CONTROLLING BIOLOGICAL RISKS AT THE GROUP (WORKPLACE) AND INDIVIDUAL LEVEL

1. CONTROLLING BIOLOGICAL RISKS AT THE GROUP (WORKPLACE) AND INDIVIDUAL LEVEL Prof Mohamed Fareed JeebhayOccupational and Environmental Health Research Unit School of Public Health and Family MedicineUniversity of Cape Town, South Africa

2. CONTROLLING BIOLOGICAL HEALTH RISKS OCCURS AT TWO LEVELS • Group (workplace) level:- policies, legislation and enforcement of exposure standards- workplace control measures- surveillance: industrial hygiene and medical surveillance- information, education and training of workers • Individual (worker/patient) level:- removal of exposure: placement- treatment and counselling- compensation claim and notification

3. SOUTH AFRICAN LEGISLATION GOVERNING HBA

4. WHAT IS A HAZARDOUS BIOLOGICAL AGENT (HBA)? Any cell (plant, animal, human), micro-organism or cell culture of natural origin or genetically engineered that constitutes a risk to human health

5. REGULATIONS FOR HAZARDOUS BIOLOGICAL AGENTS Promulgated: December 2001 Scope: Applies to every employer and self-employed person where: • HBA is deliberately produced, processed, used, handled, stored or transported • Incident or high risk exposure to a HBA in the following work situations (Annexure A): - food production plants - where there is contact with animals and/or products of animal origin - health care, including isolation and post mortem units - clinical, veterinary and diagnostic laboratories - sewage purification installations - general workplace

6. HBA REGULATIONS:Information, Education and Risk Assessment • Employer to provide information and training to employees on potential risks of HBA and risk reduction • Employees to follow safe procedures for HBA disposal and decontamination and report all incidents • Risk assessment every 2 years and record kept. Risk to be categorised (Grade 1-4)

7. HBA REGULATIONS:Risk Group Categories for HBA

8. HBA REGULATIONS:Risk Assessment for HBA • Name of the HBA and its biological properties • Where HBA is present and its physical form • Nature of the work process and effectiveness of existing controls to minimise exposure • Route of exposure (some routes eg. respiratory and skin are more important than others) • Dose/level and period of exposure • Potential health effects (eg. infection, toxic, allergenic, carcinogenic)

9. HBA REGULATIONS:Exposure and Medical Surveillance • Regular exposure monitoring using sensitive and effective procedures • Medical surveillance based on risk assessment or presence of an occupational disease directly related to exposure. Initial (within 14 days) and periodical health evaluations according to written protocol approved by the HS committee • Investigation of all incidents resulting in infections or death • All risk assessment, exposure monitoring and medical surveillance recordsto be kept for 40 years

10. HBA REGULATIONS:Risk Management and Control Measures • Hierarchy of control measures using standard and transmission-based precautions (Annexure C) • Personal protective equipment appropriate to the route of transmission eg. respirators, impermeable gloves; supply; selection; training; storage; decontamination/sterilisation • Testing of engineering control measures every 24 months • Labelling, packaging, transporting and storage in special containers with biohazard sign • Written procedures for disposal of HBA to designated site, decontamination/disinfection of containers

12. HBA REGULATIONS:Special control measures for HBA Category 2-4 • Special measures for health and veterinary isolation facilities, labs, animal rooms for human/animal materials. Use control measures in Annexure E (containment levels) and Annexure C (precautions) • Special measures for industrial processes. Use control measures in Annexure F (containment levels) and Annexure C (precautions)

13. IN SUMMARY WORKPLACES NEED TO: • Identify sources of high-risk exposure - approved inspection authority (AIA) • Control the hazard: substitution, isolation, engineering controls (eg. exhaust ventilation), administrative controls (eg. universal infection control procedures), personal protective equipment • Exposure monitoring: industrial hygiene surveillance and evaluation of bioaerosols and allergens • Medical surveillance programmes (skin prick testing, serum antibodies, target organ tests) • Information, education and training, and counseling programmes

14. Environmental monitoring

15. Questionnaire Lung function testing Medical surveillance Skin prick testing Skin patch testing

16. MANAGEMENT OF WORKER WITH AN OCCUPATIONAL DISEASE DUE TO A HAZARDOUS BIOLOGICAL AGENT • Remove the patient from exposure or isolation • Institute appropriate treatment of infection/allergy and preventive measures such as post-exposure prophylactic treatment or vaccination for as yet unaffected workers • Submit a claim for worker's compensation under COIDA • Notification of the Department of Labour and Department of Health (if infectious disease) • Investigate and treat the workplace!

17. TAKE HOME MESSAGES • The exposure standards for grain, cotton and wood dusts under the HCS Regulations needs to be lowered to protect the health of workers • The HBA Regulations are an important tool to enforce improved occupational health and safety of workers exposed to HBA • A worker with an occupational disease due to a biological agent needs to managed in wholistic manner with due consideration given to placement, treatment, compensation, disease notification and ongoing monitoring.