OSHA, Laboratory Screening, and Office-Based Surgery

28 OSHA, Laboratory Screening, and Office-Based Surgery

Ruel A. Adajar

Summary

This chapter covers the topics that create a safe working environment in a hair transplant practice. Among the many regulations that Occupational Safety and Health Administration (OSHA) imposes, the blood-borne pathogen standards prove to be integral to ensure workplace safety, especially in the hair transplant setting due to the likelihood of constant and unavoidable exposure during surgery. These standards can be found in the OSHA website or their training manual. While blood-borne transmission of selected pathogens is briefly discussed in this chapter, the reader is referred to infectious disease texts for a more thorough discussion. Preoperative laboratory workup can be requested to screen for these pathogens and also to assess the general health of the patient when performed along with a thorough history and physical examination. There are opposing schools of thought as to the validity and need for such laboratory screening in hair restoration surgery. To further promote patient safety, in recent years, state governments have required that offices be accredited before they can perform procedures that require general anesthesia or moderate or deep sedation when the procedure is performed in an office setting. With these measures in place, the practice can ensure the general safety and well-being of the patient undergoing hair transplant surgery. Each practice should refer to their own state’s laws and regulations to assure compliance and avoid sanctions.

Keywords: OSHA hair transplantation blood-borne pathogens hepatitis B hepatitis C human immunodeficiency virus office-based surgery

Key Points

•The Occupational Safety and Health Administration enforces the guidelines and safety standards to ensure a safe environment for the health care staff and patients. Noncompliance may result in fines imposed on the practice. It also provides guidelines for postexposure management in case the safety standards are breached.

•Hepatitis B, hepatitis C, and human immunodeficiency virus are the main blood-borne pathogens that were identified to be risks for health care workers in terms of exposure and contracting the disease.

•Although subject to debate and different opinions, the requirement for preoperative laboratory testing or examinations deemed necessary by some doctors still depends on the discretion of the practitioner whether such tests need to be ordered.

•Survey and accreditation by the proper state agencies cover those office-based practices that utilize general anesthesia, moderate or deep sedation, and liposuction procedures done by a licensed practitioner where the procedure is done in a place other than a hospital. It is a must for the practice to contact their state’s department of health with regard to these standards.

28.1 Occupational Safety and Health Administration

The Occupational Safety and Health Administration (OSHA) was created to enforce the health and safety standards mandated by the Occupational Safety and Health Act of 1970 to provide a safe and healthy working environment for employers and employees through training, education, and assistance. The agency has prescribed standards that are strictly enforced and documented, which cover general safety in the workplace and are applicable to a hair restoration practice. Employers are mandated to provide training to all employees to ensure proper documentation of events, information dissemination, vaccination, and hazard communication. There are various private agencies that employers can utilize that provide OSHA training to employees to comply with the standards. Noncompliance may result in significant fines that were substantially increased in 2016.1

28.2 Blood-Borne Pathogens

In addition to general safety and well-being in the workplace, the blood-borne pathogens standard in the OSHA Training Manual applies to a hair restoration practice where employers and employees alike are at risk of contracting diseases from exposure to blood products. This covers hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), all of which upon exposure pose a risk for serious or life-threatening diseases.

Among the blood-borne pathogens, OSHA has listed HBV, HCV, and HIV as the main pathogens that can be transmitted in the workplace from exposure to infected blood. An in-depth discussion of each disease entity can be obtained from an infectious disease text or the medical literature. For the purpose of this chapter, a brief summary of each disease is presented.

28.2.1 Hepatitis B Virus Infection

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