OSHA gathers input for ergonomics standard

Regional conferences, town hall meetings held

The U.S. Occupational Safety and Health Administration is holding a series of regional conferences and town hall meetings on ergonomics in preparation for a federal ergonomics program management standard.

Ten one-day conferences, titled "Practical Applications in Ergonomics Today," focus on ways to combat repetitive stress injuries, one of the fastest-growing and most costly occupational injuries in health care facilities. The sessions will bring together workers from a variety of industries, unions, employers, trade and professional associations, academics, and government to share information about effective solutions to reducing exposures to workplace ergonomic hazards.

Conferences will promote the use of ergonomic principles to improve worker safety, health, quality, and productivity. It will focus on lessons learned from successful workplace ergonomics programs and will encourage the exchange of ergonomics program experience and knowledge among participants.

"These conferences take a practical, problem-solving approach to reduction of ergonomic hazards in the workplace," says Gregory R. Watchman, acting assistant secretary of labor for occupational safety and health. "We must work together to reduce musculoskeletal disorders that result from such hazards. These disorders represent the largest group of preventable job injuries and illnesses in the United States."

Town hall meetings will follow each conference on the same day. Those meetings will give the public an opportunity to provide input on what should be included in an ergonomics program management standard. Attendees will include workers, health care providers, the medical community, industry, and any others interested in the standard.

The planned federal ergonomics standard has had a rocky history. Proposed rulemaking for a standard was announced five years ago, and a proposal was slated for release by September 1994. However, the plan crashed after attempts by Congress to weaken OSHA’s regulatory authority. A draft proposal was released in 1995, encouraging employers not to wait for a standard to implement workplace ergonomics programs.1 (See Hospital Employee Health, July 1995, pp. 85-89.) But that proposal, along with any other plans to issue a standard, was squelched by a rider attached to a subsequent federal appropriations bill adopted by Congress, which prohibited OSHA from promulgating or issuing a proposed or final ergonomics standard before Sept. 30, 1998. Even voluntary guidelines, if they are issued, could not be enforced under OSHA’s general duty clause before that time.

Nevertheless, "OSHA still has a four-pronged ergonomics plan, and rulemaking is part of that," says agency spokesman Bill Wright. "We will continue our initiatives toward developing a proposed standard."

The conferences and town hall meetings will be held in each of OSHA’s 10 regions. The New York and Chicago sessions already have been held. The others are planned for Boston, Philadelphia, Atlanta, Dallas, Kansas City, Denver, Seattle, and San Francisco. The schedule is not available yet. Registration is required for the conferences; the cost is $40. The town hall meetings are free, with no registration required. For more information on schedules and registration, call Wright at (202) 219-8151.

Reference

1. U.S. Occupational Safety and Health Administration. OSHA’s Proposed Ergonomics Protection Standard: Draft. Washington, DC: OSHA; March 13, 1995.

Kolavic SA, Kimura A, Simons SL, et al. An outbreak of Shigella dysenteriae type 2 among laboratory workers due to intentional food contamination. JAMA 1997; 278:396-398.

Outbreaks associated with Shigella dysenteriae type 2, also known as Schmitz bacillus, are uncommon in the United States. The last reported U.S. outbreak occurred among cafeteria workers in a Maryland medical center in 1983. The present report describes a maliciously perpetrated outbreak among 12 laboratory workers at a large Texas medical center from Oct. 29-Nov. 1, 1996.

The workers experienced severe gastrointestinal illness after eating muffins and doughnuts anonymously left in their break room. When stool cultures revealed S. dysenteriae, an investigation was launched to characterize the magnitude and source of the outbreak.

Investigators interviewed 45 lab employees who recalled that during the night and morning shift change on Oct. 29, an unsigned e-mail from a supervisor’s computer appeared on laboratory computer screens inviting workers to eat pastries in the break room. The break room cannot be accessed without entering a numerical security code. In the room were two boxes of commercially prepared blueberry muffins and assorted doughnuts.

Twelve workers who ate the pastries reported diarrhea with fever, headache, or vomiting. Diarrhea began between 9 p.m. Oct. 29 and 4 a.m. Nov. 1. The mean incubation period until onset was 25 hours and was preceded by nausea, abdominal discomfort, and bloating. Five workers were treated in emergency departments, and four others were hospitalized. Eight received intravenous fluids. Eleven were treated with ciprofloxacin, and one received a homeopathic medication. No deaths occurred. The attack rate was 100%. All 12 persons who ate pastries became ill, vs. 33 persons who did not eat pastries. A family member of one worker also became ill after eating a muffin that was brought home from the break room.

Investigation of the laboratory’s storage freezer showed that the reference culture of S. dysenteriae type 2 had been disturbed. The pathogen was isolated in virtually pure culture from Shigella broth enrichment cultures of the muffin specimen. "Pulsed-field gel electrophoresis revealed that the reference culture isolates were indistinguishable from those of the muffin and the stool cultures . . ."

The researchers concluded that the organism’s source was most likely the medical center’s stock culture. No cases of S. dysenteriae type 2 had been diagnosed in the hospital lab for the past five years, and no research was being conducted with the pathogen. A laboratory error therefore seemed unlikely as the cause of the outbreak.

Prompt contact with all area emergency departments and infectious disease physicians revealed that no additional cases were reported; therefore, pastry contamination during commercial handling also was unlikely. No concurrent outbreaks were reported in Texas or any other state.

The motive and method of contamination remain unknown, but researchers hypothesize that the perpetrator had access to the freezer, had the laboratory skills to culture the organism and inoculate the pastries, and had access to the locked break room. A criminal investigation is ongoing. Security measures have been implemented, including securing the laboratory freezer and replacing stock culture labels that identified microorganisms by name with a numerical identification system.

"To our knowledge, this is the first reported intentional contamination of food items with S. dysenteriae type 2," the authors state. "Bioterrorism through food contamination with microorganisms rarely is reported in the scientific literature. . . . The results of this investigation underscore the biological threat that accompanies malicious use of pathogenic microbiologic agents." t

Voss A, Widmer AF. No time for handwashing!? Handwashing versus alcoholic rub: Can we afford 100% compliance? Infect Control Hosp Epidemiol 1997; 18:205-208.

The authors begin with an anecdote about Ignaz Semmelweis, who, more than a century ago, tried to convince his colleagues that disinfecting their hands with chlorinated lime would prevent nosocomial infection and save lives. He even went so far as to denounce his unenlightened colleagues as killers, "and thereby began the tradition of blaming all healthcare workers for their lassitude, a tradition continued by hospital epidemiologists up until the present."

Today’s HCWs acknowledge that hand washing is essential for preventing pathogens transmission and nosocomial infections, but compliance rarely exceeds 40%.

Voss and Widmer maintain that HCWs fail to wash their hands due to lack of time, lack of convenient sinks, forgetfulness, or disagreement with recommendations, but rarely due to negligence. Education and monitoring improve compliance only temporarily. Guidelines recommend a washing time of between 15 and 30 seconds, but the mean observed duration is 8.6 seconds. In 90% of cases, hand washing duration is less than 10 seconds. The study explores the authors’ hypothesis that the recommended duration of proper hand washing might interfere with patient care, which could explain low compliance.

Based on published literature and the structure of an intensive-care unit at a university hospital in The Netherlands, the authors developed a model to predict the time HCWs spent daily on hand washing, noting levels of compliance, duration of hand disinfection, and use of medicated soap or alcoholic rub. The model was adapted to 14 beds and 12 HCWs, and used the following baseline variables: 40% compliance, two to three hand disinfections per HCW per hour, and hand disinfection duration of 40 to 80 seconds for hand washing and 20 seconds for alcoholic hand disinfection (AHD).

Hand washing duration included time spent walking from the patient to the sink, turning on and adjusting the tap, washing and drying hands, and returning to the patient. AHD times were based on a bedside dispenser. HCWs were asked to wash their hands after patient contact.

Minimum and maximum times were calculated for hand washing and AHD for 40%, 60%, and 100% compliance. For 40% compliance, between 2.1 and 6.4 hours per shift are devoted to hand washing, while only 1.1 to 1.6 hours would be necessary if only AHD were used. For 100% compliance, hand washing would require up to 16 hours, or two full-time nurse equivalents, while simple disinfection with alcohol would require only four hours.

In light of those results, the researchers ask whether hospitals can expect 100% compliance with handwashing, given workloads and limited resources. They argue that of alcoholic rubs and medicated soaps or foams, alcohols have the more rapid antimicrobial effect and are equally effective against gram-positive and gram-negative microorganisms.

The authors conclude that because time is a costly commodity under the managed care system, "we could improve compliance with hand antisepsis by replacing hand washing with bedside AHD, without increasing human resources or decreasing compliance. This not only will conserve human resources but finally will put an end to the reflex response that healthcare workers are neglectful of hand hygiene, which, far from helping, only demoralizes them further."

The Centers for Disease Control and Prevention offers a free information packet, "Public Health Service Recommendations for the Management of Occupational Exposure to HIV." Included are a poster depicting five steps to follow postexposure, a booklet providing information about occupational exposures for health care workers, and reprints of Morbidity and Mortality Weekly Report articles that contain Public Health Service recommendations for managing occupational HIV exposures. The packet familiarizes HCWs with the new HIV Postexposure Prophylaxis Registry that is sponsored jointly by the CDC, Glaxo Wellcome, and Merck & Co. The registry is designed to collect data on the use of antiretroviral drugs in non-HIV-infected HCWs who receive postexposure prophylaxis for occupational HIV exposure. To order a packet, call (888) PEP-4HIV ([888] 737-4448).

Workplace violence consulting services are available from the Crisis Prevention Institute (CPI) for hospitals establishing a workplace violence prevention program, improving upon an existing program, or needing an assessment of risks for violence. Services include analyzing an institution’s response efforts in workplace violence prevention and intervention, setting up intervention procedures and post-intervention policies, employee training, assistance in complying with OSHA guidelines, and more. For a free brochure or to speak with a consultant, contact CPI, 3315-K N. 124th St., Brookfield, WI 53005. Telephone: (800) 558-8976.

Musculoskeletal Disorders (MSDs) and Workplace Factors: A Critical Review of Epidemiologic Evidence for Work-Related MSDs of the Neck, Upper Extremity, and Low Back is a National Institute for Occupational Safety and Health report that reviews 2,000 published studies and included more than 600 for a detailed review process. It concludes that specific physical exposures are strongly associated with specific MSDs when exposures are intense and prolonged, and when workers are exposed to several risk factors simultaneously (such as repetitive lifting in extreme or awkward postures). To order the report, call (800) 35-NIOSH ([800] 356-4674).