Occupational Health Surveillance at Stanford University Lawrence Gibbs Gary Fujimoto, MD Ling Sue Teng web.stanford.edu/dept/ehs

Overview Stanford University Demographics and Organization Occupational Health Surveillance Approach Program Focus & Scope Current Trends and Issues

The Campus 8,180 Acres in six different governmental jurisdictions 678 major buildings 12.6 million square feet 46 miles of roadway 49-megawatt power plant w/ high-voltage distribution heating and cooling plant two separate water systems/100 miles of water mains three dams and lakes $300 million annually in capital construction between

People and Operations 1640 Faculty w/15 Nobel laureates 7000 undergraduate students 7600 graduate students 6150 staff $1.44 billion consolidated operating budget $500 million sponsored research on main campus Stanford Facts

EH&S - Our Mission We will support and advance the teaching, learning and research activities of the University, and promote a safe and healthy campus environment, by providing services and coordinating programs that minimize safety, health, environmental and regulatory risks to the Stanford University community in a manner consistent with responsible fiscal and environmental stewardship. Adopted 11/96

EH&S Risk Categories Health Decrement (Injury and Illness Prevention) Regulatory Liability (Environmental and Occupational Compliance Risk) Public Relations Operational Impact to University Mission General Liability (Third party lawsuits)

Occupational Health Challenges High turnover in population Exposure risk variability Non-routine work/activities Ensuring prompt medical and administrative follow-up for employees/students Lack of on-site occupational medical service Providing consistent support to university entities varying in size, structure, and internal administrative support.

Medical Providers/Facilities Cowell Student Health Center –student medical assistance only –space/ capabilities limited Stanford Hospital and Clinics –teaching and specialty hospital –no occupational medicine specialty –no same day service except ER Palo Alto Medical Foundation (off-site) –occupational medicine services department

Traditional Programs Asbestos exposures Hearing Conservation Employees involved in diving operations (e.g., researchers at Marine Hopkins) DOT Driver Hazardous Chemical Exposure follow up Hazardous Materials Emergency Response Team Police Officers Respiratory protection

Risk-based program approach Identify at-risk population(s) Create cross-functional program to address identified risk Ensure good communications and rapport with health care provider Provide service support, administration and follow up for program

Risk-based programs in research Laser users eye-safety Laboratory Animal Occupational Health Surveillance Research personnel with clinical patient contact Workstation Ergonomics

Laser users eye-safety Consists of baseline eye exam Required for Class 3 & 4 laser users (or completion of waiver form) Participation is optional for other laser users Estimated that 95% of Class 3 & 4 laser users complete baseline exam (5% sign waiver)

Laboratory Animal Occupational Health Surveillance (LAOHSP) Participants are grouped by Risk Categories (RC) based on animal species handled and type of work conducted Specific evaluation of allergy risks Non-human primate exposure follow-up protocol Policy on visitors to animal housing/ use areas Onsite medical consultation w/ at-risk staff

LAOHSP: Risk Categories Two defined categories of risk –Risk Category 1 –Risk Category 2 Veterinary Services Center staff are required to participate in the LAOHSP Special circumstances: non-human primate exposure protocol

Risk Category 1 Veterinary Service Center employees Dedicated animal care staff Individuals working with –non human primates –hoofed mammals –wild rodents –certain field studies final determination of risk category made by APLAC (IACUC)

Risk Category 1 LAOHSP Health Questionnaire must be filled out and submitted prior to APLAC approval of an individual to begin work with animals. Questionnaire is evaluated by Occupational Health Care Provider Specific medical surveillance can also be requested by EH&S or medical care provider depending upon other risk factors (bio agent used, patient risk factors, etc.)

Risk Category 2 Individuals All individuals working with animals and not in Category 1 Provided with information and educational materials regarding H&S issues associated with species and animal-related allergies Strongly encouraged to fill out and return LAOHSP health questionnaire, but not required to do so.

LAOHSP: Allergy prevalence

Non human primate exposure Exposure: bite, scratch, needlestick, or other exposure incident involving: –Live or dead monkey –unfixed monkey tissues, blood, or other bodily fluids –equipment that is contaminated with monkey blood, secretions or excretions

Non human Primate Bite/Scratch Protocol Treat immediate trauma (kit available) Seek medical attention from knowledgeable personnel secure blood samples and send to NIH B- virus lab with pertinent tracking info –human sample –animal sample conduct follow up as needed pay bills

Non human Primate Bite/Scratch Kit Contents ml bottle of sterile water 1- bottle of liquid dish detergent (e.g., Dawn Dish Detergent) 2 pairs of surgical gloves 1 pair of safety glasses 1 bowl 1 package of sterile gauze sponges 1 sponge/scrub brush 1 set of safety/first aid instructions 1 envelope containing medical care instructions and laboratory submission forms

Non human Primate Bite/Scratch Incidences 98-99: 9 incidents 99-00: 8 incidents

Research nurses with clinical patient contact California IIPP and JCAHO –IIPP requires protection of health & safety of employees from identified hazards –JCAHO requires medical surveillance of persons with patient contact and tracking employee participation

Risk-based approach Hep B exposure risk –High risk occupation: direct patient contact or work with clinical specimens –Not-high risk: all other nurses (e.g, telephone triage, case managers, etc.) May determine type of Hep B vaccination administered (rapid series vs. routine) - by physician

Risk-based approach TB exposure risk –High risk: respiratory therapists, pulmonary nurses –Not high risk: all other nurses High risk - PPD/TB 6 months Others - PPD/TB 12 months

Stanford’s Ergonomics Program Cal-OSHA Ergonomics Standard (1997) requires: l Training l Worksite evaluation l Correction of deficiencies SU Ergonomics Program for Computer Users: l Training (live, CD-ROM, and Web-based) l Workstation evaluations and assistance l Pre-approved ergonomic furniture and equipment list l Ergo Lab Showroom l Matching Fund For Ergonomics Equipment Purchase

Workstation Ergonomics For employees experiencing recurring symptoms of RSI: Evaluation by occupational health physician EH&S re-evaluates workstation setup and provides awareness training As necessary, EH&S works with MDs. or PTs to follow-up on unique workstation issues

Other programs Reproductive & Developmental Health Protection Program –Questionnaire-initiated review process –Concerns regarding confidentiality Biohazardous agents Blood-lead screening for children of families in student housing

Lessons Learned Need for a comprehensive data system: –helps ensure participation and necessary follow-up –allows cross-referencing between medical surveillance databases for routine compliance assessments –Ensures new medical surveillance program database modules can be added to the existing personnel data system