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.

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.

OSHA said its Site-Specific Targeting 2009 program will focus enforcement efforts on nearly 4,000 high-hazard worksites on the agency’s list for comprehensive safety inspections. The agency said the SST program helps it direct enforcement resources to workplaces such as manufacturing and nursing homes where the highest rate of injuries and illnesses occur.

Changes to this year’s program include dividing the primary list of establishments slated for inspection into three sectors–manufacturing, non-manufacturing, and nursing homes. Rather than using one rate for all establishments, OSHA established minimum injury and illness rates for each group, allowing the agency to inspect even more establishments that exceed the minimum rates specific to that sector. Additionally, some facilities that did not answer an OSHA Data Initiative survey will be added to the inspection list. The agency said its intent is to deter employers from not responding to avoid inspection.

“These inspections examine all aspects of a workplace’s operations and the effectiveness of its safety and health efforts,” said acting Assistant Secretary of Labor for OSHA Jordan Barab. “The SST program emphasizes to employers the importance of ensuring safe working conditions for workers.”

The SST-09 inspection program is based on injury and illness data from the agency’s 2008 Data Initiative survey of 80,000 employers, with 40 or more workers, in industries with historically high occupational injury and illness rates. The primary and secondary lists show case rates calculated from the number of days away from work, restricted work activity or job transfer (DART), or a “days away from work injury and illness” (DAFWII) rate.

The secondary list shows establishments in manufacturing with a DART rate between 6 and 8, or a DAFWII rate between 4 and 13; non-manufacturing with a DART rate between 6 and 15, or a DAFWII rate between 4 and 13; and nursing homes and personal care facilities with DART or DAFWII rates between 15 and 17 or between 11 and 14, respectively.

Every employer has a responsibility to make sure all employees have a safe and stable work enviroment.  These employees should have access to safety equipment and information at anytime they are on the jobsite.  These employees should be able to go to their superiors with fears or concerns about safety without fear of termination or retaliation.  In order to accomidate employees in such a fashion, we have compiled a short and condensed version of what an employer of the construction industry should have documented and in place for emergencies or for an OSHA inspection.
 
Management Commitment to Safety and Health
•Employers and managers should lead by example.  If your employee sees a superior taking safety seriously, they will too!
•Assign Safety and Health Responsiblities to employees.  If you involve and rotate employee responsibities, everyone will feel important and compliant.
•Give the assigned employees to correct minor issues.  When a subordinate is give a little more power than their position requires, they are more likely to do what it takes to keep earning your trust and respect.
•Assure your employees that they may voice their concerns regarding safety without any reprocussions.  These employees are the front line guys and they often see the danger in a position before a manager does. Listen to what they have to say and respect their position on safety.  Most state laws protect whistltblowers, so check your states regulations.
•Inform employees of any hazards that you are aware of.  Again, it is the employer’s responsibility to safeguard their employees, so keep the lines of communication open.
•If you are sharing a worksite with other companies or their employees, it is your responsiblity to commincate any known hazards to them.  Share a safe workplace.
•Post the OSHA state or Federal poster where all can see it.  Employees have a righ to know the law.
Hazard Identification and Determination
•Carefully evaluate all operations, procedures, facilities, and equipment to identify hazards to employees and others.
•Monitor exposure levels of noise, air quality, heat, electricity, silica or dust, and moisture.
•Set aside time to do routine inspections.  If you create a habit of safety awareness, you will create a timeless good habit.
•If you have an accident, conduct an investigation.  The best way to prevent history from repeating itself it to identify and address the factors that caused the accident to begin with.
•Do a PPE assessment.  For every position within construction, evaluate the potential dangers associated with that assignment, then create a list of personal protection equipment that should be worn while performing these tasks.  Determine if it goes beyond simple protection and what procautions should be taken. Document all of your findings.
Hazard Elimination and Control
•Inspect and ensure all machines and tools are in proper working order with relevant standards.
•Develop positive practices with workplace safety and health so that it becomes second nature.
•Housekeeping is a must.  Jobsites should be free of debris and cleaned up daily to ensure the safety of others.
Emergency Response Planning
•Develop emergency response plans for your jobsite.  If you are in an industry where your jobsite changes frequently, you still need to have a response plan.  These do not have to elaborate, but clear enough to communicate what needs to be done in case of an emergency.
•Have an emergency route to evacuate injured employees.  If your jobsite is in a new development area that the emergency response team may not have access too, have in a convienent location that is easily accessable by all employees.  Use established landmarks and turn by turn directions.
•Have a list of all the jobsite emergency contact information including any pre-existing medical conditions and allergies that emergency personel may need to know.
Training
•Employers should train employees to recognize hazards and unsafe working conditions and how to avoid them.
•Employers need to provide training on safe work practices, safe operation of machinery, and equipment, and how to recognize when things are not safe.
•Access ladders, stairways, confined space, and enclosed space entry hazards are all subjects that need to be trained and documented.
Recordkeeping
•You must record and post injuries and fatalities.  This is otherwise known as the 300-log.
•Maintain medical records and exposure records for all employees and past employess.
•You must maintain all appropriate documents and tags for abatement purposes.  If you do not have these items, it could mean hefty fines.

Recently, many companies and organizations have required their sub-contractors to have OSHA 10-hour training.  This is a very common practice in the construction industry.  Previously companies just had to show that the supervisor had an OSHA 10-hour card but now, some companies are requiring all the workers from the sub-contractor to have an OSHA 10-hour card. 

The first half of the OSHA 10-hour Construction Course covers certain OSHA-mandated topics, such as an overview of OSHA, tips on how to locate specific OSHA regulations, basic electrical safety, & fall protection. But the remaining 5 hours of the class can be customized to address other OSHA Construction training topics that pertain specifically to your operations (example: scaffolding, excavations, stairways & ladders, cranes, PPE, and tools & equipment . . .).  These classes should be taught by and OSHA 500 or 501 trainer.

OSHA 500 and 501 are the train-the-trainer classes that are taught through The OSHA Training Institute and The National Safety Education Center and other OSHA training sites.

If you are considering hiring a sub-contractor do you want all the workers trained in safety or just the supervisors?  Your call.

This Instruction initiates and establishes a hearing conservation program that complies
with 29 CFR 1910.95 to protect OSHA personnel covered by PER 04-00-003 from the
effects of occupational noise exposure. The Hearing Conservation Amendment to the
OSHA Occupational noise exposure standard, 29 CFR 1910.95, requires that employers
establish a hearing conservation program for employees whose noise exposures equal or
exceed an 8-hour time-weighted average (TWA) of 85 dBA.

Employers are now mandated to have a hearing conservation program that includes:

• Monitoring of work area
• Audiometric testing program
• Employee notification
• Proper PPE
• Training on hearing protectors
• Annual employee training
• Proper Recordkeeping

The Compliance Resource Center reported earlier that NIOSH had developed online tool to allow users to check their hearing protection in a minute or less.  With this new directive employers might want to take a quick look at this online tool.

The U.S. House of Representatives issued a special report in June of 2008 on the status of recordkeeping and how it has been underreported, “But extensive evidence from academic studies, media reports and worker testimony shows that work-related injuries and illnesses in the United States are chronically and even grossly underreported. As much as 69 percent of injuries and illnesses may never make it into the Survey of Occupational Injuries and Illnesses (SOII), the nation’s annual workplace safety and health “report card” generated by the Bureau of Labor Statistics (BLS).”

While the report does reach some interesting conclusions, it is not something really new to many safety professionals.  In a previous article I reported how a company failed to report an injured employee to keep the incident off the books.  Now we know it happens a lot more than we thought.  We don’t want to think it happens, but incidents cost money and production time.  The fewer incidents that are reported keep certain cost, such as worker’s comp prices and healthcare, from rising.  Also, many safety professionals job are dependent on showing a decline in the number of incidents reported.  Therefore a borderline call may never make it to the OSHA 300 form.  At least now we know that the incident rate reported by the BLS is not totally accurate.  The question is, will this really change anything? 

Let’s hear from you.  We value all your comments and concerns relating to this and any other issues.

Part of my job is researching and reading articles written about safety and compliance.  I have many different sources (none that I want to testify about) for OSHA, DOT, Homeland Security and more.  One of the reoccurring themes everyone (except me) likes to report on, is who is getting fined and how much it is costing them.  Many of OSHA fines are well over the $100,000 mark, and DOT is similar, if not more.  There doesn’t seem to be a lack of companies or organizations to fine.  Whether it is a Disney, a GE or some small construction company, incidents are still happening and the companies are still paying the price. 

Recently, I read where a construction company got fined over $250,000 for 2 employees getting injured (no deaths).  The company had previously been fined over $100,000 and warned by OSHA.  People have told me that the DOT is now going after companies who ship hazardous materials improperly, fail to provide training, failure to have a security plan and other assorted compliance issues.  These fines are reaching well over $100,000.  Remember the fine is not the only cost of incident.  The general rule is an average incident today cost the company about $25,000.  That company will have to sell an additional $700,000 at 4% gross profit to make up that cost.  That is a lot of additional sales for most companies and that is only if you have 1 incident.  Also there is the loss of productivity, and the probable increase in worker’s comp to add to that total.

So what’s the problem?  Most companies are reactive and not proactive.  Look at how many organizations reach VPP or STAR status as a percent of all the companies in business.  Not too many.  As the economy worsens positions that are non-revenue producing are the first to go, such as training or the safety manager.    Even though we know the safety and trainer indirectly add benefit to the bottom line, it is hard to quantify the amount of money they save a company.

Time is money especially in the trucking industry.  I know there are truck drivers who remove their DOT placards after they leave a company to avoid having the state police stopping them for 30-60 minutes.  What is the safety or transportation manager to do?

Really, I don’t have the answer.  Maybe some of you would like to share your success with our readers.  I only know the problem is not going away nor does it seem to be slowing down much.  Each year the top fined areas of OSHA hardly change.  Statistics show injuries and deaths are going down, but I not so sure that is a good indicator of what’s really happening. The reporting system (if the injuries are even reported) has changed to reflect fewer incidents (no first-aid is reported even if the employee sits out half the day).  As an example, I was doing some DOT consulting at a company and an employee was cut and bleeding.  The employee was put in an office until after work hours and then taken to the doctor.  After a few stitches the employee can to work the next day and was told to sit around doing nothing.  He did not miss a day of work and the incident was not reported on the OSHA 300 log.

Maybe we should look more closely are the amount of dollars fined instead of the number of reported incidents to get a true indicator that we are really in compliance and acting in a safe mode.  Safety professionals are always working to get upper management to support the safety effort, and others say we need the support of the supervisors.  Guess what people?  SAFETY NEEDS EVERYONE’S SUPPORT or there will be a breakdown somewhere.  Just like the production line.  Everyone needs to do the job to make the system work.

We most often think of employee safety with regards to manufacturing, construction or other miscellaneous industries with related safety incidents.  But how often do we consider the professional athlete as an employee or the fan in a safety situation? 

Dave from TechLife recently sent me an article by Scott Miller of CBS Sports about the number of breaking wood bats in baseball.  This number is increasing each year, and it is becoming a safety issue for the players (employees) and the fans.  Sports are becoming much more harmful to the employee.  About a year ago a minor league coach (an employee) was hit in the head by a foul ball and died.  The NAICS for sports is 71100 and the recordable rate is 5.8 that is comparable to construction and manufacturing.  We know there is an alarming increase in the number of injuries is sports such as football and hockey, but should athletics and OSHA be concerned about the incident rate in the industry as a whole?

Fans are also “in harms way” when a hard line drive or a bat flies into the stands or a herd of 30,000 people all want to leave a game at one time.  Someone(s) often gets injured.  These injuries will not appear on an OSHA 300 log even though the injury occurred on-site, because the fan is not considered an employee.  What happens when a vistor to your company gets injured, do you record it if it qualifies and a recordable?

Sports today are a dangerous profession.  The employees receive much more medical attention than employees in other professions.  Most athletic teams provide a medical staff both on and off site.  How many of you have a doctor, nurse or trainer on-site?

So when you think of employee safety and health don’t forget to consider the professional and non-professional athletic as an employee too.

A typical day in the life of the EH&S manager might go something like this:

Get in the office at 7 AM and go over all the previous days reports about any incident(s) that occurred.  Next you get that cup of coffee to spill over all those reports.  Now you check out the 50 or so E-mails of which at least 30 require a response.  Now it is time to walk the facility and do a short audit to make sure the people are wearing their PPE.  Go back and check more e-mails, and go over the budget for this month.  It’s 9AM and time for your first managers meeting of the day.  You report on 1 incident and what is happening to the employee.  Now back to the office to write your agenda for the weekly safety meeting and go over the OSHA 300 log.  After a short break you need to go over training records to see who needs what training and when can you get it done. Time to start designing a hazardous materials training class for new employeesas some of your MSDS sheets have changed.  Lunch, and then back to designing the training class you use to outsource, but not in this year’s budget.   Call coming in from the floor about a machine-guarding problem (no one hurt).  Have to go on the floor with maintenance to check the machine (lockout/tagout), they need it running for the production line.  Another call on the Nextel that employee requires minor first aid.  Go back to the office to call supervisors to schedule training, but hey are NOT happy to have to take people away from production.  Your boss calls and wants a report about safety to give to his/her boss.  Day almost over, you go back and check on machine to make sure it is properly guarded and find some flammable hazardous materials left out unattended.  Talk with supervisors about this and how to put them away correctly. 5:30PM, time to leave the building, but have to keep Nextel on just in case.  Oh no, I forgot to get the safety meeting agenda put together, well tomorrow is another day.

Here is who I was today:

• A manager
• An IT person
• Asafety person
• Administrative assistant
• A finance person
• An instructional designer
• A maintenance person
• A medic
• An arbitrator
• An employee
• Oh Ya! a family person too!!!

So what do you think, sound something like your day?  How many other jobs do you do that I left out?  Send a comment and we will compile a complete (as possible) of all the jobs a safety manager has to do.  Let’s hear from you.