Ebola Care and Lack of Consensus on Personal Protective Respiratory Equipment

The Ebola epidemic in West Africa presents a considerable occupational risk to the health personnel involved. The principal mode of virus transmission to health care personnel is through direct contact with the patient, although transmission by aerosols through the air may also occur. Many safety protocols have been suggested relating to personal protection and particularly respiratory protection. It is generally agreed that all health care workers should have easy access to personal protective equipment. However, the degree of respiratory safety escalates from a mask, to an adequate respirator, and finally to a whole body suit with integrated helmet and positive air pressure. Recent publications demonstrate a lack of consensus on the degree of safety necessary. The step from “safe enough” to being “absolutely safe” seems, in most countries, insurmountable because of costs and logistics.

Source: Hanoa, R.O., & Moen, B.E. (2016). Workplace Health & Safety, 64(2), 48-50. 

NIOSH Updates Software for Estimating Respirator Service Life

The NIOSH MultiVapor™ tool has been updated and posted to the web. MultiVapor™ is a computer tool for estimating breakthrough times and service lives of air-purifying respirator cartridges for removing toxic organic vapors from breathed air. It can also be used for larger filters and for carbon beds of any size prepared for laboratory studies. MultiVapor™ 2.2.3 replaces the 2.1.3 version.

Source: http://www.cdc.gov/niosh/npptl/multivapor/multivapor.html

Straight ladder inclined angle in a field environment

The relationship among actual angle, method of setup and knowledgee
Ladder inclined angle is a critical factor that could lead to a slip at the base of portable straight ladders, a major cause of falls from heights. Despite several methods established to help workers achieve the recommended 75.5° angle for ladder setup, it remains unclear if these methods are used in practice. This study explored ladder setup behaviors in a field environment. Professional installers of a company in the cable and other pay TV industry were observed for ladder setup at their worksites. The results showed that the actual angles of 265 ladder setups by 67 participants averaged 67.3° with a standard deviation of 3.22°. Although all the participants had training on recommended ladder setup methods, only three out of 67 participants applied these methods in their daily work and even they failed to achieve the desired 75.5° angle. Therefore, ladder setup remains problematic in real-world situations.

Source: Chang WR, Huang YH, Chang CC, et al. Ergonomics, 2015.

Z96-15 - High-visibility safety apparel

This is the third edition of CSA Z96, High-visibility safety apparel. It supersedes the previous editions published in 2009 and 2002. This edition incorporates advice on selection, use, and care of high-visibility safety material taken from the CSA Z96.1 Guideline (see Annex A). It is designed to be in technical harmony with ANSI/ISEA 107 and ISO 20471.
The focus of this Standard is on the performance of retroreflective and background materials incorporated into garments intended to provide the wearer with increased conspicuity under both wellilluminated and low-light or dark work environmental conditions. It sets out levels of retroreflective performance (i.e., light reflected from vehicle headlights as viewed by the vehicle operator), the colours and luminosity of background materials, and the human body coverage of the high-visibility components. Three classes of garments have been defined based on body coverage of bright or fluorescent-coloured materials, and two levels of performance have been specified for retroreflective materials. In addition, special allowances have been made for garments that are primarily intended to provide flame protection.

Source: http://shop.csa.ca/en/canada/high-visibility-apparel/z96-15/invt/27016522015

New NIOSH Study Supports the OSHA Annual Fit Testing Requirements for Filtering Facepiece Respirators

Results of a recently completed NIOSH study confirm the necessity of the current Occupational Safety and Health Administration (OSHA) respirator fit testing requirement, both annually and when physical changes have occurred. The study's conclusions emphasize that respirator users who have lost more than 20 pounds should be re-tested to be sure that the current size and model of respirator in use still properly fits. For over three years, NIOSH researchers followed a cohort of 229 subjects measuring N95 filtering facepiece respirator (FFR) fit and physical characteristics (e.g., face size, weight) every six months.  Prior to this study, very little research existed looking at the relationship between respirator fit over an extensive period of time and the change in facial dimensions, as could be caused by weight gain or loss. OSHA requires FFR users to undergo an annual fit test, which is vital to ensuring continued proper respirator fit. In addition to annual fit testing, OSHA requires that fit testing be repeated “whenever an employee reports, or the employer or the physician or other licensed health care professional makes visual observations of changes in the employee's physical condition that could affect respirator fit (e.g. facial scarring, dental changes, cosmetic surgery, or an obvious change in body weight.” (OSHA, 1998)

Source: http://blogs.cdc.gov/niosh-science-blog/2016/01/05/fit-testing/

Provision Increases Reported PPE Use for Mexican Immigrant Farmworkers

Objective: Personal protective equipment (PPE) reduces pesticide exposures, but many farmworkers complain that it is difficult to obtain. We examined if PPE provision increased usage. We also delivered motivational messaging aimed to promote PPE use.
Methods: First, we delivered a daily survey through a mobile phone app to assess PPE use. Farmworkers subsequently received a daily, individualized motivational message based on their PPE use and reported difficulties. PPE use was evaluated at baseline and at the close of the study.
Results: PPE behaviors improved for gloves (P?≤?0.01) and safety glasses (P?≤?0.001). Use of long-sleeved shirts, hats, and long pants were already consistently used at baseline and did not exhibit significant change.
Conclusions: Our findings demonstrate that PPE provision and delivery of motivational messaging through mobile phones may increase PPE usage for farmworkers.

Source: Snipes, Shedra Amy; Smyth, Joshua M.; Murphy, Dennis; Miranda, Patricia Y.; Ishino, Francisco Alejandro Montiel. Journal of Occupational & Environmental Medicine: December 2015, Volume 57, Issue 12, p. 1343-1346.

Heat strain imposed by personal protective ensembles

Quantitative analysis using a thermoregulation model
The objective of this paper is to study the effects of personal protective equipment (PPE) and specific PPE layers, defined as thermal/evaporative resistances and the mass, on heat strain during physical activity. A stepwise thermal manikin testing and modeling approach was used to analyze a PPE ensemble with four layers: uniform, ballistic protection, chemical protective clothing, and mask and gloves. The PPE was tested on a thermal manikin, starting with the uniform, then adding an additional layer in each step. Wearing PPE increases the metabolic rates [Formula: see text], thus [Formula: see text] were adjusted according to the mass of each of four configurations. A human thermoregulatory model was used to predict endurance time for each configuration at fixed [Formula: see text] and at its mass adjusted [Formula: see text]. Reductions in endurance time due to resistances, and due to mass, were separately determined using predicted results. Fractional contributions of PPE's thermal/evaporative resistances by layer show that the ballistic protection and the chemical protective clothing layers contribute about 20 %, respectively. Wearing the ballistic protection over the uniform reduced endurance time from 146 to 75 min, with 31 min of the decrement due to the additional resistances of the ballistic protection, and 40 min due to increased [Formula: see text] associated with the additional mass. Effects of mass on heat strain are of a similar magnitude relative to effects of increased resistances. Reducing resistances and mass can both significantly alleviate heat strain.

Source: Xu X, Gonzalez JA, Santee WR, Blanchard LA, Hoyt RW. Int. J. Biometeorol. 2015.

Predictors of Adherence to Safe Handling Practices for Antineoplastic Drugs

A Survey of Hospital Nurses
Background: Despite growing awareness of the hazards of exposure to antineoplastic drugs (ADs), surveys continue to find incomplete adherence to recommended safe handling guidelines. A 2011 survey of healthcare workers presents an opportunity to examine factors associated with adherence among 1094 hospital nurses who administered ADs. Methods: Data for these hypothesis-generating analyses were taken from an anonymous, web-based survey of healthcare workers. Regression modeling was used to examine associations between a number of predictors (engineering controls, work practices, nurse perceptions, and nurse and hospital characteristics) and three outcomes reported by nurses: use of personal protective equipment (PPE); activities performed with gloves previously worn to administer ADs; and spills of ADs. Results: Adherence to safe handling guidelines was not universal, and AD spills were reported by 9.5% of nurses during the week prior to the survey. Familiarity with safe handling guidelines and training in safe handling were associated with more reported PPE use. Nurse-perceived availability of PPE was associated with more reported PPE use and lower odds of reported spills. Use of closed system drug-transfer devices and luer-lock fittings also decreased the odds of self-reported AD spills, while more frequent AD administration increased the risk. AD administration frequency was also associated with performing more activities with gloves previously worn to administer ADs, and nurse perception of having adequate time for taking safety precautions with fewer such activities. Conclusions: The results suggest that training and familiarity with guidelines for safe handling of ADs, adequate time to adhere to guidelines, and availability of PPE and certain engineering controls are key to ensuring adherence to safe handling practices. Further assessment of training components and engineering controls would be useful for tailoring interventions targeting these areas.

Source: Sharon R. Silver, Andrea L. Steege & James M. Boiano. Journal of Occupational and Environmental Hygiene, 2015.

NIOSH Firefighter Body Dimension Data Supports Design Changes and Safety

We have come to rely on, and expect firefighters to rush into burning buildings, put out flames, and save lives. Yet, each year many firefighters die in the line of duty and thousands more sustain injuries. For these reasons, researchers at the National Institute for Occupational Safety and Health (NIOSH) recorded and developed the first database of firefighter body measurements (also known as anthropometric information) to improve the design, and ultimately the safety, of fire apparatus and equipment that firefighters depend on to help protect themselves on the job.

Source: http://www.cdc.gov/niosh/updates/upd-12-2-15.html

Precautionary Practices of Respiratory Care Practitioners who Administer Aerosolized Medications

A recent article from the National Institute for Occupational Safety and Health (NIOSH) found that safe handling of aerosolized medications is not always universally practiced in healthcare settings, placing workers, co-workers and even family members at risk. This article was published in the October issue of the Respiratory Care and is available online.
Results are derived from the 2011 Health and Safety Practices Survey of Healthcare Workers, the largest federally-sponsored survey of healthcare workers in the U.S. which addresses safety and health practices relative to chemical agents routinely used or present in healthcare settings. This paper describes current exposure control practices and barriers to using personal protective equipment (PPE) during administration of selected aerosolized medications among respiratory care practitioners including respiratory therapists (RTs), nurses, and other healthcare practitioners.
Respiratory care practitioners administer aerosolized drugs, such as pentamidine and various antibiotics, to treat respiratory infections. At the time of the survey, pentamidine was classified by NIOSH as a hazardous drug with rigorous safe handling guidelines. The antibiotics included in this study (amikacin, colistin and tobramycin) were not classified as hazardous drugs, with less comparable guidelines for administering them available.

Source: http://www.cdc.gov/niosh/updates/upd-11-18-15.html

Assessing barriers to the use of fall protection in small residential construction companies in New Jersey

Three focus groups were conducted with residential construction workers from local New Jersey labor organizations to characterize barriers to fall protection use among residential construction contractors who work for companies with fewer than ten employees. Thirty-six residential construction workers volunteered to participate, the average age was thirty-nine years, and twenty-four (67%) were of Hispanic origin. Twelve (33%) of the participants reported having fallen from greater than 6 ft at work and twenty (56%) of the participants had known someone who has fallen from greater than 6 ft. Sixteen (44%) had not been provided with fall protection equipment by their employer and eighteen (50%) reported their current employer had not provided workplace safety training. Factors that created barriers to use of fall protection equipment such as equipment availability, employee/employer relationships, cultural differences, and company size were identified. Results from this study confirm that falls remain a concern among residential construction workers in small companies.

Source: Borjan M, Patel T, Lefkowitz D, Campbell C, Lumia M. New Solut. 2015.

The hybrid personal cooling system (PCS) could effectively reduce the heat strain while exercising in a hot and moderate humid environment

This study aimed to examine the effectiveness of a hybrid personal cooling system (PCS) in mitigating body heat stain while exercising in a hot environment. Eight subjects underwent two trials: PCS and CON (i.e., no cooling). All trials were conducted at an air temperature of 36±0.5 °C and RH=59±5%. The key findings demonstrated that the PCS could significantly reduce the core temperature, mean skin temperature, heart rate and physiological strain index during both exercise and recovery periods (p<0.05). Subjective perceptions were also significantly alleviated in PCS at the end of the exercise and during the recovery (p<0.05). Besides, the PCS could also bring remarkable benefits in lowering local skin temperatures and in improving perceptual sensations in both upper and lower body during both exercise and recovery periods (p<0.05). It was thus concluded that the hybrid PCS is effective in mitigating body heat strain while exercising in a hot environment.

Source: Song W, Wang F. Ergonomics, 2015.

Contamination of Health Care Personnel During Removal of Personal Protective Equipment

Importance: Contamination of the skin and clothing of health care personnel during removal of personal protective equipment (PPE) contributes to dissemination of pathogens and places personnel at risk for infection.
Objectives: To determine the frequency and sites of contamination on the skin and clothing of personnel during PPE removal and to evaluate the effect of an intervention on the frequency of contamination.
Design, Setting, and Participants: We conducted a point-prevalence study and quasi-experimental intervention from October 28, 2014, through March 31, 2015. Data analysis began November 17, 2014, and ended April 21, 2015. Participants included a convenience sample of health care personnel from 4 Northeast Ohio hospitals who conducted simulations of contaminated PPE removal using fluorescent lotion and a cohort of health care personnel from 7 study units in 1 medical center that participated in a quasi-experimental intervention that included education and practice in removal of contaminated PPE with immediate visual feedback based on fluorescent lotion contamination of skin and clothing.
Main Outcomes and Measures: The primary outcomes were the frequency and sites of contamination on skin and clothing of personnel after removal of contaminated gloves or gowns at baseline vs after the intervention. A secondary end point focused on the correlation between contamination of skin with fluorescent lotion and bacteriophage MS2, a nonpathogenic, nonenveloped virus.
Results: Of 435 glove and gown removal simulations, contamination of skin or clothing with fluorescent lotion occurred in 200 (46.0%), with a similar frequency of contamination among the 4 hospitals (range, 42.5%-50.3%). Contamination occurred more frequently during removal of contaminated gloves than gowns (52.9% vs 37.8%, P = .002) and when lapses in technique were observed vs not observed (70.3% vs 30.0%, P < .001). The intervention resulted in a reduction in skin and clothing contamination during glove and gown removal (60.0% before the intervention vs 18.9% after, P < .001) that was sustained after 1 and 3 months (12.0% at both time points, P < .001 compared with before the intervention). During simulations of contaminated glove removal, the frequency of skin contamination was similar with fluorescent lotion and bacteriophage MS2 (58.0% vs 52.0%, P = .45).
Conclusions and Relevance: Contamination of the skin and clothing of health care personnel occurs frequently during removal of contaminated gloves or gowns. Educational interventions that include practice with immediate visual feedback on skin and clothing contamination can significantly reduce the risk of contamination during removal of PPE.

Source: Tomas, Myreen E., Kundrapu, Sirisha, Thota, Priyaleela, et al. (2015, October 12). JAMA Internal Medicine.

Évaluation de nouvelles technologies visant à réduire le stress thermophysiologique associé au port de vêtements individuels de protection pour les pompiers

Les contraintes thermiques liées au port des vêtements individuels de protection (VIP) contre la chaleur et les flammes sont un problème préoccupant pour la santé et la sécurité des pompiers. Les matériaux utilisés dans la fabrication des VIP ont souvent le désavantage d'être lourds, rigides et d'empêcher l'évacuation de la chaleur produite par l'activité physique lors d'une intervention. Deux nouvelles technologies de matériaux ont été développées par le Groupe CTT, un centre de transfert technologique spécialisé dans la recherche et la conception de matériaux textiles, et ses partenaires industriels, afin de réduire les astreintes physiologiques des travailleurs exposés au stress thermique. L'une de ces technologies consiste en un système d'absorption de la chaleur, et l'autre est un nouveau matériau qui entre dans la fabrication d'un VIP. Réalisée en deux volets, cette étude avait comme objectif d'évaluer l'efficacité de ces deux technologies par une analyse de la réponse physiologique de sujets exposés à des conditions environnementales contrôlées.

Source: http://www.irsst.qc.ca/publications-et-outils/publication/i/100842/n/technologies-thermophysiologique-vetements-protection-pompiers

Baseline evaluation with a sweating thermal manikin of personal protective ensembles recommended for use in West Africa

OBJECTIVE: Experience with the use of personal protective equipment (PPE) ensembles by health care workers responding to the Ebola outbreak in the hot, humid conditions of West Africa has prompted reports of significant issues with heat stress that has resulted in shortened work periods.
METHODS: A sweating thermal manikin was used to ascertain the time to achievement of a critical core temperature of 39°C while wearing 4 different PPE ensembles similar to those recommended by the World Health Organization and Médecins Sans Frontières (Doctors Without Borders) at 2 different ambient conditions (32°C/92% relative humidity and 26°C/80% relative humidity) compared with a control ensemble.
RESULTS: PPE ensembles that utilized coveralls with moderate to high degrees of impermeability attained the critical core temperature in significantly shorter times than did other ensembles. Encapsulation of the head and neck region resulted in higher model-predicted subjective impressions of heat sensation.
CONCLUSIONS: To maximize work capacity and to protect health care workers in the challenging ambient conditions of West Africa, consideration should be given to adjustment of work and rest schedules, improvement of PPE (e.g., using less impermeable and more breathable fabrics that provide the same protection), and the possible use of cooling devices worn simultaneously with PPE.

Source: Coca A, DiLeo T, Kim JH, Roberge R, Shaffer R. Disaster Med. Public Health Prep. 2015.

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