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                                  * * * * *