2Occupational Health Program: Section 1Elements of anOccupational Health Program:Deficiencies identified by AAALAC.David DeLong, D.V.M.Chief, Veterinary Medical Unit VAMC, Minneapolis, Minnesota
3occupational health and safety programs? Elements of an OHS program:Deficiencies identified by AAALACWhy does AAALAC assessoccupational health and safety programs?
4“An occupational health and safety program must be part of the overall Elements of an OHS program:Deficiencies identified by AAALACAccording to the Guide -“An occupational health and safetyprogram must be part of the overallanimal care and use program."
5Working with animals can be dangerous business! Elements of an OHS program:Deficiencies identified by AAALACWorking with animals can be dangerous business!Physical and chemical hazardsProtocol related hazardsAllergensZoonotic diseases
6How does AAALAC assess an OHS program? Elements of an OHS program:Deficiencies identified by AAALACHow 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.
7The Guide is the basis for the review. Elements of an OHS program:Deficiencies identified by AAALACThe Guide is the basis for the review.
8Elements of an OHS program: Deficiencies identified by AAALACOther documents:Occupational Health and Safety in the Care and Use of Research Animals NRC, National Academy of Sciences.Biosafety in Microbiological and Biomedical Laboratories HHS Pub. No. (CDC)Miscellaneous AAALAC resource documents.
9What are the required components of an OHS program? Elements of an OHS program:Deficiencies identified by AAALACWhat 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.
10What are the hallmarks of a successful program? Elements of an OHS program:Deficiencies identified by AAALACWhat are the hallmarks of a successful program?Strong administrative support.Sound implementation strategies.Effective coordination of program components.
11What trends in OHS Program deficiencies Elements of an OHS program:Deficiencies identified by AAALACWhat trends in OHS Program deficiencieshave been identified by AAALAC?
12Occupational Health and Safety of Personnel Elements of an OHS program:Deficiencies identified by AAALACOccupational Health and Safety of Personnel
13Hazard Identification and Risk Assessment Elements of an OHS program:Deficiencies identified by AAALACHazard Identification and Risk Assessment
14Personnel Training Elements of an OHS program: Deficiencies identified by AAALACPersonnel Training
15Personal Hygiene/Protection Elements of an OHS program:Deficiencies identified by AAALACPersonal Hygiene/Protection
16Facilities, Procedures, and Monitoring Elements of an OHS program:Deficiencies identified by AAALACFacilities, Procedures, and Monitoring
17Preventative Medicine for Personnel Elements of an OHS program:Deficiencies identified by AAALACMedical Evaluation/Preventative Medicine for Personnel
18More common deficiencies: Elements of an OHS program:Deficiencies identified by AAALACMore common deficiencies:Hazard identification/risk assessment.Personal hygiene/protection.
19Less common deficiencies: Elements of an OHS program:Deficiencies identified by AAALACLess common deficiencies:Personnel training.Facilities, procedures and monitoring.Medical evaluation/preventive medicine.
20Animal experimentation involving hazards Elements of an OHS program:Deficiencies identified by AAALACAnimal experimentation involving hazardsThis category reflects how OHSP components are implemented and coordinated to ensure safety in the face of a particular hazard.
21Animal Experimentation Involving Hazards Elements of an OHS program:Deficiencies identified by AAALACAnimal Experimentation Involving Hazards
22Elements of an OHS program: Deficiencies identified by AAALACOHSP expectations:Individual components that are appropriate for the facility.Evidence that the components work effectively together.
23Implementation and Participation Section 2Issues in OHSPImplementation and ParticipationChristian E. Newcomer, V.M.D., DACLAMResearch Professor and DirectorPathology and Laboratory MedicineThe University of North Carolina at Chapel Hill
24OHSP implementation: first steps Issues in OHSPimplementation and participationOHSP implementation: first stepsWhat mandates the creation of an OHSP?Who authorizes the OHSP?Who funds the OHSP?Who designs the OHSP?Who coordinates the OHSP?
25OHSP implementation issues: Issues in OHSPimplementation and participationOHSP implementation issues:What mandates the creation of an OHSP?PHS Policy: “The Guide”OSHA: CFR 29ILAR: “Occupational Health and Safety in the Care and Use of Research Animals”
26OHSP implementation issues: Issues in OHSPimplementation and participationOHSP 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.
27OHSP implementation issues: Issues in OHSPimplementation and participationOHSP 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!
28OHSP implementation issues: Issues in OHSPimplementation and participationOHSP 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?
29OHSP design team members: Issues in OHSPimplementation and participationOHSP design team members:Animal Care and Use StaffResearch StaffEnvironmental Health and SafetyOccupational Health/MedicineAdministration and Management
30OHSP implementation issues: Issues in OHSPimplementation and participationOHSP 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?
31OHSP participation issues: Issues in OHSPimplementation and participationOHSP 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?
32Issues in OHSP implementation and participation: Who reviews OHSP scope and participation?IACUCOHSP CoordinatorSenior OfficialAAALAC International
33Hazard Control and Risk Assessment Ron E. Banks, D.V.M. Section 3Hazard Controland Risk AssessmentRon E. Banks, D.V.M.University Veterinarian & DirectorOffice of Laboratory Animal Resources University of Colorado Health Sciences Center
34What is the principal objective of an OHSP? Hazard controland risk assessmentWhat 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.
35How does risk assessment relate to the greater OHSP? Hazard controland risk assessmentHow does risk assessment relate to the greater OHSP?Risk Assessment is the foundation for progressive OH&SRisk Assessment is prerequisite to selecting an appropriate health-care service for employees!
36The likelihood of a consequence. Hazard controland risk assessmentWhat is risk?The likelihood of a consequence.
37What is risk assessment? Hazard controland risk assessmentWhat is risk assessment?A measure of the likelihood of a consequence.Defining and quantifying a hazard.
38What ‘issues’ enter into risk assessment? Hazard controland risk assessmentWhat ‘issues’ enter into risk assessment?Known / unknownWork AssignmentSpeciesFacility EngineeringExperimental ConditionsDuration of StudySpecific Agent PropertiesCurrent Health StatusOutside Work / PlayFrequency of ExposureIntensity of ExposureRequired EquipmentFacility HistoryRegulatory RequirementsPrevalencePersonnel Experience
39When can I stop defining and quantifying hazards? Hazard controland risk assessmentWhen can I stop defining and quantifying hazards?Dynamic process – never completed!
40How important is risk assessment? Hazard controland risk assessmentHow important is risk assessment?Undetected / undefined hazards pose the most significant problem to research staff…Undetected and unrelated hazards are the most worrisome.You can’t protect staff from the unknown …
41Whose responsibility is it to identify hazards? Hazard controland risk assessmentWhose responsibility is it to identify hazards?The researcherThe facility management teamThe care providerIn short …. EVERYONE!
42How should risk assessment be used in the laboratory? Hazard controland risk assessmentHow should risk assessment be used in the laboratory?To manage the hazardTo avoid / control exposureTo provide therapy when exposure occurs
43What must you know to perform risk assessment for chemical agents? Hazard controland risk assessmentWhat must you know to perform risk assessment for chemical agents?Toxic dosesStabilityForm (gas/liquid/solid)Type of toxicity (irrit/corrosion/carcin/narcosis/lethality)Severity of reactionMode of actionMetabolic products
44What must you know to perform risk assessment for infectious diseases? Hazard controland risk assessmentWhat must you know to perform risk assessment for infectious diseases?Dose-response relationshipVirulenceCommunicabilityPrevalenceRoute of exposureShedding patternsStabilityAvailability of prophylaxis / therapy
45Does the IACUC have a role to play in risk assessment? Hazard controland risk assessmentDoes 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 memberA H&S committee or boardThe IACUC
46Where can you find information to assist in risk assessment? Hazard controland risk assessmentWhere can you find information to assist in risk assessment?Scientific literatureOther scientistsMSDSThe researchers themselvesYour own staff!
47Risk assessment provides a touch of reality to life! Hazard controland risk assessmentRisk 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!
48Hazard 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).
49Information Management Section 4Training andInformation ManagementBarbara Garibaldi, D.V.M., ACLAMDirector, Animal Research Facility Beth Israel Deaconess Medical CenterBoston, Massachusetts
51Training andinformation managementAn institution’s approach for providing education and training depends on its:SizeResourcesAnimal species usedResearch activitiesStaff experience and technical expertise
52Training andinformation managementInformation provided to employees should be developed through the interaction of several key people:A veterinarianA health and safety professionalA research scientist
53What types of occupational health and Training andinformation managementWhat types of occupational health andsafety training should be provided?
54The use of personnel protective equipment (PPE). Training andinformation managementThe 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.
55Training andinformation managementPersonnel 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.
56Training andinformation managementMost 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.
57What type of documentation does AAALAC look at? Training andinformation managementWhat type of documentation does AAALAC look at?
58Informational Newsletters Written Guidelines Websites Training andinformation managementTraining logsInformational NewslettersWritten GuidelinesWebsites
59How do you ensure that all individuals have received OHS training? Training andinformation managementHow do you ensure that all individuals have received OHS training?
60Some institutions choose to link training to facility access. Training andinformation managementUtilize 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.
61Approaches to achieving investigator/ scientist participation? Training andinformation managementApproaches to achieving investigator/ scientist participation?
63Training andinformation managementOccupational 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.
64Training andinformation managementOne 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.
65Training andinformation managementTraining 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.
66What would lead AAALAC to conclude that training is inadequate? Training andinformation managementWhat would lead AAALAC to conclude that training is inadequate?
67Have you been offered participation in the OHS program? Training andinformation managementHave you been offered participation in the OHS program?
68Training 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."
70Training 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."
71How are oversight mechanisms reviewed? Training andinformation managementHow are oversight mechanisms reviewed?
72An effective education and training program requires: Training andinformation managementAn effective education and training program requires: ResourcesAdministrative record keepingA mechanism for monitoring its efficiency
73A wide variety of mechanisms exist for Training andinformation managementA wide variety of mechanisms exist forevaluating the success of the educationand training program.Site inspectionsPersonnel reviewsInjury and illness recordsRegulatory-compliance citationsPeriodic questionnaires
74How is information managed? Training andinformation managementHow is information managed?
75Record keeping is essential. Training andinformation managementRecord 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.
76Rapid access to employee-specific exposure information is vital. Training andinformation managementRapid access to employee-specific exposure information is vital.The following documentation should be available:Occupational exposuresSafety trainingMedical surveillanceWork-related injury and illness
77On-line access to health and safety information could: Training andinformation managementOn-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.
78Training should be a continuing process Training andinformation managementTraining should be a continuing processA well-informed staff with safe work habits will:Minimize injuries and illnessesReduce costs related to:Labor timeInsuranceHealth careAnd legal actions
80and Preventative Medicine Section 5Medical Evaluationand Preventative MedicineDale G. Martin, D.V.M., Ph.D., ACLAM, ACVPMDirector, Laboratory Animal Science and Welfare Aventis PharmaceuticalsBridgewater, New Jersey
81Physicians should not practice veterinary medicine. Medical evaluationand preventative medicineMartin’s Observation #1:Physicians should not practice veterinary medicine.Martin’s Rule #1:Veterinarians must not practice human medicine.
82The Guide states – Input from trained health professionals Medical evaluationand preventative medicineThe Guide states –Input from trained health professionalsPre-employment risk assessmentPeriodic medical evaluationsAppropriate immunizationsZoonoses surveillanceIncident reportingPrimates (special considerations)
83Who is the appropriate health professional? Medical evaluationand preventative medicineWho is the appropriate health professional?Occupational health physicianOccupational health nurse?General practitioner?Contract nurse?Attending veterinarian?Senior animal caretaker?
84What services should be provided? Medical evaluationand preventative medicineWhat 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.
85What services can be provided? Medical evaluationand preventative medicineWhat services can be provided?Pre-employment medical evaluationPeriodic health evaluationsEpisodic health evaluationsAnalysis of adverse outcomesMedical management of worker compensation cases
86What services can be provided? (continued) Medical evaluationand preventative medicineWhat services can be provided? (continued)Immunizations/serum bankingHearing conservation programErgonomic programAllergy programRespiratory protection programReproductive counselingNon-human primate exposure program
87For pre-employment or periodic evaluations, Medical evaluationand preventative medicineFor pre-employment or periodic evaluations,should it include a questionnaire and/ora physical?Ideal- questionnaire + physical
88What questions should be asked? Medical evaluationand preventative medicineWhat 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.?
89Symptoms of allergy and asthma: Medical evaluationand preventative medicineSymptoms of allergy and asthma:Allergy-SneezingNasal congestionItchy eyesCoughAsthmaCoughingWheezingChest tightnessShortness of breath
90Components of one “allergy” program: Medical evaluationand preventative medicineComponents of one “allergy” program:ScreeningManagement of the sensitized patientManagement of the allergic and/or asthmatic patientManagement of the anaphylactic patient
91Components of one “allergy” program: Medical evaluationand preventative medicineComponents of one “allergy” program:ScreeningQuestionnaire- family/personal historyTestingSkinRAST- IgEELISA- IgE
92Components of one “allergy” program: Medical evaluationand preventative medicineComponents of one “allergy” program:ScreeningManagement of the sensitized patientAvoid exposure (PPE, procedures)Questionnaire (symptom progression)Enrollment in respiratory protection programPulmonary function testing
93Components of one “allergy” program: Medical evaluationand preventative medicineComponents of one “allergy” program:ScreeningManagement of the sensitized patientManagement of the allergic and or asthmatic patientPeriodic pulmonary function testingEmmunotherapy?Management of the anaphylactic patientEmergency (Epi)
94What immunizations or screening programs should be included? Medical evaluationand preventative medicineWhat immunizations or screening programs should be included?Tetanus (Guide)Rabies?Hepatitis B?Other immunizations?TB testing?Serum banking?
95Should serum banking be a part of an Occupational Health program? Medical evaluationand preventative medicineShould 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.
96Special precautions for primates: Medical evaluationand preventative medicineSpecial precautions for primates:TB testingHerpes B programPre-arrangement with health professionalsBite/scratch kitsSOPs for sampling/testing
97Physicians should not practice Veterinary Medicine. Medical evaluationand preventative medicineMartin’s Observation #1:Physicians should not practice Veterinary Medicine.Martin’s Rule #1:Veterinarians must not practice Human Medicine.Martin’s 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.