What is the relationship between Occupational Safety and Health (OSH) and airborne and bloodborne diseases?

Relationship Between Occupational Safety and Health (OSH) and Airborne and Bloodborne Diseases

OSH programs are legally mandated frameworks that protect workers from occupational exposure to both airborne and bloodborne pathogens through a hierarchy of controls including engineering measures, work practices, personal protective equipment, vaccination, and exposure management protocols. 1

Legal Framework and Employer Obligations

Employers are legally required under OSHA regulations to establish comprehensive exposure control plans that minimize or eliminate worker exposure to bloodborne pathogens including HBV, HCV, and HIV, as well as airborne pathogens like tuberculosis and SARS-CoV-2. 1, 2

• The OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) mandates specific protections for all workers with potential occupational exposure to blood and other potentially infectious materials 1, 3, 2
• Any occupationally exposed worker who develops an infectious disease must be presumed to have an occupationally acquired disease, requiring wage replacement, medical cost coverage, and workers' compensation. 1
• Employers must designate a safety officer responsible for conducting hazard assessments and implementing necessary controls 1

Transmission Routes in Occupational Settings

Healthcare and other high-risk workers face exposure through multiple pathways that OSH programs must address:

Bloodborne Pathogen Transmission

• Direct contact with blood, contaminated sharps injuries, and contact with mucous membranes represent primary bloodborne transmission routes 1, 4
• Patient-to-worker, worker-to-patient, and patient-to-patient transmission have all been documented in healthcare settings 1
• Contaminated hands are the predominant mode of transmission after touching intact or broken skin lesions 5

Airborne Pathogen Transmission

• Respiratory droplets generated through coughing and sneezing can transmit pathogens like influenza, pertussis, and SARS-CoV-2 1
• Tuberculosis transmission via small-particle aerosols requires special particulate respirators (N-95 or higher) rather than standard surgical masks, with mandatory medical screening, fit-testing, and education for proper use. 1
• Airborne transmission of SARS-CoV-2 aerosols has been demonstrated in laboratory experiments, with droplets remaining viable on surfaces for several days 1

Hierarchy of Controls in OSH Programs

OSH programs must apply a hierarchy of controls, with engineering and administrative controls prioritized over work practices and PPE, though the latter remain essential when higher-level controls are insufficient. 1

Engineering Controls

• Safer devices with built-in safety features must be evaluated and selected at least annually 4
• Needleless systems should be used when practical 4
• Puncture-resistant sharps containers must be located as close as feasible to the area of use 4

Work Practice Controls

• Never recap used needles using both hands or any technique directing the needle point toward any body part. 4
• Never reuse or share syringes, needles, or drug-preparation equipment between patients 4
• Hand hygiene with soap and water or alcohol-based hand rub before and after each patient contact is the single most important prevention measure 5

Personal Protective Equipment (PPE)

• Medical gloves must always be worn when potential contact with blood, blood-contaminated saliva, or mucous membranes exists 1
• Chin-length plastic face shields or surgical masks and protective eyewear are required when splashing or spattering of blood or body fluids is likely 1
• An abundance of precaution must be adopted when relying on work practices and PPE, as these are less effective than engineering or administrative controls. 1

Vaccination Requirements

Employers must offer hepatitis B vaccination at no cost to all workers with potential occupational exposure to blood, and all healthcare workers with direct patient contact should receive Tdap, MMR, varicella, and annual influenza vaccines. 1, 4

• HBV vaccination must be offered within 10 working days of initial assignment 1
• Workers should be tested for anti-HBs antibodies 1-2 months after completing the 3-dose vaccination series 4
• If employees refuse vaccination, this must be documented using OSHA declination forms 1

Exposure Management Protocols

Written bloodborne pathogen exposure control plans must be readily available to all staff, reviewed regularly, and include immediate post-exposure protocols. 1

Immediate Post-Exposure Actions

• Wash contaminated skin surfaces immediately and thoroughly with soap and water 1
• Antimicrobial prophylaxis for HIV should be initiated as soon as possible but within 24 hours of exposure 1
• The National HIV/AIDS Clinician's Post Exposure Hotline (PEPline) at 1-888-448-4911 provides 24/7 consultation 1

Follow-up Testing

• Repeat serologic testing for hepatitis C and HIV at 6 months after potential exposure 1
• Contacts of infected workers must be traced, tested, and isolated 1

Universal Precautions Principle

Because all infected patients cannot be identified by medical history, physical examination, or laboratory tests, blood and body fluid precautions must be used consistently for all patients. 1, 4

• This "universal precautions" approach treats all blood and body fluids as potentially infectious regardless of known infection status 1, 4
• Standard precautions must be applied consistently across all healthcare delivery settings 4

High-Risk Occupational Groups

Workers at elevated risk extend beyond traditional healthcare settings and include:

• Healthcare workers, first responders, and those with continuing public exposure 1
• Workers in transportation, security, construction, essential services, retail establishments, and waste management 1
• Dental health-care workers face particular risk due to aerosol generation and blood exposure during procedures 1
• Any person who has had physical contact with, transports, or cleans up contamination from persons with infectious diseases 1

Common Pitfalls to Avoid

• Never wash, disinfect, or sterilize gloves for reuse, as washing may cause "wicking" (penetration of liquids through undetected holes). 1
• Sharing multi-dose vials, medication containers, or IV bags between patients increases transmission risk 4
• Using multiple-use nozzle jet injectors without proper cleaning between patients increases transmission risk 4
• Inadequate hand hygiene between patients remains a critical failure point 4
• Shortages of filtering facepiece disposable respirators have led to attempts to sanitize and re-use them, though these respirators are designed for single use only—such improvised procedures must be avoided. 1

Worker Rights and Employer Responsibilities During Pandemics

OSH duty holders are not relieved of their responsibility to protect workers during pandemics, and workers have the absolute right to know about the risks they face from their work. 1

• All at-risk workplaces must have comprehensive OSH programs that anticipate work-related risks and describe protection strategies 1
• Workers required to self-isolate, enter quarantine, or who develop occupational infections must continue to maintain wages and benefits 1
• Any worker who dies from an occupational infection must be presumed to have died of an occupational disease, with survivors receiving all appropriate benefits 1