thesynergist | NEWSWATCH
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Controversial Infection Control Guidance Sent to CDC for Review
On Nov. 3, the Healthcare Infection Control Practices Advisory Committee (HICPAC) voted to send a draft of revised guidelines on isolation precautions in healthcare facilities to CDC for review. If accepted by CDC, the revised guidelines will be published in the Federal Register, initiating a 60-day public comment period.
According to CDC’s Safe Healthcare Blog, the revised guidelines are the first of two documents that will replace the current “Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” established in 2007 (PDF). The first document discusses concepts of disease spread in healthcare facilities and categories of isolation precautions. Due to the public commenting process, the first document is not expected to be finalized before June 2024. Work on the second document, which will focus on pathogen-specific recommendations, will begin after the first document is finalized.
The revised guidelines have been met with criticism from several organizations. In a letter to CDC in July, AIHA described the revised guidelines as “grossly deficient” (PDF). In October, a webinar cosponsored by AIHA whose speakers included scientists, advocates, and other stakeholders presented detailed objections to the revised guidelines, including that the revision would recommend healthcare workers wear surgical masks in situations where N95 respirators are necessary to protect workers’ health.
Webinar speakers also raised concerns that the revision would not require the use of airborne infection isolation rooms for patients infected with novel pathogens. “This is a step down from current practice,” said Jane Thomason, CIH, who serves as lead industrial hygienist for National Nurses United (NNU), the largest union for registered nurses in the United States. “Novel pathogens need an airborne infection isolation room because we don't know yet how they transmit.”
Speakers at the webinar included Dr. Donald Milton, a professor at the University of Maryland School of Public Health, who summarized the science of aerosol transmission and studies supporting the effectiveness of N95 respirators. Eric Berg, the deputy chief of health for Cal/OSHA, stated that the HICPAC workgroup's recommendations are contrary to state law and would cause confusion at California hospitals. William Bahnfleth from Pennsylvania State University described relevant ventilation standards for healthcare facilities, and Lisa Brosseau, ScD, CIH, from the University of Minnesota discussed personal protective equipment for healthcare workers.
Recordings of the webinar presentations are available from the Rutgers School of Public Health website. A list of 14 recommendations for the guidelines suggested by webinar participants is available as a PDF. These include ensuring the guidance is based on peer-reviewed literature from all relevant disciplines, fully recognizing the role of aerosol transmission for many infectious pathogens, and adopting the precautionary principle that novel pathogens are aerosol transmissible until demonstrated otherwise.
NNU condemned HICPAC for voting to send the revised guidelines to CDC. “HICPAC’s draft is permissive and weak and seeks not just to maintain existing practice—which has been shown to be inadequately protective—but even rolls back the use of some important measures, such as airborne infection isolation rooms,” said NNU President Zenei Triunfo-Cortez.
A PDF of the revised guidelines is available from the CDC website. As of mid-December, the revised guidelines had not yet been published in the Federal Register.
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OSHA Renews Regional Emphasis Program for Noise
OSHA has renewed a Regional Emphasis Program (REP) focusing on high levels of workplace noise in three Mid-Atlantic states and the District of Columbia, a Department of Labor press release announced in late November. First established in 2018, the renewed REP prioritizes noise exposures that can contribute to hearing loss during workplace inspections in Delaware, Pennsylvania, West Virginia, and Washington, D.C.
The renewal adds three more industry sectors for targeting by the program: sawmills and wood preservation, other wood manufacturing, and ornamental and architectural metal products.
Employers are required by law to implement hearing conservation programs when average noise exposure over eight hours reaches or exceeds 85 dB. NIOSH has estimated that 22 million workers in the U.S. are at risk for hearing loss.
More information is available from the press release from the Department of Labor and the OSHA instruction implementing the revised REP (PDF).
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Details Released in Asthma-Related Death of Cannabis Facility Worker
New reports released by CDC and the Massachusetts Department of Public Health (MDPH) show missed opportunities that could have prevented the January 2022 death of a 27-year-old cannabis facility worker who suffered a fatal attack of asthma at work. The fatality is believed to be the first caused by occupational asthma among cannabis workers in the United States.
CDC and MDPH investigators found that the worker did not have a history of asthma prior to beginning work at the facility in May 2021. Within three months she developed cough and shortness of breath. These symptoms worsened after her role at the facility changed from counting finished products to working in the grinding room.
On the day of the incident, the worker repeatedly used an inhaler to control shortness of breath, but her condition worsened, and she experienced respiratory and cardiac arrest. CPR and an AED were administered on site and succeeded in restarting her heart, but she sustained a brain injury from lack of oxygen. She was transported to a trauma center and admitted to intensive care but did not recover. Care was withdrawn three days later. A severe asthma attack was identified by the medical examiner as the likely cause of death.
Research has found that cannabis dust and smoke are asthmagens and sensitizers. The MDPH report observes that “[f]urther control of the hazard or removing the victim from this work environment could have prevented this fatality.”
For more information, read the reports from MDPH (PDF) and CDC as well as the MDPH press release.
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To Address Opioid Epidemic, White House Promotes Recovery-Ready Workplaces
The Biden administration is encouraging U.S. employers to implement recovery-ready workplace policies and recently announced the availability of new resources, including a Recovery-Ready Workplace Toolkit. Recovery-ready workplace policies support workers with substance use disorders or individuals who are in recovery by creating safe and healthy work environments, reducing stigma, dismantling barriers to employment, and promoting addiction treatment and recovery support services.
The Recovery-Ready Workplace Toolkit is available through the Department of Labor’s Recovery-Ready Workplace Resource Hub. DOL’s website explains that the toolkit “is designed to help businesses and other employers prevent and respond more effectively to substance misuse among employees, build their workforces through hiring of people in recovery, and develop a recovery-supportive culture.” It may serve as a resource for planning recovery-ready workplace initiatives at state or local levels. The Recovery-Ready Workplace Resource Hub also connects users to additional resources developed by federal departments and agencies, state and local authorities, unions and trade associations, and other organizations.
The 2018 National Survey of Drug Use and Health found that approximately 13.6 million workers, or nearly nine percent of all employed adults, had current alcohol or illicit drug use disorders. Another 13.4 million workers reported that they were in recovery or had recovered from a substance use disorder.
More information can be found in the White House press release.
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NIOSH Challenge Spurs Solutions to Counter Fake Respirators
The winning solution from NIOSH’s Counterfeit N95 Challenge is a phone app and website that would help people verify the authenticity of filtering facepiece respirators (FFRs), the agency announced in December. The competition was intended to address the influx of fake N95 FFRs into the marketplace.
The “N95 FFR Validation App and Website” developed by Essayon Engineering communicates with the NIOSH certified equipment list to help users determine whether respirators are authentic. The app portion allows users to compare pictures from respirator manufacturers’ websites against the respirators they’re assessing.
Honorable mentions went to three solutions: a system that allows users to check if their respirators are authentic using a QR code incorporated into product packaging; a platform that provides information about how to authenticate NIOSH-approved respirators; and a registry that allows manufacturers to share provenance data to help ensure respirators’ authenticity.
For more information, visit NIOSH's website.
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OSHA Outlines Employer Responsibilities to Protect Temporary Workers
Two recent OSHA bulletins focus on the responsibilities of staffing agencies and host employers to protect temporary workers from ergonomic hazards and from hazards in warehouses.
“Ergonomics for the Prevention of Musculoskeletal Disorders” (PDF) outlines staffing agencies’ and host employers’ roles in protecting temporary workers from soft tissue injuries or musculoskeletal disorders (MSDs). According to the bulletin, transportation and warehousing, healthcare and social assistance, and retail trade are the three industries with the highest incidence rates of MSDs.
OSHA urges the host employer to take the lead on hazard analysis, share the results with the staffing agency, install controls to mitigate ergonomic hazards, and ensure employees are trained on the purpose and proper use of controls. The staffing agency is responsible for reviewing the host employer’s policies and procedures prior to assigning employees, conducting a walkthrough to identify tasks that temporary workers will perform as well as relevant controls, conducting hazard assessments for tasks performed by temporary workers, and verifying controls for ergonomic hazards.
“Warehouse Industry Employment” (PDF) addresses hazards encountered in warehouses such as ergonomic stressors related to handling heavy or bulky objects, physical hazards created by forklifts and other equipment, chemical hazards, electrical hazards, temperature extremes, slip, trip, and fall hazards, and blocked exits. This bulletin also explains that the host employer is usually best able to provide a safe workplace. The staffing agency is responsible for ensuring that the host employer has met their responsibilities, as well as for providing general safety and health training for temporary employees.
Both bulletins are available for download in English and Spanish from OSHA's website.
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EPA Releases Draft Toxicological Review of Inorganic Arsenic
A draft toxicological review of inorganic arsenic from EPA’s Integrated Risk Information System (IRIS) program was released for public comment in November. According to the agency, this draft health assessment is based on a “comprehensive review of the available scientific literature” and seeks to address both cancer and non-cancer health effects that may result from chronic exposure to inorganic arsenic. Health effects discussed in the draft document include cancers of the bladder and lung as well as diseases of the circulatory system, pregnancy and birth outcomes, diabetes, and neurodevelopmental effects. EPA’s draft also summarizes the chemical properties of inorganic arsenic and includes information about hazard identification and dose-response assessment.
Inorganic arsenic forms when arsenic is combined with other elements such as oxygen, chlorine, and sulfur. Workplace exposures typically occur through inhalation, ingestion, dermal contact, or eye contact, according to OSHA. Inorganic arsenic is used in a variety of industries for hardening copper and lead alloys, as a component of electrical devices, and as a catalyst in the production of ethylene oxide. In glass manufacturing, inorganic arsenic is used as a decolorizing and refining agent, and in the textile industry, it’s used as a mordant or dye fixative.
EPA classifies inorganic arsenic as a human carcinogen. The agency’s reference dose for oral exposure to inorganic arsenic was last updated in 1991, and the weight of evidence for cancer was last updated in 1995. EPA’s IRIS webpage for the chemical details the history and chronology of its efforts related to inorganic arsenic.
The draft toxicological review is available from Regulations.gov.
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Winners of Mining Health and Safety Technology Awards Announced
In December, NIOSH announced the winners of its 2023 Mine Safety and Health Technology Innovations Awards. The awards recognized organizations in three industry sectors.
Imerys won the industrial minerals category award for redesigning a packing station and installing lift-assist devices to address injuries from repetitive motions. According to NIOSH, the changes eliminated musculoskeletal disorder injuries at the station.
Innovative Wireless Technologies and Arch Resources Inc. shared the coal category award for a wireless gas monitor that uses a multisensory platform. The solution increased workers’ situational awareness, NIOSH said.
Hecla Mining won in the metal category for developing a new mining method that reduced the injury frequency rate by more than 50 percent. The new method, "underhand closed bench" mining, allows proactive control of fault-slip seismicity in deep, high-stress, narrow-vein mining.
For more information, read the NIOSH press release. Previous winners are listed on the agency's website.
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NIOSH Publishes Guide to Safe 3D Printing
NIOSH has published Approaches to Safe 3D Printing: A Guide for Makerspace Users, Schools, Libraries, and Small Businesses (PDF). This 40-page document outlines health and safety risks and potential controls for three-dimensional (3D) printing processes used in non-industrial settings and workplaces.
According to NIOSH, 3D printing technology is “becoming a prominent part of modern innovation” due to its ability to quickly turn computer-aided design models into physical parts. 3D printers are now used in small businesses, schools, libraries, and makerspaces, which are areas where people may gather to work on projects and share ideas, equipment, and knowledge. Use of 3D printers presents possible safety hazards, such as heat, moving parts, and lasers, and can cause exposures to ultrafine particles, metal dust emissions, volatile organic compounds, and polycyclic aromatic hydrocarbons. NIOSH cautions that due to the technology’s recent emergence “it is difficult to know the potential occupational health outcomes” arising from 3D printing. However, plastics and resins similar to those used in 3D printers have been associated with substances identified as causative agents for occupational diseases.
NIOSH has evaluated emissions from various printer and feedstock combinations and recommended risk management practices to protect workers. This new guide outlines the use of ventilated enclosures, local exhaust ventilation, administrative controls, and personal protective equipment to help prevent exposures, control odors, and reduce emissions. Different sections of the guide cover 3D printing processes, risks, risk management, and exposure assessment.
The guide may be downloaded for free as a PDF from NIOSH’s website.
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EPA Proposal Would Codify Changes to Risk Evaluation Process
In October, EPA proposed a rule clarifying that its future chemical risk evaluations will not assume that workers always use personal protective equipment. EPA previously adopted this change two years ago but had not sought to support it through rulemaking.
Prior to June 2021, EPA risk evaluations assumed that employers always provided PPE to workers and that workers wore it properly. According to the text of the proposed rule, this assumption was not supported by data on PPE violations and “could lead to an underestimation of the risk to workers.”
The proposal would also formalize EPA’s “whole chemical” approach to risk determination. This change ended the agency’s practice of determining risk based on each “condition of use” for a particular chemical. Under the whole chemical approach, EPA now makes a single risk determination for a substance.
A third change concerns EPA’s consideration of exposures to the general population from air, water, and disposals. EPA had previously excluded these exposures in its risk evaluations on the grounds that they were already regulated, or could be regulated, under statutes such as the Clean Air Act and the Clean Water Act. The changes announced in June 2021 included an acknowledgment that the agency would no longer exclude these exposures.
For more information, read the proposed rule in the Federal Register and the agency’s news release. An explanation of EPA’s risk evaluations is available on the agency website.
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California Department of Public Health Highlights Asthma Linked to Wood Dust
A video produced by the California Department of Public Health (CDPH) focuses on the prevention of work-related asthma from exposure to wood dust. The state’s Work-Related Asthma Prevention Program (WRAPP), which identifies industries, occupations, and exposures that put workers at risk for work-related asthma, has found nearly 140 workers in a variety of settings who link their asthma to wood dust on the job. Workers exposed to wood dust include carpenters, cabinet makers, loggers, and artists. According to WRAPP, the industry comprising the manufacture of wood products has the fifth highest rate of asthma in California. The new video follows two workers, showcasing their experiences working with wood and highlighting the importance of preventing exposure to wood dust during everyday work tasks. The video is published to CDPH’s YouTube channel and can be viewed by both English and Spanish speakers.
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EPA Eliminates Exemption for Reporting Small Concentrations of PFAS
A rule finalized by EPA in October is intended to improve reporting on per- and polyfluoroalkyl substances (PFAS) to the Toxics Release Inventory, which tracks the management of chemicals that may pose a threat to health and the environment. Information compiled in TRI comes from U.S. facilities required to report how much of each chemical covered by the program is released into the environment or managed through recycling, energy recovery, and treatment. EPA’s rule has removed an exemption that had allowed facilities to avoid reporting PFAS used in small concentrations. PFAS are synthetic “forever chemicals” that have long-term persistence in humans and the environment.
“PFAS are used at low concentrations in many products,” EPA’s press release explains. “[As] a result of removing this reporting exemption, covered industry sectors such as manufacturing, metal mining, and chemical manufacturing, as well as federal facilities that make or use any of the 189 TRI-listed PFAS, will no longer be able to avoid disclosing the quantities of PFAS they manage or release into the environment.”
Under the new rule, facilities are required to report on PFAS regardless of their concentration in mixtures. According to EPA, removing the previous exemption helps ensure that downstream facilities that purchase mixtures and trade-name products containing PFAS will be informed of the chemicals’ presence.
The final rule and its supporting materials are available in the Federal Register. More information about changes to TRI reporting requirements is available from an EPA webpage.
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NIOSH Recommends Ventilation Improvements for Lab Facility
NIOSH personnel found traces of illicit drugs on surfaces at a laboratory facility but no evidence of exposure to lab workers, according to a report available from the agency’s website. The visit was conducted through the NIOSH Health Hazard Evaluation (HHE) program and involved inspection of a state toxicology lab that analyzed biological materials for the presence of drugs and a regional crime lab that analyzed seized drug evidence. The two labs were separated by a shared hallway and had common restrooms and a break room.
Detectable levels of methamphetamine, cocaine, fentanyl, and heroin were found on several surfaces, including vent covers, centrifuges, and benches in the toxicology lab and hood sashes, keyboards, and door handles in the crime lab. But none of the surface samples NIOSH collected exceeded the state remediation level for methamphetamine contamination of 1.5 mg/cm2, and tests of employees’ hands did not identify drug contamination.
According to the NIOSH report, drugs may have moved between labs because of incorrect pressurization within the facility that allowed air to flow from both labs into the hallway. Air is supposed to flow from low-hazard areas to high-hazard areas, according to laboratory ventilation guidelines. NIOSH recommended that the facility modify the ventilation system to maintain differential pressures.
Other agency recommendations include updating lab cleaning protocols, improving health and safety training, and updating personal protective equipment practices. For more information, read the HHE report (PDF). Other HHE reports are available from the NIOSH website.
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NIOSH Notices Address Respirator Approval Recissions and a
Recall
In October, NIOSH issued three notices concerning the voluntary rescission of respirator approvals and a recall of cartridge lots.
NIOSH honored requests by Dentec Safety Specialists Corp. and Honeywell International Inc. to voluntarily rescind some of their respirator approvals. Nineteen of Honeywell’s respirators and 30 of Dentec’s respirators are no longer approved by NIOSH and may not be used, manufactured, assembled, sold, or distributed. Users are encouraged to review the notices for Dentec and Honeywell for further information.
The manufacturer Gerson issued a recall notice for certain Gerson G71 P100 OV cartridge lots produced between Nov. 22 and Nov. 23, 2021. According to Gerson, some of the cartridges were manufactured using defective filters. The recall notice (PDF) lists the affected lot codes and provides instructions for reviewing product inventory for recalled cartridges.
NIOSH’s National Personal Protective Technology Laboratory website provides other respirator-related notices.
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NIOSH Addresses Increasing Burnout among Health Workers
The “Impact Wellbeing” campaign launched by NIOSH on Oct. 31 provides resources that hospital leaders can use to reduce burnout among healthcare workers. The campaign focuses on helping staff feel safe when seeking help for mental health concerns and strengthening professional well-being in hospital settings. Campaign resources include the NIOSH Worker Well-Being Questionnaire, or WellBQ, intended to help employers measure worker well-being and target interventions to improve it; a guide to normalizing seeking mental health support; and NIOSH’s Total Worker Health strategies, which can help staff balance work and home responsibilities.
As part of the campaign, NIOSH is also encouraging hospital leaders to remove intrusive mental health questions from hospital credentialing applications. The agency describes these questions as substantial barriers to healthcare worker wellbeing and explains that many healthcare workers fear that seeking mental health care may cost them their jobs. A toolkit (PDF) developed by the Dr. Lorna Breen Heroes’ Foundation, a nonprofit organization dedicated to reducing burnout among healthcare workers, is one resource hospital leaders can use to help staff feel safe to seek care.
These resources can be found on NIOSH’s Impact Wellbeing campaign website.
The launch of Impact Wellbeing follows the publication of a CDC report that found that health workers in the United States reported a larger increase in the number of days of poor mental health and burnout in 2022 compared with 2018 than did essential and other workers. The full report was published on Oct. 24 in CDC’s Morbidity and Mortality Weekly Report.
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NIOSH Research to Address Surgical Smoke Exposures in Veterinary Settings
A project proposed by NIOSH would examine occupational exposure to surgical smoke and related respiratory health effects in clinical veterinary settings. Surgical smoke exposure among health workers is an emerging concern in human operating rooms, according to the Federal Register notice describing the proposed project. But no research has yet characterized surgical smoke generated from animal tissue in surgical suites in veterinary clinics.
“Surgical smoke produced during tissue cutting and cauterizing tissues and blood vessels generates hazardous gaseous compounds and aerosols that are associated with cancer and respiratory irritation,” NIOSH explains. “Several states have either passed or are considering bills requiring surgical smoke evacuation systems in human operating rooms to mitigate this occupational hazard.”
Veterinary clinics often have multiple bay suites or less effective ventilation systems than those found in human operating rooms, potentially resulting in higher exposure levels among veterinary medicine and animal care workers. The agency’s proposed research would explore work-related factors that contribute to surgical smoke exposure in clinical veterinary settings, assess relationships between exposure to surgical smoke and respiratory health, and investigate barriers and aids to implementing surgical smoke extraction systems in these settings. NIOSH intends to use the findings of this study to help provide guidance on engineering controls to improve indoor air quality in veterinary medicine and animal care environments by reducing workers’ exposure to surgical smoke.
CDC accepted public comment on this proposal until Jan. 2, 2024. More information can be found in the Federal Register.