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OSHA believes that the requirements set forth in this final standard are those, based on currently available data in the record, which are necessary and appropriate to provide adequate protection to employees exposed to blood and Crime Scene Cleanup Business Information other potentially infectious materials. 

In the development of this final standard, OSHA has carefully considered the comments and testimony from interested parties given in response to the Proposed Standard and the Advance Notice of Proposed Rulemaking. In addition, numerous reference works, journal articles, Crime Scene Cleanup Business Information and other data, collected by OSHA.

Others since the initiation of this proceeding have been taken into consideration in the development of this final standard. Crime Scene Cleanup Business Information All of this information is in the rulemaking record. Paragraph (a) Scope and Application The standard applies to all occupational exposure to blood and other potentially infectious material as defined in paragraph (b) of this standard. 

The risk of infection with bloodborne pathogens is dependent on the likelihood of exposure to blood and other potentially infectious materials wherever that exposure occurs. Crime Scene Cleanup Business Information A single exposure incident may result in infection and subsequent illness and in some cases, death. 

The hazard affects employees in many types of employment and is not restricted to the healthcare industry. Crime Scene Cleanup Business Information By relating coverage to occupational exposure, OSHA hopes to protect all employees at risk regardless of their job title or place of employment. 

Blood has long been recognized as a potential source of pathogenic microorganisms that may present a risk to individuals who are exposed during the performance of their duties. Crime Scene Cleanup Business Information In 1983, the CDC published guidelines for controlling infections in hospitals (Ex 6-74). 

One section, Crime Scene Cleanup Business Information entitled "Blood and Body Fluid Precautions," recommended that certain precautions be taken in handling the blood and body fluids of patients who were known or were suspected of being infected with bloodborne pathogens. Special precautions were recommended to be followed with these patients. 

The patients were identified using special placards, and their blood specimens were labeled in order to alert employees who had contact with the specimens. Crime Scene Cleanup Business Information Specimens of blood from other patients whose infection status was unknown were collected and analyzed using no special precautions to protect the employee. 

Although some patients could be identified as infected with HIV or,  Crime Scene Cleanup Business Information allowing employees to be alerted to the increased risks present, it soon became apparent that many individuals infected with these viruses were either undiagnosed or their infection status was not known to  the healthcare employee. 

Patients being treated for unrelated injuries or illnesses, dental patients, trauma victims, Crime Scene Cleanup Business Information and blood donors are all examples of individuals whose infection status may not be known and whose blood may present a risk to the employees who come in contact with it. 

The possibility of undiagnosed infection combined with the increasing prevalence of HIV and led CDC to recommend that blood Crime Scene Cleanup Business Information and certain other body fluids from all patients be considered potentially infectious and that rigorous infection control precautions be taken to minimize the risk of exposure. 

This approach is called "Universal Precautions," and the CDC published this recommendation in its August 1987 guidelines (Ex. 6-153). Crime Scene Cleanup Business Information This is the approach taken by OSHA in the final standard. CDC/NIOSH supported this approach to the scope of the standard when they stated that "protection of workers against reasonably anticipated exposure to blood".

"Other potentially infectious materials is the only practical approach". Crime Scene Cleanup Business Information They explained their basis for this support in their comment on the proposed standard. The scope of the regulation should not be based on employment in one or a few specified industries. 

OSHA is correct in defining the scope in terms of reasonably anticipated occupational exposure to blood or other potentially infectious material. These exposures occur predominantly but not exclusively in the healthcare industry. Crime Scene Cleanup Business Information Healthcare workers may therefore be most commonly at risk, but it is their blood exposure, not the industry in which they are exposed, that places them at risk. 

Regardless of the industry in which they may be exposed, all workers with reasonably anticipated occupational exposure to blood or other potentially infectious materials should be included in the scope of this rule. Crime Scene Cleanup Business Information The recommendations of the Immunization Practices Advisory Committee (ACIP).

Protection Against Viral Hepatitis, published by the U.S. Public Health Service in 1990 also support the idea that employees who have blood exposure are at risk  and should be protected. Crime Scene Cleanup Business Information Recommendations for those at occupational risk were included as two of the 13 groups recommended for preexposure hepatitis B vaccination. 

The recommendations state: Persons at substantial risk of who are demonstrated or judged likely to be susceptible should be vaccinated. They include the following: Crime Scene Cleanup Business Information Persons with occupational risk. is a major infectious occupational hazard for health care and public safety workers. 

The risk of acquiring infection from occupational exposures is dependent on the frequency of percutaneous and permucosal exposure to blood or blood products. Crime Scene Cleanup Business Information Any health-care or public-safety worker may be at risk for exposure depending on the tasks that he or she performs. 

If those tasks involve contact with blood or blood-contaminated body fluids, such workers should be vaccinated. Vaccination should be considered for other workers depending on the nature of the task. Crime Scene Cleanup Business Information Risks among health-care professionals vary during the training and working career of each individual but are often highest during the professional training period. 

For this reason, when possible, vaccination should be completed during training in schools of medicine, dentistry , nursing, laboratory technology, and other allied health professions before workers have their first contact with blood. Crime Scene Cleanup Business Information Clients and staff of institutions for the developmentally disabled ... Staff who work closely with clients should also be vaccinated. 

This risk in institutional environments is associated not only with blood exposure but may be consequent to bites and contact with skin lesions and other infective secretions. Crime Scene Cleanup Business Information Susceptible clients and staff who live or work in smaller (group) residential setting with known carriers should also receive hepatitis B vaccine.

Staff of nonresidential day-care programs (e.g., schools, Crime Scene Cleanup Business Information sheltered  workshops for the developmentally disabled) attended by known carriers have a risk of infection comparable to that among health-care workers and therefore should be vaccinated. 

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