[MCOH-EH] [EXTERNAL] Re: Holding Blood for HIV testing for 90 days

[Hodgson, Michael - OSHA]

Hi, thanks for the inquiry, I asked Sheila Arbury, RN, MPH, our go-to BBP staffer.  She pulled out one interpretation letter on this subject. It upholds the 90-day preservation rule.  Waiting to hear back from enforcement, but it’s not clear whether OSHA has actually ever cited someone for the failure to follow the law.  Letter of July 16,2008:

Background: OSHA's Occupational Exposure to Bloodborne Pathogens standard addresses the requirement for blood testing as part of a post exposure evaluation at 29 CFR 1910.1030(f)(3)(iii)(B). The standard states: "If the employee consents to baseline blood collection, but does not give consent at that time for HIV serologic testing, the sample shall be preserved for at least 90 days. If, within 90 days of the exposure incident, the employee elects to have the baseline sample tested, such testing shall be done as soon as feasible" (boldface added).

Question: It is our experience that laboratories will typically only store a blood sample for 7-30 days. Following a work-related bloodborne pathogens exposure incident, if an employee consents to baseline blood collection, but does not give consent at that time for HIV serologic testing, is it permissible for the employer to have the employee sign a consent verifying their understanding of the lab's procedure of the 30-day storage time frame?

Reply: No, an employer may not have employees sign a consent form waiving the right to have untested baseline blood maintained for the minimum time limitation of 90 days. According to the preamble to the final rule, the Centers for Disease Control and Prevention (CDC) stated, "the worker should be advised to report and seek medical evaluation for any acute febrile illness that occurs within 12 weeks after the exposure. Such an illness, particularly one characterized by fever, rash, or lymphadenopathy, may be indicative of recent HIV infection." The preamble adds: "CDC has further stated that the first 6-12 weeks are 'when most infected persons are expected to seroconvert' (Ex. 15, MMWR 1989; 38 [No. S-6]:13)." The final rule specifically provides that untested baseline blood samples be preserved for at least 90 days in order to account for the 12 week post-exposure period when an acute retroviral illness may develop and to afford the employee the opportunity to know his/her immediate post-exposure HIV status even if consent for HIV testing was initially withheld. [56 Federal Register 64159 (1991).]

https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=27199


Sheila Arbury, RN, MPH
Office of Occupational Medicine and Nursing


From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Kathy.Dayvault at dekalbmedical.org<mailto:Kathy.Dayvault at dekalbmedical.org>
Sent: Monday, September 11, 2017 8:50 AM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Cc: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>>
Subject: [EXTERNAL] Re: [MCOH-EH] Holding Blood for HIV testing for 90 days

His only response was that he realized holding blood for 90 days would be problematic.

Dr. Hodgson,  OSHA Director or Occupational Medicine and Nursing,  is probably the best to weigh in.

Dr. Hodgson....any thoughts about the portion of the BBP standard in regards to holding blood for 90 days in the even the exposed person changes their mind about testing?

Thanks,

Kathy Dayvault, RN, BSN, MPH
 Manager, Occupational Health and Safety
 WorksWell Onsite
 Dekalb Medical  2701 North Decatur Road
 Decatur, GA 30033
ph: 404.501.4972 Fax:404-501-2045
kathy.dayvault at dekalbmedical.org<mailto:kathy.dayvault at dekalbmedical.org>




From:        Amy Olson <aolson9 at jhmi.edu<mailto:aolson9 at jhmi.edu>>
To:        'MCOH/EH' <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>,
Date:        09/11/2017 10:58 AM
Subject:        Re: [MCOH-EH] Holding Blood for HIV testing for 90 days
Sent by:        "MCOH-EH" <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>>
________________________________



Kathy,
Out of curiosity, what was the OSHA response?
AO

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Kathy.Dayvault at dekalbmedical.org<mailto:Kathy.Dayvault at dekalbmedical.org>
Sent: Monday, September 11, 2017 10:49 AM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Cc: MCOH-EH <mcoh-eh-bounces+kathy.dayvault=dekalbmedical.org at mylist.net<mailto:mcoh-eh-bounces+kathy.dayvault=dekalbmedical.org at mylist.net>>
Subject: Re: [MCOH-EH] Holding Blood for HIV testing for 90 days

We do not have the capacity in our lab to hold samples and I have had this conversation with an OSHA representative earlier this year.

We strongly encourage employees at the time to go and have their blood drawn, around 90 % of them do.

Technology has advanced, and if they came back requesting labs, we would draw them and perform viral loads on anything positive.

It might not be the best solution especially if the viral load comes into question,  we may end up owning it from a WC perspective, after lots of conversation with an ID.

Thanks,

Kathy Dayvault, RN, BSN, MPH
Manager, Occupational Health and Safety
WorksWell Onsite
Dekalb Medical  2701 North Decatur Road
Decatur, GA 30033
ph: 404.501.4972 Fax:404-501-2045
kathy.dayvault at dekalbmedical.org<mailto:kathy.dayvault at dekalbmedical.org>




From:        "Thrasher, Terri" <Terri.Thrasher at cchmc.org<mailto:Terri.Thrasher at cchmc.org>>
To:        MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>,
Date:        09/11/2017 10:18 AM
Subject:        Re: [MCOH-EH] Holding Blood for HIV testing for 90 days
Sent by:        "MCOH-EH" <mcoh-eh-bounces+kathy.dayvault=dekalbmedical.org at mylist.net<mailto:mcoh-eh-bounces+kathy.dayvault=dekalbmedical.org at mylist.net>>
________________________________




I interpreted it the same way.

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Amy Olson
Sent: Monday, September 11, 2017 8:13 AM
To: 'MCOH/EH' <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] Holding Blood for HIV testing for 90 days

Thanks for your response. I understand what you have described. The OSHA Standard states the following:
1910.1030(f)(3)(iii)(B)<https://www.osha.gov/pls/oshaweb/owalink.query_links?src_doc_type=STANDARDS&src_unique_file=1910_1030&src_anchor_name=1910.1030(f)(3)(iii)(B)>
If the employee consents to baseline blood collection, but does not give consent at that time for HIV serologic testing, the sample shall be preserved for at least 90 days. If, within 90 days of the exposure incident, the employee elects to have the baseline sample tested, such testing shall be done as soon as feasible.

Given that certain source testing results would lead to wanting to document baseline HIV status of the employee, it would seem that this particular section of the standard cannot be upheld if an employee actually had a blood draw and opted to NOT consent to HIV testing. Again, I have never encountered this, but it is a possibility and I am curious as to how people are addressing this. Am I missing something?
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Nancy Rodway
Sent: Monday, September 11, 2017 7:15 AM
To: 'MCOH/EH' <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] Holding Blood for HIV testing for 90 days

As a board certified pathologist and board certified occupational physician, your lab cannot exceed the 30 days without validity studies. And validity studies are cumbersome for the laboratorians.
Why hold them?  With post-exposure testing, the source results guide your clinical decision making pretty quickly.

Nancy Rodway MD MS MPH FASCP FCAP FACOEM


Sent from Outlook<http://aka.ms/weboutlook>

________________________________


From: MCOH-EH <mcoh-eh-bounces+nrodway=hotmail.com at mylist.net<mailto:mcoh-eh-bounces+nrodway=hotmail.com at mylist.net>> on behalf of Amy Olson <aolson9 at jhmi.edu<mailto:aolson9 at jhmi.edu>>
Sent: Monday, September 11, 2017 5:59 AM
To: 'MCOH/EH'
Subject: [MCOH-EH] Holding Blood for HIV testing for 90 days

Happy Monday from Florida,
Our hospital is doing well in St. Petersburg. Many thanks to people who have reached out.

As I wait for the sun to rise, I’m going through some things and I have a question. As I understand the BBP standard, we are required to hold an employee’s blood for 90 days so they could decide at a future date to have it tested for HIV. I have yet to run into a situation where an employee deferred testing, but now that I have direct responsibility for the Exposure Control Plan, I have more interest in ensuring what is written is something we can deliver. Our lab is continuing to research, but when I posed the question about holding blood and testing within 90 days, this is the response I got: “It’s not that we can’t hold a sample for 90 days. There isn’t a commercial ref lab that has validated this particular testing for a sample >30 days old. That seems to be the dilemma for HIV ½ analysis.”

What are other people doing? Am I misinterpreting the standard?

Thank you,
Amy Olson
Director, Employee Health and Wellness---------------------------------------
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