Tips for Passing an OSHA Bloodborne Pathogen Inspection
The Bloodborne Pathogens Standard has been on the books for decades. But exposure control plans — the principal component of compliance — should be viewed as a “living document” that changes over time, said needlestick prevention expert Amber Mitchell, DrPH, MPH, CPH.
Formerly an OSHA inspector, Mitchell is the director of the International Safety Center’s Exposure Prevention Information Network.
The exposure control plan for the OSHA bloodborne standard should be revised as needed to “stand the test of time, based on things that may be changing within an institution, changing procedures or processes, or even risks,” Mitchell said in a webinar held by the Association for Occupational Health Professionals in Healthcare (AOHP).1 “Use achieving OSHA compliance as a tool to increase your roles as occupational health professionals in healthcare.”
The OSHA Bloodborne Pathogens Standard was the second most frequently cited standard in 2020.
“I’ll tell you because I’ve been doing this a long time, that this is one of the first years — likely because of COVID-19 — that bloodborne is not [number] one,” she said. “[It was] respiratory protection — meaning failure to use N95s, PAPRs [powered air purifying respirators], and elastomeric [respirators].”
One of the most common citations of the Bloodborne Pathogens Standard is for the failure to review and update the exposure control plan annually.
“If there are no changes, all you’d have to do is sign and date saying, ‘I’ve reviewed the plan, there are no changes,” Mitchell explained. “That would be acceptable for compliance. Employers must review sharps protective devices that may be new and commercially available. If I, as an employer, did not evaluate what was commercially available on the market, I could be cited.”
The exposure control plan may be on paper or electronic, provided all employees on all shifts know how to access it.
“That’s not just the plan itself,” Mitchell said. “If there are notes from a hazard assessment committee, or an infection control committee, or an employee health committee, those [should be] linked by attachment to the exposure control plan.”
Mitchell emphasized the importance of plan access by all shifts, noting she has performed inspections where the plan was locked in a supervisor’s office at 5 p.m. — a citable offense because it was unavailable for subsequent shifts.
“Inspections within OSHA are triggered in multiple pathways,” Mitchell said. “The first and most frequent typically are through complaints from workers who work in those facilities. Mostly, the complaints are anonymous, and they’re done through the (800) 321-OSHA telephone line. They can also be done through fax, through email. But again, for bloodborne pathogens, this is usually the most typical.”
Recent assessments or survey visits from other federal agencies or The Joint Commission also can trigger inspections. OSHA inspectors are compliance, safety, and health officers with backgrounds in industrial hygiene and safety.
“[Inspections are] unannounced, so no one will know when an OSHA compliance officer shows up, which is why it’s always important to be prepared,” Mitchell said. “It’s always important to be prepared for your employees anyway, but this is all the more reason.”
The Bloodborne Pathogens Standard covers many elements such as the use of personal protective equipment, signage for biohazards, hepatitis B vaccines, and needlestick prevention. But an inspector’s first question probably will be about records in addition to the exposure control plan.
“The compliance officer’s also going to ask for your 1904 — which is OSHA recordkeeping — your 300 and your 301 logs, or your 301A,” Mitchell said. “They’re also going to ask for your sharps injury log. They are going to ask for all of these things, and they’re going to take them with them and go back to the area office and go through them. Then, they’ll [come back and] do a walk-around.”
OSHA inspections can be expanded based on what surveyors see at the site. Concerns not necessarily in their standards can be referred to other agencies.
“I’m a compliance officer, and I’m assessing a safety practice that’s done in the operating room. On my way to the operating room, I see sharps that are in an open bin in the hallway, I can extend my inspection to the hazards that I see in plain sight,” Mitchell said. “Or, if I see some external hazards with chemical emissions, let’s say from sterilization process, I could also refer that to the EPA.”
In employee interviews, the inspector will ask about the type and frequency of training, including what they were taught during onboarding. Inspectors will take photographs during the walk-around “and then, depending on how long the inspection takes, they’ll do a closing conference with the employer,” Mitchell said.
“Inspection fines have consistently gone up over the years, Mitchell said. “Currently, a fine for a serious violation — and typically, violations of the Bloodborne Pathogens Standard are considered serious — is in the range of up to $13,000. This is per violation, so if there is an inspection being done for bloodborne pathogens specifically, there are hundreds of sections of the standard and there could be multiple violations based on each section.”
Fines can be as high as “$136,000-plus” for willful violations, meaning the employer was aware of the hazard and failed to abate it. There also are repeat violations cited for recurrent problems seen in past inspections.
“If this is the first time that you’ve ever been inspected, the fines are likely to be less than if there were multiple inspections over time with similar hazards that were identified,” Mitchell said.
- Association for Occupational Health Professionals in Healthcare. Pulling through an OSHA bloodborne pathogens inspection with flying colors. Aug. 18, 2021.
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