Crime Scene Cleanup >> OSHA Requirements For Crime Scene Cleanup

Fourth, the fact that nursing homes are subject to infection control requirements imposed by the Health Care Financing Administration (HCFA) of the U.S. Department of Health and Human Services under the Medicare and OSHA Requirements For Crime Scene Cleanup Medicaid programs and to infection control requirements of states does not obviate the need to cover the employees of these facilities under this standard. 

These infection control requirements are primarily to protect the patients (residents). OSHA Requirements For Crime Scene Cleanup The preamble to 42 CFR 438.65, which requires nursing homes to have infection control programs, states, "... The emphasis we wanted to place was on the actual performance of a facility in providing care..." (emphasis added) 54 FR 5345 (February 2, 1989). 

The interpretative guidelines for this regulation suggest that HCFA surveyors ask whether the HIV/HBV infection control policies agree with OSHA requirements for protecting employees and OSHA Requirements For Crime Scene Cleanup current accepted standards of practice recommended by CDC. 

It does not appear that HCFA mandates compliance with OSHA requirements and CDC occupational health guidelines as a matter of its own regulations. OSHA Requirements For Crime Scene Cleanup To the contrary, HCFA in effect notes that nursing homes must comply with OSHA requirements. Thus, there is no conflict with HCFA or duplication of effort. 

Similarly, since States implement the same infection control requirements under 42 U.S.C. 139 6r (h), the same arguments apply to state regulations. 
State licensing agencies may possibly have different, additional occupational health requirements. OSHA Requirements For Crime Scene Cleanup See 42 U.S.C. 139 6r (h)(8). However, the purpose of the OSH Act is to provide uniform protection. 

Usery v. Lacy, 628 F. 2d 1226 (9th Cir. 1980). States which desire to address issues covered by OSHA standards must adopt a plan approved by Federal OSHA. 29 U.S.C. 667 (b). OSHA Requirements For Crime Scene Cleanup Finally, the Congress has expressly indicated that OSHA is to protect healthcare and public safety workers from HIV and HBV. 

The Congress mandated CDC to develop guidelines for protecting healthcare and OSHA Requirements For Crime Scene Cleanup public safety workers from HIV and HBV and to submit the guidelines to OSHA for its use in the development of this standard. 42 U.S.C. 300ee-2 (a)(1)(2) and (b). 

Funeral Homes and Mortuaries: The CDC considers morticians to be healthcare workers who should observe precautions because of their exposure to blood (Ex. 4-9). OSHA Requirements For Crime Scene Cleanup From the beginning of the rulemaking, there was a consensus among the commenters that employees of mortuaries have been at occupational risk because they are exposed to blood and certain body fluids and should be covered by the standard. 

For example: It is generally agreed upon within the funeral service profession that risk of occupational exposure to bloodborne pathogens exists to varying degrees during the handling of human remains prior to embalming OSHA Requirements For Crime Scene Cleanup and during the embalming process (National Funeral Directors Association, Ex. 311). 

Mortuary workers are potentially exposed to large quantities of blood during the preparation of cadavers; there is also potential for certain abrasions (SEIU, Ex. 11-161). OSHA Requirements For Crime Scene Cleanup Embalmers constitute a group of long ignored non-hospital based health care workers. 

During the embalming procedure they often come into contact with large amounts of uncontainerized blood as the vascular system is drained.  OSHA Requirements For Crime Scene Cleanup  Depending on the cause of death and whether an autopsy has been performed, they may be required to handle various body parts and tissues, as well as to make numerous incisions and subsequently suture the incised tissue. 

These procedures put them at risk of exposure. OSHA Requirements For Crime Scene Cleanup (AAOHN, Ex. 11-111) Exposure in funeral homes during embalming and other procedures described above may result in exposures similar to those encountered in surgery and autopsy. 

Research Labs and Production Facilities: Research and production facilities that produce or manipulate concentrated virus are also included within the scope of this standard. OSHA Requirements For Crime Scene Cleanup There are many researchers in academia, government and industry who are studying HIV and HBV. 

These individuals may be at even greater risk than healthcare providers because the concentration of virus is often greater than that found in blood or other body fluids. OSHA Requirements For Crime Scene Cleanup The record contains evidence that two individuals who worked with concentrated HIV in a production facility became infected as the result of occupational exposure (Exs. 6-187; 6-312; 6-368). 

The circumstances surrounding these infections were the subject of a thorough review by a committee of experts appointed by the Director of the National Institutes of Health. OSHA Requirements For Crime Scene Cleanup Expert witness Jolanda Janczewski, formerly Biological Safety Officer for the AIDS Research Program at the National Cancer Institute.

Frederick Cancer Research Facility (NCI-FCRF), described the events in her testimony at OSHA's public hearings on the proposed standard. In 1984, OSHA Requirements For Crime Scene Cleanup the NCI-FCRF began to produce the large amounts of HIV-1 that were needed for assays to test the nation's blood supply. 

Subsequently, and to date, the NCI-FCRF production laboratory was employed to prepare large quantities of HIV-1 as an agent for structural, immunological, and biochemical studies. OSHA Requirements For Crime Scene Cleanup Other commercial laboratories took over the process of producing the concentrated virus needed for the FDA-approved blood testing kits. 

By 1987, and to date [9/12/89], seven laboratories within the United States were involved in large scale HIV-1 production and employ an estimated 150 workers. OSHA Requirements For Crime Scene Cleanup In September 1987, the first occupationally-acquired HIV-1 infection of a worker in a large scale HIV-1 production facility was confirmed. 

A second worker was reported to be infected in October, of the same year... Dr. James Wyngaarden, Director, National Institutes of Health convened a Review Group to investigate the reported HIV-1 infection[s]. OSHA Requirements For Crime Scene Cleanup The Review Group... concluded with recommendations for worker training, enforcement of safety practices, medical surveillance, and evaluation of processes and equipment. 

(Ex. 25) The reporting of two infections as the result of occupational exposure in a group of employees that number less than 200 documents the potential for viral infection whenever employees concentrate or OSHA Requirements For Crime Scene Cleanup otherwise manipulate highly concentrated virus. 

The final standard incorporates many of the recommendations of the Review Committee described above and the provisions specific for these facilities are found in paragraph (e) and paragraph (g)(2)(ix). OSHA Requirements For Crime Scene Cleanup Although at present, HBV cannot be grown in tissue or organ culture, this may be possible in the future. 

Any concentrated HBV prepared from human or animal blood or OSHA Requirements For Crime Scene Cleanup body fluids would also present a risk to the laboratorian or other researcher who had occupational exposure in the laboratory or production facility.

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