Cal/OSHA recently adopted a new standard, T8 CCR § 5199, regulating employee exposure to aerosol transmissible diseases (ATDs). These diseases can be spread through the air in the form of small particles or droplets. Influenza, tuberculosis, and severe acute respiratory syndrome (SARS) are just a few examples of aerosol transmissible diseases. The standard became effective August 5, 2009.
An Aerosol Transmissible Disease (ATD) or Aerosol Transmissible Pathogen (ATP) is a disease or pathogen for which droplet or airborne precautions are recommended. These are listed in Appendix A of the standard (see below).
Aerosol Transmissible Pathogen -- Laboratory (ATP-L). A pathogen that meets one of the following criteria: (1) the pathogen appears on the list in Appendix D, (2) the Biosafety in Microbiological and Biomedical Laboratories (BMBL) recommends biosafety level 3 or above for the pathogen, (3) the biological safety officer recommends biosafety level 3 or above for the pathogen, or (4) the pathogen is a novel or unknown pathogen.
T8 CCR § 5199 Aerosol Transmissible Diseases has ten sections.
(a) Scope and Application – The standard covers:
Health care facilities: hospitals, skilled nursing facilities, clinics, medical offices, and other outpatient medical facilities, home health care, public health services, long term health care facilities and hospices, medical outreach services, paramedic and emergency medical services including these services when provided by firefighters and other emergency responders, medical transport, and facilities where high hazard procedures are performed. Also,
Occupational exposure to animals infected by aerosol transmissible pathogens is covered by a separate, newly adopted standard, T8 CCR § 5199.1 Aerosol Transmissible Diseases – Zoonotic. See the Aerosol Transmissible Diseases – Zoonotic Loss Control Bulletin.
The following are not covered:
(b) Definitions: The standard contains 59 definitions
(c) Referring Employers: A Referring Employer provides initial treatment only, does not treat people with ATDs, but only screens them. A Referring Employer does not transport, house or provide airborne infection isolation to patients infected with suspected ATDs, but only refers them to facilities that do treat them. (See the Aerosol Transmissible Diseases – Referring Employers Loss Control Bulletin)
(d) Aerosol Transmissible Diseases Exposure Control Plan
Certain employers must write an ATD Exposure Control Plan [except certain laboratories may write a Biosafety Plan]
(e) Engineering and Work Practice Controls and Personal Protective Equipment
Employers must use feasible engineering and work practice controls to minimize employee exposures to ATPs. Where engineering and work practice controls do not provide sufficient protection, the employer shall provide respiratory protection and/or other personal protective equipment. Guidance from the Centers for Disease Control and Prevention must be used, such as Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings.
(f) Laboratories – applies to laboratory operations where employees perform procedures capable of aerosolizing ATPs-L or zoonotic aerosol transmissible pathogens as defined in Section 5199.1. (See Aerosol Transmissible Diseases – Laboratories Loss Control Bulletin)
(g) Respiratory Protection
The standard specifies which respirators must be used. A minimum of an N95 filtering facepiece must be used for routine occupationally exposed tasks. As of September 1, 2010, high hazard procedures with possible ATD exposure must be done using a powered air-purifying respirator (PAPR) with a High Efficiency Particulate Air (HEPA) filter(s), or a respirator that provides equivalent or greater protection unless there are effective engineering controls. There is an exception to the PAPR requirement when the employer determines that the use of a PAPR would interfere with the procedure being performed. The justification for the exception must be documented in writing. Paramedics and EMTs may use a P100 respirator.
When respirators are required, the employer must establish and implement a written respiratory protection program in accordance with T8 CCR § 5144 Respiratory Protection. (In some instances, an alternate medical questionnaire to the one in Section 5144 can be used). Also, until January 1, 2014, in some cases fit testing may be conducted every two years after the initial fit-testing has been done.
(h) Medical Services
Each employer who has any employee with occupational exposure to ATDs or infection with ATPs or ATPs-L shall provide the employee with medical services in accordance with applicable public health guidelines for the type of work setting and disease. These services may include vaccinations, tests, post-exposure follow-up (including treatment), latent tuberculosis infection testing, and precautionary removal.
The standard outlines the training that employees with occupational exposure must receive, including training on the employer’s ATD Exposure Control Plan and/or Biosafety Plan. Training must be provided at least annually. Dental clinics and outpatient medical specialty practices not covered by the standard must be trained in screening procedures in accordance with their Injury and Illness Prevention Program (IIPP).
The employer must keep medical records, training records and other records related to the implementation of the ATD Plan and/or Biosafety Plan.
Employers are encouraged to refer to the regulations and any guidance documents Cal/OSHA may have available at www.dir.ca.gov/dosh. You may also contact your State Fund Loss Control Consultant and ask for an industrial hygiene consultation.
The above evaluations and/or recommendations are for general guidance only and should not be relied upon for legal compliance purposes. They are based solely on the information provided to us and relate only to those conditions specifically discussed. We do not make any warranty, expressed or implied, that your workplace is safe or healthful or that it complies with all laws, regulations or standards.