-neering and work practice controls.

In this review, employers must include the inputof non-managerial employees responsible fordirect patient care who are potentially exposed toinjuries from contaminated sharps in the identifi-cation, evaluation, and selection of effective engi-neering and work practice controls [See 29 CFR1910.1030(c)(1)(v)].

What are medical catheters? Medical catheters are tubes used in healthcare todeliver intravenous fluids and medications or todrain body fluids. Examples include vascularaccess devices and chest drainage tubes.

What hazards do medical catheters pose to healthcare workers?Catheters used for vascular access must be insert-ed with a needle. Inserting a catheter exposes thehealthcare worker to the risk of a needlestick.Sharps with engineered sharps injury protection(SESIPs) reduce workers' risk of needlesticks, but,unless they are effectively secured, intravenouscatheters may migrate or become dislodged andrequire reinsertion.

Some vascular access devices and chest drainagetubes have traditionally been secured withsutures. This process directly exposes the health-care worker to the risk of a needlestick injury fromthe suture needle. Therefore, for healthcare work-ers using medical catheters, the process of sutur-ing these devices presents needlestick hazards.

Who is at risk?Healthcare workers who insert and suture in placemedical catheters such as vascular devices andchest tubes face needlestick risks. These workersmay include physicians, nurses, physician assis-tants, and emergency responders.

What are the options for securing medical catheters?Generally, OSHA does not require the use of spe-cific engineering controls or work practices. OSHArelies on the professional judgment of healthcareworkers who insert and secure catheters to assesseach situation and determine the appropriatemethods and work practices to secure cathetersand minimize risk of dislodgment.

Healthcare workers have customarily used tape orsutures to secure medical catheters. Typically, theyuse sutures for central venous catheters, arterial

FactSheetSecuring Medical Catheters

How can I get more information? Information on needlestick hazards, including the full text of OSHA's bloodborne pathogens

This is one in a series of informational fact sheets highlighting OSHA programs, policies or

standards. It does not impose any new compliance requirements. For a comprehensive list of

compliance requirements of OSHA standards or regulations, refer to Title 29 of the Code of Federal

Regulations. This information will be made available to sensory impaired individuals upon request.

The voice phone is (202) 693-1999; teletypewriter (TTY) number: (877) 889-5627.

standard, is available on OSHA's website athttp://www.osha.gov/SLTC/bloodbornepathogens/index.html

U.S. Department of Labor

www.osha.gov(800) 321-OSHA

Think Safety!For more complete information:

"This course was developed from the public domain document: OSHA Fact Sheet: Bloodborne

Pathogen Exposure Incidents, Hepatitis B Vaccination Protection, OSHA’s Bloodborne Pathogens

Standard, Personal Protective Equipment (PPE) Reduces Exposure to Bloodborne Pathogens,

Protecting Yourself When Handling Contaminated Sharps, and Securing Medical Catheters –

U.S. Department of Labor, Occupational Safety and Health Administration (OSHA)."

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