Subin, Kenneth MD ksubin at aomc.org
Wed Jun 18 10:06:18 PDT 2014

If I may ask, your process would seem to eliminate confidentiality
issues during the testing and reporting processes, but where do you
maintain record of the results?  And how do you "lock" those records
from unauthorized access?




Kenneth P. Subin, MD, MPH, CIME, CMRO

Clinical Medical Director

Occupational Medicine


Elmira, NY

(607) 737-4539

(607) 737-7783 fax


From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Cunha,
Bruce E.
Sent: Wednesday, June 18, 2014 12:38 PM


That is one of the reasons we do not use the Clinical lab and do not put
names on the lab slips.  (Our lab has an outreach process for providers
requesting labs from outside our system and these do not get into the
medical record system of our facility. We use this for our employee

By assuring no one but EHS knows who is being tested, we hopefully have
reduced the issue of someone in the lab seeing who the test is being run

Of course this also raises issues with our State public health.  Since
the lab reports all positive tests for HIV, Hep B and Hep C to public
health;  Public Health does not like that they cannot identify the
person that the positive result  is on. We have had multiple discussions
on this issue and try to notify public health as soon as we have a
reportable result that is confirmed positive.    


Bruce E. Cunha RN MS COHN-S

Manager, Employee Health and Safety

Marshfield Clinic

Marshfield WI.


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[mailto:mcoh-eh-bounces+cunha.bruce=marshfieldclinic.org at mylist.net] On
Behalf Of Swift, Melanie
Sent: Wednesday, June 18, 2014 11:24 AM


In my reading of it, the interpretive letter is not about the "separate
from personnel records" part as much as it is about "confidential, not
disclosed without written permission of employee." I don't think it was
about HIV stigma in particular. 


The question specifically put to them outlined the separate nature of
the medical record as distinct from personnel records, the need for a
secure log in, and the punishment associated with unauthorized viewing
of a coworker's record. Their response was that those protections only
kick in AFTER you catch someone looking at the record - but by then
they've seen it. So employees may not report if they know coworkers
technically have the ability to see their labs. They insisted on a
system that actually will not allow unauthorized people to see the


I have not seen any more recent interpretations. 


Here's how I see it: if I work in the lab and I am exposed, I can choose
to report it or not report it. We know underreporting is a big problem.
If I know that my coworkers in the lab are going to see my result come
through their system and say "Hey, that's Melanie! Oh, she had virology
testing done. Wonder what that was about" then I may be less inclined to
report, than if I know my results cannot be seen by them.


Melanie Swift, MD

Director, Vanderbilt Occupational Health Clinic



From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Fair,
Sent: Wednesday, June 18, 2014 11:10 AM


The section under medical records below only states that they must be
kept confidential and separate from other personnel records.  I still
have difficulty understanding how that means we have to code the HIV
testing because it is only kept in systems that ARE confidential and
separate from personnel records (HR has no access to this).  Since the
CDC recommends HIV testing on everyone between 16 and 64 yo, it appears
that the previous stigma attached to testing has been mitigated.  Does
OSHA have any relevant interpretation that is more recent than 12 years
ago?  What am I missing here? 

Susan Fair, MPAS, PA-C

Yale New Haven Hospital

Occupational Health Plus

New Haven, CT


From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Kathy
Sent: Tuesday, June 17, 2014 1:26 PM


Look at the blood borne pathogen exposure regulation. I use the hospital
etool.... It helps you find specifics faster.




BBP reg: https://www.osha.gov/SLTC/etools/hospital/hazards/bbp/bbp.html


*	Employer should establish and maintain both medical and training
records [29 CFR 1910.1030(h)(1)
S&p_id=10051>  and 29 CFR 1910.1020
S&p_id=10027> ]. 

	*	If an exposure incident occurs, employer should add
reports to the medical record to document the incident, including
testing results following the incident, follow-up procedures, and the
written opinion of the health care professional. 

		*	Medical Records must be preserved and maintained
for each employee with an occupational exposure to bloodborne pathogens
[29 CFR 1910.1030(h)(1)
S&p_id=10051#1910.1030(h)(1)> ] and for at least the duration of
employment plus 30 years. They must be kept confidential (not disclosed
without written permission of employee, except by law) and separate from
other personnel records and must also include: 

			*	The employee's name and social security
number, hepatitis B vaccination status, including the dates of
vaccination and medical records related to the employee's ability to
receive vaccinations.

Hope you find this helpful.... Very quick resource once you click on the
hazard that you want.



Kathy Dayvault, RN, BSN, MPH, COHN-S/CM


Independent OHN Consultant





From: MCOH-EH [mailto:mcoh-eh-bounces+kdayvault11=att.net at mylist.net] On
Behalf Of Senior, Cathy (DRMC)
Sent: Tuesday, June 17, 2014 1:08 PM


Can anyone direct me where I can find the OSHA regulation pertaining to
the Duty to ensure privacy of employees exposed to blood and body fluid.
I know some facility use psuedo names in order to protect their
employees privacy when the test are done in their facility.  I want to
do this, however our lab is not agreeable as they are not sure how to
register the employee and keep everything straight.   The lab informed
me that they checked the state regulations (we are in PA) and there is
nothing that says we must give psuedo names.  Therefore , I am looking
for any information that would assist my mission to provide privacy to
our employees.  I thought there was an OSHA regulation if the test was
done within the facility such as the rapid HIV suds test that we could
not use their name.  Can anyone direct me on this?

Cathy Senior RN BSN CDE

Employee Health Director

Penn Highlands DuBois

100 Hospital Avenue

P.O. Box 447

DuBois Pa 15801

Phone 814-375-3392

Fax 814-372-2610

cesenior at phhealthcare.org



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