Crime Scene Cleanup >> OSHA Requirements For Crime Scene Death Cleanup

A common theme among the commenters concerned with home health care is the environment in which the care must be rendered. For example, one group stated: ... Unlike other types of providers, home health agencies (HHAs) do not control the worksite. OSHA Requirements For Crime Scene Death Cleanup The worksite is the patient's home; the nurse, home health aide, or therapist is only a visitor. 

Attempts to apply universal precautions, decontaminate the worksite, and otherwise control the risk of infection by bloodborne pathogens must take this into account. OSHA Requirements For Crime Scene Death Cleanup A home nurse, for example, cannot control the level of general sanitation or cleanliness in the home. Some homes do not have amenities such as running water. 

Home health employees cannot ensure that patients and their non-professional caregivers will take precautions that they may find objectionable or bothersome. OSHA Requirements For Crime Scene Death Cleanup Many beneficiaries and their caregivers are quite elderly and confused, and would have great difficulty in following through on decontamination instructions (Amer. Fed. of Home Health Agencies, Inc. 

OSHA is aware that in most instances home healthcare must be provided in an environment and at a location that is not under the control of the employer. OSHA Requirements For Crime Scene Death Cleanup In addition to home healthcare employees, emergency medical service providers are another group who provide healthcare services in a variety of locations outside the employer's facility. 

However, it is clear that both types of employees have occupational exposure; are at risk for HIV and HBV infection; and must be provided the protection afforded by the provisions of the standard. OSHA Requirements For Crime Scene Death Cleanup OSHA has modified several provisions of the proposed standard to take into account the circumstances described above. 

For example, paragraph (d)(2)(iv) of the standard allows the use of antiseptic hand cleansers when handwashing facilities are not available. OSHA Requirements For Crime Scene Death Cleanup Blood Banks/Plasma Centers: In blood banks and plasma centers, the potential for occupational exposure begins with the initial finger stick of the donor and continues until contaminated units are identified and destroyed. 

The blood and blood products in these facilities are regulated by the Food and Drug Administration (FDA), OSHA Requirements For Crime Scene Death Cleanup and all plasma and blood collection facilities have extensive written procedures for donor requirements, donor room procedures, and laboratory testing of the blood with blood components (ABRA, Ex. 11-71). 

However, the FDA does not set standards for the health and safety of the employees. OSHA Requirements For Crime Scene Death Cleanup One witness, a nurse employed by the American Red Cross, testified concerning the likelihood of contact with blood. To the uninitiated, phlebotomy appears to be a clean operation. After all, we aren't performing surgery, emergency service, or even patient care. 

Instead, we're dealing with individuals who don't appear to be sick. OSHA Requirements For Crime Scene Death Cleanup It may come as a surprise to some people, then, that mobile collection staff may come in contact with large amounts of blood on the job. I'm not just talking about needle sticks. Since we handle large amounts of blood all day long, the potential for contact is always present. (Pam Talbot, RN, Tr. 9/15, p. 157) 

Dr. Robert G. Chapman, President of the Council of Community Blood Centers, agreed that occupationally exposed blood bank personnel should be offered the hepatitis B vaccine and other protection. OSHA Requirements For Crime Scene Death Cleanup He felt, however, that there should be a two tiered approach to protective clothing with less stringent requirements for, for example, phlebotomists drawing homologous donors in nonhospital blood banks. 

(Tr. 10/20/89. p. 731) Dr. Paul V. Holland, representing the American Association of Blood Banks, OSHA Requirements For Crime Scene Death Cleanup argued that the risk from voluntary blood donors is very low, that wearing gloves often presents a problem to the phlebotomist (applying labels, for example). 

He further stated that they require gloves for autologous patients and hepatitis B vaccination for employees in their laboratories. OSHA Requirements For Crime Scene Death Cleanup The American Blood Resources Association (ABRA) has argued that workers in a plasma center are at a reduced risk of exposure to bloodborne pathogens because many plasma donors donate frequently, as often twice a week, and therefore their antibody status is known (Ex. 11-71). 

Similarly, the American Red Cross stated that "its healthy blood donor population does not present any increased health risks to its employees and volunteers" (ARC, Ex. 11-280). OSHA Requirements For Crime Scene Death Cleanup However, despite prescreening, both blood banks and plasma centers have donors who are infected with HIV, HBV, and other bloodborne pathogens including non-A non-B hepatitis. 

A 1990 study of intravenous drug users published in the Journal of the American Medical Association showed that 27% of a cohort of 2921 intravenous drug users had donated blood or plasma. OSHA Requirements For Crime Scene Death Cleanup Of this group 82.2% had donated after they had started using drugs and most donated at commercial plasma centers. (Ex.299, attachment) 

In a study published in the New England Journal of Medicine in 1989, Leitman and her colleagues conducted an in depth analysis of a group of volunteer blood donors who were found to be infected with HIV. OSHA Requirements For Crime Scene Death Cleanup One of the issues studied was the donors' estimation of whether or not they were at risk for HIV. 

The results of our study suggest that current measures for donor education and screening are not uniformly effective in eliminating people at high risk from the donor pool. OSHA Requirements For Crime Scene Death Cleanup The majority of our HIV-infected donors understood the definition of high-risk behavior but did not view themselves as having engaged in such behavior. 

Even more disturbing, a large proportion donated specifically in order to discover the results of HIV testing. OSHA Requirements For Crime Scene Death Cleanup Furthermore, less than 5 percent understood the purpose of the post-donation confidential unit-exclusion system and would have designated their units as solely for research. 

Clearly, both donor-education policies and interview strategies need to be strengthened. OSHA Requirements For Crime Scene Death Cleanup (Ex. 281-3) Twenty six percent of the subjects of this study did not believe their earlier behavior placed them at risk, because they had changed their lifestyles and they remained in good health. 

A similar percentage attempted to donate blood in order to undergo HIV-antibody testing because they viewed the donor center as more pleasant, more accessible, and not associated with any stigma. OSHA Requirements For Crime Scene Death Cleanup Fifteen percent of the donors felt pressured to donate despite a history of high-risk behavior. 

Only 6 percent did not read or understand the informational material provided by the blood center that presumably would have led them to disqualify themselves. OSHA Requirements For Crime Scene Death Cleanup The authors concluded that a small number of persons with HIV infection continue to donate blood despite attempts to exclude them.

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