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Volume 7  Number 8  December  2009 
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From the Director's Desk
Safety, Health, and Healthcare Workers: Rethinking Old Assumptions

New NIOSH Respirator 'One-Stop-Shop' Web Resource

In Memoriam: Joseph C. Fowler, Laborers' Safety and Health Champion

NIOSH and Partners Contribute to Occupational, Environmental Justice Resource

NIOSH Agreement Focuses on Training for Loss Prevention Professionals

NIOSH Awards Funding for Construction Research

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NIOSH Ergonomics Publication Receives Award

Global Happenings

NIOSH Seeks Public Comment

Healthy People 2020

Proposal Rule for Respirator Inward Leakage Requirements

Survey Explores Supply and Future Demand for OSH Professionals

More.

Two New Health Hazard Evaluation Reports Now Available

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News from Our Partners

Report Focuses on Fall Prevention in Construction

Exposure Code System Available to Clinicians

r2p Corner

Collaborative Opportunity - Evaluation of Source Capture Ventilation System

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NORA

NORA Award Winners Announced

NORA Liaison Committee Public Meeting Announced for January

NIOSH Science Blog

What's New on the NIOSH Blog?

New Communication Products

If It Moves, It Vibrates

What about NIOSH?

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NIOSH Mining Program Aids In Sago Mine Explosion Investigation

NIOSH Has Recently Released These Fire Fighter Fatality Investigation Reports:

Call for Abstracts

Look For Us!

Upcoming Conferences & Workshops

Word of the Month

Exposure Code List

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 From the Director's Desk
 --John Howard, M.D. Director, NIOSH
 December eNews 2009

Safety, Health, and Healthcare Workers: Rethinking Old Assumptions

It is no easy task to be an occupational safety and health practitioner in the healthcare industry. Longstanding and deeply embedded assumptions are always difficult to shake, even when the need to do so becomes increasingly apparent.

People in healthcare - including me - often take offense when we are said to belong to an "industry." In my career as a physician in an acute-care hospital setting, I have heard the words "profession" or even "calling" used to describe people who work in healthcare. And, depending on how remote, or how dangerous the part of the world where you deliver healthcare, healthcare workers are sometimes described as "noble" or "self-sacrificing."

Indeed, these descriptions are flattering and are, in some cases, accurate, but we must be careful when society characterizes routine work in any industry as "self-sacrificing." This characterization places workers engaged in such work outside the protections of the governmental worker safety and health paradigm that we apply to other all other industrial sectors where labor is exchanged for wages.

Providing occupational safety and health protections for healthcare workers is complex. In healthcare, some people have described a tension between caring for the patient and caring for the worker who cares for the patient. Healthcare has a long history of resolving that conflict entirely to the advantage of the patient without a rigorous consideration of all alternative ways to protect both the patient and the worker. The adoption of the Bloodborne Pathogens Standard http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051 in 1991 marked a real turning point in efforts to protect healthcare workers and patients.

Hazards in the Work Setting

We have known for years about the hazards that healthcare workers face every day:

  • Exposures to formaldehyde, anesthetic gases, and other potentially toxic chemicals

  • Risks for acute or chronic injuries from physical exertion such as turning and lifting patients, or standing for hours at a time in the operating room

  • Potential for work-related assault and injury from human agents in stressful situations or in public-access work areas, such as belligerent psychiatric patients, irate family members, or even gang members who engage in "shoot-outs" in hospital emergency rooms

All of these hazards, and more, characterize the risks associated with working in the industrial sector called healthcare.

Healthcare workers themselves have become more aware of these hazards. As awareness, education and research on preventing these hazards from maturing into injuries and illnesses have increased, so have the demands of healthcare workers for less "self-sacrifice" rhetoric and more straight talk about hazard identification, risk assessment, and risk management. Self-sacrifice is indeed admirable and many healthcare workers often go far beyond the duties of their job to help patients and their loved ones. However, on a routine basis in a $2 trillion industry, it should not be the operating principle if we are to create a sustainable healthcare workforce for the 21st century.

Lessons from 2009 H1N1 Influenza

And it is important that we use the opportunity of the first influenza pandemic of the 21st century to figure out what attitudes, what policies, what programs and what practical decisions we need to employ to guarantee a sustainable healthcare workforce. To do that successfully, we must confront the last frontier of occupational safety and health in the healthcare industry - the frontier associated with biological hazards.

Biological hazards include those that are transmissible from patient to healthcare worker, and from healthcare worker to the healthcare worker's unborn child, spouse, partner, children, friends, and others. Transmissible diseases are new to the lexicon of all occupational safety and health professionals, but I encourage all occupational safety and health practitioners to learn about transmissible diseases not only in the healthcare workplace, but also in non-healthcare workplaces.

The list of such agents is long and growing, and yet we in occupational safety and health know very little about such agents. In fact, we have often been led to believe that understanding the transmission of such transmissible agents requires a medical degree. That simply is not the case in the context of carrying out our duties as safety and health professionals.

Influenza - that virus that has plagued mankind since the dawn of the human race - that highly changeable virus with an 8-gene team that frequently trades and acquires new gene players-that virus that has outwitted the smartest virologists in the world - to survive through thousands of years - is upon us again. A fourth-generation relative of the virus that caused the terrible 1918 global pandemic appeared in the spring of 2009 and is now spreading throughout the world. In June, the World Health Organization declared the H1N1 influenza a pandemic.

Pivotal Documents

On October 14, 2009, the U.S. Centers for Disease Control and Prevention (CDC) updated its Interim Guidance on Infection Control in Healthcare Settings. The Guidance recommends that a robust hierarchy of controls - engineering, administrative, and personal protective equipment - be used to protect healthcare workers from the biological hazards associated with exposure to influenza. www.cdc.gov/h1n1flu/guidelines_infection_control.htm. Regarding personal protective equipment, the guidance continues to recommend that healthcare workers in close contact with patients suspected or confirmed to have H1N1 influenza wear fit-tested disposable N95 respirators.

The recommendation is based on scientific findings that the influenza virus can be spread by small particles or aerosols generated by an infected patient that can remain suspended in the air and that a surgical mask does not provide equivalent protection for the healthcare worker to a fit-tested respirator. The CDC Guidance, together with the recently adopted California Aerosol Transmissible Disease Standard www.dir.ca.gov/dosh/SwineFlu/Interim_enforcement_H1N1.pdf, are pivotal documents in the effort to promote a sustainable 21st-century healthcare workforce.

Currently, it is anticipated that there may be a shortage in the supply of disposable N95 respirators for healthcare settings trying their best to follow the CDC Guidance. NIOSH has developed a Respirator Information Clearinghouse to connect those who need to obtain respirators with those suppliers who have respirators available. As new information is obtained, NIOSH will update the clearinghouse site. I encourage you to visit this site and mark the page for ongoing reference. www.cdc.gov/niosh/npptl/topics/respirators/disp_part/RespSource.html

Where occupational safety and health practice in the healthcare industry goes from here when the current pandemic has passed us by, remains to be seen. A far more virulent influenza, so-called "avian" influenza or H5N1 influenza, may present us with even greater challenges. For this reason, I do not think we can return to an era when a healthcare worker's exposure to transmissible diseases such as influenza can be merely considered "diseases of life" for which a healthcare worker "assumes the risk" when he or she offers their labor to a healthcare employer.

We need to care for the sick and at the same time, we need to care for those who care for the sick. Our attitudes, our policies, our laws, and our practices need to more clearly and emphatically reflect this duality in the 21st century delivery of healthcare. For further information, I invite you to use our resources for preventing work-related injuries and illnesses in healthcare www.cdc.gov/niosh/topics/healthcare/, and to become familiar with NIOSH's research program portfolio in healthcare and social assistance www.cdc.gov/niosh/programs/hcsa/.

As always, we invite your partnership under the National Occupational Research Agenda (NORA) to stimulate, plan, conduct, and support the research necessary for meeting the challenges of the 21st Century. www.cdc.gov/niosh/nora/councils/hcsa/default.html

 New NIOSH Respirator 'One-Stop-Shop' Web Resource

NIOSH has developed a new respirator web page containing information that should be regarded as a reliable source to identify NIOSH-approved respirators; how to obtain products; and how to use them. The page will be dynamic; information will be added as it becomes available. http://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/RespSource.html

 In Memoriam: Joseph C. Fowler, Laborers' Safety and Health Champion

NIOSH was saddened to learn of the death of Joseph C. Fowler, Executive Director of the Laborers' Health and Safety Fund of North America, after a sudden and unexpected illness. Joe was a dedicated champion of worker health and safety, and a longtime partner of NIOSH. "His legacy will be the thousands of LiUNA members who will be safer on our highways and construction sites and healthier in the workplace and at home," the Laborers International Union of North America said on November 10.

 NIOSH and Partners Contribute to Occupational, Environmental Justice Resource

NIOSH joined with several partners, including the National Institute of Environmental Health Sciences (NIEHS), the U.S. Environmental Protection Agency (EPA), and the University of Massachusetts at Lowell, in supporting and contributing research-based articles to a new online supplement to the American Journal of Public Health, November 1, 2009, Volume 99, S3, on occupational and environmental justice. http://ajph.aphapublications.org/content/vol99/issueS3/ The concerns of occupational justice are reflected in NIOSH's strategic research to address occupational disparities. http://www.cdc.gov/niosh/programs/ohd/.

 NIOSH Agreement Focuses on Training for Loss Prevention Professionals

In November, NIOSH signed a agreement with the Loss Prevention Foundation to support and advance the educational elements of the National Occupational Research Agenda (NORA) Wholesale and Retail Trade Sector research agenda. The Loss Prevention Foundation works to advance the loss prevention profession by providing relevant, convenient and challenging educational resources. This agreement opens an opportunity to ensure that relevant NIOSH content is referenced as appropriate and that the trainees are aware of NIOSH resources. http://www.losspreventionfoundation.org/certification.html

 NIOSH Awards Funding for Construction Research

NIOSH recently awarded over $7 million over a five-year period to Virginia Tech researchers and their collaborators from five other institutions to engage in research on new construction safety and health. The overarching purpose of the seven awarded projects is to integrate an interdisciplinary focus in research that will produce systems capable of enhancing productivity, quality, and efficiency for the construction industry. http://www.vtnews.vt.edu/story.php?relyear=2009&itemno=820

 NIOSH Ergonomics Publication Receives Award

NIOSH's "Ergonomic Guidelines for Manual Materials Handling," http://www.cdc.gov/niosh/docs/2007-131/, won first place in the 2009 Outstanding Material Handling Logistics Content Award competition. The award was presented at the Material Handling Industry of America 2009 Annual Meeting in October. The award recognizes development of outstanding material handling and logistics-related content created in the previous two calendar years. http://www.mhia.org/news/mhia/9159/college-industry-council-announces-the-winners-of-the-2009-outstanding-material-handling-logistics-content-award.

 Global Happenings

At the 53rd Annual Meeting of the Human Factors and Ergonomics Society, NIOSH and the Foundation for Professional Ergonomics (FPE) signed a partnership agreement to support the Ergonomists Without Borders project. The two groups will use their collaborative efforts and expertise to advance the dissemination of ergonomics knowledge, promote best ergonomic practices, and encourage employers to develop and use ergonomics interventions to mitigate work-related musculoskeletal disorders among workers in industrially developing countries. For more information, contact Dr. Stephen Hudock at 513-533-8183, shudock@cdc.gov.

(left to right) Drs. Hal Hendrick, Project Director of Ergonomists Without Borders; Stephen Hudock, NIOSH; and Valerie Rice, President of the Foundation for Professional Ergonomics, at the signing in October.
(left to right) Drs. Hal Hendrick, Project Director of Ergonomists Without Borders; Stephen Hudock, NIOSH; and Valerie Rice, President of the Foundation for Professional Ergonomics, at the signing in October.

 NIOSH Seeks Public Comment

Healthy People 2020

NIOSH encourages its partners and stakeholders to comment on the DRAFT set of occupational safety and health objectives for the U.S. Department of Health and Human Services' Healthy People 2020. Healthy People provides a set of national 10-year health-promotion and disease-prevention objectives aimed at improving the health of all Americans. NIOSH is the coordinator of the Healthy People occupational safety and health topic area. Comments will be accepted through December 31, 2009. http://www.healthypeople.gov/hp2020/Comments/default.asp

Proposal Rule for Respirator Inward Leakage Requirements

Comments will be accepted through December 29, 2009, on the proposed rule for total inward leakage requirements for half-mask air-purifying particulate respirators. A public meeting will also be held December 3, 2009. For more information, go to http://www.cdc.gov/niosh/docket/nioshdocket0137.html.

Survey Explores Supply and Future Demand for OSH Professionals

Will there be enough occupational safety and health professionals to help protect workers from the workplace hazards of the 21st century? Will their skill-sets match employers' needs and demands? Those are the types of questions that NIOSH will explore in its proposed survey study of this workforce. NIOSH invites public comment at http://edocket.access.gpo.gov/2009/E9-27334.htm.

To view a comprehensive list of NIOSH Docket items currently open for comment, go to http://www.cdc.gov/niosh/review/public/.

 Two New Health Hazard Evaluation Reports Now Available

HHE - Health hazard Evaluations logoThe HHE Program recently evaluated risks for acquiring zoonotic disease among individuals who work with non-human primates (NHPs). Investigators found that some work tasks were associated with exposure incidents and that having more than 20 hours of contact with an NHP in a week is linked with an increased risk of bites, scratches, needle sticks, and splashes in eyes, mouth, or nose with NHP secretions. Investigators also found that, despite knowing potential health risks, employees did not report exposure incidents. Investigators recommended that facility managers create a procedure for employees to report exposure incidents and focus training on employees who have the most direct contact with NHPs. http://www.cdc.gov/niosh/hhe/reports/pdfs/2001-0273-0274-0275-0407-3091.pdf

The HHE Program received a request at a sign-manufacturing business regarding employees' exposure to organic solvent. Investigators found that employees' full-shift exposures to toluene, n-hexane, isopropyl alcohol, acetone, and cyclohexanone did not exceed occupational exposure limits. However, employees' exposure to the mixture of solvents did slightly exceed American Conference of Governmental Industrial Hygienists recommendations. Investigators also determined that short-term exposure to isopropyl alcohol may exceed short-term exposure limits during screen-printing and screen-washing activities. HHE Program investigators recommended that management investigate replacing solvent-based screen printing products with options that have low or no solvents. It was also recommended that ventilation be improved in the screen-printing area. http://www.cdc.gov/niosh/hhe/reports/pdfs/2007-0053-3092.pdf

 News from Our Partners

Report Focuses on Fall Prevention in Construction

Researchers from the New York State Fatality Assessment and Control Evaluation (NY FACE) program investigated the death of a worker who fell while positioning precast concrete floor slabs in a high rise building under construction. Specific causal and contributing factors that may be common to other similar construction projects were identified during the investigation. The preventive measures proposed in this investigation report can be used for preventing fatal falls, the leading cause of worker deaths in the construction industry. http://www.cdc.gov/niosh/face/stateface/ny/07NY015.html
http://www.health.state.ny.us/environmental/investigations/face/07ny015.htm


Exposure Code System Available to Clinicians

The Association of Occupational and Environmental Clinics (AOEC) has developed an exposure code system for use by clinicians. Details about the list may be found at http://www.aoec.org/tools.htm or at http://www.aoecdata.org/Default.aspx. The complete exposure code listing is available at http://www.aoecdata.org/ExpCodeLookup.aspx.

 r2p Corner

r2p logoCollaborative Opportunity - Evaluation of Source Capture Ventilation System

NIOSH researchers are soliciting partners, including developers, manufacturers, distributors, and vendors, to participate in a collaborative study involving the evaluation of source capture ventilation system (SCVS) units for use in nail salons. Systems (or units) can include downdraft-vented nail tables and portable SCVS units. The deadline to submit units to NIOSH is February 28, 2010. For more information, go to http://edocket.access.gpo.gov/2009/E9-27387.htm or contact Susan Reutman at 513-533-8286, SReutman@cdc.gov.

 NORA

NORA Award Winners Announced

NIOSH recently announced the winners of the intramural National Occupational Research Agenda (NORA) competition for FY2010. Thirteen projects received awards based on their technical and scientific merit. These proposals focused on moving research into practice, focusing on priority needs in the NORA sectors. For the full story, go to http://www.cdc.gov/niosh/updates/upd-11-09-09.html.

NORA Liaison Committee Public Meeting Announced for January

The next NORA Liaison Committee meeting, Partnerships to Advance the National Occupational Research Agenda, will be held January 20, 2010, in Washington, D.C. Attendees can also participate online. Details on the meeting have been posted at http://edocket.access.gpo.gov/2009/E9-28029.htm. For more information or to preregister to attend in person or online, contact the NORA coordinator noracoordinator@cdc.gov.

 NIOSH Science Blog

What's New on the NIOSH Blog?

Join in the current conversation on workplace hearing loss on the NIOSH blog. http://www.cdc.gov/niosh/blog/nsb112409_hearingloss.html

 New Communication Products

If It Moves, It Vibrates

The effects of vibration (through use of powered tools, machinery, vehicles, and heavy equipment) on workers in the industrial environment are a concern of health professionals, governments, and scientists around the world. Adequately assessing the effects of human vibration exposure is an equally important issue. NIOSH addresses these concerns in the proceedings of the second American Conference on Human Vibrationt. http://origin.cdc.gov/niosh/mining/pubs/pubreference/outputid2883.htm

What about NIOSH?

Want to know more about NIOSH or want to tell others about us? Check out the updated NIOSH fact sheet on the NIOSH "About Us" topic page. http://www.cdc.gov/niosh/about.html

NIOSH Mining Program Aids In Sago Mine Explosion Investigation

The Mine Safety and Health Administration (MSHA) and the West Virginia Office of Miners Health, Safety, and Training investigated the explosion at the Sago Mine in West Virginia, on January 2, 2006, resulting in 12 fatalities. As part of the investigation, the agencies requested that NIOSH Pittsburgh Research Laboratory evaluate the effects of explosions on specific mine ventilation seals and other structures and objects. NIOSH's research findings are detailed in a new published report. http://origin.cdc.gov/niosh/mining/pubs/pubreference/outputid2826.htm

NIOSH Has Recently Released These Fire Fighter Fatality Investigation Reports:

Volunteer Mutual Aid Fire Fighter Dies in a Floor Collapse in a Residential Basement Fire - Illinois (F2008-26) http://www.cdc.gov/niosh/fire/reports/face200826.html

Volunteer fire fighter dies in apparatus crash - Ohio (F2008-22) http://www.cdc.gov/niosh/fire/reports/face200822.html

Volunteer lieutenant dies after falling from a bridge while attending to a motor vehicle crash - Arkansas (F2007-31) http://www.cdc.gov/niosh/fire/reports/face200731.html

More…

To see other new NIOSH communication products, including documents and new and updated topic pages, go to the NIOSH "What's New" page. http://www.cdc.gov/niosh/whatsnew/

 Call for Abstracts

Nanotech Conference and Expo
Call for technical abstracts and business proposals. Deadline for submission is December 11, 2009. http://www.techconnectworld.com/Nanotech2010/

11th Biennial Kentucky Conference on Health Communication
Call for papers, posters, and panel proposals related to issues in health communication. Deadline for submission is December 13, 2009.
http://comm.uky.edu/kchc/

International Conference on Fall Prevention and Protection
Call for abstracts for presentations. Deadline for submission is December 21, 2009.
http://www.cdc.gov/niosh/topics/falls/ICFPP/2010/

ASTM, International Symposium on Surface and Dermal Sampling
Call for papers. Deadline for submission is January 14, 2010.

www.astm.org/d22symp1010.htm

NIOSH and International Journal of Occupational and Environmental Health
Call for papers on nanotechnology exposure assessment. Deadline for submission is January 15, 2010.

http://www.ijoeh.com/index.php/ijoeh/information/callforpapers

Social Marketing in Public Health
Call for abstracts. Deadline for submissions is January 18, 2010.

http://www.cme.hsc.usf.edu/smph/


 Look For Us!

The NIOSH exhibit will be at these January meetings:

Transportation Research Board 89th Annual Meeting, January 10 - 14, 2010
NIOSH Booth # 2101, Marriott Wardman Park Hotel, Washington DC

Agricultural Safety & Health Council of America - NIOSH Joint Conference
January 27 - 28, 2010, Dallas/Fort Worth Airport Marriott South, Fort Worth TX

 Upcoming Conferences & Workshops

A comprehensive list of upcoming conferences can be found at http://www.cdc.gov/niosh/exhibits.html.

 Word of the Month

Exposure Code List - a list developed by the Association of Occupational and Environmental Clinics (AOEC) to help systematically identify both existing and emerging occupational and environmental health concerns. The list includes a wide range of exposures including not only chemicals but exposures to metals, dusts, plants, animals etc. as well as physical hazards e.g. falls, lifting, repetitive strains, etc.

NIOSH eNews on the Web: www.cdc.gov/niosh/enews/

NIOSH eNews is Brought to You By:

Director John Howard, M.D.
Editor in Chief Max Lum
Story Editor Tanya Headley
Copy Editor Lynn Bonney
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