[Federal Register Volume 61, Number 243 (Tuesday, December 17, 1996)]
[Notices]
[Pages 66281-66282]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-31949]
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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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