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.

Source: http://www.hse.gov.uk/research/rrhtm/rr1066.htm

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.

Source: http://blogs.cdc.gov/niosh-science-blog/2015/09/16/anthropometry/

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.

Source: http://www.hse.gov.uk/research/rrhtm/rr1064.htm?eban=govdel-respiratory-protective-equipment&cr=14-Sep-2015

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.?

Source: http://www.csst.qc.ca/publications/200/Pages/DC_200_634.aspx

Developing a Performance Standard for Combination Unit Respirators

Workshop in Brief
Combination unit respirators, a respirator that employs the technology of two or more types of respiratory protection, are presently used in the United States by some law enforcement and military units to respond to situations in which there are unknown and potentially dangerous respiratory hazards; they also have some industrial uses and potential for use in emergency response. On April 30, 2015 the Institute of Medicine hosted a workshop to explore the standards and research issues relevant to these respirators and their certification by the National Personal Protective Technology Laboratory. Representatives from existing and potential user groups as well as manufacturers and other stakeholders discussed the benefits and challenges of combination unit respirators, and provided their ideas on next steps in research, training, and hazard assessment, as well as standards and regulatory priorities to ensure the safety of workers and improve the operation of combination unit respirators.

Source: http://iom.nationalacademies.org/Reports/2015/Developing-a-Performance-Standard-for-Combination-Unit-Respirators-WIB.aspx

Improved hand hygiene compliance after eliminating mandatory glove use from contact precautions

Is less more?
Background: Guidelines recommend that health care personnel (HCP) wear gloves for all interactions with patients on contact precautions. We aimed to assess hand hygiene (HH) compliance during contact precautions before and after eliminating mandatory glove use.
Methods: We assessed HH compliance of HCP in the care of patients on contact precautions in 50 series before (2009) and 6 months after (2012) eliminating mandatory glove use and compared these results with the hospital-wide HH compliance.
Results: We assessed 426 HH indications before and 492 indications after the policy change. Compared with 2009, we observed a significantly higher HH compliance in patients on contact precautions in 2012 (52%; 95% confidence interval [95% CI], 47-57) vs 85%; 95% CI, 82-88; P < .001). During the same period, hospital-wide HH compliance also increased from 63% (95% CI, 61-65) to 81% (95% CI 80-83) (P < .001). However, the relative improvement (RI) of HH compliance during contact precautions was significantly higher than the hospital-wide relative improvement (RI, 1.6; 95% CI, 1.49-1.81 vs 1.29; 95% CI, 1.25-1.34), with a relative improvement ratio of 1.27 (95% CI, 1.15-1.41).
Conclusion: Eliminating mandatory glove use in the care of patients on contact precautions increased HH compliance in our institution, particularly before invasive procedures and before patient contacts. Further studies on the effect on pathogen transmission are needed before revisiting the current official guidelines on the topic.

Source: Cusini, Alexia, Nydegger, Doris, Kaspar, Tanja, Schweiger, Alexander, Kuhn, Rolf, & Marschall, Jonas. American Journal of Infection Control, 2015.

Variation in health care worker removal of personal protective equipment

In the current era of emerging pathogens such as Ebola virus, removal of personal protective equipment (PPE) is crucial to reduce contamination of health care workers. However, current removal practices are not well described. We undertook a systematic evaluation of health care worker removal of PPE for contact isolation to examine variation in removal procedures. Findings indicate that under usual conditions, only about half of health care workers correctly remove their PPE, and very few remove their PPE in the correct order and dispose of it in the proper location.

Source: Zellmer, Caroline, Van Hoof, Sarah, & Safdar, Nasia. (2015). American Journal of Infection Control, 43 (7), p. 750-751.  http://dx.doi.org/10.1016/j.ajic.2015.02.005

The effect of wearer stubble on the protection given by Filtering Facepieces Class 3 (FFP3) and Half Masks

HSE Inspectors routinely come across workers with various degrees of stubble growth using respiratory protective masks, despite guidance to the contrary. This research studied the effect of 0-7 days stubble growth on the protection given by FFP3 filtering facepieces and half masks.
Fifteen male volunteers took part, each testing four masks. For most, three different design FFP3 and one half mask were tested, selected from seven models of FFP3 and 2 half masks. Fit tests were carried out immediately after shaving and repeated six times during the following week, without further shaving.
Results showed that the effect on protection was quite specific to the mask/wearer combination. Protection could be significantly reduced where stubble was present, beginning within 24 hours from shaving, and generally worsening as facial hair grew. Statistical analysis predicted this could reach an unacceptable level for all of the masks tested.

Source: http://www.hse.gov.uk/research/rrhtm/rr1052.htm


Health & safety guidance for employers & technicians carrying out fumigation operations
The guidance is primarily for employers and fumigators/fumigation technicians (including the self-employed) to help them comply with the Control of Substances Hazardous to Health Regulations 2002 (COSHH) when carrying out fumigation activities, both traditional pest control (invertebrate fumigation) and within the laboratory and biosecurity sectors. It will also be useful to their safety representatives.
It outlines the real risks and describes the law that applies to fumigation operations. There is specific advice on procedures common to all fumigation operations, including the use of monitoring equipment, personal protective equipment and respiratory protective equipment, health surveillance and first aid.

Source: http://www.hse.gov.uk/pubns/books/hsg251.htm

N95 Respirators use during pregnancy

Findings from recent research
Recent NIOSH research has shed some light on the topic of the safety of N95 filtering facepiece respirators (FFR) use by pregnant workers. Women make up approximately one-half of the US work force. At any given time, about 10% of those female workers of child-bearing age (15–44 years of age) will be pregnant. Because many women are employed in occupations that require the use of protective facemasks, such as medical/surgical masks and FFR, NIOSH conducted research into the safety of FFR use while pregnant. The most frequently used FFR in the US is the N95 FFR (commonly referred to as “N95 mask”), but little information was previously available about the safety of N95 FFR use during pregnancy. Some individuals complain of difficulty breathing when wearing an N95 FFR or other protective facemasks, and many pregnant women find that they become somewhat shorter of breath as their pregnancy progresses, causing concern that use of N95 FFRs during pregnancy might make breathing even more difficult and possibly harm the woman and her fetus. Beyond the issue of use by pregnant working women on the job, the question also has implications for pregnant women outside the workplace. People sometimes use N95 FFRs as a matter of personal choice during infectious disease outbreaks, during environmental disasters that pollute the air, and even in more common recreational activities that may expose them to airborne allergens, such as gardening and woodworking.

Source: http://blogs.cdc.gov/niosh-science-blog/2015/06/18/respirators-pregnancy/

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