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Volume
7 Number 8 December 2009
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From the Director's Desk
--John Howard, M.D. Director, NIOSH
December eNews 2009
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Safety, Health, and Healthcare Workers: Rethinking Old
Assumptions
It is no
easy task to be an occupational safety and health practitioner in the
healthcare industry. Longstanding and deeply embedded assumptions are always
difficult to shake, even when the need to do so becomes increasingly
apparent.
People in
healthcare — including me — often take offense when we are said to belong to
an “industry.” In my career as a physician in an acute-care hospital setting,
I have heard the words “profession” or even “calling” used to describe people
who work in healthcare. And, depending on how remote, or how dangerous the
part of the world where you deliver healthcare, healthcare workers are
sometimes described as “noble” or “self-sacrificing.”
Indeed,
these descriptions are flattering and are, in some cases, accurate, but we
must be careful when society characterizes routine work in any industry as “self-sacrificing.”
This characterization places workers engaged in such work outside the
protections of the governmental worker safety and health paradigm that we
apply to other all other industrial sectors where labor is exchanged for
wages.
Providing
occupational safety and health protections for healthcare workers is complex.
In healthcare, some people have described a tension between caring for the
patient and caring for the worker who cares for the patient. Healthcare has a
long history of resolving that conflict entirely to the advantage of the
patient without a rigorous consideration of all alternative ways to protect
both the patient and the worker. The adoption of the Bloodborne Pathogens
Standard http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051
in 1991 marked a real turning point in efforts to protect healthcare
workers and patients.
Hazards in the Work Setting
We have
known for years about the hazards that healthcare workers face every day:
- Exposures
to formaldehyde, anesthetic gases, and other potentially toxic chemicals
- Risks
for acute or chronic injuries from physical exertion such as turning and
lifting patients, or standing for hours at a time in the operating room
- Potential for work-related assault and injury from
human agents in stressful situations or in public-access work areas,
such as belligerent psychiatric patients, irate family members, or even
gang members who engage in “shoot-outs” in hospital emergency rooms
All of
these hazards, and more, characterize the risks associated with working in
the industrial sector called healthcare.
Healthcare
workers themselves have become more aware of these hazards. As awareness,
education and research on preventing these hazards from maturing into
injuries and illnesses have increased, so have the demands of healthcare
workers for less “self-sacrifice” rhetoric and more straight talk about
hazard identification, risk assessment, and risk management. Self-sacrifice
is indeed admirable and many healthcare workers often go far beyond the
duties of their job to help patients and their loved ones. However, on a
routine basis in a $2 trillion industry, it should not be the operating
principle if we are to create a sustainable healthcare workforce for the 21st
century.
Lessons from 2009 H1N1 Influenza
And it is
important that we use the opportunity of the first influenza pandemic of the
21st century to figure out what attitudes, what policies, what programs and
what practical decisions we need to employ to guarantee a sustainable
healthcare workforce. To do that successfully, we must confront the last
frontier of occupational safety and health in the healthcare industry — the
frontier associated with biological hazards.
Biological
hazards include those that are transmissible from patient to healthcare
worker, and from healthcare worker to the healthcare worker’s unborn child,
spouse, partner, children, friends, and others. Transmissible diseases are
new to the lexicon of all occupational safety and health professionals, but I
encourage all occupational safety and health practitioners to learn about
transmissible diseases not only in the healthcare workplace, but also in
non-healthcare workplaces.
The list
of such agents is long and growing, and yet we in occupational safety and
health know very little about such agents. In fact, we have often been led to
believe that understanding the transmission of such transmissible agents
requires a medical degree. That simply is not the case in the context of
carrying out our duties as safety and health professionals.
Influenza —
that virus that has plagued mankind since the dawn of the human race — that
highly changeable virus with an 8-gene team that frequently trades and
acquires new gene players—that virus that has outwitted the smartest
virologists in the world — to survive through thousands of years — is upon us
again. A fourth-generation relative of the virus that caused the terrible
1918 global pandemic appeared in the spring of 2009 and is now spreading
throughout the world. In June, the World Health Organization declared the
H1N1 influenza a pandemic.
Pivotal Documents
On October
14, 2009, the U.S. Centers for Disease Control and Prevention (CDC) updated
its Interim Guidance on Infection Control in Healthcare Settings. The
Guidance recommends that a robust hierarchy of controls — engineering,
administrative, and personal protective equipment — be used to protect
healthcare workers from the biological hazards associated with exposure to
influenza. www.cdc.gov/h1n1flu/guidelines_infection_control.htm.
Regarding personal protective equipment, the guidance continues to recommend
that healthcare workers in close contact with patients suspected or confirmed
to have H1N1 influenza wear fit-tested disposable N95 respirators.
The
recommendation is based on scientific findings that the influenza virus can
be spread by small particles or aerosols generated by an infected patient
that can remain suspended in the air and that a surgical mask does not
provide equivalent protection for the healthcare worker to a fit-tested
respirator. The CDC Guidance, together with the recently adopted California
Aerosol Transmissible Disease Standard www.dir.ca.gov/dosh/SwineFlu/Interim_enforcement_H1N1.pdf,
are pivotal documents in the effort to promote a sustainable 21st-century
healthcare workforce.
Currently,
it is anticipated that there may be a shortage in the supply of disposable
N95 respirators for healthcare settings trying their best to follow the CDC
Guidance. NIOSH has developed a Respirator Information Clearinghouse to
connect those who need to obtain respirators with those suppliers who have
respirators available. As new information is obtained, NIOSH will update the
clearinghouse site. I encourage you to visit this site and mark the page for
ongoing reference. www.cdc.gov/niosh/npptl/topics/respirators/disp_part/RespSource.html
Where
occupational safety and health practice in the healthcare industry goes from
here when the current pandemic has passed us by, remains to be seen. A far
more virulent influenza, so-called “avian” influenza or H5N1 influenza, may
present us with even greater challenges. For this reason, I do not think we
can return to an era when a healthcare worker’s exposure to transmissible
diseases such as influenza can be merely considered “diseases of life” for
which a healthcare worker “assumes the risk” when he or she offers their
labor to a healthcare employer.
We need to
care for the sick and at the same time, we need to care for those who care
for the sick. Our attitudes, our policies, our laws, and our practices need
to more clearly and emphatically reflect this duality in the 21st century
delivery of healthcare. For further information, I invite you to use our
resources for preventing work-related injuries and illnesses in healthcare www.cdc.gov/niosh/topics/healthcare/,
and to become familiar with NIOSH’s research program portfolio in healthcare
and social assistance www.cdc.gov/niosh/programs/hcsa/consider.
As always,
we invite your partnership under the National Occupational Research Agenda
(NORA) to stimulate, plan, conduct, and support the research necessary for
meeting the challenges of the 21st Century. www.cdc.gov/niosh/nora/councils/hcsa/default.html
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New NIOSH Respirator ‘One-Stop-Shop’ Web Resource
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In Memoriam: Joseph C. Fowler, Laborers' Safety and
Health Champion
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NIOSH was saddened to learn of the death of Joseph C.
Fowler, Executive Director of the Laborers' Health and Safety Fund of North
America, after a sudden and unexpected illness. Joe was a dedicated champion
of worker health and safety, and a longtime partner of NIOSH. "His
legacy will be the thousands of LiUNA members who will be safer on our
highways and construction sites and healthier in the workplace and at
home," the Laborers International Union of North America said on
November 10.
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NIOSH and Partners Contribute to Occupational,
Environmental Justice Resource
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NIOSH joined with several partners, including the
National Institute of Environmental Health Sciences (NIEHS), the U.S.
Environmental Protection Agency (EPA), and the University of Massachusetts at
Lowell, in supporting and contributing research-based articles to a new
online supplement to the American
Journal of Public Health, November 1, 2009, Volume 99, S3, on
occupational and environmental justice. http://ajph.aphapublications.org/content/vol99/issueS3/
The concerns of occupational justice are reflected in NIOSH's strategic
research to address occupational disparities. http://www.cdc.gov/niosh/programs/ohd/.
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NIOSH Agreement Focuses on Training for Loss Prevention
Professionals
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In November, NIOSH signed a agreement with the Loss
Prevention Foundation to support and advance the educational elements of the
National Occupational Research Agenda (NORA) Wholesale and Retail Trade
Sector research agenda. The Loss Prevention Foundation works to advance the
loss prevention profession by providing relevant, convenient and challenging
educational resources. This agreement opens an opportunity to ensure that
relevant NIOSH content is referenced as appropriate and that the trainees are
aware of NIOSH resources. http://www.losspreventionfoundation.org/certification.html
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NIOSH Awards Funding for Construction Research
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NIOSH recently awarded over $7 million over a five-year
period to Virginia Tech researchers and their collaborators from five other
institutions to engage in research on new construction safety and health. The
overarching purpose of the seven awarded projects is to integrate an
interdisciplinary focus in research that will produce systems capable of
enhancing productivity, quality, and efficiency for the construction
industry. http://www.vtnews.vt.edu/story.php?relyear=2009&itemno=820
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NIOSH Ergonomics Publication Receives Award
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At the
53rd Annual Meeting of the Human Factors and Ergonomics Society, NIOSH and
the Foundation for Professional Ergonomics (FPE) signed a partnership
agreement to support the Ergonomists Without Borders project. The two groups
will use their collaborative efforts and expertise to advance the
dissemination of ergonomics knowledge, promote best ergonomic practices, and
encourage employers to develop and use ergonomics interventions to mitigate
work-related musculoskeletal disorders among workers in industrially
developing countries. For more information, contact Dr. Stephen Hudock at
513-533-8183, shudock@xxxxxxx.
(left to
right) Drs. Hal Hendrick, Project Director of Ergonomists Without Borders;
Stephen Hudock, NIOSH; and Valerie Rice, President of the Foundation for
Professional Ergonomics, at the signing in October.
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NIOSH Seeks Public Comment
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Healthy People 2020
NIOSH
encourages its partners and stakeholders to comment on the DRAFT set of
occupational safety and health objectives for the U.S. Department of Health
and Human Services’ Healthy People 2020. Healthy People provides a set of
national 10-year health-promotion and disease-prevention objectives aimed at
improving the health of all Americans. NIOSH is the coordinator of the
Healthy People occupational safety and health topic area. Comments will be
accepted through December 31, 2009. http://www.healthypeople.gov/hp2020/Comments/default.asp
Proposal Rule for Respirator Inward Leakage Requirements
Comments
will be accepted through December 29, 2009, on the proposed rule for total
inward leakage requirements for half-mask air-purifying particulate
respirators. A public meeting will also be held December 3, 2009. For more
information, go to http://www.cdc.gov/niosh/docket/nioshdocket0137.html.
Survey Explores Supply and Future Demand for OSH Professionals
Will there
be enough occupational safety and health professionals to help protect
workers from the workplace hazards of the 21st century? Will their skill-sets
match employers’ needs and demands? Those are the types of questions that
NIOSH will explore in its proposed survey study of this workforce. NIOSH
invites public comment at http://edocket.access.gpo.gov/2009/E9-27334.htm.
To view a comprehensive list of NIOSH
Docket items currently open for comment, go to http://www.cdc.gov/niosh/review/public/.
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Two New Health Hazard Evaluation Reports Now Available
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 The HHE Program
recently evaluated risks for acquiring zoonotic disease among individuals who
work with non-human primates (NHPs). Investigators found that some work tasks
were associated with exposure incidents and that having more than 20 hours of
contact with an NHP in a week is linked with an increased risk of bites,
scratches, needle sticks, and splashes in eyes, mouth, or nose with NHP
secretions. Investigators also found that, despite knowing potential health
risks, employees did not report exposure incidents. Investigators recommended
that facility managers create a procedure for employees to report exposure
incidents and focus training on employees who have the most direct contact
with NHPs. http://www.cdc.gov/niosh/hhe/reports/pdfs/2001-0273-0274-0275-0407-3091.pdf
The HHE Program received a request at a
sign-manufacturing business regarding employees’ exposure to organic solvent.
Investigators found that employees’ full-shift exposures to toluene,
n-hexane, isopropyl alcohol, acetone, and cyclohexanone did not exceed
occupational exposure limits. However, employees’ exposure to the mixture of
solvents did slightly exceed American Conference of Governmental Industrial
Hygienists recommendations. Investigators also determined that short-term
exposure to isopropyl alcohol may exceed short-term exposure limits during
screen-printing and screen-washing activities. HHE Program investigators
recommended that management investigate replacing solvent-based screen
printing products with options that have low or no solvents. It was also
recommended that ventilation be improved in the screen-printing area. http://www.cdc.gov/niosh/hhe/reports/pdfs/2007-0053-3092.pdf
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 Collaborative
Opportunity – Evaluation of Source Capture Ventilation System
NIOSH researchers are soliciting partners, including
developers, manufacturers, distributors, and vendors, to participate in a
collaborative study involving the evaluation of source capture ventilation
system (SCVS) units for use in nail salons. Systems (or units) can include
downdraft-vented nail tables and portable SCVS units. The deadline to submit
units to NIOSH is February 28, 2010. For more information, go to http://edocket.access.gpo.gov/2009/E9-27387.htm
or contact Susan Reutman at 513-533-8286, SReutman@xxxxxxx.
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NORA Award Winners Announced
NIOSH
recently announced the winners of the intramural National Occupational
Research Agenda (NORA) competition for FY2010. Thirteen projects received
awards based on their technical and scientific merit. These proposals focused
on moving research into practice, focusing on priority needs in the NORA
sectors. For the full story, go to http://www.cdc.gov/niosh/updates/upd-11-09-09.html.
NORA Liaison Committee Public Meeting Announced for January
The next NORA Liaison Committee meeting, Partnerships
to Advance the National Occupational Research Agenda, will be held January
20, 2010, in Washington, D.C. Attendees can also participate online. Details
on the meeting have been posted at http://edocket.access.gpo.gov/2009/E9-28029.htm.
For more information or to preregister to attend in person or online, contact
the NORA coordinator noracoordinator@xxxxxxx.
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New Communication Products
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If It Moves, It Vibrates
The
effects of vibration (through use of powered tools, machinery, vehicles, and
heavy equipment) on workers in the industrial environment are a concern of
health professionals, governments, and scientists around the world.
Adequately assessing the effects of human vibration exposure is an equally
important issue. NIOSH addresses these concerns in the proceedings of the
second American Conference on Human Vibrationt. http://origin.cdc.gov/niosh/mining/pubs/pubreference/outputid2883.htm
What about NIOSH?
Want to
know more about NIOSH or want to tell others about us? Check out the updated
NIOSH fact sheet on the NIOSH “About Us” topic page. http://www.cdc.gov/niosh/about.html
NIOSH Mining Program Aids In Sago Mine Explosion Investigation
The Mine
Safety and Health Administration (MSHA) and the West Virginia Office of
Miners Health, Safety, and Training investigated the explosion at the Sago
Mine in West Virginia, on January 2, 2006, resulting in 12 fatalities. As
part of the investigation, the agencies requested that NIOSH Pittsburgh
Research Laboratory evaluate the effects of explosions on specific mine
ventilation seals and other structures and objects. NIOSH’s research findings
are detailed in a new published report. http://origin.cdc.gov/niosh/mining/pubs/pubreference/outputid2826.htm
NIOSH Has Recently Released These Fire Fighter Fatality
Investigation Reports:
Volunteer
Mutual Aid Fire Fighter Dies in a Floor Collapse in a Residential Basement
Fire – Illinois (F2008-26) http://www.cdc.gov/niosh/fire/reports/face200826.html
Volunteer
fire fighter dies in apparatus crash – Ohio (F2008-22) http://www.cdc.gov/niosh/fire/reports/face200822.html
Volunteer
lieutenant dies after falling from a bridge while attending to a motor
vehicle crash – Arkansas (F2007-31) http://www.cdc.gov/niosh/fire/reports/face200731.html
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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The NIOSH
exhibit will be at these January meetings:
Transportation
Research Board 89th Annual Meeting, January 10 – 14, 2010
NIOSH Booth # 2101, Marriott Wardman Park Hotel, Washington DC
Agricultural Safety & Health Council of
America – NIOSH Joint Conference
January
27 – 28, 2010, Dallas/Fort Worth Airport Marriott South, Fort Worth TX
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Upcoming Conferences & Workshops
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Exposure
Code List -
a list developed by the Association of Occupational and Environmental Clinics
(AOEC) to help systematically identify both existing and emerging
occupational and environmental health concerns. The list includes a wide
range of exposures including not only chemicals but exposures to metals,
dusts, plants, animals etc. as well as physical hazards e.g. falls, lifting, repetitive
strains, etc.
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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
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Tanya
Headley
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Copy
Editor
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Lynn
Bonney
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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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Kevin
Whaley
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Please send your comments and suggestions
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