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Most recommendations for minimizing or eliminating these hazards focus on limiting the risk by minimizing handling of soiled laundry. This practice not only reduces the likelihood of skin contact with blood contaminated laundry but also reduces the likelihood of a puncture wound from a needle or  Crime Scene Clean Up Tools For Murder Clean Up  other sharp object. 

The risk of handling this laundry is present whether the servicing laundry is within the institution or at another site. Crime Scene Clean Up Tools For Murder Clean Up Personnel Services: These agencies provide nurses and other healthcare professionals to hospital and other healthcare facilities that require their services. 

The occupational exposure experienced by these employees would be expected to occur in hospitals, physician's offices, and other healthcare facilities, rather than in the facility of the Personnel Service. Crime Scene Clean Up Tools For Murder Clean Up These employees' occupational exposure would be similar to other employees performing the same tasks and procedures in the healthcare facility that has contracted for their services. 

Tissue Banks: Another potential source of bloodborne pathogens is human tissue that is removed for transplantation. Crime Scene Clean Up Tools For Murder Clean Up The American Association of Tissue Banks, representing 700 individual and institutional members, supported the implementation of a standard and recommended including the category "tissue bank personnel" in the coverage (Exs. 11-50; 20-720). 

Examples of tasks and procedures that may result in occupational exposure in tissue banks were described by Dr. John Kateley, president of the American Association of Tissue Banks (AATB). Crime Scene Clean Up Tools For Murder Clean Up Tissue banking professionals are at risk for infection in a manner similar to laboratory technologists, phlebotomists, surgeons and other healthcare professionals dealing in patient care. 

Tissue banks are responsible for the removal, preparation and storage of bone, skin, ligaments, tendons, corneas, heart valves, and saphenous veins for transplantation. Crime Scene Clean Up Tools For Murder Clean Up These tissues are surgically removed and then further processed in a tissue bank laboratory for storage and future transplantation. (Dr. John Kateley, AATB, Ex. 20-720) 

The evidence in the record shows that tissue bank employees have exposures similar to those seen in hospital and medical laboratory personnel. Crime Scene Clean Up Tools For Murder Clean Up Drug Treatment Facilities: These facilities include hospitals, residential treatment programs, and outpatient treatment facilities. 

The types of occupational exposures that occur would range from those described above for hospitals to those associated with rendering first aid and performing phlebotomy in an outpatient clinic or residential setting.  Crime Scene Clean Up Tools For Murder Clean Up Physicians' Offices: 

The physician's office is often the scene of blood collection, treatment of wounds, minor surgery, and other invasive procedures. Crime Scene Clean Up Tools For Murder Clean Up Physicians, nurses, nurse practitioners, physicians' assistants and other healthcare employees may be exposed in this setting. 

The office may also contain a laboratory where additional exposure may occur when blood and other potentially infectious materials are analyzed.  Crime Scene Clean Up Tools For Murder Clean Up Employees who perform these tasks have the same risk as their hospital-based colleagues. 

Freestanding Clinics: A number of healthcare employees work in freestanding clinics that operate outside the hospital. Crime Scene Clean Up Tools For Murder Clean Up For example, employees of hemodialysis clinics, urgent care clinics, health maintenance organization (HMO) clinics, and family planning clinics perform many of the same tasks that have traditionally taken place in either the hospital or the physician's office. 

Examples of these tasks include performing hemodialysis, phlebotomy, surgery, wound care and dressing changes. Crime Scene Clean Up Tools For Murder Clean Up These tasks clearly carry the same risk whether they are conducted in a hospital or a free-standing clinic. Clinics in Industrial, Educational, and Correctional Facilities: 

Many commenters made the point that healthcare is also being provided as a service to a larger facility, such as in industrial, in educational, and in correctional settings. Crime Scene Clean Up Tools For Murder Clean Up These facilities often provide services such as emergency first aid, collection of blood, and cleaning.

Dressing of wounds, activities that may place the healthcare provider at risk for exposure to blood and other potentially infectious materials. Crime Scene Clean Up Tools For Murder Clean Up (Exs. 11-111; 11-86; 11-216). Dental Facilities: Dentists, dental hygienists, dental assistants and dental laboratory technicians are continually exposed to blood and bloody saliva during almost all dental procedures. 

Because saliva in dental procedures is so likely to contain blood, the CDC recommends personal protective equipment to practitioners for all dental procedures (Ex. 6-316). Crime Scene Clean Up Tools For Murder Clean Up The record contains many references to occupational hepatitis B infections in dental health professionals.(Exs. 6-68; 6-441) 

Ms. Karen Boulton, a dental hygienist who testified at the public hearings, gave examples of preventive dental hygiene services, including scaling and polishing of the teeth, periodontal root planing and subgingival curettage. Crime Scene Clean Up Tools For Murder Clean Up She estimated that "almost 100 percent of [her] patients in private practice exhibit some extent of bleeding during routine treatment." A number of commenters who considered this issue agreed that these dental employees are at risk and supported a standard for dental operations.

The position of the American Dental Association (ADA) regarding the scope of the standard and the major provisions was given by Dr. Enid Neidle in her testimony at the public hearing on the proposed rule. Crime Scene Clean Up Tools For Murder Clean Up She stated, in part: The purpose of OSHA in protecting, through this proposed rule, the health care worker is clear, unequivocal, and laudable. 

The American Dental Association shares that purpose. Over the past 15 years, the Association has invested substantial resources in the development of educational materials to prevent the transmission of infection in the dental office. Crime Scene Clean Up Tools For Murder Clean Up However, the ADA stated its belief that OSHA overstated the risks to dental healthcare workers in the preamble to the proposed standard. 

In their posthearing comments (Ex. 282), they stated: Over the past several years, data have been amassed thatsuggest that the dental profession is at very low risk of contracting infectious bloodborne diseases. Crime Scene Clean Up Tools For Murder Clean Up The following documented facts support this position: 

Over the past five years, the American Dental Association Health Screening Program and other testing programs have done a total of 4,973 tests on dentists for antibodies to HIV. Crime Scene Clean Up Tools For Murder Clean Up In 1988, Klein et al. reported that one dentist in theirsample of 1,132 dentists...was seropositive.

This case was subsequently adjudged by the Centers for Disease Control to meet the criteria for an occupational transmission. As shown in Table 1, of the total sample of 4,973 tests between 1985 and 1989, only two have been positive. Crime Scene Clean Up Tools For Murder Clean Up Table 2 shows that the prevalence of HIV infection among dentists is low compared to the general population. 

Inasmuch as dentists have been treating HIV-infected patients for at least 15 years (and did not wear personal protective equipment for at least the first ten years), Crime Scene Clean Up Tools For Murder Clean Up the occupational risk to dentists is extremely low.

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