Because all articles about OHSA should start out with a “fun fact,” here’s one; the Bloodborne Pathogens Standard was one of OSHA’s fastest developed major health standards! We all know how speedy the government is when it comes to making policy, so this should come as no surprise to you. In this case, it was actually pretty easy to create because several of the elements already existed, and they were able to roll it up into one single law.
So, once again, we find ourselves in the annals of administrative legal history to get an understanding into why we have the regulations that we do.
The Pre- Regulation Era (1970’s-1980’s)
Before HIV became the dominant public fear, Hepatitis B (HBV) was the primary occupational bloodborne risk. HBV is highly infectious and significantly more transmissible through blood exposure than HIV. By the late 1970s and early 1980s, CDC surveillance showed thousands of occupational infections annually. Healthcare workers had infection rates 10x higher than the general population. This included embalmers as well as people who worked with the living. The availability of the HBV vaccine (approved in 1981) created pressure for employers to implement vaccination programs which would be later mandated under OSHA.
Next, because body fluids are gross, in 1987 OSHA implemented Universal Precautions which (say it with me) is to treat everyone as if they were infected. Before that people were only treated as infectious when they had a diagnosis. Because HBV and HIV/AIDS infections were becoming more widespread, risk-based models were failing, so they needed a better plan. By labeling everything as infectious, we were now covered for anything that hadn’t been identified and everything that might be identified. Begrudgingly, embalmers everywhere started wearing gloves more often.
Concurrently, another factor was in play, and it can be summed up by my most sage advice as an embalming instructor. If the students who have embalmed with me were asked what wisdom I gave them resonated with them the most, it would invariably be “DON’T STAB TOWARDS YOURSELF!” In over a decade of embalming labs, this is the most important advice I can give because it was also one of the drivers of the Blood Borne Pathogens Standard as studies conducted by OSHA in the 1980’s revealed hundreds of thousands of needle stick injuries annually for healthcare workers including pathology workers, autopsy techs and funeral service professionals. Now OSHA emphasizes the use of engineering controls and work practice controls to minimize exposure, including avoiding the recapping of needles whenever possible, disposing of sharps immediately after use in approved puncture-resistant containers, and maintaining clear hand positioning to reduce accidental injury during procedures (DON’T STAB TOWARDS YOURSELF).
Culturally, there was also a shift from labor unions and public health associations. These groups pushed OSHA to create the rule by demanding enforceable standards, litigation, and congressional hearing. Without these groups, OSHA may have continued to offer simply voluntary suggestions. In 1987, a memo was released that discussed the expansion of the OSHA General Duty Clause into protecting workers from bloodborne diseases. The reasoning behind this is because OSHA was already losing lawsuits under the General Duty Clause. Just as a reminder, the General Duty Clause is the catch all enforcement tool used when no specific OSHA standard can be applied and it reads:
Each employer --
- shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees;
- shall comply with occupational safety and health standards promulgated under this Act.
- Each employee shall comply with occupational safety and health standards and all rules, regulations, and orders issued pursuant to this Act which are applicable to his own actions and conduct.
During this time there was a very high profile civil case Prego v. City of New York filed in 1988 over an incident that happened in 1983 when Dr. Veronica Prego contracted HIV from an infected needle when working at Kings County Hospital after the needle was improperly disposed of by another doctor after being used on an AIDS patient. Dr. Prego ultimately settled for 1.35 million dollars (3.3 million in 2026) in 1990 before the summations by the jury. The case drew public attention and is still referenced in works related to hospital safety.
Really makes you think about the way your needles may or may not just sit in your prep room sink with the other instruments, doesn’t it?
So now we have the skeletons of the Bloodborne Pathogen Standard, worker safety organizations, and a civil suit all coming together at once.
Time to make a Rule!
So everybody just agreed and the Bloodborne Pathogen Standard just appeared right?
Yeah, okay...
Although CDC guidance on Universal Precautions emerged in 1987, OSHA did not finalize the Bloodborne Pathogens Standard until 1991. This delay was not science’s fault (of course), it was political and bureaucratic (duh). The main issues were the Office of Management and Budget reviewing the economic impact, cost concerns about the burden on healthcare institutions, and whether the voluntary guidelines were sufficient. It was of course when the labor advocates got involved and argued that preventative measures would save things in the long run. Needlesticks, in particular, were preventable, and remember the second part of the General Duty Clause is aimed at the employee so by making something official not only could hold employers accountable but the workers as well.
The rulemaking phase of the Bloodborne Pathogens Standard during the mid-1980s through 1991 represented one of OSHA’s most complex regulatory efforts. Scientific collaboration with the Centers for Disease Control and Prevention ensured that the emerging infection-control model of “Universal Precautions” formed the technical foundation of the rule. However, development was far from smooth. Healthcare and industry stakeholders voiced strong opposition, particularly regarding compliance costs and concerns that personal protective equipment might interfere with patient care. OSHA received roughly 3,000 public comments and conducted five national hearings where more than 400 witnesses testified.
Believe it or not, in 1991, Congress actually did something for once, and inserted language into OSHA’s appropriations bill requiring that the rule be completed by a certain date. Extensive economic analysis, including surveys of thousands of workplaces such as funeral homes, was required to demonstrate that the standard was both necessary and feasible.
Thank goodness for elected officials who were too grossed out to vote against this and the requirement that the rule be completed by December 1991 was passed. It was indeed a Merry Christmas for embalmers everywhere.
The Cold War Declared Over, and Kevin McCallister was Lost in New York
1992 was indeed an amazing year, and in addition to the US victory over the Russians and arguably one of the best sequels of all time, in March of 1992, the Bloodborne Pathogen Standard took effect. Now, under the rule funeral homes had these responsibilities:
Exposure Control Plan (The Core Requirement)
Every funeral home with employees who have reasonably anticipated exposure must maintain a written Exposure Control Plan and it must:
Identify job classifications with exposure risk:
- Embalmers
- Removal staff
- Funeral assistants involved in prep
- Anyone handling human remains or contaminated materials
- The old guys you have on staff that watch you embalm while they drink their coffee
Describe procedures to reduce exposure.
Outline engineering controls and PPE.
Detail post-exposure procedures.
Annual Review and update
Because we are special, this plan should match actual prep room practices, not generic healthcare templates.
Engineering Controls
Engineering controls (physical devices or systems that reduce exposure risk).
Examples relevant to funeral service:
Needle disposal sharps containers.
Closed drainage systems (not angular forceps).
Vacuum aspiration systems (that don’t back up and spray the walls and ceiling).
Leak-proof biohazard waste containers.
These engineering controls are to be used before relying on PPE alone.
Work Practice Controls
These are behavioral procedures that reduce risk.
For funeral homes:
No hand recapping of needles (or one-handed technique if necessary).
Proper handling of sharps during suturing (don’t stab towards yourself), feature setting, and feature building
Use of forceps to remove and replace scalpel blades.
Handwashing immediately after glove removal.
No eating/drinking in prep room.
Proper cleaning and disinfection protocols.
Personal Protective Equipment (PPE)
Employer responsibilities:
Provide PPE at no cost.
Ensure availability and proper sizes.
Enforce usage.
Remember there are two parts to the General Duty Clause, meaning the employees are also responsible for wearing their PPE.
Hepatitis B Vaccination Program
One of OSHA’s most significant mandates, considering this was the major diriving force when it came to the Bloodborne Pathogen Standard.
Funeral homes must:
Offer Hep B vaccination FREE.
Offer within 10 working days of assignment to exposure-risk position.
Provide after training.
Maintain vaccination or declination records.
Employees may decline but must sign a declination form.
Training Requirements
Required:
At initial assignment.
Annually thereafter.
Training must include:
Bloodborne pathogen risks.
Transmission routes.
Exposure control plan.
PPE use.
Post-exposure procedures.
Training should include embalming-specific scenarios, not generic hospital examples.
Post-Exposure Evaluation and Follow-Up
If exposure occurs (needle stick, splash to mucous membrane, etc.):
Employer must:
Provide confidential medical evaluation.
Document incident.
Offer testing and follow-up.
Provide counseling as needed.
Post-exposure counseling under the Bloodborne Pathogens Standard refers primarily to medical risk communication rather than traditional psychological therapy. Following an exposure incident, employers must ensure that a qualified healthcare professional explains the potential disease risks, recommended testing schedule, treatment options, and signs or symptoms to monitor. This counseling helps employees understand the real level of risk, reduces unnecessary fear, and supports informed medical decisions. Emotional support may be included when appropriate, but OSHA’s primary focus is ensuring that exposed workers receive accurate medical guidance and follow-up care in a confidential setting.
Post exposure follow will provide post-exposure follow-up at no cost to employees.
Housekeeping and Decontamination
Funeral homes must maintain:
Written cleaning schedules.
Approved disinfectants.
Procedures for spills and contaminated surfaces.
Labeling and Waste Disposal
Required:
Biohazard labeling.
Proper disposal of regulated medical waste.
Sharps containers.
Good news, there’s more administrative law to be had!
While we were all wigging out about the Y2K exploding our computers or taking over Ask Jeeves, Congress mandated tighter regulations on needlestick safety and prevention in an amendment cleverly named “The Needle Stick Safety and Prevention Act” . This is because people wouldn’t stop stabbing towards themselves or improperly storing and disposing of their needles. So, this new revision required the development of safer needle technology as well as input from employees who responsible for direct patient care as well as documenting the input.
Some safer technologies that exist now because of this are:
syringes with a sliding sheath that shields the attached needle after use;
needles that retract into a syringe after use;
shielded or retracting catheters
intravenous medication (IV) delivery systems that use a catheter port with a needle housed in a protective covering.
IV medication systems which administer medication or fluids through a catheter port using non-needle connections; and
jet injection systems which deliver liquid medication beneath the skin or through a muscle.
While embalmers do not directly use all of these in practice, we are, however, frequently required to remove and dispose of medical devices still attached to decedents.
We are in compliance...
Of course, nothing written by me is complete without some sort of myths and misconceptions section, so go ahead and check yourself to see if you are as good as you think you are:
“Template” Exposure Control Plans That Don’t Match Reality
One of the biggest issues:
Funeral homes download a generic healthcare plan.
It mentions hospital procedures that don’t apply.
It fails to address embalming-specific risks.
Common missing elements:
Aspiration procedures.
Feature setting and sharps handling.
Removal and transfer risks.
Autopsy case handling.
Failure to Update the Plan Annually
OSHA requires yearly review.
Common problems:
Plan written once and never revisited.
No documentation of review.
New equipment or procedures not included.
Treating Known Cases Differently (Instead of Universal Precautions)
A frequent mindset issue, and we have all been there especially since we rarely know what a person died of at the time of embalming:
Staff become extra cautious only when diagnosis is known (HIV, hepatitis, etc.).
Reduced PPE when history is unknown.
Inconsistent PPE Use in the Prep Room
Common real-world examples:
Gloves worn but no eye protection during aspiration.
Face shields only used for “messy” cases.
Aprons/gowns avoided due to comfort.
Sorry, tucking your tie in your shirt is not in compliance. Speaking of which, you may find this study interesting pertaining doctors and neck ties.
Improper Sharps Handling
Big inspection issue.
Examples:
Recapping needles with two hands.
Using improvised containers instead of approved sharps containers.
Improper scalpel removal and replacement.
Hepatitis B Vaccination Program Errors
VERY common problems:
Employer assumes staff already vaccinated.
No formal offer made.
Missing declination forms.
No documentation.
Training That Is Too Generic
Typical mistake:
Online healthcare training used for compliance.
No embalming-specific content.
Missing topics:
Aerosolization during aspiration.
Decomposition fluid risks.
Instrument cleaning unique to prep rooms.
Eating or Drinking in Prep Areas
Surprised?
Examples:
Coffee cups near prep tables.
Water bottles in embalming room.
Let’s add smoking or vaping to the list.
While not specifically eating, let’s also not forget answering the prep room phone with your gloves on and or barehanded.
Misunderstanding Who Is Covered
Some funeral homes think only embalmers are covered.
But exposure-risk positions can include:
Removal technicians.
Transport staff.
Assistants handling contaminated linens or instruments.
So there you have it, another astonishing tale of how we have the laws that we do.