Many of the issues raised by commenters who disagreed with the Agency's approach to the "Scope of the Standard" related to coverage of workplaces where employees provide service to individuals who are not members of groups known to be at increased risk for HIV or Pennsylvania OSHA Regulations On Crime Scene Clean HBV infection.
OSHA recognizes that certain populations have more members who are infected with HIV or HBV than other populations. Pennsylvania OSHA Regulations On Crime Scene Clean A hospital ward dedicated to the care of AIDS patients, for example, would be expected to contain a population that is 100% HIV positive.
A group of young male trauma victims entering the emergency room of an urban hospital might reasonably be expected to have a higher percentage of HIV positive individuals than the population as a whole. Pennsylvania OSHA Regulations On Crime Scene Clean Conversely, a group of repeat blood or plasma donors would be expected to have a relatively low number of individuals who are HIV positive.
However, even populations of volunteer blood donors are not free of infected individuals and considerable efforts are expended to identify and discard units donated by those individuals. Pennsylvania OSHA Regulations On Crime Scene Clean A similar assessment can be made of the risk for HBV.
For example, immigrant and refugee populations from areas of high HBV endemicity have a high percentage of members who are hepatitis B surface antigen positive. In other words, they are carriers of the hepatitis B virus. Pennsylvania OSHA Regulations On Crime Scene Clean Users of illicit parenteral drugs and household contacts of HBV carriers also have a substantially increased risk of being HBV carriers.
Elderly nursing home residents would be expected to have fewer infected individuals, but it is clear that even an elderly population has individuals who are hepatitis B carriers often as the result of infections that occurred earlier in life. Pennsylvania OSHA Regulations On Crime Scene Clean Unlike AIDS, a substantial number of cases of hepatitis B infection have not been associated with a known risk factor.
In CDC's Sentinel County Study, the percentage of cases where no known risk factor could be identified averaged 36% for the years 1982 to 1987. The risk factors remained unidentified, despite a thorough effort to pinpoint the source, as described below: Pennsylvania OSHA Regulations On Crime Scene Clean Each patient with viral hepatitis is extensively interviewed for risk factors associated with acquiring the disease.
In addition, to determine the actual source of infection for HB patients who have no identifiable source, attempts are made to obtain serum from household and sexual contacts of these patients. Pennsylvania OSHA Regulations On Crime Scene Clean (Ex 6-245) Some commenters contended that blood or other potentially infectious materials present a negligible risk after a few hours.
The record contradicts this and contains evidence that the hepatitis B virus can survive for at least one week dried at room temperatures on environmental surfaces. Pennsylvania OSHA Regulations On Crime Scene Clean Transmission of HBV infection as the result of exposure to contaminated environmental surfaces has been documented to be a major mode of HBV spread in certain settings, particularly hemodialysis units.
Likewise, the death of the source individual does not result in the instantaneous inactivation of HIV or HBV that may be present in the individual's blood and body fluids. Pennsylvania OSHA Regulations On Crime Scene Clean For example, HIV was recovered at autopsy from a person with AIDS who had died 18 hours earlier (Ex. 286M).
An LPN from rural Pennsylvania addressed another mistaken notion, the belief that people who are infected with HIV are only found in urban areas when she said: Don't be fooled by the statistics of our rural areas. Pennsylvania OSHA Regulations On Crime Scene Clean AIDS patients are counted where they are diagnosed, not where they die. I've had patients from California, New York and Florida come home to die.
It is vital that we treat every patient as if he or she has an infectious disease and then take the appropriate precautions. Pennsylvania OSHA Regulations On Crime Scene Clean (Ms. Alice Donovan, Ex. 36) Section 6(b)(5) of the OSH Act instructs the Secretary to promulgate a standard that protects an employee "even if such employee has regular exposure to the hazard dealt with by such standard for the period of his working life."
An employee may have occupational exposure to blood or other potentially infectious materials from a large number of source individuals in a working lifetime. Pennsylvania OSHA Regulations On Crime Scene Clean For example, the record contains several estimates of the number of hemoglobin determinations and phlebotomies that are performed per hour. The estimates range from 8 to 24 per hour.
If we use the lower end of the range with 10 patients per hour, the employee would have occupational exposure to the blood of 17,500 different source individuals per year and Pennsylvania OSHA Regulations On Crime Scene Clean 87,500 different source individuals after 5 years [10 per hour X 7 hours X 5 days X 50 weeks X number of years].
The number of occupational exposures over a working lifetime of 45 years would be 787,500 source individuals. A single needlestick contaminated with blood containing HIV gives a risk of infection of 3 to 4 per 1,000. Pennsylvania OSHA Regulations On Crime Scene Clean A single needlestick contaminated with blood containing HBV gives a risk of infection of 60 to 300 per 1,000.
It is important to note, however, that an employee can become infected as the result of a single exposure incident. Infection does not require multiple exposures. Pennsylvania OSHA Regulations On Crime Scene Clean Both HIV and HBV infections have been reported in rural as well as urban populations and in every state and territory.
The fact that the viruses are transmitted sexually and through the sharing of needles by I.V. drug users points to the fact that the viruses may be present in any group. Pennsylvania OSHA Regulations On Crime Scene Clean Furthermore, the likelihood that infected individuals will become carriers means that individuals may continue to pose a threat of infection years after the initial infection takes place.
In summary, the Agency knows of no population that is free of these infections. Pennsylvania OSHA Regulations On Crime Scene Clean Although OSHA does not intend to present an exhaustive list of job classifications that may be associated with tasks that have occupational exposure to blood and other potentially infectious materials.
A brief discussion of some of the environments where occupational exposure may occur follows. Pennsylvania OSHA Regulations On Crime Scene Clean The 1985 CDC guideline recommending HBV vaccination for personnel at risk included these examples of occupational groups having frequent exposure to blood: medical technologists; operating room staff.
Phlebotomists and intravenous therapy nurses; surgeons and pathologists; oncology and dialysis unit staff; emergency room staff; nursing personnel; and staff physicians. Pennsylvania OSHA Regulations On Crime Scene Clean CDC also cites the need for vaccination of students in schools of medicine, dentistry, nursing, laboratory technology and other allied health professions.
This set of recommendations also included healthcare workers based outside hospitals such as dental professionals, laboratory and Pennsylvania OSHA Regulations On Crime Scene Clean blood bank technicians, dialysis center staff, emergency medical technicians, and morticians (Ex. 4-9).
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