Federal Register / Vol. 75, No. 87 / Thursday, May 6, 2010 / Proposed Rules 24835 

[FR Doc. 2010–10500 Filed 5–5–10; 8:45 am] 

BILLING CODE 6717–01–C 

DEPARTMENT OF LABOR 

Occupational Safety and Health 

Administration 

29 CFR Part 1910 

[Docket No. OSHA–2010–0003] 

RIN No. 1218–AC46 

Infectious Diseases 

AGENCY: Occupational Safety and Health 

Administration (OSHA), Department of 

Labor. 

ACTION: Request for information. 

SUMMARY: OSHA requests information 

and comment on occupational exposure 

to infectious agents in settings where 

healthcare is provided, (e.g., hospitals, 

outpatient clinics, clinics in schools and 

correctional facilities), and healthcarerelated settings (e.g., laboratories that 

handle potentially infectious biological 

materials, medical examiner offices and 

mortuaries). OSHA is interested in 

strategies that are being used in such 

healthcare and other healthcare-related 

work settings to mitigate the risk of 

occupationally-acquired infectious 

diseases. As such, OSHA would like to 

collect information and data on the 

facilities and the tasks potentially 

exposing workers to this risk; successful 

employee infection control programs; 

control methodologies being utilized 

(including engineering, work practice, 

and administrative controls and 

personal protective equipment); medical 

surveillance programs; and training. 

OSHA will use the information received 

in response to this request to determine 

what action, if any, the Agency may take 

to further limit the spread of 

occupationally-acquired infectious 

diseases in these types of settings. 

DATES: Comments must be submitted by 

the following date: 

Hard copy: Your comments must be 

submitted (postmarked or sent) by 

August 4, 2010. 

Facsimile and electronic 

transmission: Your comments must be 

sent by August 4, 2010. 

ADDRESSES: You may submit comments 

and additional materials by any of the 

following methods: 

Electronically: You may submit 

comments and attachments 

electronically at http:// 

www.regulations.gov, which is the 

Federal eRulemaking Portal. Follow the 

instructions online for making 

electronic submissions: 

Fax: If your submissions, including 

attachments, are not longer than 10 

pages, you may fax them to the OSHA 

Docket Office at (202) 693–1648; or 

Mail, hand delivery, express mail, 

messenger or courier service: You must 

submit three copies of your comments 

and attachments to the OSHA Docket 

Office, Docket No. OSHA–2010–0003, 

U.S. Department of Labor, Room N– 

2625, 200 Constitution Avenue, NW., 

Washington, DC 20210. Deliveries 

(hand, express mail, messenger and 

courier service) are accepted during the 

Department of Labor’s and Docket 

Office’s normal business hours, 8:15 

a.m.–4:45 p.m., EST. 

Instructions: All submissions must 

include the Agency name and the OSHA 

docket number for this rulemaking 

(OSHA Docket No. OSHA–2010–0003). 

Submissions, including any personal 

information you provide, are placed in 

the public docket without change and 

may be made available online at 

http://www.regulations.gov. 

Docket: To read or download 

submissions or other material in the 

docket, go to http://www.regulations.gov 

or the OSHA Docket Office at the 

address above. All documents in the 


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24836 Federal Register / Vol. 75, No. 87 / Thursday, May 6, 2010 / Proposed Rules 

docket are listed in the http:// 

www.regulations.gov index, however, 

some information (e.g., copyrighted 

material) is not publicly available to 

read or download through the Web site. 

All submissions, including copyrighted 

material, are available for inspection at 

the OSHA Docket Office. 

FOR FURTHER INFORMATION CONTACT: 

Press Inquiries: Jennifer Ashley, 

Director, OSHA Office of 

Communications, Room N–3647, U.S. 

Department of Labor, 200 Constitution 

Avenue, NW., Washington, DC 20210; 

telephone: (202) 693–1999. 

General and Technical Information: 

Andrew Levinson, Director, Office of 

Biological Hazards, OSHA Directorate of 

Standards and Guidance, Room N–3718, 

U.S. Department of Labor, 200 

Constitution Avenue, NW., Washington, 

DC, 20210; telephone: (202) 693–2048. 

SUPPLEMENTARY INFORMATION: 

Table of Contents 

I. Background 

A. Introduction 

B. History of Occupational Safety and 

Health Regulations Addressing 

Protection of Workers From Infectious 

Diseases 

C. Summary 

II. Request for Data, Information and 

Comments 

A. General 

B. Infection Prevention and Control Plan 

C. Methods of Control 

D. Vaccination and Post-Exposure 

Prophylaxis 

E. Communication of Hazards 

F. Recordkeeping 

G. Economic Impacts and Benefits 

H. Impacts on Small Entities 

III. Public Participation 

I. Background 

A. Introduction 

In 2007, the healthcare and social 

assistance sector as a whole had 16.5 

million employees.1 Healthcare 

workplaces can range from small private 

practices of physicians to hospitals that 

employ thousands of workers. In 

addition, healthcare is increasingly 

being provided in other settings such as 

nursing homes, free-standing surgical 

and outpatient centers, emergency care 

clinics, patients’ homes, and prehospitalization emergency care settings. 

Over the last 10 years, the number of 

healthcare workers (HCWs) (defined as 

healthcare professionals, technicians, 

and healthcare support workers, 

including those not directly providing 

patient care such as maintenance or 

laundry workers) has increased from 8.4 

million in 1998, to approximately 11 

million in 2008. In 1998, of the 8.4 

million HCWs, 3.0 million were 

employed in hospitals and 5.4 million 

were employed outside of hospitals. In 

2008, 3.6 million HCWs were employed 

in hospitals and 7.3 million outside of 

hospitals. Of the 7.3 million workers 

employed outside of hospitals, 2.1 

million were employed by 

establishments not defined as part of the 

healthcare sector.2 The increasing 

number of HCWs outside of hospital 

settings who are exposed to 

occupational injuries and illnesses 

likely has implications for risk 

management. 

Depending on the setting and the job 

tasks, HCWs may be exposed to a 

number of occupational hazards 

including: Exposure to infectious 

agents, radiation and chemicals. The 

Bureau of Labor Statistics (BLS) reports 

that for 2008, the incidence of all 

occupational injury and illness 

(including musculo-skeletal disorders 

from slips and falls and lifting patients 

and equipment) in the healthcare sector 

as a whole was 5.6 cases per 100 fulltime workers, in contrast to an average 

of 4.2 cases per 100 full-time workers 

for private industry overall.3 Higher 

rates have been documented in 

hospitals, with an incidence rate for all 

injuries and illnesses of 7.6 per 100 fulltime workers, and nursing homes, with 

an incidence rate for all injuries and 

illnesses of 8.4 per 100 full-time 

workers. 

In addition to settings where 

healthcare is provided, there are other 

work settings where workers might be at 

increased risk for occupational exposure 

to infectious agents. Occupational 

exposure to infectious agents may occur 

in settings where healthcare is provided 

(e.g., hospitals, clinics, some emergency 

response settings; clinics in schools or 

correctional facilities); and healthcarerelated settings where there is increased 

potential for exposure to infectious 

agents due to the populations being 

served or the materials being handled 

(e.g., drug treatment programs; 

laboratories that handle potentially 

infectious biological materials; medical 

examiners’ and coroners’ offices; and 

mortuaries). The purpose of this Request 

for Information (RFI) is to gather 

additional information on occupational 

exposure to infectious agents, how 

occupational exposure is being 

mitigated, and other types of work 

settings where there may be an 

increased risk of exposure. It should be 

noted that bloodborne pathogens (e.g., 

HIV, hepatitis B), are already covered by 

OSHA’s Bloodborne Pathogens standard 

(§ 1910.1030) and are not included in 

this RFI. 

The primary routes of infectious 

disease transmission in US healthcare 

settings are contact, droplet, and 

airborne. Contact transmission can be 

sub-divided into direct and indirect 

contact.4 Direct contact transmission 

involves physical contact between an 

infected person and another person, and 

the physical transfer of microorganisms 

(e.g., direct skin-to-skin contact). 

Indirect contact transmission occurs in 

situations where the physical transfer of 

microorganisms to a person comes from 

contact with a contaminated surface 

(e.g., contaminated environmental 

surfaces, such as a door knob, 

inadequately cleaned patient-care 

instruments or equipment, such as an 

examination table or patient bed). 

Droplets containing microorganisms 

are generated when an infected person 

coughs, sneezes, or talks, or during 

certain medical procedures, such as 

suctioning or endotracheal intubation. 

Transmission occurs when droplets 

generated in this way come into direct 

contact with the mucosal surfaces of the 

eyes, nose, or mouth of a susceptible 

individual.5 Droplets are too large to be 

airborne for long periods of time, and 

droplet transmission does not occur 

through the air over long distances. 

However, some of the droplets expelled 

by the infected patient will desiccate 

(dry out) very quickly (less than 1–2 

seconds) and form what are called 

droplet nuclei (residue from evaporated 

droplets). These small particles can 

remain suspended in air for long 

periods of time and travel significantly 

longer distances. 

Airborne transmission occurs when 

infectious droplet nuclei or particles 

containing infectious agents that remain 

suspended in air, are inhaled, enter the 

respiratory tract and cause infection.6

Since air currents can disperse these 

droplet nuclei or particles over long 

distances, airborne transmission does 

not require face-to-face contact with an 

infected individual. Airborne 

transmission only applies to those 

organisms that are capable of surviving 

and retaining infectivity for relatively 

long periods of time in airborne droplet 

nuclei or particles. Only a limited 

number of diseases are transmissible via 

the airborne route. 

The major goal of infection control 

(IC) is to prevent transmission of 

infectious diseases to patients and 

HCWs. This fundamental approach is 

set forth in the guidelines of the 

Department of Health and Human 

Services (HHS) Centers for Disease 

Control and Prevention’s (CDC) 

Healthcare Infection Control Practices 

Advisory Committee (HICPAC), a 

Federal advisory committee to CDC on 

the practice of health care infection 

control in U.S. healthcare facilities. The 

HICPAC guidelines include: 


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Identification and isolation of infectious 

cases; immunizations for vaccinepreventable diseases; standard and 

transmission-based precautions; 

training; personal protective equipment 

(PPE); management of HCWs’ risk of 

exposure to infected persons, including 

post-exposure prophylaxis; and work 

restrictions for exposed or infected 

healthcare personnel.7

These recommendations have been 

endorsed by professional associations 

such as the Association for Professionals 

in Infection Control and Epidemiology 

(APIC),8 the Society for Healthcare 

Epidemiology of America (SHEA),9 and 

the Association of periOperative 

Registered Nurses (AORN).10 OSHA is 

soliciting comment through this RFI on 

any other strategies that might be 

applied within healthcare or healthcarerelated work settings to mitigate the risk 

of occupationally transmitted infectious 

diseases. 

While the CDC/HICPAC guidelines 

present the recommended practices for 

reducing the risk of infectious disease 

transmission to patients and HCWs, the 

guidelines are non-mandatory. 

However, Centers for Medicare and 

Medicaid Services (CMS) mandates that 

in order for hospitals and other 

providers to receive certification and 

reimbursement through Medicare or 

Medicaid, the ‘‘facility must establish 

and maintain an Infection Control 

Program designed to provide a safe, 

sanitary and comfortable environment 

and to help prevent the development 

and transmission of disease and 

infection.’’ 11 Similarly, the Joint 

Commission (formerly called the Joint 

Commission on Accreditation of 

Healthcare Organizations), a private notfor-profit organization that evaluates 

and accredits more than 17,000 

healthcare organizations and programs 

in the United States, requires an 

effective Infection Prevention and 

Control Plan for accreditation.12

CDC/HICPAC has stated that 

‘‘adherence to recommended infection 

control practices decreases transmission 

of infectious agents in healthcare 

settings.’’ 13 While the infection control 

guidelines and requirements are widely 

recognized, day-to-day compliance, 

surveillance and oversight is left to each 

individual employer. Due to the 

continued prevalence of healthcareassociated infections (HAIs), 

particularly among patients,14 and the 

emergence of new infectious diseases 

that affect both patients and HCWs [e.g., 

severe acute respiratory syndrome 

(SARS), 2009 H1N1 pandemic 

influenza], compliance with routine 

infection control procedures is an 

increasingly important issue. 

The lack of adherence to voluntary 

infection control procedures is of 

particular interest to OSHA. CDC/ 

HICPAC states that ‘‘several 

observational studies have shown 

limited adherence to recommended 

practices by healthcare personnel.’’ 15 It 

should be noted that these were small 

case studies which were not designed to 

be representative of healthcare settings 

in general. CDC/HICPAC has also noted 

that HCWs generally reported greater 

self-adherence to infection control 

practices than was actually reported in 

observational studies. Observed 

adherence to universal precautions 

(now part of standard precautions) 

ranged from 43% to 89%, with even 

greater variability reported for certain 

recommended infection control 

practices (e.g., glove use).16

The World Health Organization 

(WHO) recognized the lack of 

compliance with hand hygiene and 

launched the First Global Patient Safety 

Challenge to achieve improvement in 

hand hygiene worldwide. In 2009, WHO 

issued hand hygiene guidelines that 

were based upon a thorough review of 

hundreds of manuscripts that dealt with 

the negative impact of non-compliance 

with hand hygiene on the transmission 

of infectious diseases in healthcare 

settings.17 A second review that 

examined the results of 20 hospitalbased studies published between 1977 

and 2008, concluded that despite study 

limitations, most studies showed a 

temporal relation between improved 

hand hygiene practices and reduced 

infection and cross-contamination 

rates.18

A study of adherence to CDC 

recommended respiratory infection 

control practices examined 653 

healthcare workers in primary care 

clinics and emergency departments of 

five medical centers and found 

significant gaps in compliance. There 

were shortcomings in overall personal 

and institutional use of CDC 

recommended practices, including 

deficiencies in posted alerts, patient 

masking and separation, hand hygiene, 

PPE use, staff training, and written 

procedures.19 Another study, published 

in 2009, surveyed nurses and doctors 

from five medical facilities and 

documented the lack of compliance 

with both hand hygiene and respiratory 

protection guidelines. Although not 

necessarily representative of, or 

generalizable to, the healthcare 

industry, it is of interest that of those 

doctors that responded to the survey, 

only 8% of 177 reported using 

recommended respiratory protection 

and only 33% of 156 reported practicing 

recommended hand hygiene. In 

addition, of those nurses that responded 

to the survey, only 25% of 249 reported 

practicing appropriate respiratory 

precautions and only 43% of 266 

reported practicing recommended hand 

hygiene measures.20

In another recent study 292 HCWs 

were surveyed about their use of PPE for 

protection against influenza. These 

HCWs consisted of internal medicine 

house-staff, pulmonary/critical care 

fellows, faculty, respiratory therapists 

and nurses working in four ICU’s in two 

large hospitals. The study found that 

only 63% of the HCWs surveyed were 

able to correctly identify appropriate 

PPE for influenza. The study’s authors 

stated that of the respondents ‘‘nearly 

40% of HCWs reported poor adherence 

with influenza PPE, and 53% reported 

that their colleagues often forget to use 

appropriate PPE.’’ 21 The CDC initiated a 

similar investigation of possible 

occupationally-acquired 2009 H1N1 

pandemic influenza, which was 

published in the April-May 2009 

MMWR. In response to a solicitation 

from CDC, State health departments 

reported 48 cases of confirmed or 

probable cases of H1N1 infection in 

HCWs. Of the 48 cases, information on 

PPE use was available for 11 of the 

HCWs who were deemed to have 

probable or possible acquisition from a 

patient. Of these 11 HCWs who were 

infected, only 3 reported always using 

either a surgical mask or an N95 

respirator when appropriate and none 

reported always following standard 

precautions (e.g., use of gloves, gown, 

facemask) and airborne precautions 

(e.g., use of a respirator).22

In its revised 2007 guidelines, CDC/ 

HICPAC noted that ‘‘a recent review of 

the literature concluded that variations 

in organizational factors (e.g., safety 

culture, policies and procedures, 

education and training) and individual 

factors (e.g., knowledge, perceptions of 

risk, past experience) were determinants 

of adherence to infection control 

guidelines for protection against SARS 

and other respiratory pathogens.’’ 23

Several studies have found 

organizational factors to be the most 

significant predictor of safe work 

behaviors. A study by Gershon et al. of 

1716 hospital-based HCWs, at three 

regional hospitals, found that those who 

perceived that their institution had a 

strong commitment to safety were 

almost three times more likely to be 

compliant with standard precautions 

than those who did not.24 Similar 

results were found when a group of 350 

HCWs from 28 State correctional 

facilities were surveyed.25 In addition, a 

series of studies demonstrated that 

interventions targeted at improving 


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organizational support for worker safety 

and health, resulted in enhanced 

compliance with standard precautions. 

These studies were: a survey of 789 

hospital-based HCWs at a large regional 

research medical center; a survey of 452 

nurses employed at one large medical 

center; a review of behavioral 

interventions to improve infection 

control practices; a survey of 1135 

HCWs at one large teaching hospital; 

and finally, a survey of 742 nurses at a 

900-bed urban teaching 

hospital.26 27 28 29 30 A study by Nichol et 

al sent 400 surveys to nurses in nine 

nursing units from two urban hospitals. 

Of these surveys, 177 were returned 

with responses. The study found that 

nurses used recommended facial 

protection (e.g., respirators, surgical 

masks, and eye/face protection) when 

they felt that management made health 

and safety a high priority, took all 

reasonable steps to minimize hazards, 

encouraged employees’ involvement in 

health and safety issues, and actively 

worked to protect employees.31 Other 

studies in industrial settings have 

shown that safety culture has an 

important influence on implementation 

of training skills and knowledge.32 33

The lack of compliance with 

recommended infection control 

practices is also noted by the Institute 

of Medicine (IOM), a Congressionallychartered independent, nonprofit 

organization that provides unbiased and 

authoritative advice to decision makers 

and the public. In 2009, the IOM issued 

a report entitled, Respiratory protection 

for healthcare workers in the workplace 

against novel H1N1 influenza A: A letter 

report. The report was requested by both 

CDC and OSHA, and concluded that: 

* * * although workers are aware of 

expert guidance and the risk they face, they 

often do not wear PPE when faced with 

conditions requiring its use. Such 

noncompliance is also seen in low rates of 

hand hygiene and use of gloves, respirators, 

and eye protection. To improve the 

compliance rates and thereby improve 

worker protection, a ‘‘culture of safety’’ for 

workers must be established in all healthcare 

organizations evidenced by senior leadership 

commitment.’’ 34

The relationship between safety 

culture and compliance with 

recommended infection control 

guidance in some portions of the 

healthcare sector is not a newly 

recognized issue. A 1999 IOM report on 

medical errors in the healthcare sector 

emphasized the pivotal role of system 

failures and the benefits of a strong 

safety culture in the prevention of such 

errors. The report notes that a safety 

culture is created through: (1) The 

actions management takes to improve 

both patient and worker safety; (2) 

worker participation in safety planning; 

(3) the availability of appropriate 

protective equipment; (4) the influence 

of group norms regarding acceptable 

safety practices; and (5) the 

organization’s socialization process for 

new personnel.35 Similarly, CDC/ 

HICPAC has noted that ‘‘several 

hospital-based studies have linked 

measures of safety culture with both 

employee adherence to safe practices 

and reduced exposures to blood and 

body fluids.’’ 36 This evidence was cited 

by CDC/HICPAC as one of the primary 

reasons for updating its guidance in 

2007.37 CDC/HICPAC noted that 

organizational characteristics, including 

safety culture, influence healthcare 

personnel adherence to recommended 

infection control practices and, 

therefore, are important factors in 

preventing transmission of infectious 

agents. CDC/HICPAC further 

emphasized the need for administrative 

involvement in the development and 

support of IC programs. 

Noncompliance with recommended 

infection control practices (e.g., hand 

hygiene, and proper use of gloves, 

facemasks, and respirators) increases the 

risk of transmission of infectious 

diseases among patients and 

workers.19 31 38 HHS notes that HAIs are 

among the leading causes of death in the 

United States, accounting for an 

estimated 1.7 million infections and 

99,000 associated deaths in 2002.39 The 

2007 CDC/HICPAC guidelines note that 

infectious agents are also transmitted 

from HCWs to patients.40

More specifically, poor infection 

control practices have been implicated 

in both acquisition and transmission of 

methicillin-resistant Staphylococcus 

aureus (MRSA) by healthcare 

personnel.41 Other studies have 

documented the nosocomial (hospitalacquired) transmission of adenovirus 

from patients to HCWs 42 43; invasive 

Group A Strep (GAS) from a patient to 

an HCW44; Clostridium difficile 

infection from a patient to a nurse in an 

oncology ward 45; and a norovirus 

outbreak in HCWs in a hospital.46

Additionally, CDC/HICPAC has 

documented the occupational 

transmission of influenza in hospitals 

and nursing homes.47 OSHA previously 

documented occupational exposure to 

tuberculosis (TB) in its notice 

‘‘Occupational Exposure to 

Tuberculosis; Proposed Rule’’ (62 FR 

54160–54308; October 17, 1997). 

Additionally, an investigation of the 

2003 SARS outbreak in Toronto, 

Canada, described the nosocomial 

transmission of SARS at a hospital. The 

investigation found that 42.5% of the 

cases occurred among hospital 

employees.48

Although HCW infections have been 

documented, published data on the 

prevalence of these infections is limited. 

Recently, the National Institute for 

Occupational Safety and Health 

(NIOSH) noted that a lack of 

occupational data in existing healthcare 

surveillance systems made tracking 

illnesses among HCWs difficult.49 The 

healthcare sector puts forth substantial 

effort to track patient infections, but 

does not appear to match that effort 

with a systematic means for tracking 

occupationally acquired worker 

infections. A weak culture of worker 

safety in this sector may be a 

contributing factor to this issue. 

B. History of Occupational Safety and 

Health Regulations Addressing 

Protection of Workers From Infectious 

Diseases 

OSHA’s past efforts to protect workers 

against occupationally acquired 

infectious diseases include the 

Bloodborne Pathogens standard 

(§ 1910.1030), promulgated in 1991. 

That standard requires a comprehensive 

programmatic approach to controlling 

transmission of bloodborne diseases. 

Following its promulgation, the 

incidence of Hepatitis B in HCWs 

dropped from more than 100 cases per 

100,000 HCWs in 1991 to only 9.1 cases 

per 100,000 HCWs in 1995.50 The 

standard was revised in 2001 in 

response to the Needlestick Safety and 

Prevention Act, Pub. L. 106–430. In 

general, the revisions require employers 

to evaluate and use safer medical 

devices (e.g., needleless devices, sharps 

with engineered sharps injury 

protections), and to establish and 

maintain a sharps injury log for 

recording percutaneous injuries from 

contaminated sharps. 

As a result of a marked increase in 

tuberculosis (TB) during the early 

1990s, which included worker 

infections, OSHA initiated action to 

address occupational exposure to TB. A 

standard was proposed, but was later 

withdrawn. In part, the proposal was 

withdrawn because of healthcare 

facilities’ increased adherence to CDC’s 

TB guidelines and the subsequent 

decline in TB infection rates.51 To 

assure continued protection of workers, 

OSHA addresses occupational exposure 

to TB through its TB compliance 

directive.52 The directive utilizes the 

CDC guidelines as the recognized means 

for controlling TB exposure. When 

OSHA determines that a TB hazard 

exists in a facility, exposure control 

deficiencies may be cited under existing 

OSHA standards [e.g., the Respiratory 


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Protection standard (§ 1910.134)] and 

the General Duty Clause [Section 5(a)(1) 

of the Occupational Safety and Health 

Act of 1970, Pub. L. 91–596 (OSH Act)]. 

The General Duty Clause requires 

employers to ‘‘* * * furnish to each of 

his employees employment and a place 

of employment which are free from 

recognized hazards that are causing or 

are likely to cause death or serious 

physical harm to his employees.’’ 

California-OSHA (Cal-OSHA) recently 

promulgated an Aerosol Transmissible 

Diseases (ATD) Standard 53 to protect 

workers from exposure to infectious 

agents transmitted via the droplet or 

airborne routes. Following Federal 

OSHA’s withdrawal of the TB proposal, 

Cal-OSHA developed its standard in 

response to concerns about TB, the 2003 

SARS epidemic, and a potential 

influenza pandemic. The standard 

significantly expands protection of 

California workers against aerosol 

transmissible diseases (this term, as 

defined by Cal-OSHA, encompasses 

those diseases that can be transmitted 

by the droplet or airborne routes). It 

should be noted that the standard does 

not deal with occupational exposure to 

infectious agents that are transmitted 

primarily via the contact route (e.g., 

MRSA, Group A strep, and noroviruses). 

Existing OSHA standards that may be 

applicable to controlling occupational 

exposure to infectious agents, other than 

the bloodborne pathogens standard, 

include: The Respiratory Protection 

standard (§ 1910.134); the Personal 

Protective Equipment standard 

(§ 1910.132); and the Specifications for 

Accident Prevention Signs and Tags 

standard (§ 1910.145). OSHA is seeking 

information through this RFI on 

whether or not its existing standards 

and the voluntary guidelines issued by 

other organizations are effectively 

protecting workers from occupational 

exposure to infectious agents. If not, 

OSHA seeks comment on what 

measures might be appropriate for the 

Agency to take to protect workers 

against infectious diseases (e.g., 

development of a proposed standard, 

issuance of guidelines, or other 

alternatives). 

C. Summary 

In summary, as a result of several 

factors raised in the preceding 

discussion, OSHA is seeking additional 

information to more fully evaluate 

worker exposures to infectious agents in 

healthcare and healthcare-related 

settings. We are particularly interested 

in additional data regarding indications 

in some studies that transmission of 

infectious diseases to both patients and 

HCWs may be occurring as a result of 

incomplete adherence to voluntary 

infection control measures in traditional 

healthcare facilities. Another concern is 

the movement of healthcare delivery 

from the traditional hospital setting, 

with its greater infrastructure and 

resources to effectively implement 

infection control measures, into more 

diverse and smaller workplace settings 

with less infrastructure and fewer 

resources, but with an expanding 

worker population. 

Consequently, the Agency is seeking 

information to assist in its deliberation 

on these issues. OSHA is interested in 

more accurately characterizing the 

nature and extent of occupationallyacquired infectious diseases and the 

strategies that are currently being used 

to mitigate the risk of occupational 

exposure to infectious agents in 

healthcare and healthcare-related 

settings, including patient and nonpatient settings and sites where 

healthcare is embedded within nonhealthcare settings such as clinics in 

schools and correctional facilities. The 

information being sought includes: the 

types of facilities and workers incurring 

this risk; successful employer infection 

control programs; control methodologies 

being utilized (including engineering, 

administrative, and work practice 

controls, and the use of appropriate 

personal protective equipment); medical 

surveillance programs; and training 

programs. The information received in 

response to this notice will be carefully 

reviewed and will assist OSHA in 

determining the effectiveness of 

approaches currently being used to 

eliminate and minimize occupational 

exposure to infectious agents. Based 

upon its analysis of this information, 

OSHA will determine what action, if 

any, the Agency may take to address 

these issues. 

II. Request for Data, Information and 

Comments 

A. General 

The following general information 

will assist OSHA in more fully 

understanding each commenter’s 

submissions and the possible 

differences in their approaches to 

infection control. The answers to the 

questions will also help OSHA 

understand the risk of workers 

contracting various infectious diseases 

in different types of workplaces. 

Note: Diseases spread through bloodborne 

pathogens are not encompassed by this RFI 

since a specific OSHA standard (Bloodborne 

Pathogens, § 1910.1030) addresses those 

diseases. OSHA encourages those with 

experience in non-traditional or nonhealthcare work settings to respond to these 

questions. 

1. Since healthcare is provided in a 

wide variety of settings (as previously 

described), OSHA is interested in being 

able to sort the responses received by 

the characteristics of the workplace 

about which each responding entity is 

providing information. As such, please 

describe the characteristics of the 

workplace to which you are referring. 

For example: type of workplace (e.g., 

hospital, long-term care, physician/ 

dentist office, emergency medical 

services); size (e.g., number of hospital 

beds, number of residents, average 

number of patients/clients); total 

number of employees (both direct care 

and administrative support). 

2. While OSHA is primarily 

concerned about worker exposure to 

infectious agents in traditional 

healthcare settings, the Agency 

recognizes that there are other settings 

where healthcare may be provided and 

where occupational exposure to 

infectious agents may be a significant 

concern (e.g., drug treatment facilities, 

home health services, prison clinics, 

school clinics, and laboratories that 

handle potentially infectious biological 

materials). Please describe any other 

work settings with an increased risk for 

occupational exposure to infectious 

agents that OSHA should consider, 

including why they should be 

considered. Please describe the nature 

and extent to which occupational 

exposure to infectious agents is a 

significant concern. For example, to 

which infectious agents are workers in 

these settings exposed and how often 

are they exposed? Please describe any 

infection control measures that can be 

or are being used in these settings. 

3. One of the most important steps in 

determining how to effectively protect 

workers from infectious diseases is 

identifying who is at risk of exposure. 

What recommendations do you have for 

how to determine which employees are 

potentially exposed to contact, droplet, 

and airborne transmissible diseases in 

the type of workplace about which you 

are responding? How many of your total 

workers have a risk of exposure to such 

diseases during the performance of their 

job duties? What proportion of your 

workforce does this represent? What are 

the job titles or classification(s) of these 

workers? What are the job duties of 

these workers? To which diseases are 

they exposed? 

4. Workplaces vary in the types of 

infectious diseases and the number of 

infected individuals encountered. 

OSHA is interested in the types of 

diseases that your workplace encounters 

and how often they are encountered. 

Please describe your workplace’s 

experience with infectious diseases over 


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the past ten years (e.g., which diseases, 

how often). 

5. OSHA is interested in data and 

information that will further assist in 

characterizing workers’ occupational 

exposure to contact, droplet, and 

airborne transmissible infectious 

diseases. 

(a) OSHA encourages the submission 

of your workplace or your industry’s 

experience with these diseases and the 

impact of infectious diseases on your 

workers (e.g., type and number of 

exposure incidents, occupationallyacquired infectious diseases, days of 

work missed, and fatalities). 

(b) Please provide information about 

any database that collects and aggregates 

data on occupationally-acquired 

infectious diseases (e.g., Federal, State, 

provider network, or academic). 

(c) Please provide any additional 

information, including peer-reviewed 

studies, which addresses occupational 

exposure to infectious agents that you 

think OSHA should consider. 

6. Infection control (IC) programs are 

currently the primary means of 

controlling occupational exposure to 

infectious agents. However, these 

programs are largely voluntary. OSHA is 

particularly interested in case studies 

that highlight experience in the 

implementation and effectiveness of IC 

programs in protecting workers against 

infectious diseases (e.g., the extent to 

which employers are fully 

implementing and consistently 

following their written IC programs). 

For example, has your workplace had 

instances where a significant increase in 

infections (among either patients or 

workers) required more rigorous 

implementation of your IC program? If 

so, please describe any factors that 

contributed to the increase and what 

steps your workplace took to address 

the situation. Please provide any studies 

that demonstrate the difference in 

infection rates between situations where 

the IC program had lapsed and 

situations where rigorous 

implementation of control measures was 

instituted. 

7. While OSHA has a Bloodborne 

Pathogens standard (§ 1910.1030), the 

Agency does not have a comprehensive 

standard that addresses occupational 

exposure to contact, droplet, and 

airborne transmissible diseases. The 

Agency has other standards [(e.g., 

Respiratory Protection (§ 1910.134) and 

General Personal Protective Equipment 

(§ 1910.132)] that may apply and, in 

some situations, Section 5(a)(1) of the 

OSH Act (the General Duty Clause) 

would apply. OSHA is interested in 

commenters’ insights regarding the 

adequacy of existing OSHA 

requirements to protect workers against 

occupational exposure to infectious 

agents. 

8. California OSHA recently issued a 

standard for occupational exposure to 

‘‘Aerosol’’ Transmissible Diseases that 

covers infectious diseases transmitted 

through the airborne and droplet routes. 

IC programs that are established in most 

healthcare settings address exposure to 

contact, droplet, and airborne 

transmissible diseases. Please explain 

whether the Agency’s deliberations on 

occupational exposure to infectious 

diseases should focus on only droplet 

and airborne transmission or if contact 

transmissible diseases should also be 

included. 

9. If the Agency pursues rulemaking 

and promulgates a standard, 

jurisdictions with OSHA-approved State 

plans will be required to cover workers 

who OSHA determines are at 

occupational risk for exposure to 

infectious agents, including public 

employees. State and local governments 

are defined very broadly, and would 

typically include such entities as a 

university hospital associated with a 

State university as well as public 

hospitals and health clinics. What 

public sector healthcare or healthcarerelated workers are at increased risk for 

occupational exposure to infectious 

agents? Please describe conditions 

unique to any of these occupations that 

are not seen in the private sector. Please 

describe any other issues specific to 

OSHA-approved State plans that the 

Agency should consider. 

B. Infection Prevention and Control Plan 

10. CDC/HICPAC’s 2007 Guideline for 

Isolation Precautions: Preventing 

Transmission of Infectious Agents in 

Healthcare Settings recommends an IC 

program for addressing the transmission 

of airborne and other infectious 

diseases. In certain settings, the Center 

for Medicare and Medicaid Services 

(CMS) and the Joint Commission require 

that healthcare facilities have such 

programs. 

(a) If you are subject to the CMS or 

Joint Commission requirements or 

otherwise have an IC program, please 

provide information on the elements of 

this program (e.g., early identification of 

infectious patients, implementation of 

transmission-based control measures, 

HCW training) and how the program 

works. 

(b) If you are not subject to these 

requirements and do not have an IC 

program, how does your workplace 

address preventing contact, droplet and 

airborne transmissible infectious 

diseases? 

11. In most cases, an IC program is 

managed by an infection control 

preventionist or other designated 

person. For example, the CDC/HICPAC 

guidelines recommend that the IC 

program be managed by individuals 

with training in infection control. Who 

manages your program? What 

percentage of this individual’s time is 

spent managing the IC program? 

12. For the IC program(s) established 

in your workplace, please describe, in 

detail, the resource requirements and 

associated costs, if available, expended 

to initiate the program(s) and conduct 

the program(s) annually. Please 

estimate, in percentage terms where 

possible, the extent to which the 

components or elements in your 

program(s) are typical of those practiced 

throughout your industry. 

13. In your industry, for the IC 

programs established in your workplace 

or for IC programs in other workplaces 

of which you are aware, are there any 

components or features that may present 

economic difficulties to small 

businesses? Please describe and 

characterize in detail these components 

and why they might present difficulties 

for small businesses. 

14. Periodic evaluation of IC program 

effectiveness is recommended by CDC/ 

HICPAC and required by the Joint 

Commission and CMS for most types of 

facilities under their jurisdiction. Please 

describe how your workplace or 

industry evaluates the effectiveness of 

its IC program, including the methods 

and criteria used. How often does your 

workplace evaluate its program? Please 

describe the results your program has 

achieved (e.g., if there has been a 

decrease in patient and/or worker 

infections). Please describe any specific 

problems and/or successes that have 

been encountered in the 

implementation and operation of the 

program. 

15. Most peer-reviewed literature 

evaluating IC programs focuses on 

protecting patients from contracting 

HAIs. While this body of evidence can 

be an indicator of worker exposure, 

OSHA is seeking data that more 

specifically address the occupational 

risk to workers. If your workplace has a 

system for tracking worker exposures or 

infections that may have been 

occupationally acquired, please share 

with us the following information: 

(a) A description of the tracking 

system and how it works; 

(b) The types of infection diseases 

encountered in your workplace and the 

number of exposures and/or infections 

tracked; 

(c) Exposure/infection rates; and 

(d) Any trend data. 


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C. Methods of Control 

16. If your workplace has a process for 

early identification of patients or clients 

who may have an infectious disease, 

please explain how your workplace 

conveys information to workers about 

individuals who are confirmed or 

suspected of being infectious, so that 

proper precautions can be implemented. 

Please describe the degree of success 

with these procedures and whether you 

think that such procedures are likely to 

be effective in other healthcare or 

healthcare-related settings. 

17. CDC/HICPAC, CMS, and the Joint 

Commission provide a variety of 

approaches that employers can 

implement to reduce or eliminate 

workers’ exposure to infectious agents. 

For example, a well-structured IC 

program can include: immunizations for 

vaccine-preventable diseases, isolation 

precautions to prevent exposures to 

infectious agents, training, personal 

protective equipment, management of 

workers’ risk of exposure to infected 

persons, including post exposure 

prophylaxis, and work restrictions for 

exposed or infected personnel. Please 

describe the types of problems/obstacles 

your workplace or industry encountered 

with implementing specific control 

measures. Please include a discussion of 

each control measure, the problem/ 

obstacle encountered, the affected 

worker group, and any particularly 

effective solutions your workplace or 

industry has implemented to address 

the obstacle/problem. 

18. When developing and 

implementing infection control 

measures in your workplace, are there 

any recommended controls that you 

have found to be ineffective or 

unnecessary in controlling infectious 

diseases? If so, please explain how you 

arrived at this conclusion. 

19. Airborne infection isolation rooms 

(AIIRs) are recommended as one aspect 

of controlling certain airborne 

transmitted diseases (e.g., TB, SARS). 

OSHA recognizes that most workplaces 

outside of hospitals do not have an AIIR 

and will transfer persons requiring 

airborne precautions to a facility with 

the necessary capabilities. If your 

workplace provides healthcare or other 

services to individuals requiring 

airborne precautions, how many of 

these patients/individuals has your 

workplace encountered in each of the 

last ten years? If individuals requiring 

airborne precautions must be transferred 

to another facility, please describe how 

your workplace identifies and isolates 

them while they are awaiting transfer. If 

your workplace provides extended care 

to these individuals (e.g., a hospital), 

does it have sufficient AIIRs to isolate 

the number of infected individuals your 

workplace has handled at any one time? 

If not, how does your facility provide 

alternate means of isolation and how 

many additional AIIRs would be 

necessary to fully accommodate your 

normal patient load? Please describe 

how your workplace plans to address 

surge capacity in the event of an 

outbreak, epidemic, or pandemic. Please 

provide any additional information, 

including peer-reviewed studies, which 

addresses issues relevant to the use of 

AIIRs in your workplace or industry. 

20. CDC/HICPAC’s 2007 Guideline for 

Isolation Precautions: Preventing 

Transmission of Infectious Agents in 

Healthcare Settings addresses the need 

for a safety culture and its role in 

improving a workplace’s IC program 

(e.g., worker adherence to safe work 

practices). Please describe the policies 

and actions undertaken in your 

workplace or industry to develop and 

maintain a culture of worker safety. 

Please describe any means that have 

been particularly effective in fostering a 

safety culture and any problems or 

obstacles that have been encountered in 

developing and/or maintaining the 

safety culture. 

21. Poor adherence to infection 

control measures (e.g., failure to use 

necessary PPE or to follow 

recommended hand hygiene practices) 

can be one indicator of the breakdown 

of an IC program. Please describe what 

actions have been undertaken in your 

workplace or industry to assess and 

enforce adherence to infection control 

measures. What obstacles has your 

workplace encountered in maintaining 

adherence and are there any particularly 

successful ways you have found to 

maintain adherence (e.g., training 

initiatives, worker incentives)? Please 

discuss any underlying factors that you 

feel may affect non-compliance with 

current infection control guidelines and 

standards in your facility. 

22. The use of proper PPE is an 

essential component of an effective IC 

program. For example, CDC/HICPAC 

recommends that facemasks (e.g., 

surgical masks) be worn by workers 

when droplet precautions are 

implemented and respirators be worn 

under certain circumstances when 

airborne precautions are in place. Please 

describe how your workplace 

determines when a facemask (e.g., 

surgical mask) is used for worker 

protection and when a respirator is used 

for worker protection. How does your 

workplace determine which employees 

use a facemask and which use a 

respirator? If your workplace uses 

different types of respirators, please 

describe what types and when they are 

used. 

23. NIOSH regulates the testing and 

certification of respiratory protective 

equipment, has established minimum 

performance standards, and conducts 

independent testing and verification of 

all respirators prior to certification. The 

Food and Drug Administration (FDA) 

approval process for facemasks does not 

have established minimum performance 

standards and allows manufacturer 

submitted data. As noted in a 2009 IOM 

report,54 a 2008 study that examined the 

filter performance of nine different 

types of facemasks using the sodium 

chloride NIOSH challenge test, found 

wide variation in penetration (4 percent 

to 90 percent) of smaller aerosol 

particles.55 Therefore, the protective 

properties of different manufacturers’ 

facemasks may vary. Is there a need for 

a more rigorous certification/approval 

process for facemasks and additional 

independent verification of the personal 

protective properties of these devices? 

24. Some HCWs have medical 

conditions or are receiving treatments 

that impair their ability to resist 

infection. These HCWs may be unable to 

develop protective immune responses 

after vaccination. What is your 

workplace or industry doing to educate 

its workers about these conditions? 

What approaches are being used or 

should be used to address the special 

needs of HCWs with these conditions? 

D. Vaccination and Post-Exposure 

Prophylaxis 

25. In the Bloodborne Pathogens 

standard (§ 1910.1030), OSHA requires 

that hepatitis B vaccinations be made 

available to employees occupationally 

exposed to blood or other body fluids. 

It should be noted that while employers 

are required to offer the vaccine, 

employees are permitted to decline it. 

CDC/ACIP recommends a number of 

other vaccines for various groups of 

HCWs including: influenza (both 

seasonal and the 2009 H1N1); measles, 

mumps, rubella (MMR); varicella; 

tetanus, diphtheria, pertussis (Td/Tdap); 

and meningococcal vaccines. What 

vaccinations, other than hepatitis B, do 

you consider to be necessary to protect 

workers from occupational exposure to 

infectious agents? Who should receive 

these vaccinations, and why? Does your 

workplace offer vaccines other than the 

hepatitis B vaccine to workers and how 

do you determine who is offered these 

vaccines? 

26. The Bloodborne Pathogens 

standard (§ 1910.1030) requires that 

employers follow certain administrative 

and recordkeeping procedures (e.g., 

signing a declination statement; placing 


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an employee’s vaccination status in his/ 

her medical record). Does your 

workplace or industry use similar 

administrative and recordkeeping 

procedures for vaccines other than 

hepatitis B? If not, please describe what 

administrative and recordkeeping 

procedures are or should be used. 

27. Post-exposure prophylaxis (PEP) 

and evaluation for bloodborne pathogen 

exposures, such as hepatitis B and HIV, 

are addressed in the Bloodborne 

Pathogens standard [§ 1910.1030(f)]. 

OSHA is interested in post-exposure 

evaluation and PEP for other infectious 

diseases. Please describe the current 

PEP and evaluation practices in your 

workplace. For what infectious agent 

exposures should workers be provided 

with PEP and/or evaluation? Please 

describe the disease, its associated PEP, 

and the PEP efficacy. 

28. In some instances, a vaccine may 

be available for a disease but a worker 

may decline vaccination. Please 

describe procedures in your workplace 

that ensure workers who have declined 

vaccination have access to necessary 

PEP. 

29. In order to appropriately evaluate 

the health status of a worker, some basic 

health information is needed. CDC/ 

HICPAC recommends a personnel 

health service program for infection 

control that includes a number of 

components including: pre-placement 

evaluations, evaluation and treatment of 

exposure-related illnesses, and work 

restriction or work-exclusion policies 

for exposed HCWs. OSHA is interested 

in the prevalence, content and efficacy 

of such personnel health service 

programs. 

(a) What should be included in a preplacement medical evaluation for a 

worker who will be exposed to 

infectious agents? Please describe the 

possible components of the medical 

history and physical exam and specific 

tests (e.g., TB skin test, spirometry, 

blood tests). How are pre-placement 

medical evaluations of workers 

addressed in your workplace? What do 

these evaluations include? If preplacement medical evaluations are used 

in your workplace, have they been 

effective, and what metrics are used to 

evaluate effectiveness? Give the 

rationale, including references if 

available. 

(b) What type of ongoing medical 

surveillance or periodic medical 

evaluations should be provided for 

exposed workers? Please describe the 

possible components of such 

surveillance or evaluations. How often 

should periodic medical evaluations be 

conducted? In what situations should 

medical evaluations or surveillance be 

performed (e.g., return-to-work, fitness 

for duty)? How are periodic medical 

evaluations addressed in your 

workplace? 

(c) In your State, are there State laws 

that apply to pre-placement and 

periodic medical evaluations of exposed 

workers? If so, what are they? 

(d) Please describe the administrative 

procedures used by your workplace to 

evaluate and treat workers who have 

been occupationally exposed and/or 

infected (e.g., who do they notify of the 

exposure/infection). How are the costs 

for treatment and follow-up (e.g., visits 

to physician, lab tests) handled in your 

workplace? If a worker is put on 

restrictions or excluded from work due 

to a work-related infectious exposure or 

illness, how are the worker’s salary, 

benefits, and seniority handled by your 

workplace? 

E. Communication of Hazards 

30. Training is generally considered a 

necessary component of an effective IC 

program in order to assure that workers 

understand the hazards they are 

exposed to and the proper methods of 

protection. Please describe how your 

workplace assures that workers are 

adequately trained in the use of 

infection control measures, including 

how your workplace assesses if a worker 

has been adequately trained. Please 

describe the contribution of training and 

education to improving adherence to 

your IC program. Please describe the 

format used by your workplace to 

conduct training (e.g., computer-based, 

written material, interactive classes, 

hands-on practice, other) and whether 

you have found some more effective 

than others. Please describe what role, 

if any, knowledge and/or competency 

assessment plays in your workplace 

training program. 

31. Both initial and periodic worker 

training are recognized as important 

components of an effective IC program. 

Initial training provides information 

that workers need to protect themselves 

against exposures to hazards while 

periodic training refreshes worker 

knowledge, reinforces the importance of 

the IC program and provides a means of 

introducing new information and 

procedures. 

(a) What information should be 

included in initial training for workers 

who may be exposed to infectious 

agents? What is the best format for 

providing initial training to these 

workers (e.g., specifying a minimum 

number of hours of training, specifying 

training content based on job tasks, 

specifying that training be adequate to 

demonstrate specified competencies, by 

a combination of these methods or by 

some other method)? 

(b) How frequently does your 

workplace provide workers with 

refresher training on its IC program? 

What information should be included in 

periodic refresher training for workers 

who may be exposed to infectious 

agents? What is the best format for 

providing periodic training to these 

workers (e.g., specifying a minimum 

number of hours of training, specifying 

training content based on job tasks, 

specifying that training be adequate to 

demonstrate specified competencies, by 

a combination of these methods or by 

some other method)? Should refresher 

training be provided based on lack of 

competency, or be provided at regular 

time intervals regardless of 

demonstrated competency? 

F. Recordkeeping 

32. Please describe the worker health 

surveillance system used in your 

workplace. Does the system include 

tracking of occupational exposures to 

infectious agents and/or occupationallyacquired infectious diseases? Please 

describe the procedures used by your 

workplace to determine whether an 

infectious disease is considered to have 

been occupationally-acquired. How is 

the worker health surveillance 

information collected under the system 

used in your IC program? Please 

describe the factors that affect the 

successful implementation of such 

surveillance systems. 

33. The OSHA requirements for 

recording and reporting occupational 

injuries and illnesses contain an 

exemption for the common cold and flu 

(§ 1904.5(b)(2)(viii)). However, the 

Agency has determined that, if certain 

criteria are met, occupationally-acquired 

2009 H1N1 pandemic influenza is 

recordable (OSHA Directive CPL–02– 

02–075). As OSHA more broadly 

considers the issue of occupational 

exposure to infectious agents, what are 

the implications, if any, for the Agency’s 

existing recording and reporting 

requirements under § 1904? 

G. Economic Impacts and Benefits 

As part of the Agency’s consideration 

of occupational exposure to infectious 

agents, OSHA is interested in the costs, 

economic impacts, and benefits of 

related practices to prevent such 

exposure. OSHA is also interested in the 

benefits of such practices in terms of 

reduced deaths, illnesses, and 

compromised operations (i.e., infirm 

personnel, quarantined or disabled 

units, unexpected reallocation of 

resources). The following questions will 


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provide OSHA with needed economic 

impact and benefits information. 

34. As the Agency considers possible 

actions to address the prevention and 

control of infectious diseases (e.g., 

prospective standards or guidelines), 

what are the potential economic impacts 

associated with the promulgation of a 

standard specific to the hazards of 

infectious diseases? Describe these 

impacts in terms of benefits from the 

reduction of incidents and illnesses; 

effects on revenue and profit; and any 

other relevant impact measure. If you 

have any estimates of the costs of 

controlling infectious disease hazards, 

please provide them. 

35. What changes, if any, in market 

conditions would reasonably be 

expected to result from issuing a 

comprehensive infectious diseases 

standard? Describe any changes in 

market structure or concentration, and 

any effects on services, that would 

reasonably be expected from issuing 

such a standard. 

36. What are the potential benefits of 

more widespread compliance with 

infection control guidelines? How can 

OSHA best assure such compliance 

takes place? 

H. Impacts on Small Entities 

As part of the Agency’s consideration 

of occupational exposure to infectious 

agents, OSHA is concerned whether its 

actions will have a significant economic 

impact on a substantial number of small 

entities. If the Agency pursues 

development of a standard and the 

standard has such impacts, OSHA is 

required to develop a regulatory 

flexibility analysis and assemble a Small 

Business Regulatory Enforcement 

Fairness Act (SBREFA) Panel prior to 

publishing a proposal. Regardless of the 

significance of the impacts, OSHA seeks 

ways of minimizing the burdens on 

small businesses consistent with 

OSHA’s statutory and regulatory 

requirements and objectives. 

37. How many, and what type of 

small firms, or other small entities, have 

infectious disease hazards, and what 

percentage of their industry (NAICS 

code) do these entities comprise? Please 

specify the types of infectious diseases 

encountered. 

38. How, and to what extent, would 

small entities in your industry be 

affected by a potential comprehensive 

OSHA infectious diseases standard 

regulating occupational exposure to 

infectious agents? Do special 

circumstances exist that make 

controlling infectious diseases more 

difficult or more costly for small entities 

than for large entities? Describe these 

circumstances. 

III. Public Participation 

You may submit comments in 

response to this document by (1) hard 

copy, (2) fax transmission (facsimile), or 

(3) electronically through the Federal 

Rulemaking Portal. Because of securityrelated problems, there may be a 

significant delay in the receipt of 

comments by regular mail. Contact the 

OSHA Docket Office at (202) 693–2350 

for information about security 

procedures concerning the delivery of 

materials by express delivery, hand 

delivery and messenger service. 

All comments and submissions are 

available for inspection and copying at 

the OSHA Docket Office at the above 

address. Comments and submissions are 

also available at http:// 

www.regulations.gov . OSHA cautions 

you about submitting personal 

information such as social security 

numbers and birth dates. Contact the 

OSHA Docket Office at (202) 693–2350 

for information about accessing 

materials in the docket. 

Electronic copies of this Federal 

Register notice, as well as news releases 

and other relevant documents, are 

available at OSHA’s Web page: http:// 

www.osha.gov/index.html. 

Authority and Signature 

This document was prepared under 

the direction of David Michaels, Ph.D., 

MPH, Assistant Secretary of Labor for 

Occupational Safety and Health, U.S. 

Department of Labor. It is issued 

pursuant to sections 4, 6, and 8 of the 

Occupational Safety and Health Act of 

1970 (29 U.S.C. 653, 655, 657), 29 CFR 

1911, and Secretary’s Order 5–2007 (72 

FR 31160). 

Signed at Washington, DC, this 30th day of 

April, 2010. 

David Michaels, 

Assistant Secretary of Labor for Occupational 

Safety and Health. 

Footnotes: 

1U.S. Bureau of Labor Statistics. 

Occupational Employment Statistics. 2007. 

(http://data.bls.gov/cgi-bin/print.pl/oes/ 

2007/may/naics3_622000.htm). 2U.S. Bureau of Labor Statistics. 

Occupational Employment Statistics. 1998. 

(http://www.bls.gov/oes/oes_dl.htm). 3U.S. Bureau of Labor Statistics. 

Occupational Employment Statistics. 2008. 

(http://www.bls.gov/oes/2008/may/ 

naics3_622000.htm). 4Siegel JD, Rhinehart E, Jackson M, 

Chiarello L, and the Healthcare Infection 

Control Practices Advisory Committee, 2007 

Guideline for Isolation Precautions: 

Preventing Transmission of Infectious Agents 

in Healthcare Settings. Page 15. (http:// 

www.cdc.gov/ncidod/dhqp/pdf/ 

isolation2007.pdf). 5 Ibid. Page 17. 

6 Ibid. 

7Bolyard EA et al. and the Healthcare 

Infection Control Practices Advisory 

Committee. Guideline for Infection Control in 

Health Care Personnel, 1998. Page 292. 

(http://www.cdc.gov/ncidod/dhqp/pdf/ 

guidelines/InfectControl98.pdf). 8Smith PW, et al. SHEA/APIC Guideline: 

Infection prevention and control in the longterm care facility. Am J Infect Control 2008, 

36:504–535. 9 Ibid. 

10Tarrac SE. Application of the updated 

CDC isolation guidelines for health care 

facilities. AORN Journal. 2008. 87:534–542. 11CMS Manual System. State Operations 

Provider Certification. Transmittal 51. 

Department of Health & Human Services 

(DHHS) Centers for Medicare & Medicaid 

Services (CMS) Publication 100–07. July 20, 

2009. (http://www.cms.hhs.gov/transmittals/ 

downloads/R51SOMA.pdf). 12The Joint Commission: Infection Control 

Prevention and Control. 2009. 13Siegel JD, Rhinehart E, Jackson M, 

Chiarello L, and the Healthcare Infection 

Control Practices Advisory Committee, 2007 

Guideline for Isolation Precautions: 

Preventing Transmission of Infectious Agents 

in Healthcare Settings. (http://www.cdc.gov/ 

ncidod/dhqp/pdf/isolation2007.pdf). 14 Klevens RM et al, Estimating health careassociated infections and deaths in U.S. 

hospitals in 2002. Public Health Rep. 2007, 

122:160–166. 15Siegel JD, Rhinehart E, Jackson M, 

Chiarello L, and the Healthcare Infection 

Control Practices Advisory Committee, 2007 

Guideline for Isolation Precautions: 

Preventing Transmission of Infectious Agents 

in Healthcare Settings. (http://www.cdc.gov/ 

ncidod/dhqp/pdf/isolation2007.pdf). 16 Ibid. 17WHO Guidelines on Hand Hygiene in 

Health Care: A Summary. First Global Patient 

Safety Challenge: Clean Care is Safer Care. 

2009. World Health Organization, 

Switzerland. (http://whqlibdoc.who.int/ 

publications/2009/9789241597906_eng.pdf). 18Allegranzi B and Pittet D. Role of hand 

hygiene in healthcare-associated infection 

prevention. J Hosp Infect. 2009. 73:305–315. 19Turnberg W, et al. Appraisal of 

recommended respiratory infection control 

practices in primary care and emergency 

department settings. Am J Infect Control. 

2008. 36:268–275. 20Turnberg W, et al. Personal healthcare 

worker (HCW) and work-site characteristics 

that affect HCWs’ use of respiratory infection 

control measures in Ambulatory Healthcare 

Settings, Infect. Control Hosp Epidemiol. 

2009. 30:47–52. 21 Daugherty EL, et al. Use of personal 

protective equipment for control of influenza 

among critical care clinicians: A survey 

study. Crit Care Med. 2009. 37:1210–1216. 22Harriman K, et al. 2009 Novel influenza 

A (H1N1) virus infections among health-care 

personnel—United States, April–May. 

MMWR. 2009. 58:641–645. (http:// 

www.cdc.gov/mmwr/preview/mmwrhtml/ 

mm5823a2.htm). 23Siegel JD, Rhinehart E, Jackson M, 

Chiarello L, and the Healthcare Infection 

Control Practices Advisory Committee, 2007 


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24844 Federal Register / Vol. 75, No. 87 / Thursday, May 6, 2010 / Proposed Rules 

Guideline for Isolation Precautions: 

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[FR Doc. 2010–10694 Filed 5–5–10; 8:45 am] 

BILLING CODE 4510–26–P 

ENVIRONMENTAL PROTECTION 

AGENCY 

40 CFR Part 52 

[EPA–R10–OAR–2008–0155; FRL–9144–8 ] 

Approval and Promulgation of State 

Implementation Plans: Oregon 

AGENCY: Environmental Protection 

Agency (EPA). 

ACTION: Proposed rule. 

SUMMARY: The EPA is proposing to 

approve State Implementation Plan 

(SIP) revisions submitted by the State of 

Oregon, Department of Environmental 

Quality (ODEQ). These revisions pertain 

to the Clean Air Act (CAA) section 

110(a)(1) maintenance plans prepared 

by ODEQ to maintain the 8-hour 

national ambient air quality standard 

(NAAQS) for ozone in the Portland 

portion of the Portland/Vancouver Air 

Quality Maintenance Area (Pdx/Van 

AQMA) and the Salem-Keizer Area 

Transportation Study (SKATS) air 

quality area. The 110(a)(1) maintenance 

plans for this area meet CAA 

requirements and demonstrate that each 

of the above mentioned areas will be 

able to remain in attainment for the 

1997 and 2008 8-hour ozone NAAQS 

through 2015. As SKATS appears to be 

significantly impacted by emissions 

from the Portland area, an approved 

plan for the Pdx/Van AQMA is one of 

the control strategies for SKATS air 

quality area. Therefore, EPA is 

proposing to approve the section 

110(a)(1) plans for the Portland portion 

of the Pdx/Van AQMA and the SKATS 

area at the same time. 

Additionally, the EPA is proposing to 

approve SIP revisions submitted by 

ODEQ that phase out the State’s Vehicle 

Inspection Program (VIP) enhanced 

BAR–31 test, and eliminate the Gas Cap 

Pressure Test and the Evaporative Purge 

Tests. 

DATES: Written comments must be 

received on or before June 7, 2010. 

ADDRESSES: Submit your comments, 

identified by Docket ID No. EPA–R10– 


emcdonald on DSK2BSOYB1PROD with PROPOSALS