Occupational Health

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Occupational Health and Safety Programs An
AAALAC Perspective
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Section 1
Elements of an Occupational Health Program
Deficiencies identified by AAALAC. David
DeLong, D.V.M. Chief, Veterinary Medical
UnitVAMC, Minneapolis, Minnesota
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Elements of an OHS program Deficiencies
identified by AAALAC
Why does AAALAC assess occupational health and
safety programs?
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Elements of an OHS program Deficiencies
identified by AAALAC
According to the Guide -   An occupational
health and safety program must be part of the
overall animal care and use program."
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Elements of an OHS program Deficiencies
identified by AAALAC

• Working with animalscan be dangerous business!
•  
• Physical and chemical hazards
• Protocol related hazards
• Allergens
• Zoonotic diseases

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Elements of an OHS program Deficiencies
identified by AAALAC

• How does AAALAC assess an OHS program?
•  
• Prior to the site visit, review the Program
  Description.
• During the site visit, review facilities
  and documents interview personnel.

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Elements of an OHS program Deficiencies
identified by AAALAC
The Guide is the basis for the review.
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Elements of an OHS program Deficiencies
identified by AAALAC

• Other documents
•  
• Occupational Health and Safety in the Care and
  Use of Research Animals. 1997. NRC, National
  Academy of Sciences.
•  
• Biosafety in Microbiological and Biomedical
  Laboratories. 1999. HHS Pub. No. (CDC)
  93-8395.
•  
• Miscellaneous AAALAC resource documents.

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Elements of an OHS program Deficiencies
identified by AAALAC

• What are the required components of an OHS
  program?
•  
• Risk assessment and hazard identification.
• Training.
• Personal hygiene and personal protective
  equipment.
• Facilities, procedures, and monitoring.
• Medical evaluation and preventive medicine.

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Elements of an OHS program Deficiencies
identified by AAALAC

• What are the hallmarks of a successful program?
•  
• Strong administrative support.
• Sound implementation strategies.
• Effective coordination of program components.

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Elements of an OHS program Deficiencies
identified by AAALAC
What trends in OHS Program deficiencies have been
identified by AAALAC?
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Elements of an OHS program Deficiencies
identified by AAALAC
Occupational Health and Safety of Personnel
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Elements of an OHS program Deficiencies
identified by AAALAC
Hazard Identification and Risk Assessment
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Elements of an OHS program Deficiencies
identified by AAALAC
Personnel Training
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Elements of an OHS program Deficiencies
identified by AAALAC
Personal Hygiene/Protection
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Elements of an OHS program Deficiencies
identified by AAALAC
Facilities, Procedures, and Monitoring
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Elements of an OHS program Deficiencies
identified by AAALAC
Medical Evaluation/ Preventative Medicine for
Personnel
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Elements of an OHS program Deficiencies
identified by AAALAC

• More common deficiencies
•  
• Hazard identification/risk assessment.
• Personal hygiene/protection.

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Elements of an OHS program Deficiencies
identified by AAALAC

• Less common deficiencies
• Personnel training.
• Facilities, procedures and monitoring.
• Medical evaluation/preventive medicine.

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Elements of an OHS program Deficiencies
identified by AAALAC

• Animal experimentation involving hazards
• This category reflects how OHSP components are
  implemented and coordinated to ensure safety in
  the face of a particular hazard.

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Elements of an OHS program Deficiencies
identified by AAALAC
Animal ExperimentationInvolving Hazards
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Elements of an OHS program Deficiencies
identified by AAALAC

• OHSP expectations
• Individual components that are appropriate
  for the facility.
• Evidence that the components work effectively
  together.

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Section 2
Issues in OHSP Implementation and Participation
Christian E. Newcomer, V.M.D.,
DACLAM Research Professor and Director Pathology
and Laboratory Medicine The University of North
Carolina at Chapel Hill
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Issues in OHSP implementation and participation

• OHSP implementation first steps
• What mandates the creation of an OHSP?
• Who authorizes the OHSP?
• Who funds the OHSP?
• Who designs the OHSP?
• Who coordinates the OHSP?

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Issues in OHSP implementation and participation

• OHSP implementation issues
• What mandates the creation of an OHSP?
• PHS Policy The Guide
• OSHA CFR 29
• ILAR Occupational Health and Safety
  in the Care and Use of Research
  Animals

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Issues in OHSP implementation and participation

• OHSP implementation issues
• Who authorizes the OHSP?
• The senior official must
• Understand the issues.
• Provide guidance.
• Establish and support policies.
• Have resource authority.
• Assemble the team.

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Issues in OHSP implementation and participation

• OHSP implementation issues
• Who funds the OHSP?
• The Senior Official is accountable.
• By what funding mechanism?
• The funding mechanism is not of concern to
  the AAALAC peer review process!

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Issues in OHSP implementation and participation

• OHSP implementation issues
• Who designs the OHSP?
• Who or what qualifies the OHSP designers?
• Does one design fit all or are there
  various successful models?
• Opportunities for cost containment?

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Issues in OHSP implementation and participation

• OHSP design team members
• Animal Care and Use Staff
• Research Staff
• Environmental Health and Safety
• Occupational Health/Medicine
• Administration and Management

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Issues in OHSP implementation and participation

• OHSP implementation issues
• Who coordinates the OHSP?
• Single point coordination of OHSP.
• Team management of OHSP.
• Interaction and communication among team
  members to refine approach, measure results and
  improve outcomes.
• Are participants clear on the available
  OHSP services?

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Issues in OHSP implementation and participation

• OHSP participation issues
• What is participation in the OHSP?
• Who participates in the OHSP?
• Can personnel waive OHSP participation?
• How are participants identified/enrolled?
• Who tracks OHSP enrollment?
• What are the enrollment recall provisions?
• Periodic? Status change?

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Issues in OHSP implementation and participation

• Issues in OHSP implementation and participation
• Who reviews OHSP scope and participation?
• IACUC
• OHSP Coordinator
• Senior Official
• AAALAC International

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Section 3
Hazard Control and Risk Assessment Ron E.
Banks, D.V.M. University Veterinarian
Director Office of Laboratory Animal
ResourcesUniversity of Colorado Health Sciences
Center
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Hazard control and risk assessment

• What is the principal objective of an OHSP?
• To reduce to an acceptable level, the risk
  associated with using materials or systems
  that have inherent danger by controlling or
  eliminating hazards.

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Hazard control and risk assessment

• How does risk assessment relate to the greater
  OHSP?
• Risk Assessment is the foundation for
  progressive OHS
• Risk Assessment is prerequisite to selecting an
  appropriate health-care service for
  employees!

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Hazard control and risk assessment

• What is risk?
• The likelihood of a consequence.

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Hazard control and risk assessment

• What is risk assessment?
• A measure of the likelihood of a consequence.
• Defining and quantifying a hazard.

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Hazard control and risk assessment
What issues enter into risk assessment?
Known / unknown Work Assignment Species Facility Engineering
Experimental Conditions Duration of Study Specific Agent Properties Current Health Status
Outside Work / Play Frequency of Exposure Intensity of Exposure Required Equipment
Facility History Regulatory Requirements Prevalence Personnel Experience
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Hazard control and risk assessment

• When can I stop defining and quantifying hazards?
  
• Dynamic process never completed!

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Hazard control and risk assessment

• How important is risk assessment?
• Undetected / undefined hazards pose the
  most significant problem to research staff
• Undetected and unrelated hazards are the
  most worrisome.
• You cant protect staff from the unknown

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Hazard control and risk assessment

• Whose responsibility is it to identify hazards?
• The researcher
• The facility management team
• The care provider
• In short . EVERYONE!

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Hazard control and risk assessment

• How should risk assessmentbe used in the
  laboratory?
• To manage the hazard
• To avoid / control exposure
• To provide therapy when exposure occurs

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Hazard control and risk assessment

• What must you know to perform risk assessment
  for chemical agents?
• Toxic doses
• Stability
• Form (gas/liquid/solid)
• Type of toxicity (irrit/corrosion/carcin/narcosi
  s/lethality)
• Severity of reaction
• Mode of action
• Metabolic products

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Hazard control and risk assessment

• What must you know to perform risk assessment for
  infectious diseases?
• Dose-response relationship
• Virulence
• Communicability
• Prevalence
• Route of exposure
• Shedding patterns
• Stability
• Availability of prophylaxis / therapy

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Hazard control and risk assessment

• Does the IACUC have a role to play in risk
  assessment?
• Yes!
• Protocol review can (and should) include
  requests for information on the potential
  hazards of a particular study.
• Hazard review can be performed by
• A committee member
• A HS committee or board
• The IACUC

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Hazard control and risk assessment

• Where can you find informationto assist in risk
  assessment?
• Scientific literature
• Other scientists
• MSDS
• The researchers themselves
• Your own staff!

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Hazard control and risk assessment

• Risk assessment providesa touch of reality to
  life!
• The likelihood of occupationally acquired
  zoonoses is MUCH lower than is popularly
  perceived.
• The likelihood of occupationally acquired
  immune response to chemical is MUCH higher
  than is popularly perceived.
• Substantial animal contact IS NOT a
  sufficient indicator of the need for
  enrollment in OHSP!

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Hazard control and risk assessment

• How can I assure AAALAC site visitors we have a
  risk assessment based OHSP?
• OHS Committee minutes showing program
  formation / review.
• Note in semiannual review of OHSP assessment
  (program review).
• Occasional changes in OHSP process (dynamic
  process).
• Common sense subtle differences (consistent
  inconsistencies) in the OHSP between care
  facilities.
• A suggestion process involving employees
  (program enhancements).
• Ready explanations (consistent between
  employees) to site visitor inquiry of why
  they do something a certain way (PPE / process).

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Section 4
Training and Information Management Barbara
Garibaldi, D.V.M., ACLAM Director, Animal
Research FacilityBeth Israel Deaconess Medical
Center Boston, Massachusetts
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Training and information management

• An institutions approach for providing education
  and training depends on its
• Size
• Resources
• Animal species used
• Research activities
• Staff experience and technical expertise

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Training and information management

• Information provided to employees should
  bedeveloped through the interaction of several
  key people
• A veterinarian
• A health and safety professional
• A research scientist

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Training and information management
What types of occupational health and safety
training should be provided?
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Training and information management

•  
• The use of personnel protective equipment
  (PPE).
• Good hygiene practices and universal
  precautions.
• Laboratory animal allergies.
• Zoonotic agents.
• Ergonomics Physical Hazards Noise.
• Training sessions in chemical, radiation,
  biohazardous material safety, and bloodborne
  pathogens may be provided by experts in the
  appropriate department.

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Training and information management

•  
• Personnel who have contact with
  experimental animals should receive training
  in the proper handling of the animals that
  they will work with.
• Personnel should be instructed to avoid
  unnecessary risk when working with animals,
  and to seek expert assistance when in doubt.

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Training and information management

•  
• Most animal inflicted injuries occur because
  of inadequate training and experience, or
  because of carelessness.
• Training should be provided that injuries,
  splashes, animal bites and/or scratches, and
  cuts sustained while working with animals
  should be promptly reported and the employee
  referred to employee health service.

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Training and information management
What type of documentation does AAALAC look at?  
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Training and information management

• Training logs
• Informational Newsletters
• Written Guidelines
• Websites

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Training and information management
How do you ensure that all individuals have
received OHS training?
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Training and information management

• Utilize human resources (HR) to obtain a list
  of graduate students, and new employees.
• Name a designee from each approved protocol
  responsible for listing new employees on the
  protocol and contacting the IACUC coordinator
  to set up training.
• This individual can serve as a source of
  information, guidance, and instruction for
  their colleagues.
• Some institutions choose to link training to
  facility access.

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Training and information management
Approaches to achieving investigator/scientist
participation?
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Training and information management

• Occupational health and safety goals and how they
  will be achieved must be clearly communicated to
  all employees through
• Formal orientation.
• Distribution of written guidelines.
• And periodic refresher training.

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Training and information management

• One option is a mandatory course offered several
  times during the year
•  
• Live" organized class.
• Distance learning i.e. teleconferencing or
  video.
• Online training/Web site.
• Individual may be asked to take a test
  verifying that the information was
  understood.

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Training and information management

• Training may be conducted in individual
  investigator laboratories, instead of
  organized classes.
• One-on-one training offered by a veterinarian,
  occupational health professional, or
  designee (smaller institutions).
• Written guidelines appropriately designed to
  the scope of the institution's animal care
  and use program.
• Brochures/pamphlets.

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Training and information management
What would lead AAALAC to conclude that training
is inadequate?
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Training and information management
Have you been offered participation in the OHS
program?
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Training and information management

• "Details of OHS training program were not
  provided to employees and did not include
  foreseeable hazards such as exposure to
  animal allergens."
• "Several procedures described in the
  occupational health and safety program
  (OHSP) brochure, used to train employees,
  were not being practiced."

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Training and information management

• Training provided to researchers using animals
  consisted of general print-outs and dated
  booklets and was not well-matched to the
  scope of the program of animal care and use
  a training program covering subjects relevant to
  the needs of the institution must be
  developed and implemented."
• The communication of the potential hazards of
  working with macaques had been done verbally
  between the veterinarian and the investigator
  but had not been formally documented."

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Training and information management
How are oversight mechanisms reviewed?
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Training and information management

• An effective education and trainingprogram
  requires  
• Resources
• Administrative record keeping
• A mechanism for monitoring its efficiency

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Training and information management

• A wide variety of mechanisms exist for
• evaluating the success of the education
• and training program.
• Site inspections
• Personnel reviews
• Injury and illness records
• Regulatory-compliance citations
• Periodic questionnaires

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Training and information management
How is information managed?
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Training and information management

• Record keeping is essential.
• Training records are necessary to satisfy
  specific requirements of federal and state
  environmental health and safety regulations.
• Establish a simple system with minimal
  administrative burden.
• A computer based system may facilitate such an
  approach.

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Training and information management

• Rapid access to employee-specific exposure
  information is vital.
• The following documentation should be available
• Occupational exposures
• Safety training
• Medical surveillance
• Work-related injury and illness

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Training and information management

• On-line access to health and safety information
  could
• Improve the management and performance of an
  occupational health and safety program.
• Make it practical to develop records that are
  specific for each research protocol.
• Computer links with other institutions through
  external networks, such as electronic mail,
  are useful for obtaining current health and
  safety information.
• Safety bulletin boards should be available for
  communicating with other health
  professionals.

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Training and information management

• Training should be a continuing process
• A well-informed staff with safe work habits will
• Minimize injuries and illnesses
• Reduce costs related to
• Labor time
• Insurance
• Health care
• And legal actions

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Section 5
Medical Evaluation and Preventative Medicine
Dale G. Martin, D.V.M., Ph.D., ACLAM,
ACVPM Director, Laboratory Animal Science and
WelfareAventis Pharmaceuticals Bridgewater, New
Jersey
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Medical evaluation and preventative medicine
Martins Observation 1 Physicians should not
practice veterinary medicine.   Martins Rule
1 Veterinarians must not practice human
medicine.
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Medical evaluation and preventative medicine

• The Guide states
• Input from trained health professionals
• Pre-employment risk assessment
• Periodic medical evaluations
• Appropriate immunizations
• Zoonoses surveillance
• Incident reporting
• Primates (special considerations)

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Medical evaluation and preventative medicine

• Who is the appropriate health professional?
• Occupational health physician
• Occupational health nurse?
• General practitioner?
• Contract nurse?
• Attending veterinarian?
• Senior animal caretaker?

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Medical evaluation and preventative medicine
What services should be provided? The
occupational health services are often the most
difficult for an institution to plan or carry out
because consensus on what needs to be done has
not yet been established. ILAR, NRC
Occupational Health and Safety in Research Animal
Facilities.
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Medical evaluation and preventative medicine

• What services can be provided?
• Pre-employment medical evaluation
• Periodic health evaluations
• Episodic health evaluations
• Analysis of adverse outcomes
• Medical management of worker compensation cases

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Medical evaluation and preventative medicine

• What services can be provided? (continued)
• Immunizations/serum banking
• Hearing conservation program
• Ergonomic program
• Allergy program
• Respiratory protection program
• Reproductive counseling
• Non-human primate exposure program

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Medical evaluation and preventative medicine
For pre-employment or periodic evaluations, should
it include a questionnaire and/or a physical?
Ideal- questionnaire physical
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Medical evaluation and preventative medicine

• What questions should be asked?
• Do you have any allergies?
• Are you allergic to animals?
• What hazards were you/will you be exposed to?
• What animals do you/you work with?
• Have you had illnesses associated with working
  with animals (zoonoses)?
• Do you have back problems, etc.?

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Medical evaluation and preventative medicine

• Symptoms of allergy and asthma
• Allergy-
• Sneezing
• Nasal congestion
• Itchy eyes
• Cough

• Asthma
• Coughing
• Wheezing
• Chest tightness
• Shortness of breath

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Medical evaluation and preventative medicine

• Components of one allergy program
• Screening
• Management of the sensitized patient
• Management of the allergic and/or asthmatic
  patient
• Management of the anaphylactic patient

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Medical evaluation and preventative medicine

• Components of one allergy program
• Screening
• Questionnaire- family/personal history
• Testing
• Skin
• RAST- IgE
• ELISA- IgE

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Medical evaluation and preventative medicine

• Components of one allergy program
• Screening
• Management of the sensitized patient
• Avoid exposure (PPE, procedures)
• Questionnaire (symptom progression)
• Enrollment in respiratory protection program
• Pulmonary function testing

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Medical evaluation and preventative medicine

• Components of one allergy program
• Screening
• Management of the sensitized patient
• Management of the allergic and or asthmatic
  patient
• Periodic pulmonary function testing
• Emmunotherapy?
• Management of the anaphylactic patient
• Emergency (Epi)

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Medical evaluation and preventative medicine

• What immunizations or screening programs should
  be included?
• Tetanus (Guide)
• Rabies?
• Hepatitis B?
• Other immunizations?
• TB testing?
• Serum banking?

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Medical evaluation and preventative medicine
Should serum banking be a part of an
Occupational Health program? Only when there
is a clear reason for obtaining the specimens
AND there is a plan to analyze the data as a
part of a risk assessment strategy.
..substantial issues should be considered in
advance of instituting a serum banking program
including chain of custody, confidentiality,
identification and handling of samples,
retention, potential deterioration of sample
quality over time, and cost. ILAR, NRC
Occupational Health and Safetyin the Care and
Use of Research Animals.
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Medical evaluation and preventative medicine

• Special precautions for primates
• TB testing
• Herpes B program
• Pre-arrangement with health professionals
• Bite/scratch kits
• SOPs for sampling/testing

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Medical evaluation and preventative medicine
Martins Observation 1 Physicians should not
practice Veterinary Medicine. Martins Rule
1 Veterinarians must not practice Human
Medicine.   Martins Advice 1 Obtain and retain
appropriate health professionals to set up and
administer the Medical Evaluation and Preventive
Medicine aspects of your Occupational Health and
Safety program.
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Occupational Health and Safety Programs An
AAALAC Perspective