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.


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.


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.

Disinfection of personal protective equipment for management of Ebola patients

Bessesen et al highlight the potential utility of reusable elastomeric face masks to bypass the risk of N95 respirator shortages during a respiratory illness pandemic and stress the importance of efficacious disinfection to reuse facial protective equipment safely.1 We would like to take the opportunity to underline the need that awareness on personal protective equipment (PPE) stocks is included in any pandemic preparedness plan. The demand for PPE must be established on the basis of the health care facility's role, defined by public health authorities to create a coordinated network approach.

Source: Vincenzo Puro, Silvia Pittalis, Pierangelo Chinello, Emanuele Nicastri, Nicola Petrosillo, Mario Antonini, Giuseppe Ippolito. American Journal of Infection Control, 2015.

The use and non-use of seat belts in the operation of forward tipping dumpers

In the event of a forward tipping dumper (FTD) overturning, the operator will be protected from death and serious injury by wearing their seat belt. The seat belt works in combination with the roll over protection system (ROPS) to keep the operator in their seat, preventing them being crushed by the machine.
Unfortunately, a proportion of operators choose to operate FTDs without wearing a seat belt and thus increasing their risk of death or serious injury should the machine overturn. Using semi-structured interviews to gauge the opinions of trainers, original equipment manufacturers, seat and seat belt manufacturers and FTD operators, this research aimed to better understand the reasons why FTD operators choose not to wear their seat belt when operating their machines.
The research also explored potential solutions that would encourage operators to wear their seat belt more, including possible design control measures such as immobilisation technology, alternative designs of seats and seat belts, and of the overall FTD machine.


Adherence to Precautionary Guidelines for Compounding Antineoplastic Drugs

A Survey of Nurses and Pharmacy Practitioners
Precautionary guidelines detailing standards of practice and equipment to eliminate or minimize exposure to antineoplastic drugs during handling activities have been available for nearly three decades. To evaluate practices for compounding antineoplastic drugs, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted among members of professional practice organizations representing primarily oncology nurses, pharmacists, and pharmacy technicians. This national survey is the first in over 20 years to examine selfreported use of engineering, administrative, and work practice controls and PPE by pharmacy practitioners for minimizing exposure to antineoplastic drugs. The survey was completed by 241 nurses and 183 pharmacy practitioners who compounded antineoplastic drugs in the seven days prior to the survey. They reported: not always wearing two pairs of chemotherapy gloves (85%, 47%, respectively) or even a single pair (8%, 10%); not always using closed system drug-transfer devices (75%, 53%); not always wearing recommended gown (38%, 20%); I.V. lines sometimes/always primed with antineoplastic drug (19%, 30%); and not always using either a biological safety cabinet or isolator (9%, 15%). They also reported lack of: hazard awareness training (9%, 13%); safe handling procédures (20%, 11%); and medical surveillance programs (61%, 45%). Both employers and healthcare workers share responsibility
for adhering to precautionary guidelines and other best practices. Employers can ensure that: workers are trained regularly; facility safe-handling procedures reflecting national guidelines are in place and support for their implementation is understood; engineering controls and PPE are available and workers know how to use them; and medical surveillance, exposure monitoring, and other administrative controls are in place. Workers can seek out training, understand and follow facility procedures, be role models for junior staff, ask questions, and report any safety concerns.

Source: James M. Boiano, Andrea L. Steege & Marie H. Sweeney (2015). Journal of Occupational and Environmental Hygiene, 12:9, p. 588-602.

One Size Does Not Fit All

When your safety and your life depends on it, you need your equipment to fit properly. This is especially true in the workplace. Improper fit may prevent workers from performing their job duties safely and effectively. If your respirator does not seal properly to your face, if your gloves are too big, if your seatbelt cannot buckle with your safety gear on . . . you get the picture.
Anthropometry is the science of defining human body dimensions and physical characteristics. The National Institute for Occupational Safety and Health (NIOSH) conducts anthropometric research to prevent work-related injuries and deaths by studying how work spaces and equipment fit today's diverse worker population. This includes the fit of machines, vehicles, and personal protective equipment (PPE). Much of the available data were collected in the 1950s and 1970s from military personnel and the general population from that era. These decades-old data do not represent, on average and collectively, the sizes and body types of today's workers, who are much more diverse in age, gender, and ethnicity. NIOSH research has shown workers have unique shapes and sizes for specific occupations.


Investigation into exposure when the visor of air fed RPE is raised during spraying

Air-fed visors (AFV) are commonly used within the Motor Vehicle Repair (MVR) trade for protection against exposure to isocyanate paints. However, a common practice amongst paint sprayers is to flip up the visor of their AFV immediately after spraying to check the quality of the paint finish. This may be only for a few seconds but if repeated numerous times during a work shift, this could potentially result in a significant increase in exposure. The aim of this project was to determine the reduction in protection and thus potential increase in exposure when the visor is lifted and to explore potential engineering solutions (by modifying the AFV design) to prevent exposure during any visor lift.
The results clearly demonstrate that lifting the visor whilst still within a contaminated atmosphere had a significant detrimental effect on the protection afforded by the AFV. Mean protection factors were measured at 1.7 in the lifted position and at 2.7 over the whole of the exposure period (from start of the lift to recovery of protection after refitting). This latter figure equates to a 15 fold increase in exposure when related to the assigned protection factor of40 for AFV when used correctly.


Skin sites to predict deep-body temperature while wearing firefighters' personal protective clothing during periodical changes in air temperature

The aim of this study was to investigate stable and valid measurement sites of skin temperatures as a non-invasive variable to predict deep-body temperature while wearing firefighters' personal protective equipment (PPE) during air temperature changes. Eight male firefighters participated in an experiment which consisted of 60-min exercise and 10-min recovery while wearing PPE without self-contained breathing apparatus (7.75 kg in total PPE mass). Air temperature was periodically fluctuated from 29.5 to 35.5°C with an amplitude of 6°C. Rectal temperature was chosen as a deep-body temperature and 12 skin temperatures were recorded. The results showed that the forehead and chest were identified as the most valid sites to predict rectal temperature (R(2) = 0.826 and 0.824, respectively) in an environment with periodically-fluctuated air temperatures. The present study suggests that particular skin temperatures are valid as a non-invasive variable when predicting rectal temperature of an individual wearing PPE in changing ambient temperatures. Practitioner summary This study should offer assistance for developing a more reliable indirect indicating system of individual heat strain for firefighters in real time, which can be used practically as a precaution of fire fighters' heat-related illness and utilized along with physiological monitoring.

Source: Kim S, Lee JY. Ergonomics, 2015.

Firefighter hand anthropometry and structural glove sizing

A new perspective
OBJECTIVE: We evaluated the current use and fit of structural firefighting gloves and developed an improved sizing scheme that better accommodates the U.S. firefighter population.
BACKGROUND: Among surveys, 24% to 30% of men and 31% to 62% of women reported experiencing problems with the fit or bulkiness of their structural firefighting gloves.
METHOD: An age-, race/ethnicity-, and gender-stratified sample of 863 male and 88 female firefighters across the United States participated in the study. Fourteen hand dimensions relevant to glove design were measured. A cluster analysis of the hand dimensions was performed to explore options for an improved sizing scheme.
RESULTS: The current national standard structural firefighting glove-sizing scheme underrepresents firefighter hand size range and shape variation. In addition, mismatch between existing sizing specifications and hand characteristics, such as hand dimensions, user selection of glove size, and the existing glove sizing specifications, is significant. An improved glove-sizing plan based on clusters of overall hand size and hand/finger breadth-to-length contrast has been developed.
CONCLUSION: This study presents the most up-to-date firefighter hand anthropometry and a new perspective on glove accommodation. The new seven-size system contains narrower variations (standard deviations) for almost all dimensions for each glove size than the current sizing practices.
APPLICATION: The proposed science-based sizing plan for structural firefighting gloves provides a step-forward perspective (i.e., including two women hand model-based sizes and two wide-palm sizes for men) for glove manufacturers to advance firefighter hand protection.

Source: Hsiao H, Whitestone J, Kau TY, Hildreth B. Hum. Factors, 2015.

Efficacy of a rubber outsole with a hybrid surface pattern for preventing slips on icy surfaces

Conventional winter-safety footwear devices, such as crampons, can be effective in preventing slips on icy surfaces but the protruding studs can lead to other problems such as trips. A new hybrid (rough and smooth) rubber outsole was designed to provide high slip resistance without use of protruding studs or asperities. In the present study, we examined the slip resistance of the hybrid rubber outsole on both dry (-10 °C) and wet (0 °C) icy surfaces, in comparison to three conventional strap-on winter anti-slip devices: 1) metal coils ("Yaktrax Walker"), 2) gritted (sandpaper-like) straps ("Rough Grip"), and 3) crampons ("Altagrips-Lite"). Drag tests were performed to measure static (SCOF) and dynamic (DCOF) coefficients of friction, and gait trials were conducted on both level and sloped ice surfaces (16 participants). The drag-test results showed relatively high SCOF (?0.37) and DCOF (?0.31) values for the hybrid rubber sole, at both temperatures. The other three footwear types exhibited lower DCOF values (0.06-0.20) when compared with the hybrid rubber sole at 0 °C (p < 0.01). Slips were more frequent when wearing the metal coils, in comparison to the other footwear types, when descending a slope at -10 °C (6% of trials vs 0%; p < 0.05). There were no other significant footwear-related differences in slip frequency, distance or velocity. These results indicate that the slip-resistance of the hybrid rubber sole on icy surfaces was comparable to conventional anti-slip footwear devices. Given the likely advantages of the hybrid rubber sole (less susceptibility to tripping, better slip resistance on non-icy surfaces), this type of sole should contribute to a decrease in fall accidents; however, further research is needed to confirm its effectiveness under a wider range of test conditions.

Source: Yamaguchi T, Hsu J, Li Y, Maki BE. Appl. Ergon. 2015; 51: 9-17.


Cette brochure traite des travaux de débroussaillage, des techniques de travail et des situations dangereuses. On y décrit également les responsabilités de l'employeur et du travailleur, l'équipement de protection individuelle à utiliser et des règles à suivre en matière de premiers secours et de premiers soins. Pour cette 3e édition, des changements importants ont été apportés aux pages 14-15 et 16 où il est question du choix des lames.?


Plus de Messages Page suivante »

Abonnement courriel

Messages récents


Mots-Clés (Tags)