National Institute for Occupational Safety and Health; Request for Comments on the Proposed NIOSH Document on Guidelines for Protecting the Safety and Health of Health Care Workers

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health; Request

for Comments on the Proposed NIOSH Document on Guidelines for

Protecting the Safety and Health of Health Care Workers

AGENCY: National Institute for Occupational Safety and Health (NIOSH),

Centers for Disease Control and Prevention (CDC), Department of Health

and Human Services.

ACTION: Request for comments.

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SUMMARY: NIOSH requests comments concerning the updating of the 1988

NIOSH document, Guidelines for Protecting the Safety and Health of

Health Care Workers (NIOSH Publication No. 88-119 \1\).

\1\ This publication (NTIS Publication No.PB-89-148621) is

available from the National Technical Information Service (NTIS),

5285 Port Royal Road, Springfield, VA 22161, telephone (703) 487-

4650.

DATES: Written comments to this notice should be submitted to Diane

Manning, NIOSH Docket Office, 4676 Columbia Parkway, Mailstop C-34,

Cincinnati, Ohio 45226. Comments or data may be submitted on the

following topics (but are not limited to these): (1) Target audience,

(2) format, (3) content, and (4) methods of distribution. Comments must

be received on or before February 18, 1997. Comments may also be faxed

to Diane Manning at (513) 533-8285 or submitted by email to:

[email protected] as WordPerfect 5.0, 5.1/5.2, 6.0/6.1, or ASCII

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files.

FOR FURTHER INFORMATION CONTACT: Technical information may be obtained

from John J. Whalen, NIOSH, CDC, 4676 Columbia Parkway, Mailstop C-14,

Cincinnati, Ohio 45226, telephone (513) 533-8270.

SUPPLEMENTARY INFORMATION: Pursuant to Sections 20 and 22 of the

Occupational Safety and Health Act of 1970 (29 U.S.C. 669 and 671),

NIOSH is authorized to gather information and develop recommendations

for improving occupational safety and health.

More than 8 million health care workers are employed in the United

States, and they constitute about 6 percent of the entire workforce.

These workers represent many different occupations and are found in a

wide variety of work settings.

Since health care workers have very diverse functions and duties,

they are exposed to many hazards. These hazards include radiation,

toxic chemicals, biological agents, ergonomic stressors, violence,

stress, and physical hazards such as heat and noise.

Few workplaces are as complex as hospitals, where more than 50

percent of health care workers are employed. The number and types of

hazards in hospitals are extremely large. For example, maintenance

workers may be exposed to solvents, asbestos, and electrical hazards.

Housekeepers are exposed to detergents and disinfectants that can cause

skin rashes and eye and throat irritation. Also, housekeepers may be

exposed to infectious diseases such as hepatitis or acquired

immunodeficiency syndrome (AIDS) from hypodermic needles that have not

been properly discarded. Nurses confront such potential hazards as

exposure to infectious diseases and toxic substances, back injuries,

radiation exposure, and stress.

In 1988, NIOSH published the Guidelines for Protecting the Safety

and Health of Health Care Workers. However, since that time, knowledge

concerning these hazards has increased, and additional recommendations

have been made. For example, CDC recommendations for protecting health

care workers from tuberculosis and AIDS have changed significantly, as

have NIOSH recommendations concerning relevant respiratory protection.

NIOSH is aware that a number of directions can be taken to update

the document; therefore, a draft document outline and list of issues

have been prepared by CDC to ascertain the appropriateness of the

proposed document content and format. NIOSH is soliciting comments on

the document outline provided below:

I. Document Outline

Foreword

Abstract

Contents

Abbreviations

Acknowledgments

Introduction

[[Page 66282]]

Overview of Health Care Industry

Overview of Hazards

Development of Occupational Safety and Health Programs

Administrative support

Employee involvement

Health and safety committee

Multidisciplinary team approach

Medical surveillance program

Rehabilitation

Legal and ethical considerations

Americans with Disabilities Act (ADA)

Worksite analysis

Literature review

Identification of hazard categories

Worksite survey

Hazard analysis

Exposure monitoring (biological and environmental)

Safety and health training

Program review and evaluation

Development of emergency plans

Hazards

Hazardous agents

Biological agents

Chemical agents

Disinfectants and sterilants

Antibiotics

Hormones

Antineoplastics

Waste anesthetic gases

Latex (allergy)

Aerosolized medications (e.g., ribavirin)

Hazardous waste

Physical hazards

Compressed gases and chemicals (toxic, reactive, corrosive, or

flammable properties)

Extreme temperatures (e.g., burns caused by cryogenic compounds

such as dry ice or liquid nitrogen, or burns caused by the use of

autoclaves or incinerators for sterilization)

Mechanical (e.g., lacerations, punctures, and abrasions)

Electrical

Radiation (ionizing and nonionizing)

Noise

Violence

Slips and falls

Ergonomic hazards

Lifting (strains or back injuries)

Standing (for long periods of time)

Poor lighting (eye strain)

Psychological hazards

Job specialization

Discrimination

Ergonomic factors

Technological changes

Work schedules (e.g., shift work, leave policies)

Downsizing

Violence

Staff/patient ratios and occupational mix

Each of the major hazard categories identified above will be

divided into the following subsections:

a. Explanation of the hazard

b. Occupations at risk

c. Locations in the health care facility where the hazard may occur

d. Discussion of relevant regulations

e. Discussion of controls that are specific for the hazard that

will not otherwise be covered in the general control technology chapter

f. Additional resources (e.g., relevant literature, World Wide Web

(www) sites).

Control Technology--General

Directory of Occupational Safety and Health Information for Health

Care Workers

Appendices

a. Publications relevant to controlling infectious agents in the

health care environment

b. Occupational hazards by location

c. Chemicals encountered in selected health care occupations

d. Annotated bibliography

Index

II. Issues

The draft outline provided above assumes that each chapter or

section of the updated document will be developed by an expert in the

area. Many of these experts will come from CDC but outside experts will

also be utilized. To ensure that the information in the document is

appropriate and reaches the target audiences, there are several issues

which should be considered by commentors:

a. The 1988 Guidelines discussed only hazards associated with

hospitals (not other health care settings such as nursing homes or drug

treatment centers). It is assumed that information that is relevant for

hospitals is also relevant for other health care facilities. The issue

is whether information (e.g., reports of hazards) about health care

facilities other than hospitals should be included in the revised

guidelines, if available.

b. The draft format is based on the type of hazard (e.g., physical,

ergonomic, and chemical). The issue is whether this is the best

approach or if another format (e.g., presenting hazards by job task or

occupation) would be better. Another issue involving the format

structure is whether suggested chapters should be deleted or additional

chapters included.

c. The development of small documents for different health care

settings (e.g., biomedical laboratory, nursing home, home care, etc.)

or occupations (e.g., nursing aids, radiological technicians,

pharmacists) would be useful. The issue is whether or not these smaller

documents should be done in place of one larger, all inclusive document

as outlined above or in addition to this document.

d. The potential users of the health care worker guidelines include

occupational physicians, administrators of health care facilities,

nurses, engineers, nursing aides, safety professionals, industrial

hygienists, and safety and health committees. The issue is whether the

language and content should be targeted to specific occupations.

e. Information and recommendations applicable to controlling

hazards in the health care industry change on a regular basis. There

are a number of mechanisms that can be utilized to update this

information such as providing ``updates'' on a website (e.g., as a

subsection of the Institute's www site on the internet) and/or

providing the information on a CD-ROM that is updated on a regular

basis. The issue is what is the best mechanism(s) for reaching each

intended audience(s).

Dated: December 2, 1996.

William E. Halperin,

Acting Director, National Institute for Occupational Safety and Health

Centers for Disease Control and Prevention (CDC)

[FR Doc. 96-31949 Filed 12-16-96; 8:45 am]

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