Is your practice following the mandatory requirements?

Aerosol Transmissible Disease (ATD) Standard requirements adopted by Cal/OSHA Standards Board, affects all medical facilities regardless of size, location or specialty. The law went into effect on August 5th, 2009. It was mandatory to have an ATD Plan in place by October 2010.

What businesses are required to comply?

California businesses of any employee size including:

  • Hospitals;

  • Skilled nursing facilities;

  • Clinics, medical offices, and other outpatient facilities;

  • High hazard procedure facilities;

  • Home health care;

  • Long term health care facilities and hospices;

  • Medical outreach services;

  • Paramedic and emergency medical services; and

  • Medical transport; and

  • Homeless shelters and drug treatment programs.

What businesses are exempt from the regulations?

Outpatient dental clinics are not required to comply with the ATD standard IF they meet ALL of the following conditions:

  • Dental procedures are not performed on patients identified to be ATD cases or suspected cases

  • Their Injury & Illness Prevention Program (IIPP) includes a written procedure for screening patients of ATDs that is consistent with the current CDC guidelines for infection control in dental settings AND this procedure is followed before any procedure is performed

  • Employees have been trained in the screening procedure

  • Aerosol-generating dental procedures are not performed on a patient identified through the screening

  • The procedure as presenting possible ATD exposure risk UNLESS a licensed physician determines that the patient does not currently have an ATD.


Outpatient medical specialty practices whose policy is not to diagnose or treat ATDs are not required to comply with the ATD standard IF they meet ALL of the following conditions:

  • Do not perform aerosol-generating procedures on cases or suspected cases of ATD

  • Their IIPP includes written screening procedures to identify potential ATD cases, then refer those patients for further evaluation to an appropriate medical provider

  • Employees have been trained in the screening procedure

How can our small medical office with less than 10 employees conform to the new standard?

  • While some older medical offices will be expensive to upgrade to meet the engineering controls of the standard, employees MUST be protected with a written Injury & Illness Prevention Program (IIPP), which among other requirements, include a written Aerosol Transmissible Diseases Exposure Control Plan.

  • An Administrator must be assigned to the program, as well as a back-up administrator. The Plan must be available to employees at the worksite.

  • One of the most difficult parts of the standard is protecting your employees’ exposure to ATD. While this may be somewhat done with the right Personal Protective Equipment, it is important to know that Cal/OSHA requires an employer to first provide Engineering Controls and/or Administrative Controls in lieu of Personal Protective Equipment. Engineering controls may include isolation rooms for ATD patients, separate specialized air filtration systems.

As an employer what are my requirements to protect my employees?

As an employer, you must develop various written safety plans by law, including your (IIPP). As part of your IIPP, you will be required to have three very important and integral Programs which would include:

  • A Respirator Protection Program 

  • An Aerosol Transmissible Diseases Exposure Control Plan and

  • Personal Protective Equipment section dealing with other required safety equipment, such as gloves, aprons, non-respirator type masks, and safety glasses/splash proof goggles or shields.

  • Provide documented training at various times throughout the employee’s employment, including when they are hired.

  • Provide vaccinations and medical testing

As an employer what are my liabilities with respect to ATD?

Based upon previous enforcement of the Bloodborne Pathogen Standard by Cal/OSHA, it is expected that if an employer were cited for not having an ATD Program, the citation would be a “serious violation” with a fine not exceeding $25,000.


This would not include other fines for violations found such as not having an IIPP, with a maximum fine of $5,000.00.


However, fines can be “stacked,” so they can add up quickly. These fines are based on whether an injury has occurred or not. If it could be proven that an employee died from the failure of the employer to not protect the employee’s safety, the fines would go up significantly and the owner of the practice could face criminal homicide charges. These fines do not include any attorney fees or civil fines should an employer be sued for wrongful death, etc.