Occupational Healthand Safety Programs:

An AAALAC Perspective

Elements of anOccupational Health Program: Deficiencies identified by AAALAC.

David DeLong, D.V.M.Chief, Veterinary Medical Unit VAMC, Minneapolis, MinnesotaSection 1

Why does AAALAC assessoccupational health and safety programs? 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." Elements of an OHS program:Deficiencies identified by AAALAC

Working with animals can be dangerous business! Physical and chemical hazards Protocol related hazards Allergens Zoonotic diseases

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. Elements of an OHS program:Deficiencies identified by AAALAC

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

What trends in OHS Program deficiencieshave been identified by AAALAC?Elements of an OHS program:Deficiencies identified by AAALAC

Occupational Health and Safety of Personnel Elements of an OHS program:Deficiencies identified by AAALAC

Hazard Identification and Risk Assessment Elements of an OHS program:Deficiencies identified by AAALAC

Personnel Training Elements of an OHS program:Deficiencies identified by AAALAC

Personal Hygiene/Protection Elements of an OHS program:Deficiencies identified by AAALAC

Facilities, Procedures, and Monitoring Elements of an OHS program:Deficiencies identified by AAALAC

Medical Evaluation/Preventative Medicine for Personnel Elements of an OHS program:Deficiencies identified by AAALAC

More common deficiencies: Hazard identification/risk assessment. Personal hygiene/protection. Elements of an OHS program:Deficiencies identified by AAALAC

Less common deficiencies:

Personnel training. Facilities, procedures and monitoring. Medical evaluation/preventive medicine. 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. Elements of an OHS program:Deficiencies identified by AAALAC

Animal Experimentation Involving Hazards 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. Elements of an OHS program:Deficiencies identified by AAALAC

Issues in OHSPImplementation and Participation

Christian E. Newcomer, V.M.D., DACLAMResearch Professor and DirectorPathology and Laboratory MedicineThe University of North Carolina at Chapel HillSection 2

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

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

Issues in OHSPimplementation 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.

Issues in OHSPimplementation 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!Issues in OHSPimplementation 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?Issues in OHSPimplementation and participation

OHSP design team members:

Animal Care and Use Staff Research Staff Environmental Health and Safety Occupational Health/Medicine Administration and ManagementIssues in OHSPimplementation 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?Issues in OHSPimplementation 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?Issues in OHSPimplementation and participation

Issues in OHSP implementation and participation:

Who reviews OHSP scope and participation? IACUC OHSP Coordinator Senior Official AAALAC InternationalIssues in OHSPimplementation and participation

Hazard Controland Risk Assessment

Ron E. Banks, D.V.M.University Veterinarian & DirectorOffice of Laboratory Animal Resources University of Colorado Health Sciences Center Section 3

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.Hazard controland risk assessment

How does risk assessment relate to the greater OHSP?

Risk Assessment is the foundation for progressive OH&S

Risk Assessment is prerequisite to selecting an appropriate health-care service for employees!Hazard controland risk assessment

What is risk?

The likelihood of a consequence.Hazard controland risk assessment

What is risk assessment?

A measure of the likelihood of a consequence.

Defining and quantifying a hazard.

Hazard controland risk assessment

What issues enter into risk assessment?Hazard controland risk assessment

Known / unknown Work AssignmentSpeciesFacility EngineeringExperimental ConditionsDuration of StudySpecific Agent PropertiesCurrent Health StatusOutside Work / PlayFrequency of ExposureIntensity of ExposureRequired EquipmentFacility HistoryRegulatory RequirementsPrevalencePersonnel Experience

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

Hazard controland risk assessment

Whose responsibility is it to identify hazards?

The researcher The facility management team The care provider In short . EVERYONE!

Hazard controland risk assessment

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

Hazard controland 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/narcosis/lethality) Severity of reaction Mode of action Metabolic productsHazard controland 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 / therapyHazard controland 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 H&S committee or board The IACUCHazard controland risk assessment

Where can you find information to assist in risk assessment? Scientific literature Other scientists MSDS The researchers themselves Your own staff!Hazard controland risk assessment

Risk assessment provides a 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 OH&SP!Hazard controland risk assessment

Hazard controland risk assessmentHow 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).

Training andInformation Management

Barbara Garibaldi, D.V.M., ACLAMDirector, Animal Research Facility Beth Israel Deaconess Medical CenterBoston, MassachusettsSection 4

An institutions approach for providing education and training depends on its:

Size Resources Animal species used Research activities Staff experience and technical expertiseTraining andinformation management

Information provided to employees should be developed through the interaction of several key people:

A veterinarian

A health and safety professional A research scientistTraining andinformation management

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

What type of documentation does AAALAC look at? Training andinformation management

Training andinformation management Training logs Informational Newsletters Written Guidelines Websites

How do you ensure that all individuals have received OHS training?Training andinformation 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.Training andinformation management

Approaches to achieving investigator/ scientist participation? Training andinformation 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. Training andinformation 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. Training andinformation 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.

Training andinformation management

What would lead AAALAC to conclude that training is inadequate? Training andinformation management

Have you been offered participation in the OHS program? Training andinformation 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." Training andinformation 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." Training andinformation management

How are oversight mechanisms reviewed? Training andinformation management

An effective education and training program requires: Resources Administrative record keeping A mechanism for monitoring its efficiency Training andinformation 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 Training andinformation management

How is information managed? Training andinformation 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. Training andinformation 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 Training andinformation 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. Training andinformation 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 actionsTraining andinformation management

Medical Evaluationand Preventative Medicine

Dale G. Martin, D.V.M., Ph.D., ACLAM, ACVPMDirector, Laboratory Animal Science and Welfare Aventis PharmaceuticalsBridgewater, New JerseySection 5

Martins Observation #1:Physicians should not practice veterinary medicine.Martins Rule #1:Veterinarians must not practice human medicine. Medical evaluationand 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) Medical evaluationand preventative medicine

Who is the appropriate health professional?

Occupational health physician Occupational health nurse? General practitioner? Contract nurse? Attending veterinarian? Senior animal caretaker? Medical evaluationand 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 Safetyin Research Animal Facilities.Medical evaluationand 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 Medical evaluationand 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 Medical evaluationand preventative medicine

For pre-employment or periodic evaluations,should it include a questionnaire and/or a physical?

Ideal- questionnaire + physical Medical evaluationand 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.? Medical evaluationand preventative medicine

Symptoms of allergy and asthma:

Allergy- Sneezing Nasal congestion Itchy eyes CoughMedical evaluationand preventative medicineAsthma Coughing Wheezing Chest tightness Shortness of breath

Components of one allergy program:

Screening Management of the sensitized patient Management of the allergic and/or asthmatic patient Management of the anaphylactic patient Medical evaluationand preventative medicine

Components of one allergy program:

Screening Questionnaire- family/personal history Testing Skin RAST- IgE ELISA- IgE Medical evaluationand 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 Medical evaluationand 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) Medical evaluationand preventative medicine

What immunizations or screening programs should be included?

Tetanus (Guide) Rabies? Hepatitis B? Other immunizations? TB testing? Serum banking? Medical evaluationand 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 Safety in the Care and Use of Research Animals.Medical evaluationand preventative medicine

Special precautions for primates:

TB testing Herpes B program Pre-arrangement with health professionals Bite/scratch kits SOPs for sampling/testing Medical evaluationand 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.Medical evaluationand preventative medicine

Occupational Healthand Safety Programs:

An AAALAC Perspective