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In response to an inquiry from the Association, the Centers for Disease Control has stated that no dental staff members (hygienist, assistant, dental laboratory technician) How To Clean A Crime Scene At A Homocide have been reported to have been infected with HIV as a result of occupational exposure. 

As of 1989, 71% of U.S. dentists had been vaccinated against HBV; this percentage has increased steadily since the vaccine first became available in 1982. (ADA, Ex.282) One of the difficulties in relating this information to the final standard is that it focuses almost entirely on dentists, How To Clean A Crime Scene At A Homocide who are more likely to be employers and not covered by the standard. 

It does not adequately address the status of dental hygienists, dental assistants, How To Clean A Crime Scene At A Homocideand dental laboratory technicians who make up 75% of dental healthcare workers who are employees and are therefore covered by this standard. 

In any case, we will address the points made by the ADA to support their contention that OSHA has overestimated the occupational risk faced by dentists. How To Clean A Crime Scene At A Homocide First, it would be more complete to say that the Klein study, cited above in the quote from the ADA, found five (5) HIV infected dentists, not one (Ex.6-366). 

Four of these individuals were found to have other risk factors leaving one occupational HIV infection in a group of 1,132 dentists. How To Clean A Crime Scene At A HomocideA finding of 1 occupational HIV infections in a group of 1,132 dentists, or 2 occupational HIV infections in a group of 4,973 for that matter, is not "extremely low" or "minimal" or "insignificant" as the ADA has argued. 

On the contrary, this finding is compatible with a finding of a 1 in 1,000 risk of a fatal illness as the result of an occupational exposure. How To Clean A Crime Scene At A HomocideIn the "Benzene Decision," the Supreme Court clearly defined this as a significant risk. (See Section VI: Significance of Risk) This does not take into consideration the additional occupational risk caused by HBV. 

The ADA's contention that the HIV risk in dentists is lower than that of the general population is confusing and is not supported by the data the ADA cited in their posthearing comments. How To Clean A Crime Scene At A Homocide They use the figure "2 HIV infected dentists per 4,973" and as we have noted above, the Klein study alone found 5 HIV infected dentists (5 per 1,132). 

There is no information in the record to indicate how many other HIV positive dentists with other risk factors were found in the other groups that make up the total 4,973 tested individuals. How To Clean A Crime Scene At A Homocide Second, in the past it has been relatively uncommon for dental hygienists, dental assistants and dental laboratory technicians to be tested for HIV following occupational exposure. 

Since an HIV infection may be silent for many years before AIDS develops, it is highly unlikely that untested individuals would know whether or not they were infected with HIV. Third, OSHA agrees that the HB vaccine is a central component of any effort to control hepatitis B, and it is How To Clean A Crime Scene At A Homocide important to note that a relatively high percentage (71%) of dentists are vaccinated. 

However, the remaining 29% who have not been vaccinated continue to be at increased risk. How To Clean A Crime Scene At A Homocide An article from the Journal of the American Dental Association begins, "In the late 1970s, it became clear that dentists are at a risk three times greater than that of the general population for hepatitis B (ADA, Ex. 282-2b)] 

In addition, as the ADA acknowledged in their posthearing brief, other dental healthcare workers are considerably less likely to have been vaccinated (ADA, Ex. 295). How To Clean A Crime Scene At A Homocide For example, in 1989 only 15% of dental laboratory technicians had been vaccinated. 

Clearly, dental health professionals perform tasks that place them at risk for infection due to their occupational exposure. How To Clean A Crime Scene At A Homocide Institutions for the Developmentally Disabled: Although the overwhelming majority of cases of HBV and HIV infections occur in adults, one group of children have a high risk for hepatitis B infection. 

This group consists of developmentally disabled children who are or have been institutionalized. How To Clean A Crime Scene At A Homocide Surveys conducted in large state institutions indicate that the risk of a child contracting hepatitis B in one of these institutions ranges from 50% to 90% with 5% to 20% of those infected becoming hepatitis B carriers (Ex. 11-165, p. 4). 

The behavior of these children, including scratching, biting, and self-mutilation, may present a risk to those who teach or otherwise care for them. How To Clean A Crime Scene At A Homocide Developmentally disabled adults who are or have been institutionalized also have an increased risk for being infected with HBV. 

In 1990, the CDC recommended the hepatitis B vaccine for both the clients and the staff of institutions for the developmentally disabled (Ex. 286G). Hospice: How To Clean A Crime Scene At A Homocide A hospice is one of several alternative health care programs open to the terminally ill, including terminally ill AIDS patients. 

Employees provide healthcare services to these patients which place the employee at risk for occupational exposure. How To Clean A Crime Scene At A Homocide The Hospice Association of America provided examples of the types of employees (and volunteers) who provide hospice care and some of the types of care rendered by these individuals that place them at risk. 

Hospice employees engaged in direct patient care include, but are not limited to, registered nurses, homemaker/home health aides,  physicians,  How To Clean A Crime Scene At A Homocide  licensed practical nurses and various therapists....Hospice services provided in the home include...dressing change and intravenous drug administration.

Blood specimen collection, intramuscular and subcutaneous injections, management of intrathecal, epidural, venous and arterial shunts and catheters and suctioning of tracheal and upper respiratory secretions. How To Clean A Crime Scene At A Homocide In other words, much of the direct patient care provided in the hospital is also provided in the home by hospice employees and volunteers. 

(Hospice Association of America, Ex. 11-202) Hospice employees who perform the services outlined above as well as other duties that result in occupational exposure are at risk of infection by bloodborne pathogens. How To Clean A Crime Scene At A Homocide Home Health Care: Another alternative to hospital care is home healthcare. 

There was recognition among the commenters that some How To Clean A Crime Scene At A Homocide employees who provide home health care have occupational exposure and are at risk of HIV and HBV infection. 

Tasks that home healthcare providers may be expected to perform include collecting a blood specimen, cleaning How To Clean A Crime Scene At A Homocide and dressing wounds, and managing intrathecal, epidural, venous and arterial shunts and catheters (National Association for Home Care, Ex. 11-203).

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