1-1 By: Bernsen S.B. No. 905 1-2 (In the Senate - Filed March 4, 1999; March 8, 1999, read 1-3 first time and referred to Committee on Health Services; 1-4 May 7, 1999, reported adversely, with favorable Committee 1-5 Substitute by the following vote: Yeas 4, Nays 0; May 7, 1999, 1-6 sent to printer.) 1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 905 By: Madla 1-8 A BILL TO BE ENTITLED 1-9 AN ACT 1-10 relating to the standards for occupational exposure of public 1-11 employees to bloodborne pathogens. 1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-13 SECTION 1. Chapter 81, Health and Safety Code, is amended by 1-14 adding Subchapter H to read as follows: 1-15 SUBCHAPTER H. BLOODBORNE PATHOGEN EXPOSURE CONTROL PLAN 1-16 Sec. 81.301. DEFINITIONS. In this subchapter: 1-17 (1) "Bloodborne pathogens" means pathogenic 1-18 microorganisms that are present in human blood and that can cause 1-19 diseases in humans. The term includes hepatitis B virus, hepatitis 1-20 C virus, and human immunodeficiency virus. 1-21 (2) "Engineered sharps injury protection" means: 1-22 (A) a physical attribute that is built into a 1-23 needle device used for withdrawing body fluids, accessing a vein or 1-24 artery, or administering medications or other fluids and that 1-25 effectively reduces the risk of an exposure incident by a 1-26 mechanism such as barrier creation, blunting, encapsulation, 1-27 withdrawal, retraction, destruction, or another effective 1-28 mechanism; or 1-29 (B) a physical attribute built into any other 1-30 type of needle device, into a nonneedle sharp, or into a nonneedle 1-31 infusion safety securement device that effectively reduces the risk 1-32 of an exposure incident. 1-33 (3) "Governmental unit" means: 1-34 (A) this state and any agency of the state, 1-35 including a department, bureau, board, commission, or office; 1-36 (B) a political subdivision of this state, 1-37 including any municipality, county, or special district; and 1-38 (C) any other institution of government, 1-39 including an institution of higher education. 1-40 (4) "Needleless system" means a device that does not 1-41 use a needle and that is used: 1-42 (A) to withdraw body fluids after initial venous 1-43 or arterial access is established; 1-44 (B) to administer medication or fluids; or 1-45 (C) for any other procedure involving the 1-46 potential for an exposure incident. 1-47 (5) "Sharp" means an object used or encountered in a 1-48 health care setting that can be reasonably anticipated to penetrate 1-49 the skin or any other part of the body and to result in an exposure 1-50 incident, including a needle device, a scalpel, a lancet, a piece 1-51 of broken glass, a broken capillary tube, an exposed end of a 1-52 dental wire, or a dental knife, drill, or bur. 1-53 (6) "Sharps injury" means any injury caused by a 1-54 sharp, including a cut, abrasion, or needlestick. 1-55 Sec. 81.302. APPLICABILITY OF SUBCHAPTER. This subchapter 1-56 applies only to a governmental unit that employs employees who: 1-57 (1) provide services in a public or private facility 1-58 providing health care-related services, including a home health 1-59 care organization; or 1-60 (2) otherwise have a risk of exposure to blood or 1-61 other material potentially containing bloodborne pathogens in 1-62 connection with exposure to sharps. 1-63 Sec. 81.303. EXPOSURE CONTROL PLAN. The department shall 1-64 establish an exposure control plan designed to minimize exposure of 2-1 employees described by Section 81.302 to bloodborne pathogens. In 2-2 developing the plan, the department must consider: 2-3 (1) policies relating to occupational exposure to 2-4 bloodborne pathogens; 2-5 (2) training and educational requirements for 2-6 employees; 2-7 (3) measures to increase vaccinations of employees; 2-8 and 2-9 (4) increased use of personal protective equipment by 2-10 employees. 2-11 Sec. 81.304. MINIMUM STANDARDS. The board by rule shall 2-12 adopt minimum standards to implement the exposure control plan and 2-13 the other provisions of this subchapter. The rules shall be 2-14 analogous to standards adopted by the federal Occupational Safety 2-15 and Health Administration. Each governmental unit shall comply 2-16 with the minimum standards adopted under this subchapter. 2-17 Sec. 81.305. NEEDLELESS SYSTEMS. (a) The board by rule 2-18 shall recommend that governmental units implement needleless 2-19 systems and sharps with engineered sharps injury protection for 2-20 employees. 2-21 (b) The recommendation adopted under Subsection (a) does not 2-22 apply to the use of a needleless system or sharps with engineered 2-23 sharps injury protection in circumstances and in a year in which an 2-24 evaluation committee has established that the use of needleless 2-25 systems and sharps with engineered sharps injury protection will 2-26 jeopardize patient or employee safety with regard to a specific 2-27 medical procedure or will be unduly burdensome. A report of the 2-28 committee's decision shall be submitted to the department annually. 2-29 (c) At least half of the members of an evaluation committee 2-30 established by a governmental unit to implement Subsection (b) must 2-31 be employees who are health care workers who have direct contact 2-32 with patients or provide services on a regular basis. 2-33 (d) The rules adopted under Subsection (a) may not prohibit 2-34 the use of a prefilled syringe that is approved by the federal Food 2-35 and Drug Administration. This subsection expires May 1, 2003. 2-36 Sec. 81.306. SHARPS INJURY LOG. (a) The board by rule 2-37 shall require that information concerning exposure incidents be 2-38 recorded in a written or electronic sharps injury log to be 2-39 maintained by a governmental unit. This information must be 2-40 reported to the department and must include: 2-41 (1) the date and time of the exposure incident; 2-42 (2) the type and brand of sharp involved in the 2-43 exposure incident; and 2-44 (3) a description of the exposure incident, including: 2-45 (A) the job classification or title of the 2-46 exposed employee; 2-47 (B) the department or work area where the 2-48 exposure incident occurred; 2-49 (C) the procedure that the exposed employee was 2-50 performing at the time of the incident; 2-51 (D) how the incident occurred; 2-52 (E) the employee's body part that was involved 2-53 in the exposure incident; and 2-54 (F) whether the sharp had engineered sharps 2-55 injury protection and, if so, whether the protective mechanism was 2-56 activated and whether the injury occurred before, during, or after 2-57 the activation of the protective mechanism. 2-58 (b) Information regarding which recommendations under 2-59 Section 81.305(a) were adopted by the governmental unit shall be 2-60 included in the log. 2-61 Sec. 81.307. DEVICE REGISTRATION. (a) The department, in 2-62 accordance with rules adopted by the board, shall implement a 2-63 registration program for existing needleless systems and sharps 2-64 with engineered sharps injury protection. 2-65 (b) The department shall compile and maintain a list of 2-66 existing needleless systems and sharps with engineered sharps 2-67 injury protection that are available in the commercial marketplace 2-68 and registered with the department to assist governmental units to 2-69 comply with this subchapter. 3-1 (c) The department shall charge a fee to register a device 3-2 in an amount established by the board. The fees collected under 3-3 this section may be appropriated only to the department to 3-4 implement this subchapter. 3-5 SECTION 2. (a) Except as provided by Subsection (e) of this 3-6 section, this Act takes effect September 1, 1999. 3-7 (b) The Texas Board of Health shall adopt the exposure 3-8 control plan and the rules required by Subchapter H, Chapter 81, 3-9 Health and Safety Code, as added by this Act, not later than 3-10 September 1, 2000. 3-11 (c) Except as provided by Subsection (d) of this section, a 3-12 governmental unit, as defined by Subdivision (3), Section 81.301, 3-13 Health and Safety Code, as added by this Act, shall comply with 3-14 Subchapter H, Chapter 81, Health and Safety Code, as added by this 3-15 Act, not later than January 1, 2001. 3-16 (d) The Texas Department of Health may, in accordance with 3-17 rules adopted by the Texas Board of Health, waive the application 3-18 of Subchapter H, Chapter 81, Health and Safety Code, as added by 3-19 this Act, to a rural county if the department finds that the 3-20 application of the subchapter to the county would be unduly 3-21 burdensome. A waiver granted under this subsection expires 3-22 December 31, 2001. For purposes of this subsection, "rural county" 3-23 means a county that: 3-24 (1) has a population of 50,000 or less; or 3-25 (2) has a population of more than 50,000 but: 3-26 (A) does not have located within the county a 3-27 general or special hospital licensed under Chapter 241, Health and 3-28 Safety Code, with more than 100 beds; and 3-29 (B) was not, based on the 1990 federal census, 3-30 completely included within an area designated as urbanized by the 3-31 Bureau of the Census of the United States Department of Commerce. 3-32 (e) This Act takes effect only if a specific appropriation 3-33 for the implementation of this Act is provided in H.B. No. 1 3-34 (General Appropriations Act), Acts of the 76th Legislature, Regular 3-35 Session, 1999. If no specific appropriation is provided in H.B. 3-36 No. 1, the General Appropriations Act, this Act has no effect. 3-37 SECTION 3. In adopting the initial rules establishing the 3-38 duties of an evaluation committee under Subsection (c), Section 3-39 81.305, Health and Safety Code, as added by this Act, the Texas 3-40 Board of Health shall consider the duties of similar committees in 3-41 existence on the effective date of this Act. 3-42 SECTION 4. The importance of this legislation and the 3-43 crowded condition of the calendars in both houses create an 3-44 emergency and an imperative public necessity that the 3-45 constitutional rule requiring bills to be read on three several 3-46 days in each house be suspended, and this rule is hereby suspended. 3-47 * * * * *