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Volume
7 Number 6 October 2009
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From the Director's Desk
--John Howard, M.D. Director, NIOSH
October eNews 2009
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Protecting the Providers
The U.S.
Centers for Disease Control and Prevention (CDC) has issued its new interim
guidance for infection control during care of patients with confirmed or
suspected novel 2009 H1N1 influenza virus in a health care setting. http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm
The new guidance reflects experience gained since CDC’s original
interim guidance earlier this year, notably in deliberations on important
scientific questions related to occupational exposures to H1N1. NIOSH worked
with its colleagues across CDC in helping to craft the recommendations for
protecting healthcare personnel from risk of job-related exposure to the 2009
H1N1 influenza virus.
2009 H1N1
influenza presents a daunting challenge for occupational health and public
health. Maintaining a healthy, capable population of doctors, nurses, aides,
and other healthcare personnel during the 2009-2010 flu season will be vital.
NIOSH is gratified to have a role in strategic national preparedness to
accomplish that goal.
The new
interim CDC guidance recommends that healthcare employers take comprehensive
measures from across the entire hierarchy of controls generally employed in
preventing work-related illnesses and injuries, by:
- Eliminating
sources of infection, through such measures as taking steps to minimize
outpatient visits for patients with mild influenza-like illness who do
not have risk factors for complications, and postponing elective visits
by patients with suspected or confirmed influenza until they are no longer
infectious.
- Using
engineering controls such as installation of partitions in triage areas,
and using closed suctioning systems for airways suction in intubated
patients.
- Implementing
administrative controls. Promoting and providing vaccination is especially
important. Examples of other administrative controls include enforcing
exclusion of ill healthcare personnel, and implementing respiratory
hygiene/cough etiquette strategies.
- Using respiratory protection that is at least as
protective as a NIOSH-certified, fit-tested, disposable N-95 respirator
for healthcare personnel who are in close contact with patients with
suspected or confirmed 2009 H1N1 flu. In this context, close contact is
defined as working within six feet of the patient or entering into a
small, enclosed airspace shared with the patient, such as an average
patient room.
Consistent with IOM Findings
The
guidance on the use of NIOSH-certified N-95 respirators for healthcare
personnel at highest risk of exposure to the 2009 H1N1 influenza virus is
consistent with the findings of a blue-ribbon Institute of Medicine
committee, issued in September. The report is available at http://www.iom.edu/CMS/3740/71769/72967.aspx.
CDC and the Occupational Safety and Health Administration had asked the
committee to evaluate the efficacy of respirators and medical masks, and
NIOSH was one of the organizations that provided scientific information for
the committee’s deliberations. NIOSH’s presentations at the
committee’s Aug. 11-13 workshop, along with other presentations and
discussions, can be found at http://www.iom.edu/Activities/Workforce/RespProtH1N1.aspx.
Importantly, the IOM committee recommended additional research, including
research to evaluate the relative contribution of various routes of influenza
transmission and to fully explore the effectiveness of personal respiratory
protection technologies in a variety of clinical settings through randomized
clinical trials. NIOSH will conduct and sponsor such research to help inform
future guidelines.
The CDC
guidance is based on the unique considerations associated with the current
2009 H1N1 pandemic. These considerations include 1) low levels of immunity to
the 2009 H1N1 virus in the current population, 2) availability of vaccination
programs well after the start of the pandemic, 3) the susceptibility of
people who are in the age-range of healthcare personnel, 4) increased risk
for complications in some healthcare personnel workers such as pregnant
women, and 5) the potential for healthcare personnel to be exposed to 2009
H1N1 influenza patients because of their occupation.
Strategies for Potential Shortages
The
guidance recognizes that some facilities are experiencing shortages of
respiratory protection equipment, and that further shortages are anticipated.
Therefore, the appropriate selection and use of respirators is critical. Key
strategies include:
- Use
of source control, engineering, and administrative measures to reduce
the number of personnel who come in contact with patients who have
influenza-like illness – and consequently, reduction in the
consumption of respiratory protection equipment.
- Use
of alternatives to disposable N95 filtering-facepiece respirators for
certain applications, including more protective filtering-facepiece
respirators, reusable elastomeric tight-fitting respirators, and
reusable powered air-purifying respirators (PAPRs). For facilities that are
able to use alternatives such as elastomeric respirators or PAPRs,
processes must be in place to ensure that they are used properly and are
reliably decontaminated. Additional information about these strategies,
including frequently asked questions, are posted on the CDC 2009 H1N1
website (see http://www.cdc.gov/h1n1flu).
- Strategies to reduce consumption of respirators or
to extend their use during severe shortage conditions.
CDC
recommends that facilities assess their projected needs and take special care
to ensure that respirators are available for situations where respiratory
protection is most important, such as performance of aerosol-generating
procedures on patients with suspected or confirmed 2009 H1N1 flu or provision
of care to patients with diseases other than influenza that require
respiratory protection. If a facility projects that it will be unable to meet
these needs despite taking measures to minimize consumption, and maximize
benefit, of available respirators, then it should institute a
“prioritized use mode” governing use of respiratory protection
for influenza until supplies are expected to be replenished.
In
prioritized use mode, respiratory protection is reserved for situations where
respiratory protection is most important, such as attendance at highest-risk,
aerosol-generating procedures involving 2009 H1N1 patients. Levels of
priority for respiratory protection based on exposure scenario, vaccination
status, and personal health risk factors for serious infection are detailed
in the guidance document. Facemasks provide a barrier against splashes,
droplet sprays, and hand contact with the nose and mouth, and thus should be
chosen over no protection for workers at lower risk, the CDC guidance states.
NIOSH will continue to work closely and strategically
with our colleagues and stakeholders in the coming months to help the
healthcare industry and the dedicated U.S. healthcare workforce meet the
ongoing challenge of 2009 H1N1 influenza.
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NIOSH Research Part of Good Morning America Feature Story
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On September 17, ABC’s Good Morning America
highlighted NIOSH’s computer modeling research to help protect flight
crews from job-related health and safety hazards. NIOSH scientist James
Bennett described computer modeling used to identify how far, and in what
pattern, contaminants such as viruses may spread through an airplane cabin
from a source. http://abcnews.go.com/GMA/scared-swine-flu-avoid-germs-viruses-plane/story?id=8596700
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Work-Stress Topic of Wall
Street Journal Story
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On
September 16, the Wall
Street Journal highlighted NIOSH’s research on work-stress
prevention in a column reporting on a new Gallup survey on job satisfaction.
Findings in the survey—that business owners, self-employed people, and
farmers generally report high satisfaction with their jobs—are
consistent with NIOSH’s research findings that work stress can be
caused or worsened by lack of control over one’s job or a feeling that
the work may be meaningless and unfulfilling. http://online.wsj.com/article/SB10001424052970203917304574414853397450872.html#mod=WSJ_
hps_RIGHTTopCarousel
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N.Y.
Daily News Salutes Dr. Robin Herbert
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Occupational Safety and Health Goes WestOn
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On September 24–25, the Western
States Occupational Network (WestON) held its second annual meeting in
Denver, Colorado. Sponsored by the NIOSH Denver Regional Office, the Council
of State and Territorial Epidemiologists, and the NIOSH Mountain and Plains
Education and Research Center, the meeting provided a venue for approximately
60 state, federal, and academic occupational safety and health professionals
to meet and share ideas for collaboration, information exchange, and capacity
building throughout the western U.S. For more information on this conference,
please contact Yvonne Boudreau (AYB1@xxxxxxx).
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New Virtual Reality Resource Trains Miners to Navigate
an
Underground World
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Safety training for new miners enters the 21st century
with a computer-based training program now available from NIOSH. This new technology
helps to prepare young miners to read mine maps, a critical skill in learning
how to navigate the labyrinth of tunnels and to stay safe in underground
mines. The program can be completed in about two hours and is available for
free download at http://www.cdc.gov/niosh/mining/products/product165.htm.
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Research to Improve Fire Fighters? Protective Clothing
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Indoor Air Quality Evaluated at PAHO Headquarters
In
September, engineers from the NIOSH Division of Applied Research and
Technology conducted an evaluation at the Pan American Health Organization
(PAHO) headquarters facilities in Washington DC. The team collected data
related to concerns of the PAHO staff about indoor air quality and HVAC
system noise on certain floors within the 10-story building. The team will
develop a report to summarize their findings and possible measures that can
be taken to improve the work environment in their facility. For more
information, contact Scott Earnest at GEarnest@xxxxxxx
or go to the NIOSH Topic Page: Indoor Environmental Quality at http://www.cdc.gov/niosh/topics/indoorenv/.
Preparing World Healthcare Leaders for Exposure to Bloodborne
Infections
NIOSH
researcher Ahmed Gomaa, with partners from the University of Virginia and the
World Health Organization, provided a workshop onsite in Saudi Arabia to 92
healthcare leaders from Egypt, Saudi Arabia, Kuwait, Bahrain, Oman, and
Qatar. Workshop topics included occupational health programs for the prevention
of exposure to bloodborne infections and the evaluation and development of
recommendations to protect healthcare workers. For more information contact
Ahmed Gomaa at AGomaa@xxxxxxx.
Colleagues
attending a NIOSH/WHO-sponsored training workshop.
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NIOSH Seeks Comments on the Following:
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Three New Health Hazard Evaluation Reports Now Available
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 The Health Hazard
Evaluation (HHE) Program evaluated workers’ asthma and respiratory
symptoms at a soy processing facility. Investigators found that some dust
concentrations in the air exceeded current occupational exposure limits.
Investigators recommended respiratory protection for all workers with
work-related asthma and, if that is ineffective, relocating those workers to
lower exposure areas.
http://www.cdc.gov/niosh/hhe/reports/pdfs/2007-0073-3089.pdf
The HHE
Program evaluated employees’ concerns about exposure to lead solder
paste and fumes and noise at a printed circuit board manufacturing plant.
Investigators found that auto insertion operators’ noise exposures were
very low. Investigators found lead on employees’ hands, on work
surfaces, and in a break room. Investigators recommended improving general housekeeping
and using engineering controls when removing solder dross and cleaning wave
solder machines.
http://www.cdc.gov/niosh/hhe/reports/pdfs/2007-0201-3086.pdf
The HHE Program evaluated airport cargo handlers’
exposure to carbon monoxide. Investigators found that all airport terminal
service employees’ carbon monoxide levels measured in the evaluation
were above recommended limits but transportation security and air logistics
employees’ carbon monoxide levels were not. Investigators recommended
replacing fuel-driven forklifts and tugs with electric ones, reminding
drivers to turn off vehicle engines when at the dock doors, increasing
warehouse ventilation, and installing carbon monoxide alarms.
http://www.cdc.gov/niosh/hhe/reports/pdfs/2007-0144-3087.pdf
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Morbidity and Mortality @ Work
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Sickness Absenteeism among Full-Time Workers in the U.S.,
August 2009
Sickness absenteeism in the workplace is strongly
correlated with the occurrence of influenza-like illness and may serve as an
indicator of the level of influenza activity in the employed population
during the current pandemic (Figure 1). NIOSH tracks sickness absenteeism
among full-time workers on a monthly basis, using data from the Current
Population Survey (CPS). Figure 2 shows the geographic distribution of
sickness absenteeism among full-time workers in the U.S. by state for August
2009. Since CPS data are population-based and nationally representative,
either of these analyses can be stratified by a number of demographic and
labor force characteristics such as age, sex, industry, and occupation to
provide benchmarks for those interested in specific segments of the
population. Link to chartFor more details, see the chart at http://www.cdc.gov/niosh/enews/enewsv7n6chart.html.
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Preventing Lead Poisoning in Indoor Firing Ranges in Colorado
The Colorado Department of Public Health and
Environment has developed a fact sheet to provide information about the risks
of lead exposure to workers and hobby and recreational shooters at indoor
firing and shooting ranges. Indoor firing and shooting ranges are common
sources of adult lead exposure in Colorado. Workers at indoor firing ranges
can be exposed to hazardous lead concentrations and may be at risk for lead
exposure and lead poisoning. http://www.cdphe.state.co.us/dc/OH/shooting.html
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 NIOSH
Seeks Partners
NIOSH is
seeking partners to further develop and commercialize a new point-anchoring
device, the Bolthead Clamp. The device provides a temporary or permanent
anchoring point to assist with pulling, lifting, suspending, and material
handling where there are exposed square-head bolts and where S-hooks and other
suspension devices are not adequate or feasible. Numerous industries
can benefit from this device, such as tunneling, mining, construction,
maintenance, and renovation. Please contact Kathleen Goedel at Kgoedel@xxxxxxx or 513-533-8686 for more
information.
NIOSH and the National Safety Council Renew Partnership
NIOSH and the National Safety Council have renewed
their partnership to improve occupational safety and health conditions in the
workplace. The renewal reaffirms the commitment of both organizations to
advance the protection of workers, promote best practices, and encourage
employers to develop and utilize occupational safety and health management
programs and effective prevention strategies and technologies. For more
information, please contact Nancy Stout at Nstout@xxxxxxx.
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Draft National Manufacturing Agenda
The NORA Manufacturing Sector Council requests
comments on its draft national agenda http://www.cdc.gov/niosh/review/public/184/,
which consists of ten strategic goals covering a range
of diseases, injuries, and priority issues. The Council also seeks
organizations to join partnership efforts to advance the draft
priorities. For more information, contact the NORA coordinator at noracoordinator@xxxxxxx.
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NIOSH Blog Making the Business Case
This
month, NIOSH blogs about the partnership with the National Safety Council and
the Williams College of Business at Xavier University to integrate
occupational safety and health into the school’s business curriculum.
The course addresses how companies can evaluate occupational safety and
health interventions and programs in order to choose and implement the most
cost-effective ones that will both improve occupational safety and health for
workers and support the business objectives of the company. http://www.cdc.gov/niosh/blog/nsb092109_businesscase.html
NIOSH Wants To Hear Your Thoughts on Our Blog
When you visit the NIOSH blog this month you may be
asked to answer a short survey. We are currently evaluating the NIOSH blog
and we hope you will take a couple minutes to answer the questions in order
to help us to continue to meet the needs of our readers. If you have any
questions, please contact Virginia Sublet vsublet@xxxxxxx.
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Guidelines for Refuge Chamber Setup, Use, and Maintenance
Take
Refuge! NIOSH announces the release of guidelines on how to set up, use, and
maintain refuge chambers (emergency structures designed to provide safe
shelter) in underground mines. Refuge chambers may save the lives
of miners trapped underground and waiting for rescue after a mine explosion
or cave-in. http://www.cdc.gov/niosh/mining/pubs/pubreference/outputid3169.htm
Two NIOSH Resources on the Horse Racing Industry, Now
Available in Spanish
The NIOSH
horse racing industry topic page, “La Industria Hípica” http://www.cdc.gov/spanish/niosh/topics/hipica.html
NIOSH document, Perspectiva
General de la Seguridad y la Salud de los Trabajadores de la Industria Hípica,
http://www.cdc.gov/spanish/niosh/docs/2009-128_sp/
More…
To see other new NIOSH communication products,
including documents and new and updated topic pages, go to the NIOSH
“What’s New” page. http://www.cdc.gov/niosh/whatsnew.html
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Association of Professionals in Infection Control
Call for papers and presentations related to infection prevention and
control, healthcare epidemiology, and related fields. Deadline for submission
is October 16, 2009.
http://www.apic.org//AM/Template.cfm?Section=Home1
Society of Manufacturing Engineers Rapid 2010 Conference and
Exposition
Call for speakers. Deadline for submission is October 16, 2009.
http://www.sme.org/cgi-bin/get-evdoc.pl?&&001887&000007&speakers&&SME&
Emergency Nurses Association Annual Conference
Call for course proposals. Deadline for submission is October 23, 2009.
http://www.ena.org/about/calls/Pages/2010ACFaculityCall.aspx
History of Occupational and Environmental Health Conference
Call for abstracts, International Conference on the History of Occupational
and Environmental Health. Deadline for submission is November 2, 2009. http://www.ucsfcme.com/2010/miscfiles/MMJ10014Abstract.pdf
11th Biennial Kentucky Conference on Health
Communication
Call
for papers, posters, and panel proposals related to issues in health
communication. Special consideration will be given to submissions that
address issues related to the conference theme on Health Communication Theory
and Practice. Deadline for submission is December 13, 2009. http://comm.uky.edu/kchc/
American Society for Testing and Materials (ASTM)
International Symposium on Surface and Dermal Sampling
Call for papers for the ASTM International Symposium on Surface and Dermal
Sampling. Deadline for submission is January 14, 2010. www.astm.org/d22symp1010.htm
NIOSH and International
Journal of Occupational and Environmental Health
Call for papers on nanotechnology exposure assessment. Deadline for
submission is January 15, 2010.
http://www.ijoeh.com/index.php/ijoeh/information/callforpapers
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Upcoming Conferences & Workshops
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Refuge
Chamber
- emergency structures designed to provide safe shelter.
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NIOSH eNews on the Web:
www.cdc.gov/niosh/enews/
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NIOSH
eNews is Brought to You By:
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Director
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John
Howard, M.D.
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Editor
in Chief
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Max
Lum
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Story
Editor
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Tanya
Headley
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Copy
Editor
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Cathy
Rotunda
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Public
Affairs Officer
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Fred
Blosser
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Technical
Lead
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Glenn
Doyle
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Technical
Support
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Joseph
Cauley
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Please send your comments and suggestions
to us at nioshenews@xxxxxxx.
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