Crime Scene Cleanup >> Pennsylvania OSHA Regulations On Crime Scene Clean
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).
Mechanical radon mitigation system monitors, such as manometer type pressure gauges, shall be clearly marked to indicate the range or zone of pressure readings that existed when the system was initially activated. A system description label shall be placed on the mitigation system, the electric serv
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