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Occupational Health & Safety in the Response to Smallpox

Occupational Health & Safety in the Response to Smallpox. Scott Deitchman, MD MPH National Institute for Occupational Safety and Health Centers for Disease Control and Prevention. Age Distribution- Nurses (2.2M). Source: HRSA/BHP, 2000 survey. Age Distribution- Physicians (814K).

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Occupational Health & Safety in the Response to Smallpox

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  1. Occupational Health & Safety in the Response to Smallpox Scott Deitchman, MD MPH National Institute for Occupational Safety and Health Centers for Disease Control and Prevention

  2. Age Distribution- Nurses (2.2M) Source: HRSA/BHP, 2000 survey

  3. Age Distribution- Physicians (814K) Source: AMA

  4. Age Distribution- EM Physicians (23K) Source: AMA

  5. Transmission Lessons from Smallpox Experience • The weight of experience indicates that most cases present transmission risk to close contacts • Meschede and Monschau suggest rare instances where patients produce infectious aerosols that can travel longer distances

  6. Fomites in Smallpox Transmission • Clothing and bed linen can be contaminated with virus from oropharyngeal secretions, pustules, or scabs • Documented cases among laundry personnel, hotel maids • Rao, 1972 (India): virus on deliberately contaminated objects was rapidly inactivated

  7. Infection Control for Smallpox For patients with suspected or confirmed smallpox, both Airborne and Contact Precautions should be used in addition to Standard Precautions. (CDC/APIC 1999)

  8. It’s Not Just Vaccination! Prevent exposure through the occupational health hierarchy of controls: • Administrative controls • Engineering controls • Personal protective equipment (respirators)

  9. Administrative Controls • Many of the strategies of smallpox infection control reduce worker risk for exposure • Work practices that limit number of workers potentially exposed • Isolate patients who may be infectious • Assign only vaccinated workers to jobs with potential exposure • Work practices that limit exposure to the hazard • Infection control strategies • Procedures for handling waste, laundry, specimens

  10. Engineering Controls:Isolation Rooms • Patients housed in rooms under negative pressure compared to hall • At least 6 to12 air changes/hour • Air not recirculated to other rooms Source: CDC, 1994

  11. Test the Engineering Controls! • Negative pressure of isolation room should be tested daily (CDC, 1994) • NYC DOH, 1998 • 38% of “negative pressure” rooms blew air outwards ! • Automatic airflow monitors were wrong 50% of the time

  12. Testing Negative Pressure The smoke tube

  13. Respiratory Protection - Smallpox • Airborne precautions • Particles < 5 μM • Remain suspended in air, can be dispersed by air currents • Recommendation: fitted respirators meeting NIOSH N95 or better • Source: CDC/APIC, 1999

  14. What are you breathing? Without fit testing With fit testing

  15. Using respirators • Must have an OSHA-compliant program (OSHA 1910.134) • Training • Maintenance • Fit testing • Hospitals should already have this in place for TB prevention (CDC, 1994)

  16. Benefits of fit testing • Study: 25 volunteers, 21 masks, 4 trials each = 2100 data points • Without fit testing • 95% of the tests had more than 33% leakage • for some respirators, 95% of the time the wearer had 88% leakage • With fit testing, 95% of the respirators had no more than 4% leakage

  17. More Protective Respirators • Some hospitals recommend PAPR • Advantages • more protective • NIOSH APF: Hooded: 25, Tight-fitting: 50 • ANSI APF: 1000 for both • cooling • Disadvantages • cost • weight • battery dependence • noise • Need?

  18. Remember:health and safety applies to you and your team, too!

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