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IBC: Promoting Optimal Practice Now and In the Future … · 2020. 11. 13. · Additional Risks...
Transcript of IBC: Promoting Optimal Practice Now and In the Future … · 2020. 11. 13. · Additional Risks...
IBC: Promoting Optimal Practice Now and In the Future
Occupational Health and Medical Surveillance
June 25, 2009L. Casey Chosewood, MD
Director, Office of Health and SafetyMedical Officer, Strategy and Innovation, Office of the Director
Centers for Disease Control and Prevention
DisclaimerThe views herein represent current approaches and practices of the CDC Office of Health and Safety as described by the author and presenter. Your own workplace may have similar or vastly different needs and requirements. This is not official, cleared guidance from the Centers for Disease Control and Prevention. Such guidance can be found at www.cdc.gov. The mention of organizations and commercial entities and products in this presentation is for illustrative purposes only and does not represent an endorsement by CDC or the US Department of Health and Human Services.
HighlightsCDC Today: An Overview of Current Public Health ChallengesOccupational Health and Worker Protection at CDCScreenings, Medical Clearance and SurveillanceMedical Clearance, Immunization and Serum Banking IssuesOccupational Health Issues of Animal Care WorkersPost-incident and Post-Exposure Management
TsunamiDecember
04-05
West Nile
VirusAug-Nov 02
SpaceShuttle
Columbia Disaster
Feb 03
SARS Mar-Aug 03
Monkeypox June-Aug 03
Northeast Blackout
Aug 03
California Wildfires
Oct-Nov 03
Ricin TularemiaAnthrax Oct-Nov 03
BSE Dec 03
Avian Influenza
Jan-Mar 04
Guam Typhoon
Feb 04
Ricin Domestic Response
Feb 04
Global AIDS Program
Deployments
Hurricanes (Charley, Frances,
Ivan, Jean) Aug-Oct 04
West Nile Virus
Aug-Nov 04
Influenza VaccineShortage
Oct 04-05
World Trade Center
Sept2001
AnthraxAttacksOct-Nov 01
Influenza Sept 03
Hurricane IsabelSept 03
CDC: Health Protection and ResponseHurricane
KatrinaAug. 05 - 2006
Marburg Virus
Mar 05-Sept 05
Hurricane Rita
Sept. 05 - present
HurricaneWilma
Oct 04-Present
H5N1 Response and Pan Flu Prep
Novel H1N1
Response April 2009 -
present
CDC’s Current Global Challenges
Pandemic Influenza PreparednessNovel H1N1 Response
Hien TT et al., New England J Med 2004;350:1179-1188
DAY 5 DAY 7 DAY 10
Emerging Infections and Threats Quiz
CDC’s Current Global Challenges
CDC’s Current Global ChallengesBonus Question: Name This Mystery Virus
SARS
E. coli 0157HPS
CryptosporidiosisCyclospora
GuanaritoDengueCholera
HPS
New variant CJDFoot & mouth disease
Avian influenza
Rift Valley feverEbola HFHIV / TBMalaria
Yellow fever
Nipah virus
PlagueHIV
HIVSARS
Avian influenza
DiphtheriaWest Nile virus
HIVMDR-TB
DengueHendra virus
West Nile virus
MonkeypoxVRSA
AnthraxWest Nile virus
Polio
VISAE. coli 0157
Leptospirosis
CDC’s Global Health Challenges
Emerging and Re-emerging Infectious Diseases
CDC Infrastructure OverviewCDC Director
Chief Operating OfficerChief Operating OfficerOffice of Health and SafetyOffice of Health and SafetyOffice of Security and Emergency PreparednessOffice of Security and Emergency PreparednessBuildings and Facilities OfficeBuildings and Facilities OfficeHuman ResourcesHuman ResourcesEqual Employment Opportunity OfficeEqual Employment Opportunity OfficeFinancial Management OfficeFinancial Management Office
Coordinating Center DirectorsCoordinating Center DirectorsNational Centers, Institutes, OfficesNational Centers, Institutes, Offices
LaboratoriansLaboratoriansAnimal Care and Use ProgramAnimal Care and Use Program
CDC Office of Health and Safety Protects the Health, Safety, and Resilience of the CDC WorkforceApproximately 125 employeesInternal Activities
Physicians (3) MidPhysicians (3) Mid--Levels (3) Nurses (8)Levels (3) Nurses (8)Biosafety Officers and Technicians (5)Biosafety Officers and Technicians (5)Industrial Hygienists (8)Industrial Hygienists (8)Safety and Environmental Engineers (5)Safety and Environmental Engineers (5)Health Physicists (2)Health Physicists (2)Safety and Occupational Health Specialists, Safety and Occupational Health Specialists, Trainers, and TechniciansTrainers, and Technicians
CDC’s Office of Health and Safety at Work
Occupational Health and Safety at CDC
Comprehensive Risk AssessmentsGeneral Job Hazard AnalysesBiological, Chemical, Radiation Risks
Integrated Occupational Health and Safety ProgramsWith Programs (labs, PI’s, response elements)With Support Partners (Animal Care, Facilities, Security)
Interlocked Workplace Safety and Clinical ProgramsRisk Assessments lead clinical screenings and interventions
Aggressive Incident Management and InvestigationEmergency Response ElementSafety Help Desk, Safety Info Line, CDC Clinic Hotline, Worker Injury Reporting
SystemHealth Promotion and Prevention Activities
Safety TrainingQuality of Work Life Initiatives
Continuous Vigilance and Process ImprovementMetrics Review and Program Evolution
Safety Challenges in the High-Containment Lab Environment
People
Processes
Places
Pathogens
The Risk Assessment and Occupational Health
Basis for sound, comprehensive safety decisions and occupational health planningMust be customized and universal for all potentially affected personnelDefine potential exposure and other risks based upon actual job duties Translate outcomes of the assessment to create optimal screening, worker protection and surveillance programs
The Ideal Occupational Health Clinic
Onsite or Near the WorkplaceNear Ambulance AccessElectronic Health RecordsWide Variety of PPE Always AvailableOne-pass Air or Negative Pressure Space*Isolation Room*
Anteroom for donning or doffing PPEAnteroom for donning or doffing PPEShower insideShower insideSurfaces that can be easily decontaminatedSurfaces that can be easily decontaminated
*As determined by risk assessment
The Ideal Occupational Health Clinician
Available and readily accessible 24/7KnowledgeableIntegrated into research programsFamiliar with work, agents, protocolsAble to Access Subject Matter Experts and Consultants when NecessaryGenuine Interest in Laboratory Worker Protection IssuesAgent-, PPE-, Decon-, and Procedure-Savvy
Pre-Placement Medical Screening
Evaluation of past medical history
Medical, surgical, social and family historyMedical, surgical, social and family historyAllergies and sensitivities (latex, dander, drugs, Allergies and sensitivities (latex, dander, drugs, foods)foods)Previous occupational history and activityPrevious occupational history and activityMedications and other treatmentsMedications and other treatmentsActive conditions and review of major body Active conditions and review of major body systemssystemsReview and record past immunization historyReview and record past immunization history
Medical Assessment and Interventions
Targeted physical examination if necessaryFitness for Duty AssessmentBaseline serum collection and storageImmunizationsTiters when indicatedOther lab work when indicated
Serum BankingPros
Helps identify and characterize silent or inadvertent Helps identify and characterize silent or inadvertent infectionsinfectionsMay be useful in assessing risks with novel or emerging May be useful in assessing risks with novel or emerging agentsagentsMay help with a workerMay help with a worker’’s nons non--occupational health issuesoccupational health issuesMay protect the employer from liability related to previouslyMay protect the employer from liability related to previously--acquired infectionsacquired infections
ConsCostly and resource intensiveCostly and resource intensiveStorage, retention and legacy issuesStorage, retention and legacy issuesPrivacy, trust and confidentiality issuesPrivacy, trust and confidentiality issuesMany believe postMany believe post--exposure serum collection adequate for exposure serum collection adequate for baseline purposesbaseline purposes
Medical Assessment and Interventions
Respirator clearance and spirometryRespiratory fit testing and training programsInterventions to protect research animalsRepeat all interventions at appropriate intervals
Additional Risks Related to Work with Laboratory Animals
Animals react variably in lab environmentVariety of job tasks and processes increase riskAnimal handling less automated, “hands on”Fewer engineering and administrative controlsGreater reliance on personal protective equipment, consistent work practices, and personal behaviorTraining levels of animal care staff and lab workers vary widely
Commonly Used Immunizations Hepatitis B SeriesMMR, PolioVaricellaRabiesSmallpox/VacciniaTetanus-DiphtheriaHepatitis A SeriesQ fever, Yellow Fever, JEOthers as Research Warrants
Personal Protective Equipment
Gloves and GownRespiratory ProtectionFace and Eye ProtectionClosed-toe ShoesField Gear and Clothing
Periodic Medical Surveillance
and Evaluation
Assess need for interval surveillance on case-by-case basisUpdate medical screenings in at-risk employeesAssess titers and offer boosters as neededAnnual medical clearance to use respirator, fit testing and training Builds trust and ongoing relationship between lab workers and occ health staff
Never Hesitate to Raise a Red FlagWorkers should understand incubation periods, modes of transmission and clinical symptomsWorkers, supervisors and clinicians should always maintain a high index of suspicion for exposure and a lowthreshold for actionNever discourage reporting of concernsPay attention to work absencesAny fever or illness clustering should lead to prompt evaluationKnow that symptoms of work-acquired infection and natural infection may differ
Medical AlertAttending Physicians
This card holder works at the _______________________ in areas where hazardous biological, chemical or radioactiveagents or materials may be used. In the event of anunexplained illness, please contact the supervisor listed on thereverse side for information on specific agents or materials towhich this person may have been exposed.
Clinic 8 - 16:30 EST xxx.xxx.xxxxAgency Contact xxx.xxx.xxxx
Medical Alert Card
Employee Name _______________________ ______________
_____________________________________________________Employee Emergency Contact Telephone Number
Allergies _____________________________________________
Organizational Unit ____________________________________
1º Supervisor Work Telephone Alternate Telephone_____________________________________________________2º Supervisor Work Telephone Alternate Telephone
Medical Alert Card(back)
Post-Exposure Management
Clinical Focus
Repeat or extend first aid measures if neededEvaluate patient, event and agent-specific risksObtain supervisory, safety, expert or other specialty inputIncrease or expand vigilance (clinical follow-up, education, after-hours contacts)Aggressive use of prophylaxes / interventions where appropriate
Post-Exposure ManagementSafety Focus
Thorough incident investigationAssess risks for multiple victimsAssure control for secondary incidentsAccentuate the “opportunity this presents”not the “failure it represents”Use multi-disciplinary “systems approach”to assure follow-thru with corrective action/prevention efforts
Specialists and In-Patient Management Issues
Plan for seamless transition to specialty care or in-patient management in advanceEstablish a work-specific relationships with specialists and facilitiesSpecialized in-patient units for high-risk agent exposures likely to be increasingly commonInfection control in hospital setting is not newOngoing communication and planning
CDC’s In-patient Management Unit at Emory University Hospital
Protecting High-Containment Laboratory WorkersBasic Tools for Success
Comprehensive Risk Assessments Dictate Essentials for Optimal Occupational HealthInter-locked Workplace Safety and Clinical ProgramsAggressive Incident Management and InvestigationCredible Surveillance and Post-Exposure ManagementHealth Promotion and Prevention ActivitiesContinuous Vigilance and Process Improvement
More information…The 5th Edition of the Biosafety in Microbiological and Biomedical Laboratories is now available online at www.cdc.gov/od/ohs/Extensive Biosafety and Biosecurity risk assessment material is included in this editionNew chapter on Occupational Health