OSHA may cite for failure to use rapid HIV testing

Perform test 'as soon as feasible'

Hospitals face possible citation for failing to use a rapid HIV test after a bloodborne pathogen exposure, according to a letter of interpretation by the U.S. Occupational Safety and Health Administration.

The standard states that "[t]he source individual's blood shall be tested as soon as feasible and after consent is obtained in order to determine HBV and HIV infectivity." That means that "an employer's failure to use rapid HIV antibody testing …would usually be considered a violation of that provision," according to Richard Fairfax, director of OSHA's Directorate of Enforcement Programs.

In the past five years, OSHA has issued 31 citations for failing to comply with that provision. That would include situations in which hospitals did not act quickly enough to obtain source patient consent.

Katherine West, BSN, MSEd, CIC, an infection control consultant with Infection Control/Emerging Concepts in Manassas, VA, raised the question after she noticed that many hospitals around the country were not using the rapid tests, which are readily available and cost about $10 to $20 per test.

"I was finding that there were medical facilities all over the country who stated they would not do rapid HIV testing at all," she says. "Some would do it for their employees but not for non-hospital [workers], like an exposure that occurred in doctors' offices or among EMS [emergency medical services] responders. There was a resistance, and I couldn't understand it."

West notes that guidelines from the Centers for Disease Control and Prevention in Atlanta state that post-exposure testing "should be performed as soon as possible…. An FDA-approved rapid HIV-antibody test should be considered for use in this situation, particularly if testing by EIA cannot be completed within 24-48 hours."1 Under the bloodborne pathogens standard, OSHA requires employers to comply with current CDC guidelines.

Furthermore, several of the rapid tests have Clinical Laboratory Improvement Act (CLIA) waivers, which means they can be used even if the lab is not CLIA-certified, says West.

Tests spare HCWs tremendous anxiety

The rapid tests spare employees tremendous anxiety as well as the need to take a regimen of toxic drugs, notes West. "People are worried for weeks when we could bring this to closure in one hour," she says.

Hospitals also benefit, she says. "Doing this is good risk management for the medical facility. It's cost-effective because it's cheaper to do rapid testing than put people on expensive drugs."

West acknowledges that in some states, consent laws regarding HIV testing may cause some delays in testing source patients. The CDC recently recommended routine HIV testing of patients.2 Employee health professionals also may want to contact their legislators to get outdated laws changed, West advises.

As of press time for Hospital Employee Health, OSHA had not posted the interpretation letter on its web site. West is trying to get the word out. "I look at this as a really, really positive step for health care workers," she says.


1. Centers for Disease Control and Prevention. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for post-exposure prophylaxis. MMWR 2005; 54(RR09):1-17.

2. Centers for Disease Control and Prevention. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in healthcare settings. MMWR 2006; 55(RR14):1-17.