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Improving Personal Protective Technology Workplace Practices

Maryann D’Alessandro, Ph.D.Associate Director for SciencePPT Program CoordinatorNIOSH, National Personal Protective Technology Lab

Council of State and Territorial Epidemiologists (CSTE)

David L. Lawrence Convention CenterPittsburgh, PA 15222

June 12, 2011

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Overview

· NPPTL and PPT Program Overview

· PPT Workplace Practice Studies- Roadway Construction

- Agriculture Pesticide Handlers

- Healthcare

· Summary

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NIOSH Program Portfolio NORA / NIOSH

Industry Sectors (10)

NIOSH

Cross Sector Programs (24)• Agriculture, forestry, and

fishing• Construction• Healthcare and social

assistance• Mining• Public Safety• Oil & Gas Extraction• Manufacturing• Services• Transportation,

warehousing, and utilities• Wholesale and retail trade

• Personal Protective Technology (PPT)

• Health hazard evaluation (HHE)

• Hearing loss prevention• Respiratory diseases• Traumatic injury• Authoritative

recommendations and development

• Cancer, reproductive, and cardiovascular diseases

• Communications and information dissemination

• Emergency preparedness and response

• Global collaborations• Immune, dermal and

infectious diseases

• Musculoskeletal disorders• Radiation dose

reconstruction• Training grants• Work organization and

stress-related disorders• Economics• Exposure assessment• Engineering controls• Total Worker Health

(Formerly WorkLife initiative)• Occupational health

disparities• Small business assistance

and outreach• Surveillance• Nanotechnology• Prevention through design

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· Office of the Director, NIOSH

· National Personal Protective Technology Laboratory (NPPTL)

· Office of Mine Safety and Health Research (OMSHR)

· Office of Extramural Programs

· Division of Respiratory Disease Studies (DRDS)

· Division of Safety Research (DSR)· Health Effects Laboratory Division

(HELD)· Education and Information Division

(EID)· Division of Applied Research and

Technology (DART)· Division of Surveillance Hazard

Evaluation and Field Studies (DSHEFS)

· Division of Compensation Analysis and Support (DCAS)

· Research to Practice (r2p)· Spokane Research Laboratory

NIOSH Divisions & Laboratories

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An estimated 20 million workers use PPE on a regular basis to protect themselves from job hazards.

NIOSH PPT Program and NPPTL Mission

The VISION is to be the leading provider of quality, relevant, and timely PPT research, training, and evaluation.

The MISSION of the PPT program is to prevent work-related injury, illness and death by advancing the state of knowledge and application of personal protective technologies (PPT).

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PPT Program Goal Interactions

PPEWorkplace

needsSurveillance

CommunicationsSurveillance

Communications

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PPT Program Workplace Practice Industry Focus

· Roadway Construction

· Agriculture Pesticide Handlers

· Healthcare

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PPT Surveillance and Intervention Studies in Roadway Construction

• 360,000 road and transportation workers nationwide

• 90% establishments <20 employees

• 25% of workforce is Hispanic

• Transient highly variable work practices and exposures

• Heavy dependence on PPE compared to general industry- Silica - Asphalt fumes - Diesel exhaust

Sources: 1) BLS, 2006 2) NIOSH, National Occupational Respiratory Mortality System (NORMS)

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PPT Surveillance and Intervention Studies Roadway Construction

Objectives - Evaluate and identify methods to improve respirator use and the interfaces of respirators with other PPE

• 2005 – 2007 – Assess roadway construction practices

• 2007 – 2012 - Identify shortcomings in current respiratory protection programs and develop interventions

• 2008 – 2012 - Evaluate interventions for utility and acceptance as judged by contractors/workers

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PPT Surveillance in Roadway Construction Findings

• Assessed airborne hazards and exposure control methods

• Identified barriers to using respiratory protection

• Use and design factors• Comfort, interfaces, communications

• Management factors• Enforcement, proper storage and cleaning

• Worksite factors• Worker turnover, short duration projects

• Worker factors• Training, facial hair, non-English speakers

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PPT Surveillance in Roadway Construction Partnerships

· Key Partners

American Road and Transportation Builders Association (ARTBA)

ARTBA sites visited throughout the country

· Stakeholders National Demolition Association

OSHA

ISEA and manufacturers

Construction workers

Laborers International Union of North America

Center for Construction Research and Training

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PPT Surveillance and Intervention Studies in Agriculture Pesticide Handlers

• 23,200 Pesticide Handlers Nationwide

• 1998 – 2005: 3,281 cases of acute occupational pesticide poisonings among farm workers

• 81% of farm workers reported Spanish as their native language

Sources: 1) BLS, 2010 2) National Agricultural Worker Survey (NAWS)

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Agriculture Pesticide HandlersPPT Surveillance and Intervention Studies

Objectives - Understand PPT practices and barriers among agricultural pesticide handlers and their employers over time and develop interventions to address PPT barriers to best practices

· 2009 – 2010 - Assess current surveillance studies

· 2010 - 2011 - Develop and pilot data gathering strategies

· 2011 – 2012 - Implement questionnaires and focus groups

· 2013 – 2015 - Develop and implement interventions

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PPT Surveillance in Agriculture

Findings

• Worked with partners to assess barriers

• Identified barriers to using PPT

• Use and design factors• Comfort, interfaces, hinders job performance

• Pesticide label challenges (too technical, vague requirements)

• Management factors• Difficulty obtaining PPT , proper storage and cleaning

• Fear of retaliation, low perceived risk

• Worker factors• Limited knowledge (i.e. training on use), non-English speakers

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· Key Partners EPA, OSHA and Oregon OSHA

State Cooperative Extension Services, Departments of Health and Agriculture: WA, PA, AZ, FL, OR, NC, IA

NIOSH Ag Centers including PNASH

Pesticide and PPE Manufactures and Suppliers

· Stakeholders Agricultural Pesticide Handlers (workers who mix/load/apply pesticides) Employers of agricultural pesticide handlers

PPT Surveillance in Agriculture Partnerships

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PPT Initiatives in Healthcare

• Fastest growing industry sector

• About 17 million workers (11% US workforce)

• 2nd with over 30% of all lost time nonfatal occupational illness and injuries

• Pandemic preparedness has been priority since 2004

• H1N1 influenza pandemic provided opportunity to focus efforts

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Public Health Practice Study of 16 California facilities selected by stratified random sample

• Objective: Describe extent to which hospitals in California have implemented required elements of RPPs for H1N1 Influenza

• Opportunity to assess Healthcare workers during pandemic operations:• Barriers to proper respirator use• Knowledge, attitudes, and beliefs

regarding N95 respirators• Workplace safety climate

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Interviews and observations conducted at 16 hospitals

· Interviews: At each hospital, 15-21 interviews conducted from Jan 20 – Feb 23, 2010

• Hospital Managers in Nursing, Employee Health, Infection Control

• Unit Managers in Emergency Dept., ICU, Pediatrics or Medical/Surgical units

• 3-5 HCWs in each of the 3 units

· Observations: HCW N95 respirator use/non-use observed when in close contact with patients on airborne precautions

· Respiratory Protection Program Assessment

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Most Deficient Areas of Written Programs(n=16)

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Improving Respiratory Protection Programs in Hospitals - Summary

• Many hospitals rely on staff with no formal training in OHS to administer their RPP

• User-friendly interventions to develop and implement RPP in hospitals needed

• Best practice interventions based on the results of pilot testing and stakeholder input developed

• Widespread distribution of RPP Toolkit throughout California

• Interventions to be made available for modification and implementation nationwide

• Parallel efforts underway in 5 states (NY, NC, MN, IL, MI)

Attend Tuesday’s session to learn more: Occupational Health Session, B. Materna : 2:30 – 3:00, Room 315

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Demonstration and Sentinel Surveillance System of PPE Usage in US Healthcare

Workers

Objectives: Determine the feasibility to identify, describe, develop, pilot, monitor and evaluate PPE surveillance systems used in a medical center setting.

Develop data collection points at VUMC (PPE usage, types, selection, fit-test, clearance, compliance, resources, recalls, outcomes etc.)

Pilot System at VUMC in 2011

Use data to Establish “Best Practices”

Develop a National PPE Usage Surveillance System

Attend Tuesday’s session to learn more: Poster Board #108, M. Yarborough : 10:00 – 10:30 am

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Project BREATHE - Better Respirator Equipment using Advanced Technology for Healthcare Employees

Objective - Improve respirator use compliance among healthcare workers (HCW) by developing information products, respirator performance requirements, and advanced technologies for the next generation of HCW respirators that are more comfortable and tolerable.

• Comfort & tolerability research and test method development (underway)

• Respirator clinical effectiveness study (underway)

• Partnership / prototype development (underway)

• Prototype lab & field trials • Commercialization / standards

development

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VanderbiltVanderbiltCDPHCDPHBREATHEBREATHE

Identification of best practicesIdentification of best practices

Improved respirator designsand

Development of National Surveillance System

Improved respirator designsand

Development of National Surveillance System

Early intervention response and Improved Workplace Practices

Early intervention response and Improved Workplace Practices

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· Unique hazards across industry sectors· Common barriers across industry sectors· Opportunities for collaboration in all

sectors described across all states

Summary

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Quality Partnerships Enhance Worker Safety & Health

Thank you

Visit Us at: http://www.cdc.gov/niosh/programs/ppt/

http://www.cdc.gov/niosh/npptl/default.html

Contact information: bpj5@cdc.gov

Disclaimer: The findings and conclusions in this presentation have not been formally disseminated by the National Institute for Occupational Safety and Health and should not be construed to represent any agency determination or policy.