Hepatitis B Vaccination and Post-Exposure Follow-Up Procedures

Q. Who must be offered the hepatitis B vaccination?

A. The hepatitis B vaccination series must be made available to all employees who have occupational exposure. The employer does not have to make the hepatitis B vaccination available to employees who have previously received the vaccination series, who are already immune as their antibody tests reveal, or who are prohibited from receiving the vaccine for medical reasons.

Q. When should the hepatitis B vaccination be offered to employees?

A. The hepatitis B vaccination must be made available within 10 working days of initial assignment, after appropriate training has been completed. This includes arranging for the administration of the first dose of the series. In addition, see page 17 for vaccination of designated first aiders.

Q. Can pre-screening be required for hepatitis B titer? Post-screening?

A. No. The employer cannot require an employee to take a pre-screening or post-vaccination serological test. An employer may, however, decide to make pre-screening available at no cost to the employee. Routine post-vaccination serological testing is not currently recommended by the CDC unless an employee has had an exposure incident, and then it is also to be offered at no cost to the employee.

Q. If an employee declines the hepatitis B vaccination, can the employer make up a declination form?

A. If an employee declines the hepatitis B vaccination, the employer must ensure that the employee signs a hepatitis B vaccination declination. The declination’s wording must be identical to that found in Appendix A of the standard. A photocopy of the Appendix may be used as a declination form, or the words can be typed or written onto a separate document.

Q. Can employees refuse the vaccination?

A. Employees have the right to refuse the hepatitis B vaccine and/or any post-exposure evaluation and follow-up. Is important to note, however, that the employee needs to be properly informed of the benefits of the vaccination and post-exposure evaluation through training. The employee also has the right to decide to take the vaccination at a later date if he or she so chooses. The employer must make the vaccination available at that time.

Q. Can the hepatitis B vaccination be made a condition of employment?

A. OSHA does not have jurisdiction over the issue.

Q. Is a routine booster does of hepatitis B vaccine required?

A. Because the U.S. Public Health Service (USPHS) does not recommend routine booster doses of hepatitis B vaccine, they are not required at this time. However, if a routine booster dose of hepatitis B vaccine is recommended by the USPHS at a future date, such booster doses must be made available at no cost to those eligible employees with occupational exposure.

Q. Whose responsibility is it to pay for the hepatitis B vaccine?

A. The responsibility lies with the employer to make the hepatitis B vaccine and vaccination, including post-exposure evaluation and follow-up, available at no cost to the employees.

Q. What information must the employer provide to the healthcare professional following an exposure incident?

A. The healthcare professional must be provided with a copy of the standard, as well as the following information:

•A description of the employee’s duties as they relate to the exposure incident;

•Documentation of the route(s) and circumstances of the exposure;

•The results of the source individual’s blood testing, if available; and

•All medical records relevant to the appropriate treatment of the employee, including vaccination status, which are the employer’s responsibility to maintain.

Q. What serological testing must be done on the source individual?

A. The employer must identify and document the source individual if know, unless the employer can establish that identification is not feasible or is prohibited by state or local law. The source individual’s blood must be tested as soon as feasible, after consent is obtained, in order to determine HIV and HBV infectivity. The information on the source individual’s HIV and HBV testing must be provided to the evaluating healthcare professional. Also, the results of the testing must be provided to the exposed employee. The exposed employee must be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual.

Q. What if consent cannot be obtained from the source individual?

A. If consent cannot be obtained and is required by state law, the employer must document in writing that consent cannot be obtained. When the source individual’s consent is not required by law, the source individual’s blood if available shall be tested and the results documented.

Q. When is the exposed employee’s blood tested?

A. After consent is obtained, the exposed employee’s blood is collected and tested as soon as feasible for HIV and HBV serological status. If the employee consents to the follow-up evaluation after an exposure incident, but does not give consent for HIV serological testing, the blood sample must be preserved for 90 days. If, within 90 days of the exposure incident, the employee elects to have the baseline sample tested for HIV, testing must be done as soon as feasible.

Q. What information does the healthcare professional provide to the employer following an exposure incident?

A. The employer must obtain and provide to the employee a copy of the evaluating healthcare professional’s written opinion within 15 days of completion of the evaluation. The healthcare professional’s written opinion for hepatitis B is limited to whether hepatitis B vaccination is indicated and if the employee received the vaccination. The written opinion for post-exposure evaluation must include information that the employee has been informed of the results of the evaluation and told about any medical conditions resulting from exposure that may further require evaluation and treatment. All other findings or diagnoses must be kept confidential and not included in the written report.

Q. What type of counseling is required following an exposure incident?

A. The standard requires that post-exposure counseling be given to employees following an exposure incident. Counseling should include USPHS recommendations for prevention of HIV. These recommendations include refraining from blood, semen, or organ donation; abstaining from sexual intercourse or using measures to prevent HIV transmission during sexual intercourse; and refraining from breast feeding infants during the follow-up period. In addition, counseling must be made available regardless of the employee’s decision to accept serological testing.

Q. What information about exposure incidents is recorded on the OSHA 300 Log?

Revision 10/02 A. All work-related needlestick injuries and cuts from sharp objects that are contaminated with another person’s blood or other potentially infectious materials must be recorded. Enter the case on the 300 Log as an injury. To protect the employee’s privacy, do not enter the employee’s name. Enter the case on the sharps injury log or enter comparable data on the OSHA 300 Log.

Recently, I have been speaking to various groups about distracted driving.  While speaking at the Chicagoland Safety & Health Conference someone told and sent me the link to this video Teens Texting.

We know that more employees die and are injured from traffic accidents than any other type of incidents.  Distracted driving is done all the time.  The next time you are driving just look at the car next to you.  Within minutes you are bound to see someone either:

• Talking on a cell phone
• Eating/drinking
• Reading
• Putting on makeup
• Shaving
• One of many other things other than just driving

Also, if you have teenagers or someone about to drive you might want to watch this.  There are some graphic scenes, but the point is well done.  17 states have made laws to prohibit texting while driving, and there is a bill in front of congress.  Lastly, a recent study showed that talking on cell phone (regular or hand-free) reduces your reaction time to the same as if your blood alcohol rate is 0.8, or the accepted rate for DUI in almost every state in the US.

Nonfatal workplace injuries and illnesses among private industry employers in 2008 occurred at a rate of 3.9 cases per 100 equivalent full-time workers — a decline from 4.2 cases in 2007, the Bureau of Labor Statistics reported Oct. 29th. Similarly, the number of nonfatal occupational injuries and illnesses reported in 2008 declined to 3.7 million cases, compared to 4 million cases in 2007. The total recordable case (TRC) injury and illness incidence rate among private industry employers has declined significantly each year since 2003, when estimates from the Survey of Occupational Injuries and Illnesses (SOII) were first published using the 2002 North American Industry Classification System (NAICS).

National public sector estimates covering nearly 19 million State and local government workers — for example, police protection and fire protection — are available for the first time from the SOII for reference year 2008.  Nonfatal workplace injuries and illnesses among state and local government workers combined occurred at a higher rate (6.3 cases per 100 full-time workers) than among private industry workers in 2008.

Key findings of the 2008 Survey of Occupational Injuries and Illnesses:

• Incidence rates for injuries and illnesses combined among private industry establishments declined significantly in 2008 for all case types, with the exception of job transfer or restriction cases whose rate remained unchanged from 2007.  The number of cases of injuries and illnesses combined declined significantly in 2008 for all case types.
• For injuries only, both the incidence rate and the number of cases in private industry establishments declined significantly in 2008 compared to 2007 — each falling 8 percent from the year earlier.
• Looking at illnesses, both the incidence rate and the number of cases declined significantly in 2008 compared to 2007 — mainly the result of a decline among the ‘All other illnesses’ category, which accounted for nearly 84 percent of the decline in illness cases among private industry establishments.
• Manufacturing was the only private industry sector in 2008 in which the rate of job transfer or restriction cases exceeded the rate of cases with days away from work, continuing an 11 year trend.
• The total recordable case injury and illness incidence rate was highest in 2008 among mid-size private industry establishments (those employing between 50 and 249 workers) and lowest among small establishments (those employing fewer than 11 workers) compared to establishments of other sizes.

Slightly more than one-half of the 3.7 million private industry injury and illnesses cases reported nationally in 2008 were of a more serious nature that involved days away from work, job transfer, or restriction — commonly referred to as DART cases.  These occurred at a rate of 2.0 cases per 100 workers, declining from 2.1 cases in 2007.   Among the two components of DART cases, the rate of cases involving days away from work fell from 1.2 to 1.1 cases per 100 workers, while the rate for cases resulting in job transfer or restriction remained unchanged at 0.9 cases in 2008. Other recordable cases — those not involving days away from work, job transfer, or restriction–accounted for the remaining injury and illness cases nationally and occurred at a lower rate in 2008 (1.9 cases per 100 workers) compared to 2007 (2.1 cases per 100 workers).

Private Industry Injuries and Illnesses

Injuries. Approximately 3.5 million (94.9 percent) of the 3.7 million nonfatal occupational injuries and illnesses in 2008 were injuries — of which 2.5 million (71.2 percent) occurred in service-providing industries, which employed 80.1 percent of the private industry workforce covered by this survey.  The remaining 1.0 million injuries (28.8 percent) occurred in goods-producing industries, which accounted for 19.9 percent of private industry employment in 2008.

Illnesses. Workplace illnesses accounted for slightly more than 5 percent of the 3.7 million injury and illness cases in 2008. Private industry employers reported 18,900 fewer illness cases in 2008 — down to 187,400 cases compared to 206,300 in 2007. This resulted in a decline in the rate of workplace illnesses in 2008 from 21.8 to 19.7 cases per 10,000 full-time workers.

Goods-producing industries as a whole accounted for approximately 38 percent of all occupational illness cases and were responsible for more than two-thirds of the decline in illnesses reported among private industry workplaces in 2008. Consequently, both the number and rate of illnesses declined significantly for goods-producing industries as a whole in 2008. The manufacturing sector accounted for 31.5 percent of all occupational illnesses cases and reported 12,000 fewer illnesses in 2008 compared to 2007. Both the number and rate of illness cases among service-providing industries as a whole remained statistically unchanged in 2008, compared to 2007.

National Public Sector Estimates

National public sector estimates covering nearly 19 million State and local government workers — for example, Police protection (NAICS 922120) and Fire protection (NAICS 922160) — are available from the SOII for the first time for 2008.

Nearly 940,000 injury and illness cases were reported among State and local government workers combined in 2008, resulting in a rate of 6.3 cases per 100 workers — significantly higher than the rate among private industry workers (3.9 cases per 100 workers). Approximately 4 in 5 injuries and illnesses reported in the public sector occurred among local government workers, resulting in an injury and illness rate of 7.0 cases per 100 workers — significantly higher than the 4.7 cases per 100 workers in State government.

In addition to the industry-level estimates available for the first time with this release, more detailed national public sector estimates will be available in the future covering case and worker demographics for cases that involved days away from work.

In general, health care management emphasizes the prevention of impairment and disability through early detection, prompt treatment, and timely recovery. Medical management responsibilities fall on employers, employees, and health care professionals (HCPs). A medical management program can help to either eliminate or substantially reduce the risk of development of ergonomics-related problems and symptoms through early identification and treatment.

Musculoskeletal disorders are caused or aggravated by repetitive motions, forceful exertions, vibration, mechanical compression (hard and sharp edges), and sustained or awkward postures that occur over extended periods of time. MSDs can affect nearly all tissues, the nerves, tendons, tendon sheaths, and muscles, with the upper extremities being the most frequently affected. These injuries range from disorders of the back, the neck, the arms and legs, or the shoulders and involve strains, sprains, or tissue inflammation, and dislocation.

Workers suffering from MSDs may experience less strength for gripping, less range of motion, loss of muscle function, and inability to do everyday tasks. These painful and sometimes crippling injuries develop gradually over periods of weeks, months, and years as the result of the repeated actions required to perform their jobs.

Awareness is the key to preventing serious MSD injuries. It is important for employers and employees alike to know the signs and symptoms of MSDs. These signs and symptoms are often ignored, because they seem slight at first and go away when the employee is not at work. However, as time goes on, the symptoms increase and last longer until finally it’s impossible to perform simple tasks such as holding a drinking glass or keyboarding. Early intervention is essential to recovery.

That’s why it’s important to train employees about MSD signs and symptoms and encourage them to report symptoms as soon as they become aware of them. They also need to understand what may happen if they continue to perform their regular job and don’t report the symptoms. Early reporting is essential to lessen the severity of the injury. The longer warning signs are ignored, the more damage is done, the longer recovery takes, and in some cases, the damage can’t be repaired.

Signs and Symptoms

The presence of MSD signs and/or symptoms is usually the first indication that an employee may be developing an MSD. The signs are objective physical findings that an MSD may be developing. The symptoms, on the other hand, are physical indications that an employee may be developing an MSD.

Symptoms can vary in severity, depending on the amount of exposure to MSD hazards and often appear gradually, for example, as muscle fatigue or pain at work that disappears during rest. Usually symptoms become more severe as exposure continues. If the employee continues to be exposed, symptoms may increase to the point that they interfere with performing the job. Finally, pain may become so severe that the employee is unable to perform physical work activities).

Signs that may indicate an MSD include deformity, decreased grip strength, decreased range of motion, and loss of function. Common symptoms of MSDs include:

• Painful joints,
• Pain, tingling, or numbness in the hands or feet,
• Shooting or stabbing pains in the arms or legs,
• Swelling or inflammation,
• Burning sensation,
• Pain in wrists, shoulders, forearms, or knees,
• Fingers or toes turning white,
• Back or neck pain, and
• Stiffness

Workers in Illinois will continue to benefit from the renewal of an alliance between JULIE Inc. (Joint Utility Locating Information for Excavators), the State of Illinois Onsite Safety and Health Consultation Program and the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA). The alliance is designed to combine resources to prevent hazards faced by workers involved in trenching and excavation operations in the state of Illinois.

“Excavation hazards are still one of OSHA’s national emphasis programs and excavations that are entered without proper precautions present a significant risk for workers,” said OSHA Area Director for Peoria Nick Walters. “We believe that this alliance will give employers and employees throughout the state a greater opportunity to understand the hazards associated with excavations and the controls that need to be used to prevent serious injuries.”

The alliance requires each organization to contribute to the development of training sessions and materials on safe excavation activities. The groups will share resources and information to raise awareness and commitment to workplace safety and health. Information will be shared through participation in a variety of forums throughout Illinois.

OSHA health and safety alliances are part of OSHA’s ongoing efforts to improve the health and safety of employees through cooperative partnerships with trade associations, labor organizations, employers and government agencies. OSHA currently has more than 470 alliances throughout the nation with organizations committed to fostering safety and health in the workplace.

The U.S. Centers for Disease Control and Prevention has launched CDC-TV, a new online video resource on a variety of health, safety and preparedness topics.

The premiere series on CDC-TV is “Health Matters.” The first segment of the series, “Break the Silence: Stop the Violence,” addresses the topic of teen dating violence. In this video, parents and teens discuss the problem of dating violence and how to prevent it.

The library of available videos through CDC-TV will expand to include single-topic presentations as well as series for children, parents and public health professionals. Most are short and all include captioning for the hearing-impaired.
The videos are part of CDC’s efforts to increase access to information that can help people prevent illness and injury. “Online video is one of the best tools we have to reach a large number of people and help them make informed health decisions by providing accurate health information,” said Jay Bernhardt, Ph.D., director of CDC’s National Center for Health Marketing. “CDC-TV marks an exciting new chapter in our continuing efforts to provide CDC’s health information to the public when, where, and how they want it.”

The videos are available at http://www.cdc.gov/CDCtv.