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Occupational Healthand Safety Programs: An AAALAC Perspective

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Elements of anOccupational Health Program:

Deficiencies identified by AAALAC.

David DeLong, D.V.M.

Chief, Veterinary Medical UnitVAMC, Minneapolis, Minnesota

Section 1

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Why does AAALAC assessoccupational health and safety programs?

Elements of an OHS program:Deficiencies identified by AAALAC

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According to the Guide -

An occupational health and safety program must be part of the overallanimal care and use program."


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Working with animalscan be dangerous business!

Physical and chemical hazards

Protocol related hazards

Allergens

Zoonotic diseases


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How doesAAALAC assess an OHS program?

Prior to the site visit, review theProgram Description.

During the site visit, review facilities

and documents; interview personnel.


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Other documents:

Occupational Health and Safety in the Care and

Use of Research Animals. 1997. NRC, NationalAcademy of Sciences.

Biosafety in Microbiological and BiomedicalLaboratories. 1999. HHS Pub. No.

(CDC) 93-8395.

Miscellaneous AAALAC resource documents .


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What are the requiredcomponents 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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What are the hallmarksof a successful program?

Strong administrative support.

Sound implementation strategies.

Effective coordination of program components.


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What trends in OHS Program deficiencieshave been identified by AAALAC?


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0

20

40

60

80

100

120

1993 1994 1995 1996 1997 1998 1999*

MandatorySuggestion

Occupational Health and Safety of Personnel


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0

10

20

30

40

50

60

1993 1994 1995 1996 1997 1998 1999*

MandatorySuggestion

Hazard Identification and Risk Assessment


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0

10

20

30

40

50

60

1993 1994 1995 1996 1997 1998 1999*

MandatorySuggestion

Personnel Training


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Personal Hygiene/Protection

0

10

20

30

40

50

60

1993 1994 1995 1996 1997 1998 1999*

MandatorySuggestion


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Facilities, Procedures, and Monitoring

0

10

20

30

40

50

60

1993 1994 1995 1996 1997 1998 1999*

MandatorySuggestion


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More common deficiencies:

Hazard identification/risk assessment. Personal hygiene/protection.


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Less common deficiencies:

Personnel training.

Facilities, procedures and monitoring.

Medical evaluation/preventive medicine.


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Animal experimentation involving hazards

This category reflects how OHSP components areimplemented and coordinated to ensure safety in theface of a particular hazard.


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OHSP expectations:

Individual components that are appropriatefor the facility.

Evidence that the components work effectivelytogether.


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Issues in OHSPImplementation and Participation

Christian E. Newcomer, V.M.D., DACLAMResearch Professor and DirectorPathology and Laboratory MedicineThe University of North Carolina at Chapel Hill

Section 2

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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?

Issues in OHSPimplementation and participation

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OHSP implementation issues:

What mandates the creation of an OHSP?

PHS Policy: The Guide

OSHA: CFR 29

ILAR: Occupational Health and Safetyin the Care and Use of Research

Animals


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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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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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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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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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Who coordinates the OHSP?

Single point coordination of OHSP.

Team management of OHSP.

Interaction and communication among team

members to refine approach, measure results andimprove outcomes.

Are participants clear on the availableOHSP services?


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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 OHSPimplementation and participation:

Who reviews OHSP scope and participation?

IACUC OHSP Coordinator

Senior Official AAALAC International


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Hazard Controland Risk Assessment

Ron E. Banks, D.V.M.University Veterinarian & DirectorOffice of Laboratory Animal ResourcesUniversity of Colorado Health Sciences Center

Section 3

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What is the principalobjective of an OHSP?

To reduce to an acceptable level, the risk associatedwith using materials or systems that haveinherent danger by controlling or eliminating hazards.

Hazard controland risk assessment

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How does risk assessmentrelate to the greater OHSP?

Risk Assessment is the foundation for progressive OH&S

Risk Assessment is prerequisite to selecting an appropriatehealth-care service for employees!


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What is risk?

The likelihood of a consequence.


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What issues enter into risk assessment?

Known /

unknown

Work

Assignment

Species Facility

EngineeringExperimentalConditions

Duration ofStudy

Specific AgentProperties

Current HealthStatus

Outside Work /

Play

Frequency of

Exposure

Intensity of

Exposure

Required

EquipmentFacility History Regulatory

RequirementsPrevalence Personnel

Experience


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


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How important is risk assessment?

Undetected / undefined hazards pose themost significant problem to research staff

Undetected and unrelated hazards are themost worrisome.

You cant protect staff from the unknown


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Whose responsibility is itto identify hazards?

The researcher

The facility management team

The care provider

In short . EVERYONE!


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How should risk assessment be used in the laboratory?

To manage the hazard

To avoid / control exposure

To provide therapy when exposure occurs


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What must you know to performrisk assessment for chemical agents?

Toxic doses Stability Form (gas/liquid/solid) Type of toxicity (irrit/corrosion/carcin/narcosis/lethality)

Severity of reaction Mode of action Metabolic products


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What must you know to perform riskassessment for infectious diseases?

Dose-response relationship Virulence Communicability Prevalence Route of exposure Shedding patterns Stability Availability of prophylaxis / therapy


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Does the IACUC have a roleto play in risk assessment?

Yes!

Protocol review can (and should) include requestsfor information on the potential hazardsof a particular study.

Hazard review can be performed by: A committee member A H&S committee or board The IACUC


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Where can you find informationto assist in risk assessment?

Scientific literature Other scientists MSDS The researchers themselves Your own staff!


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How can I assure AAALAC site visitorswe 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 visitorinquiry of why they do something a certain way (PPE / process).

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Training andInformation Management

Barbara Garibaldi, D.V.M., ACLAMDirector, Animal Research FacilityBeth Israel Deaconess Medical CenterBoston, Massachusetts

Section 4

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An institutions approach for providingeducation and training depends on its:

Size

Resources

Animal species used

Research activities

Staff experience and technical expertise

Training andinformation management

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Information provided to employees should bedeveloped through the interaction of severalkey people:

A veterinarian

A health and safety professional

A research scientist


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What types of occupational health and

safety training should be provided?


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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, biohazardousmaterial safety, and bloodborne pathogens may be

provided by experts in the appropriate department.


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Personnel who have contact withexperimental animals should receive trainingin the proper handling of the animals that

they will work with.

Personnel should be instructed to avoidunnecessary risk when working with

animals, and to seek expert assistance whenin doubt.


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Most animal inflicted injuries occur becauseof inadequate training and experience, or

because of carelessness.

Training should be provided that injuries,splashes, animal bites and/or scratches, andcuts sustained while working with animalsshould be promptly reported and the employeereferred to employee health service.


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What type of documentationdoes AAALAC look at?


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Training logs

Informational Newsletters

Written Guidelines

Websites

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Utilize human resources (HR) to obtain a listof graduate students, and new employees.

Name a designee from each approved protocol responsiblefor listing new employees on the protocol and contacting theIACUC 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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Approaches to achieving investigator/scientist participation?


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Occupational health and safety goals and howthey will be achieved must be clearlycommunicated to all employees through:

Formal orientation.

Distribution of written guidelines.

And periodic refresher training.


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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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What would lead AAALAC to conclude

that training is inadequate?


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Have you been offered participation

in the OHS program?


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"Details of OHS training program were not providedto employees and did not include foreseeable hazards such

as exposure to animal allergens."

"Several procedures described in the occupational healthand safety program (OHSP) brochure, used to train

employees, were not being practiced."


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Training provided to researchers using animals consistedof general print-outs and dated booklets and was notwell-matched to the scope of the program of animal care anduse a training program covering subjects relevant to theneeds of the institution must be developed andimplemented."

The communication of the potential hazards of workingwith macaques had been done verbally between theveterinarian and the investigator but had not been formallydocumented."


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How are oversight mechanisms reviewed?


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An effective education and training program requires:

Resources Administrative record keeping A mechanism for monitoring its efficiency


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How is information managed?


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Record keeping is essential.

Training records are necessary to satisfy specificrequirements of federal and state environmental health andsafety regulations.

Establish a simple system with minimal administrative

burden. A computer based system may facilitate such an approach.


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Rapid access to employee-specificexposure information is vital.

The following documentation should be available:

Occupational exposures Safety training

Medical surveillance Work-related injury and illness


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On-line access to healthand safety information could:

Improve the management and performance of an occupational healthand 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 safetyinformation.

Safety bulletin boards should be available for communicatingwith other health professionals.


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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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Medical Evaluationand Preventative Medicine

Dale G. Martin, D.V.M., Ph.D., ACLAM, ACVPMDirector, Laboratory Animal Science and Welfare

Aventis PharmaceuticalsBridgewater, New Jersey

Section 5

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Martins Observation #1:

Physicians should not practiceveterinary medicine.

Martins Rule #1:

Veterinarians must not practicehuman medicine.

Medical evaluationand preventative medicine

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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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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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What services should be provided?

The occupational health services are often the most

difficult for an institution to plan or carry out becauseconsensus on what needs to be done has not yet beenestablished.

ILAR, NRC Occupational Health and Safetyin Research Animal Facilities.


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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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For pre-employment or periodic evaluations,

should it include a questionnaire and/ora physical?

Ideal- questionnaire + physical


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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 workingwith animals (zoonoses)?

Do you have back problems, etc.?


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Symptoms of allergy and asthma:

Allergy- Sneezing Nasal congestion Itchy eyes Cough


Asthma Coughing Wheezing Chest tightness Shortness of breath

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Components of oneallergy program:

Screening Management of the sensitized patient Management of the allergic and/or asthmatic patient Management of the anaphylactic patient


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Components of one allergy program:

Screening

Questionnaire- family/personal history

Testing

Skin RAST- IgE ELISA- IgE


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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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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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What immunizations or screening programs should be included?

Tetanus ( Guide ) Rabies? Hepatitis B? Other immunizations? TB testing? Serum banking?


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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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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 PreventiveMedicine aspects of your Occupational Health and Safety

program.


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Occupational Healthand Safety Programs:

An AAALAC Perspective

Documents

Aaalac Ohs (1)