This is RICOSH's latest newsletter with stories on the lessons the US can learn from the West African Ebola epidemic, climate change and worker safety and health and a lockout and tagout fact sheet.
The Ebola Outbreak: Some Take Away Lessons W hile recent disputes over appropriate worksite infection control during the Ebola outbreak have been difficult, workers have benefited from the discussion. It is now clear that preventing transmission to and infection of health care (and other responders) is a critical plank in infection control policies to slow and to terminate an infectious disease outbreak. The federal Centers for Disease Control and Prevention (CDC) had, after some vigorous debate, expanded its previous infection control guidance for healthcare workers caring for patients with Ebola beyond the contact precautions usually associated with blood borne pathogens. The new CDC recommendations incorporate protocols that ensure all workers involved in the care of Ebola patients receive repeated training and can demonstrate competency in performing infection control practices and procedures, especially in donning/doffing proper personal protective equipment ((PPE). The necessity of this additional guidance was demonstrated when Emory University Hospital ‘s Bruce Ribner MD found he had just three days to prepare his team for the arrival of the two Ebola-infected doctors. Fortunately, the staff had undergone years of training and drills of training precisely for the care of such patients and the doctors were successfully treated. The new CDC guidelines include a variant of the buddy system. This means there is onsite monitoring to assess and supervise the proper use of PPE by health care workers to ensure they adhere the established protocols. It also stresses administrative and environmental controls such as maintaining isolation containments, disinfecting equipment and designating areas for putting on and taking off PPE. There are now expanded recommendations for additional respiratory protection to be added to the PPE splash ensemble, particularly when workers are performing activity that may stimulate coughing or promote the generation of aerosols. (CDC guidance is not a mandatory regulation, but remains best practices for the health care community.) C limate change is already affecting Rhode Island. Narragansett Bay is getting warmer. Sea levels are rapidly rising. Shorelines are eroding. And we’re experiencing more severe weather events. The earth’s climate is changing due to emissions from human activity. These events are expected to have dramatic impact on human health, directly and indirectly. We need to assure that our awareness is all-inclusive and provides for the critical role that workers play in mitigating and responding to climate change. Workers and ‘Resiliency’ The term “resiliency’ has gained currency to acknowledge the need to prepare and plan for the variety of climate impacts; but what seems to slip through the coinage is any attention to the health and safety or workers involved in response, repair and replacement. During Hurricane Katrina investigations, exposure samples obtained from workers during cleanup operations revealed carbon monoxide levels above the National Institute for Occupational Safety and Health (NIOSH) ceiling limit. Carbon monoxide {CO} exposures occur when internal combustion engines of cleanup equipment are used indoors or in circumstances that impede safe dispersion of exhaust gases. CO can cause immediate effects by impairing mental function and at high doses death; long term effects also include mental impairment. In addition, safety hazards such as broken glass and skin contact with floodwater posed a risk to workers. Heat stress was also a potential health hazard for crews who worked on a hot day or were wearing PPE to clean up spoiled food (such as maggot-infested meat) and flood debris. (After Hurricane Katrina, wound-related Vibrio illnesses were reported, which were likely a result of floodwaters infecting a wound.) US climate researchers and federal agencies with the sole exception of NIOSH have largely overlooked workers in their summary of the impacts of climate change on human health and have failed to identify the disproportionate impact on many workers. The National Institute for Environmental Health Sciences [NIEHS] has also been one of the few federal agencies that have pressed for more attention to the worker safety. The NIEHS has sponsored several workshops and program that assess the impact and have been developing training programs that provide workers and other with skills and information. The Service Employees Union [SEIU] has received funding from FEMA to build ‘resiliency’ in the areas affected by Hurricane Sandy to improve preparedness for future disasters. Worker Safety and Health in a Changing Climate RESILIENCY AND MITIGATION continued on page 4 - Climate Change Rhode Island Committee on Occupational Safety and Health Newsletter on Occupational & Environmental Health THE RICOSH NEWSLETTER Winter 2015 CDC guidance is not a mandatory regulation, but remains best practices for the health care community continued on page 4 - Ebola
Transcript
The Ebola Outbreak: Some Take Away Lessons
While recent disputes over appropriate worksite infection control during the Ebola outbreak have been difficult, workers have benefited from the discussion. It is now
clear that preventing transmission to and infection of health care (and other responders) is a critical plank in infection control policies to slow and to terminate an infectious disease outbreak.The federal Centers for Disease Control and Prevention (CDC) had, after some vigorous debate, expanded its previous infection control guidance for healthcare workers caring for patients with Ebola beyond the contact precautions usually associated with blood borne pathogens. The new CDC recommendations incorporate protocols that ensure all workers involved in the care of Ebola patients receive repeated training and can demonstrate competency in performing infection control practices and procedures, especially in donning/doffing proper personal protective equipment ((PPE).The necessity of this additional guidance was demonstrated when Emory University Hospital ‘s Bruce Ribner MD found he had just three days to prepare his team for the arrival of the two Ebola-infected doctors. Fortunately, the staff had undergone years of training and drills of training precisely for the care of such patients and the doctors were successfully treated. The new CDC guidelines include a variant of the buddy system. This means there is onsite monitoring to assess and supervise the proper use of PPE by health care workers to ensure they adhere the established protocols. It also stresses administrative and environmental controls such as maintaining isolation containments, disinfecting equipment and designating areas for putting on and taking off PPE. There are now expanded recommendations for additional respiratory protection to be added to the PPE splash ensemble, particularly when workers are performing activity that may stimulate coughing or promote the generation of aerosols. (CDC guidance is not a mandatory regulation, but remains best practices for the health care community.)
Climate change is already affecting Rhode Island. Narragansett Bay is getting warmer. Sea levels are rapidly rising. Shorelines are eroding. And we’re experiencing more severe weather
events. The earth’s climate is changing due to emissions from human activity. These events are expected to have dramatic impact on human health, directly and indirectly. We need to assure that our awareness is all-inclusive and provides for the critical role that workers play in mitigating and responding to climate change.
Workers and ‘Resiliency’The term “resiliency’ has gained currency to acknowledge the need to prepare and plan for the variety of climate impacts; but what seems to slip through the coinage is any attention to the health and safety or workers involved in response, repair and replacement.During Hurricane Katrina investigations, exposure samples obtained from workers during cleanup operations revealed carbon monoxide levels above the National Institute for Occupational Safety and Health (NIOSH) ceiling limit. Carbon monoxide {CO} exposures occur when internal combustion engines of cleanup equipment are used indoors or in circumstances that impede safe dispersion of exhaust gases. CO can cause immediate effects by impairing mental function and at high doses death; long term effects also include mental impairment.In addition, safety hazards such as broken glass and skin contact with floodwater posed a risk to workers. Heat stress was also a potential health hazard for crews who worked on a hot day or were wearing PPE to clean up spoiled food (such as maggot-infested meat) and flood debris. (After Hurricane Katrina, wound-related Vibrio illnesses were reported, which were likely a result of floodwaters infecting a wound.)US climate researchers and federal agencies with the sole exception of NIOSH have largely overlooked workers in their summary of the impacts of climate change on human health and have failed to identify the disproportionate impact on many workers. The National Institute for Environmental Health Sciences [NIEHS] has also been one of the few federal agencies that have pressed for more attention to the worker safety. The NIEHS has sponsored several workshops and program that assess the impact and have been developing training programs that provide workers and other with skills and information. The Service Employees Union [SEIU] has received funding from FEMA to build ‘resiliency’ in the areas affected by Hurricane Sandy to improve preparedness for future disasters.
Worker Safety and Health in a Changing Climate
RESiLiEncy And MiTigATiOn
continued on page 4 - Climate Change
Rhode Island Committee on Occupational Safety and Health
Newsletter on Occupational & Environmental Health
THE RICOSHNEWSLETTER
Winter 2015
CDC guidance is not a mandatory regulation, but remains best practices for the health care community
continued on page 4 - Ebola
■ 2 ■ Spring / Summer • 2013THE RICOSH NEWSLETTER
Winter 2015THE RICOSH NEWSLETTER is a publication of the R.I. Committee for Occupational Safety and Health.
Newsletter Committee: James Celenza, Mary G. HarringtonDesign: Second Story Graphics
Graphic images courtesy of: The Labor Institute, TNEC, CDC and OSHA
RICOSH751 Westminster Street, Providence, RI 02903
The threat to health care and other workers from Ebola virus disease (EVD) is that the viral load in an infected patient’s body fluids is colossal – in the billions of viral particles – along with the fact workers caring for (EVD) infected patients have significant physical contact with these patients while they are shedding virus because of fluid loss. The EVD patients healthcare workers treated in Atlanta lost five to ten liters of fluid a day.
Some of the Back StoryThis is not the first time disputes regarding effective worksite safety protocols have occurred during a severe biologic outbreak. Tensions rose during the HIV/AIDS epidemic in the early 1980s over hospital management and health care workers’ safety. The Occupational Safety and Health Administration’s Bloodborne Pathogen standard emerged as a result of these tensions. (This standard covers all bloodborne pathogens.)Once again in the late 1980s, an outbreak of multi-drug resistant tuberculosis (TB) inflamed many about appropriate worker safety measures. Indeed there was a kafuffle between occupational health professionals and the infectious disease profession regarding respirators and respiratory protection. The subsequent worldwide SARs outbreak reinforced the need for clear guidance to protect health care workers and the need for coordinated surveillance and communications. For example, at one point, 60% of quarantined healthcare workers in Toronto could not explain why they were under quarantine.
Associated and parallel developments were the emergence of bioterrorism threats, such as the anthrax attacks through the United States Post Office. The avian flu (H5N1) outbreak in 2009 renewed attention to infection control policies that are becoming hard-wired into the structure of occupational and public health practices. These include:
Pharmaceutical therapies that can immunize, or minimize the impact of the infectious agent
Systematic laboratory and epidemiologic surveillanceLocating and isolating patients
Monitoring and quarantining contacts
Travel restrictions and the screening of travelers
Maintaining strict infection control procedures especially within high risk settings
Providing the best methods of controlling exposure and transmission to medical and responding personnel
Moving ForwardThe current EVD epidemic, though mostly confined to West Africa, should be an opportunity to discuss and perhaps adopt some relevant approaches.
Resource Allocations Recently, the Bill & Melinda Gates Foundation and others have announced their funding of the development of an EVD vaccine(s). While praiseworthy, the funding of public health systems, i.e., the people and institutions on the frontlines of the epidemic merit foundation support as well. During the 1995 EVD outbreak in Democratic Republic of the Congo, there were 315 cases resulting in 244 deaths. One fourth of the cases were health care workers. This outbreak along with others was halted without any vaccines, but by classical infection control systems in tandem with appropriately trained health care workers. It is useful to note here that after barrier nursing practices (such as wearing protective clothing) were implemented, no new cases were reported among health care workers who used them. Even when there are effective pharmaceutical therapies (as with Polio) without functioning public health infrastructures – institutions and people – to address the surrounding social networks, the incidence of disease will not be curtailed, as in Pakistan where political upheaval is preventing the distribution of Polio vaccines. We can only hope that as much funding will be allocated to enhance
the system(s) of disease control (such as those practiced by Doctors without Borders) as will be allocated to vaccine development. To date, the public health agencies that protect us from infectious diseases like Ebola and prevent and control chronic diseases – the leading cause of death and disability in our country – have been woefully underfunded.
Regional Biocontamination Centers. So far less than half a dozen EVD patients have been seen in the United States. Imagine if it had been 30 or 300? We need federally funded regional biocontamination centers as they provide the highest levels of protection both to health care workers and the public. This would relieve local hospital and health care facilities of the additional burden of caring for (EHV) patients. At this moment there are only four such biocontamination centers in the US with a total of 16 available beds. And as of this writing, no Rhode Island hospital has notified the Department of Health that it will assume the official role of taking on identified EVD patients.
Access to Experience.Scores of health professionals from the United States have been working to stem the West African Ebola outbreak. Others are in similar situations addressing outbreaks of better-known tropical diseases such as the Haitian cholera epidemic. These remarkable folks have a wealth of knowledge and experiences in dealing with tropical disease and the social networks that play a key role in infection control. There is also a strong emphasis on infectious and communicable diseases in medical education in the military. This wealth of experience should be shared in some official capacity to assist local health departments and health care institutions.
Share the Wealth We should also be rapidly deploying infection disease control systems, protective equipment and training to regions where healthcare and responders are at the most risk such as western Africa where the EVD outbreak is epidemic.Climate change is causing an increase in unstable climate patterns. These play an ever increasing role in the emergence of infectious diseases. In 1998, for example, a hurricane dropped six feet of rain in three days in Central America. In its wake, the incidence of malaria, dengue fever and cholera soared.Hopefully the ongoing EVD epidemic will prompt us to implement best practices and policies to enhance our collective capacities to address this epidemic but also the ones that undoubtedly lie ahead.
Ebola Outbreak - continued from page 1
We should also be rapidly deploying infection disease control systems, protective equipment and training to regions where healthcare and responders are at the most risk such as western Africa where the EVD outbreak is epidemic.
Factsheet
RI Committee on Occupational Safety and Health {RICOSH} is a (non-profit) resource center for occupational and environmental health and safety.
RI Committee on Occupational Safety & Health 741 Westminster St. Providence, RI 02903 (401) 751-2015/[email protected]
Solids, liquids and gases can flow into a vessel or a space while workers are in them. Industrial equipment such as saw blades, gears, rotating shafts, fans, cutting or bending devices, presses, ovens and dryers can be activated while workers are trying to clean or maintain them putting them at high risk for serious injury. Lockout is a procedure designed to protect workers while working on, in or near dangerous equipment.If you install a light switch, you shut off the power at the fuse box and make sure no one accidentally turns it back on. The same is true in the workplace where the equipment and the power are far more dangerous. Lockout ensures that power sources are shut down, remain off and that equipment (blades, rotors, presses, etc.) cannot move.
A Lockout checklist:Identify each hazardous energy source.
Notify personnel that equipment will be shut down and locked out.
Shut down each hazardous energy source and lock in off position.
Lockout energy sources with each individual worker’s lock.
Test to make sure sources are off.
Check equipment: Use isolation or blocking devices so equipment will not run.
Deplete potential energy sources in pipelines vat tanks by bleeding, blocking, grounding, etc.
Before energy is unlocked and equipment turned on, ensure all workers are accounted for and it is safe to proceed.
What About Tags?Sometimes tags are used instead of locks. While lockout physically blocks the energy sources, tags only alert workers not to start a source. Tags should be relied upon only when a locking mechanism is absolutely impossible. Tags must be highly visible and strategically placed in a way that best prevents anyone from starting up the equipment.Most industrial equipment is run by electricity, but not all. There are also hydraulic (water pressure), pneumatic (air pressure), mechanical or chemical forms of energy. Stored energy may be present even though the source is down. A moving part may be in a raised position and the sheer weight of the object may make it drop on someone. So you need to look at energy stored in springs, electrical capacitors, and suspended parts.While the federal Occupational Safety and Health Administration’s (OSHA) Lockout Rule (1910.147) is designed for maintenance activities, its procedures should be followed in many other situations, e.g. emergency response. Here is a brief summary of OSHA’s Lockout/Tagout rule.
Lockout/Tagout rule.A lockout plan should identify WHICH energy sources will be locked-out and how to lock them out. Restart procedures should also be outlined.
BEFORE turning off the power, check that no one is operating the equipment. Inform operators before power is turned off.
Each worker puts a lock on the equipment’s lockout device(s). Each lock remains on the equipment until the work is completed. Each lock will have individual workers’ identification on it. Each worker will have the ONLY key to remove the lock.
Steam, air, and hydraulic lines should be bled, drained, and cleaned out. If complete draining is not possible use a Blinding Technique (inserting a circular disk into the line to block flow and then draining the blocked off portion).
Release and block any mechanism under tension or pressure such as springs. If there is a ram, which could drop, support the ram with safety blocks or pins. Fully interlocked safety blocks are the safest.
Test the main valve or main electrical disconnect to be sure that the power to the machine is off.
Check electrical circuit(s) with proper and calibrated testing equipment. An electrical failure could energize the equipment even if the switch is in the off position. Stored energy in electric capacitors should be safely discharged.
THE OSHA RULE MANDATES THAT EMPLOYERS AUDIT THEIR LOCKOUT/TAGOUT PROCEDURES.
Lockout/Tagout
A mechanic and manager entered a confined space to fix a leaking sulfur trioxide valve. They decided to disassemble the valve. The manager left to go to the control room. He heard a scream and ran beck to find a white gas cloud pouring out of the space. He immediately shut down the line; after two attempts he rescued the mechanic. The mechanic later died from chemical burns. They failed to shut down the sulfur trioxide line and relieve its pressure before they started work on the valve.
Inside this Issue
RI Committee on Occupational Safety and Health741 Westminster StreetProvidence, RI 02903
The New England Consortium (TNEC) based at the University of Massachusetts/ Lowell is sponsored by the National Institute of Environmental Health and Safety’s Worker Education Training
program (NIEHS/WETP) to provide health and safety training relating to hazardous materials. TNEC is a New England regional partnership between the University of Massachusetts Lowell (UML) and Western MASSCOSH, MASSCOSH, RICOSH, CTCOSH, and NHCOSH. and (AFSCME) CSEA in New York. TNEC also collaborates with the OSHA New England Training Institute Education Center at Keene State, NH. ■Hazardous Waste Site Workers Training (HAZWOPER)
■Emergency Responder Health and Safety Trainings
■OSHA 10 Hr construction safety training
■Work and Construction Zone Safety
■Confined Space Training
TRAINING PROGRAMS AvAILABLE
A contract course can be specifically
designed for the facility and will be held at the facility
[Check TNEC website for additional information]
RICOSH741 Westminster Street, Providence, RI 02903 [401] [email protected]
Workers involved in ‘Mitigation’A second category of workers directly impacted by climate change are those that work in occupations and industries that are making alternative energy to reduce the fossil fuel emissions that are at the root cause of climate change. The manufacturer of solar and energy efficient lights and batteries involves exposure to extremely hazardous chemicals and gases. Safety and health issues during construction of wind generation/turbine facilities include working at heights, mechanical assembly of large components, medium voltage electrical safety and working in exposed environments. The American Society of Safety Engineers (ASSE) proposed a National Standard for the Safe Construction and Demolition of Wind Generation/Turbine Facilities (A10.21-20xx), due to increasing green energy development and the potential risks involved in construction operations relating to green energy initiatives.Ironically, global sugar agriculture is booming because of the demand for “climate-neutral” biofuels. Yet, in Central America sugar plantations workers have died from chronic kidney disease most likely caused by combined exposure to extreme temperature, pesticide exposures, a “piece work” payment system, and other employment conditions that prevent adequate hydration, rest, and protection from chemical exposures.Rhode Island has set ambitious emission reduction targets through the recently enacted Resilient Rhode Island Act, the state’s first comprehensive climate change bill. We need to assure that the term “resiliency” is all-inclusive and provides for the critical role that workers play in mitigating and responding to climate change. 1/18/15
The Resilient Rhode Island Act of 2014 institutes the processes of the need to investigating and coordinating adaptation and planning solutions to climate change. It creates a greenhouse gas reduction goal of 85% by 2025. The Department of Environmental Management, supported by the 24-member Division of Administration Planning program and 13 other state agencies, are now charged with conducting vulnerability assessments and setting goals to reduce the impact of climate change on the state’s population. The bill includes language pertaining to programs that strive toward “modernizing the electric grid, regulation and rates; improving incentives for combined heat and power systems [CHP], [and] expanding the renewable energy standard and procurement.
