health and safety in trauma andc3...• osha –confined space entry. (rare, mainly industrial...

2019 IAQA Annual Meeting

Scott W. Vogel, MS, CEOP, CBRM

Emergi-Clean, Inc.

[email protected]

EmergiClean.com

ehsInc.org

Health and Safety in Trauma and

Crime Scene Mitigation…

It’s Not Just BLOOD


About The Presenter

• Scott W. Vogel, CBRM, CEOP, is COO of Emergi-Clean

Inc., a nationally recognized company specializing in

biohazard and Infectious materials remediation.

• Mr. Vogel also runs and operates the East Coast Learning

Centers for ehsInc, a nationally recognized company

specializing in occupational safety consulting and training.


The Arms Against Cross Contamination Has Begun

Photo: Movie – Outbreak Warner Bros. Pictures 1995


Complacency and Public Health

(It will never happen here)


So what does it take

to get into the

business?


https://my.matterport.com/show/?m=YE8LYLnRXes&brand=0


Drug Labs


ZOONOTIC


Bio Recovery

• Bio Recovery is the act of mitigating and remediating

conditions resulting from the release of biological hazards.

• This may include crime and trauma mitigation (bloodborne

and body fluids), outbreak response, zoonotic

diseases, foodborne diseases, public health threats

and clandestine drug labs.


Applicable OSHA Training Requirements

• OSHA – Bloodborne Pathogens

• OSHA – Confined Space Entry. (Rare, Mainly Industrial Accidents)

• OSHA – 10 Hr. General or Construction Industry (Regional or Client

Demanded)

• OSHA – 30 Hr. General or Construction Industry Supervisory Level

(Regional Demand or Client Demanded

• OSHA - 40 Hr. Hazardous Waste Operations and Emergency

Response – General Site Worker (Grey Area)


“Hazardous Substance” Defined CFR 1910.120

• Content

Definition of “Hazardous Substance” under HAZWOPER:

Any substance designated or listed under (A) through (D) of this definition, exposure to which

results or may result in adverse effects on the health or safety of employees:

(A) Any substance defined under section 103(14) of the Comprehensive Environmental Response

Compensation and Liability Act (CERCLA) (42 U.S.C. 9601).

(B) Any biologic agent and other disease causing agent which after release into the

environment and upon exposure, ingestion, inhalation, or assimilation into any person,

either directly from the environment or indirectly by ingestion through food chains, will or

may reasonably be anticipated to cause death, disease, behavioral abnormalities, cancer,

genetic mutation, physiological malfunctions (including malfunctions in reproduction) or

physical deformations in such persons or their offspring.

(C) Any substance listed by the U.S. Department of Transportation as hazardous materials under

49 CFR 172.101 and appendices; and

(D) Hazardous waste as herein defined.


“Health Hazard” Defined CFR 1910.120

• Content

“Health Hazard” - A chemical or a pathogen where acute or chronic health

effects may occur in exposed employees. It also includes stress due to

temperature extremes.

Health Hazards include chemicals that are classified in accordance with the

Hazard Communication Standard, 29 CFR 1910.1200, as posing one of the

following hazardous effects: Acute toxicity (any route of exposure); skin

corrosion or irritation; serious eye damage or eye irritation; respiratory or

skin sensitization; germ cell mutagenicity; carcinogenicity; reproductive

toxicity; specific target organ toxicity (single or repeated exposure);

aspiration toxicity or simple asphyxiate.


Definition of a “Biohazard”

• Content

Biohazard Defined: Biological hazards, also known as biohazards,

refer to biological substances that pose a threat to the health of living

organisms, primarily that of humans. This can include medical waste

or samples of a microorganism, virus or toxin (from a biological

source) that can affect human health. It can also include substances

harmful to other animals.


Development of an Effective

Exposure Control Plan (ECP)

• Content

• Your ECP must be reviewed on an annual basis and updated when

necessary to reflect new or modified tasks and procedures that

affect occupational exposure and to reflect new or revised employee

positions with occupational exposure.

• Employees covered by the OSHA Bloodborne Pathogens Standard

will receive an explanation of this ECP during their initial training

session.

• It will also be reviewed during the required annual refresher training.


ECP Element – Purpose

• Content

• The purpose of the ECP is to comply with OSHA's Occupational

Exposures to Bloodborne Pathogens standard.

• The intent of the ECP is to prevent bloodborne infections by

eliminating or minimizing employee exposures to blood, blood

byproducts, serums, and other potentially infectious materials

(OPIM) which may harbor human or animal pathogens encountered

during the course of the employee’s job site related work activities.


ECP Element – Purpose (continued)

• Content

• It is also a goal of this plan to prevent an employee’s family from

acquiring an infectious disease as a result of the activities the

employee may participate in while performing his/her job

description.

• This will be accomplished through on the job training, field

experience, attending the required bi-annual refreshers, and best

management practices coupled with direct supervision.


ECP Element – Employee Responsibilities

• Content

• Employees are required to follow the policies, practices, and procedures for

their particular job description and place of work. When new procedures or

duties will be performed by an employee previously determined not to be at risk

for potential exposure, it is the supervisor’s responsibility to notify the

Departmental Exposure Control Officer listed below. The employee will be

subject to the requirements of this standard.

• The exposure control officer will ensure the required employee training is

completed and an annual program review and update is performed, as required

by the regulations.


ECP Element – Employee Responsibilities

• Content

• The Exposure Control Officer is, ___________________________

who has overall responsibility for the implementation of this

program.

• A copy, if requested, of the plan may be obtained from

___________________, and is available in ___________________.


ECP Element – Exposure Determination

• Content

• OSHA requires employers to perform an initial exposure

determination concerning which employees may incur occupational

exposure to blood or other potentially infectious materials (OPIM).

• The exposure determination will be made without regard to the use

of personal protective equipment. This initial exposure

determination is required in order to create a list of job

classifications and descriptions in which all employees may be

expected to incur occupational exposure, to Bloodborne Pathogens

regardless of frequency.


ECP Element – Exposure Determination

• Content

Bear in mind that our work environments are dynamic and no

two-biohazard cleanups are the same.

a. The job classifications where all employees are considered

potentially at risk are found on the list entitled "List of Job

Classification Risk Categorization by Department- All at Risk."

b. In this department, the job classifications where some

employees are considered potentially at risk are found on the list

entitled "List of Job Classification Risk Categorization by

Department- Some at Risk."


ECP Element – Job Classifications at Risk

• Content

Division Managers, Project Manager – BBP Exposure - Potentially At Risk

• These employees may encounter biological hazards during an initial site

visit to determine and review the scope of work and determine remediation

costs for cleanup purposes. While handling contaminated material on site is

usually not required, accidental or incidental exposure may occur from

walking through and touching objects located on a potential project site.

Proper PPE will be worn. Respiratory protection may depend on site

conditions and the nature of the contaminate of concern. Sanitary

disinfection of hands is required before leaving the jobsite. In some cases

full personnel decontamination procedures must be followed.



• Content

Estimator - BBP Exposure - Potentially At Risk

• These employees may encounter biological hazards during an initial site visit

to review the scope of work and determine costs for cleanup. While handling

contaminated material on site is usually not required, accidental exposure

may occur from walking through and touching objects. PPE should be worn.

Respiratory protection may depend on site conditions. Sanitary disinfection

of hands is required before leaving the site. In some cases full personnel

decontamination procedures must be followed.



• Content

Warehouse – BBP Exposure - Potentially At Risk

• These employees may encounter biological hazards during equipment

loading and breakdown of equipment. While the handling contaminated

material on site is usually not required, accidental exposure may occur from

handling equipment and touching objects returning from a cleanup. PPE

should be worn. Respiratory protection may depend on site conditions where

equipment is returning from. Sanitary disinfection of hands is required before

changing tasks. In some cases full personnel decontamination procedures

must be followed.



• Content

Operations Supervisor/Field Supervisor:

Environmental - BBP Exposure - At Risk

Cleaning - BBP Exposure - At Risk

Air Systems - BBP Exposure - At Risk

• These employees will most likely encounter biological hazards during site

work. Handling contaminated material on site is usually required, accidental

exposure may occur from splashing and touching objects. Full PPE will be

worn. Respiratory protection will be worn. Sanitary disinfection of hands is

required before breaks and leaving the site. In some cases full personnel

decontamination procedures must be followed.



• Content

Field Technician:

Environmental - BBP Exposure - At Risk

Cleaning - BBP Exposure - At Risk

Air Systems- BBP Exposure - At Risk

• These employees will most likely have the greatest exposure to biological

hazards during site work. Handling contaminated material on site is usually

required, accidental exposure may occur from splashing and touching

objects. Full PPE will be worn. Respiratory protection will be worn. Sanitary

disinfection of hands is required before breaks and leaving the site. In some

cases full personnel decontamination procedures must be followed.



• Content

Trades - BBP Exposure – Possible Risk:

• These employees may encounter biological hazards during the normal

work day. While handling contaminated material on site is usually not

required, accidental exposure may occur from handling equipment and

touching objects at the site of a cleanup. Minimal PPE such as gloves,

eye protection, and foot covers must be worn. Respiratory protection

may depend on site conditions where equipment is returning from.

Sanitary disinfection of hands is required before changing tasks. In some

cases full personnel decontamination procedures must be followed.

Support Staff - BBP Exposure – Not At Risk



• Content

• The list of job classifications in which some employees may have

occupational exposure is required, and can be created in the

manner that was just described.

• For employees in these classifications, a list of the tasks or

procedures that place them at risk must be listed in the exposure

control plan. By listing the job classifications and the duties where

there is potential risk, it should be clearly understood which

employees in these categories must be considered at risk to have

occupational exposure.


ECP Element – 3rd Party Certification

• Content

• There are three (3) technician third party levels of cleanup

certification. Three of these certifications are provided by the

American Bio Recovery Association and the IICRC new Trauma

Technician certification. Each level requires additional training and

experience as well as increasing levels of responsibility and

potential hazard exposure.


ECP Element – 3rd Party Certification Levels

• Content

1. CBRT Certified Bio-Recovery Technician/IICRC Trauma Technician Certification-

Level 1: Trained workers who select PPE and handle the cleanup and disinfection

of BBP & raw sewage but no RMW. Also, there is no work performed involving

toxic chemicals, dental, clinical, medical, or research wastes. Oversight is

provided by a Level 2 Supervisor.

1. CBRS Certified Bio-Recovery Supervisor - Level 2: Trained biohazard workers

who also have 40hr. HAZWOPER training but no work is performed in hospitals,

Biosafety Laboratories or Pharmaceutical Research Facilities. Without

supervision of a CBRM or CIH. It does not include infectious outbreaks where

victim decontamination including fire, police and EMS is required. Oversight is

provided by a Level 3 Master or Industrial Hygienist.


ECP Element – 3rd Party Certification Levels

3. CBRM/CIH Certified Bio-Recovery Master/Certified Industrial Hygienist LEVEL 3:

Is the highest level of training and practice in the industry where workers are

required to contain, control, clean up, and neutralize the worst of biosafety

research lab, nosocomial acquired infection, Bioterrorism Response or special

communicable pathogens. They are familiar with Facility Infection Control Risk

Assessment and Biosafety and Security Concerns.


ECP Element – Implementation Schedule

and Methodology

• Content

OSHA requires that the ECP also include a

schedule and method of implementation for the

various requirements of the standard.


ECP Element – Universal Precautions

• Content

• The increasing prevalence of HIV, HAV and HBV increases the risk of

infection to individuals who have occupational exposure. ALL patients'

blood and certain body fluids should be considered infected with HIV,

HAV HBV, HCV and/or other bloodborne pathogens, and infection-

control precautions adhered to that minimize the risk of exposure to

these materials.

• This is "universal precautions" and should be used when handling

blood, bodily fluids containing visible blood, semen, vaginal secretions,

cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid,

pericardial fluid, and amniotic fluid.


ECP Element – Universal Precautions

• Content

• Universal precautions do not apply to saliva, feces, nasal secretions,

sputum, sweat, tears, urine, and vomit unless they contain visible blood. If

it is difficult or impossible to differentiate between body fluid types in a

particular circumstance, all body fluids must be considered potentially

infectious material.

• All blood or other potentially infectious material is considered infectious

regardless of the perceived status of the source individual.

• For our purposes, all sewer backups In hospitals or down gradient from

health care facilities, trauma/crime scenes, and any location involving

medical waste will be considered to be OPIM.


ECP Element – Engineering Controls

• Content• Engineering controls are utilized to eliminate or minimize exposure to

employees. Where occupational exposure remains after institution of

these controls, personal protective equipment must also be used.

• Examples of engineering controls: Sharps containers, splash guards,

biosafety cabinets, mechanical removal devices, safety equipment,

hand tools, PPE, and decon stations.


ECP Element – Work Practices

• Content

• Provide readily accessible washing facilities or washing materials

(e.g. emergency eye wash station). At some locations, running water

may not be available. Portable eyewash stations, antiseptic towels or

rags with chemical solutions will be provided.

• Washing hands immediately or as soon as feasible after glove

removal. Hand washing facilities are also available for employees

who incur exposure to blood or other potentially infectious materials.

OSHA requires that these facilities be readily accessible after

experiencing an exposure.


ECP Element – Work Practices

• Content

• The site safety officer will go over the location of washing facilities

before work commences.

• If hand-washing facilities are not feasible, the employer is required to

provide either an antiseptic cleanser in conjunction with a clean

cloth/paper towels or antiseptic towelettes. If these alternatives are

used, hands must be washed with soap and running water as soon

as feasible.


ECP Element – Needles

• Content

• If you encounter medical waste, it is considered hazardous. Needles

and other contaminated sharps must not be recapped, bent,

removed, sheared, or purposely broken. Do not remove needles from

the syringe. Place directly into a rigid red sharps container

immediately or as soon as possible.

• A disposable needle holder is now available and must be evaluated

and used where appropriate, eliminating the need to remove the

needle from the holder. The needle and holder are to be discarded in

a rigid red sharps container.


ECP Element – Sharps Containers

• Content

• All sharps must be placed into

appropriate sharps containers. The

sharps containers are puncture resistant,

labeled with a biohazard label, and are

leak proof. If a project is scheduled for a

site with known medical waste such as a

drug shooting gallery house, self-

medicator or doctor’s office, an unused

sharps container will be obtained for use.


ECP Element – Work Area Restrictions

• Content

• In work areas where there is a reasonable likelihood of exposure to

blood or other potentially infectious materials, employees are not to

eat, drink, apply cosmetics or lip balm, smoke, or handle contact

lenses.

• Food and beverages are not to be kept in refrigerators, freezers,

shelves, cabinets, or on counter tops or bench tops where blood or

other potentially infectious materials are present or have been stored.


ECP Element – Hospitals

• Content

Working in and around hospitals and other care facilities:

• All procedures will be conducted in a manner that will minimize

splashing, spraying, splattering, and generation of droplets of blood

or other potentially infectious materials. The closer to hospitals and

long-term care facilities we work, the greater the chance that raw

sewage contains viable HIV, HAV, HBV, and HCV.


ECP Element – Specimens and Labeling (Bodily Fluid Soaked Materials)

• Content

• Specimens of blood or other potentially infectious materials will be placed

in a container to prevent leakage during the collection, handling,

processing, storage, and transport of the specimens. The container used

for this purpose will be properly labeled or color-coded in accordance with

the requirements of the OSHA standard.

• Any specimen that could puncture a primary container must be placed in a

puncture resistant secondary container. If the primary container becomes

contaminated on the outside, it must be placed within a secondary

container that prevents leakage during the handling, processing, storage,

transport, or shipping of the specimen or waste.


ECP Element – Contaminated Equipment

• Content

• Equipment that has become contaminated with blood, sewage or

other potentially infectious materials shall be examined and

decontaminated prior to servicing or shipping and shall be

decontaminated as necessary unless decontamination of the

equipment is not feasible. If it should not be cleaned send it off as

over classified medical waste and expense it to the job.


ECP Element – PPE

• Content

• The purpose of personal protective clothing and equipment is to

prevent or minimize the entry of pathogenic material into or onto the

worker's body. This includes entry via apparent or in-apparent skin

lesions, or through the membranes of the eye, nose, or mouth.

• All personal protective equipment will be provided without cost to

employees.

• Personal protective equipment will be chosen based on the

anticipated exposure to blood or other potentially infectious materials.


ECP Element – PPE

• Content• The protective equipment will be considered appropriate only if it

does not permit blood or other potentially infectious materials to

reach the employees' clothing, skin, eyes, mouth, or other mucous

membranes under normal conditions of use and for the duration of

time and conditions, which the protective equipment will be used.


ECP Element – PPE

• Content

• All personal protective equipment will be cleaned, repaired, replaced

and/or disposed of by the employer at no cost to employees.

• Immediately (or as soon as feasible) remove garments penetrated by

blood. All personal protective equipment will be removed prior to

leaving the work area.

• Disposable items such as booties, gloves, Tyveks are to be bagged

for disposal based upon specific job protocol of sewage, or biological

hazard.


ECP Element – PPE

• Content

• Gloves shall be worn where it is reasonable to anticipate employees will

have hand contact with blood, or other potentially infectious materials, or

when non-intact skin, and mucous membranes are at risk of exposure.

• Disposable gloves are not to be washed or decontaminated for re-use and

are to be replaced as soon as practical when they become contaminated.

If they are torn, punctured, or when their ability to function as a barrier is

compromised, they need to be replaced as soon as feasible. Utility gloves

may be decontaminated for re-use provided that the integrity of the glove

is not compromised. Utility gloves are to be discarded if they are cracked,

peeling, torn, punctured, or exhibit other signs of deterioration or when

their ability to function as a barrier is compromised.


ECP Element – PPE

• Content• Respiratory protection in conjunction with eye protection devices,

such as goggles or glasses with solid side shield, or PAPRS, are

required to be worn whenever splashes, spray, splatter, or droplets of

blood or other potentially infectious materials may be generated and

eye, nose, or mouth contamination can reasonably be anticipated.


ECP Element – Worksite Cleaning Schedule

• Content

Areas where body fluids or raw sewage are present shall be cleaned and

decontaminated:

• Identify a cleaner to use. Surfactant to remove proteins

• Identify a General Sanitizer (4-Log or Kills 99.99% ) Bacteria and Enveloped Virus

• Identify an Intermediate Disinfectant (5-Log or Kills 99.999%) TB Rated

• Identify a Sporicide (6-Log or Kills 99.9999% of C.Diff or Geobacillus Stearothermophilus or other

surrogate Bacterial Endospore)

• All contaminated work surfaces will be decontaminated after completion of procedures and

immediately or as soon as feasible after any spill of blood or OPIM, as well as the end of the work

shift if the surface may have become contaminated since the last cleaning. All biocides listed

above have a wet kill time of ten (10) minutes in duration or less.

• All bins, pails, cans, and similar receptacles shall be inspected and decontaminated on a regularly

scheduled basis.

• Do not use hands to pick up broken glassware that may be contaminated. Use a mechanical

means, such as a brush and dustpan, and place in a sharps container for disposal.


ECP Element – Infectious/Biohazard Waste

Handling Procedures

• Content

• Infectious waste has been defined as blood, blood products,

pathologic wastes, soaked in body fluids, microbiological wastes, and

contaminated sharps.

• Development of a procedure to cleanup blood spills according to the

BBP Standard.

• Consider Containment and Exposure routes for cross contamination.

• Consider Solidification procedures.

• Doffing and Donning of PPE to mitigate Cross-Contamination.


ECP Element – Contaminated Laundry

• Content

• Laundry contaminated with blood or other potentially infectious materials must be

handled as little as possible. Such laundry must not be sorted or rinsed in the

area of use, but placed directly into Bio-Hazard labeled bags for proper disposal.

• All employees who handle contaminated laundry will utilize personal protective

equipment to prevent contact with blood or other potentially infectious materials.

If laundry is wet with contaminated fluids, make sure the laundry bag will contain

the fluid. If the bag leaks, place it inside another plastic bag.

• Laundry will be cleaned at the University of Iowa's Laundry Services. Laundry

workers wear protective gloves and fluid resistant aprons or gowns while

handling and sorting soiled linen.


ECP Element – Vaccinations: HVA, HVB

• Content

• All employees who have potential exposure to blood or other potentially

infectious materials will be offered the Hepatitis A & B vaccines, at no cost

to the employee. The vaccine will be offered within 10 working days of

their initial assignment to work involving the potential for occupational

exposure to blood or other potentially infectious materials.

• All injections are given intramuscularly, 1.0 ml in the deltoid muscle,

followed at 1 and 6 months, respectively, with a second and third dose.

After a series of three injections, over 95% of healthy adults develop

protective antibodies.


ECP Element – Vaccinations: HVA, HVB

• Content

• Your employer is responsible for the direct cost of the HVA, HVB, and tetanus

vaccines and any related costs. The vaccines will be available to the employee

after training is received, and should be offered/given within 10 working days of

initial assignment.

• ______________________ will provide this service and administer the vaccine

according to standard recommendations for medical practice. An individual does

not need the vaccine if he has immunity or previously received the vaccine.

Should booster doses be recommended at a future date, they will be provided. If

an employee initially declines the vaccine, a waiver must be signed and kept on

file. If "at risk" employees initially decline the vaccine, they may decide later to

receive it. You can not perform biohazard work until you are fully vaccinated.


ECP Element – Employee Training

• Content

• Training for all employees must be conducted before undertaking

tasks where occupational exposure may occur, with training each

year if employees remain at risk for exposure.

• Bloodborne Pathogens training is required annually and is conducted

in conjunction with the Hazard Communication Standard.


ECP Element – Employee Training

• Content

Annual training must include an explanation of the following:

• The OSHA standard for Bloodborne Pathogens.

• Epidemiology and symptomology of bloodborne diseases.

• Modes of transmission of bloodborne pathogens.

• The Exposure Control Plan.

• Procedures which may cause exposure to blood or other potentially infectious materials.

• Control methods used in the work area to control exposure to blood or other potentially infectious

materials.

• Personal protective equipment available and who should be contacted.

• Post-Exposure evaluation and follow-up.

• Signs and labels used.

• Hepatitis A &B vaccine program


ECP Element – Recordkeeping

• Content

• All records required by the OSHA standard shall be maintained.

Medical records are also maintained by the medical offices in which

the diagnostics took place.

• Training records shall be maintained for at least 3 years from date of

training. They must include: Dates of the training sessions, contents

of the training sessions, names and qualifications of persons

conducting the training, names and job titles of all persons attending

the training sessions.


ECP Element – Medical Evaluation

• Content

When an exposure incident occurs, a 3rd Party Medical Provider conducts a confidential

medical evaluation and follow-up. In the event of an exposure, take the following steps:

• Properly cleanse the affected area thoroughly.

• Report the incident immediately to the supervisor. The employee, along with the supervisor and/or

department, completes the accident report within 24 hrs.

• Always call your supervisor for instruction and directions to follow.

• The supervisor must document route of exposure and circumstances of incident.

• Departmental supervisors will make the necessary calls to identify the source of exposure and, if

possible, determine HAV, HBV, HCV and/or HIV status. Consent must be obtained from the

source in order to perform testing for HIV.

• Your employer maintains a sharps injury record for the recording of percutaneous injuries from

contaminated sharps. The sharps injury record contains the type and brand of device involved the

department or work area where the exposure incident happened and an explanation of how the

incident occurred. The confidentiality of the injured employee is maintained.

• Your employer will collect a blood sample from the exposed worker as soon as possible to provide

a baseline. Your employer will obtain a third party medical opinion if so desired.


• Content


The Terrifying Reality

• Content

• We are not prepared for an Outbreak Response to High Hazard Risk

Level 3 and 4 Events.

• The lack of New Antibiotic Development.

• The Mobile World.

• Antibiotic Resistance and NDM-1 Level Microorganisms.

• It will never happen here.

• Lessons Learned during the Ebola Crisis.

• Lack of federal knowledge of organizations that are able and willing

to assist in the response.


Guideline Development Track

• Content

Biosafety Risk Analysis - Front end procedures for qualifying risk

of the response.

A. How do we go about screening an loss?

B. Do we have to be HIPPA compliant?

C. Is my team trained or qualified to handle the condition.?

D. Front End Information Gathering


Decontamination Setup

• So many decontamination stations are setup according to

HAZWOPER training or asbestos management, what is available to

the industry now and how can we develop our own specifications to

mitigate cross-contamination issues when going through the

personnel biological decontamination or equipment decontamination

process?

• A review of current advertised procedures that were developed by

health care facilities during the Ebola Crisis.


Use of High Level Disinfection Products

and Devices

• Cleaning methodology. Use of Microfiber cloths and wiping and

cleaning processes.

• Front end disinfection? Is it a good idea?

• Cleaning products - description and efficacy to the suspect

microorganism.

• Room Space and high hazard surface disinfection


Personal Protective Equipment

• Coverall Suits - what type and are they able to be wiped or spray

decontaminated?

• Review of PAPR systems or SCBA?

• Proper Donning and Doffing procedures.


Bio Safety Risk Assessment Documents

CDC

• https://www.cdc.gov/biosafety/publications/BiologicalRisk

AssessmentWorksheet.pdf

FLORIDA HEALTH

• http://www.floridahealth.gov/programs-and-

services/public-health-laboratories/

https://www.cdc.gov/biosafety/publications/BiologicalRiskAssessmentWorksheet.pdf

http://www.floridahealth.gov/programs-and-services/public-health-laboratories/


Bio Safety Risk Assessment Guidelines

(BSRA) – Under Development


Bio Safety Risk Assessment Strategy


Microbiological Risk Assessment Risk Groups

Have Been Assigned to Biohazardous Agents

They indicate how dangerous a particular bacterium, virus, or other biohazard is.

First, determine the risk group of the agent(s) with which you are working. Other

factors include:

• Pathogenicity/Virulence: Is the agent able to infect and cause disease in humans or animals?

• What is the degree of disease severity in individuals?

• Route of Infection: How does the agent gain entry in to the host?

• Mode of Transmission: How does the agent travel to the host?

Survival in the Environment:

• How stable is the agent outside the host? Under what environmental conditions can it survive and

for how long?


Biological Safety Level (BSL)

CDC and NIH DEFINED LEVELS OF PATHOGENIC RISK


Guideline Development Track

• Content

Biosafety Risk Analysis - Front end procedures for qualifying risk

of the response.

A. How do we go about screening an loss?

B. Do we have to be HIPPA compliant?

C. Is my team trained or qualified to handle the condition.?

D. Front End Information Gathering


Use of High Level Disinfection Products

and Devices

• Cleaning methodology. Use of Microfiber cloths and wiping and

cleaning processes.

• Front end disinfection? Is it a good idea?

• Cleaning products - description and efficacy to the suspect

microorganism.

• Room Space and high hazard surface disinfection


Personal Protective Equipment

• Coverall Suits - what type and are they able to be wiped or spray

decontaminated?

• Review of PAPR systems or SCBA?

• Proper Donning and Doffing procedures.


BSRA-Key Front End Questions

• Content

I. Type of Biological Loss: Drug Trauma Zoonotic Infectious Disease Food Borne Mold Terrorism

II. Are their casualties or illness? Yes No If yes, How many _______________III. Has the person(s) traveled outside of the country with in the past three weeks? Yes NoIV. Have the police or health department cleared the scene for mitigation / cleanup? Yes NoV. If yes – Contact ______________________________________________ Phone number ____________________VI. Is there a diagnosis? ___________________________________ Cause of Death ___________________________

Condition or syndrome name ____________________________________________________________________ If applicable - examples – (sepsis, meningitis, heart disease, mad cow, stroke, diabetes, dehydration, necrotizing fasciitis)

SUSPECT PATHOGEN – ______________________________________________________ Bio Safety Risk Group ________ If applicable – examples – (MRSA, Staph, Strep, Clostridium, Bacillus, HIV, Hepatitis, TB, Ebola)

©


BSRA-Key Front End Questions

• Content

VII. Has the Property Insurance Carrier been notified Yes NoName of Insurance Company ____________________________________________________________________________Phone Number ________________________________ Determination of Coverage Y N

Amount _____________________________________________________________________

Deductible Amount ____________________________________________________________

Claim number___________________________________________________

Adjuster Phone Number _______________________

E-Mail __________________________________________________


Personal Protective Equipment Review

• Coverall Suits – Suits that meet the ASTM standard

• Booties

• Outer glove

• Inner glove

• Taping procedures

• PAPR Review – What is a PAPR and how do they work?

• When is supplied Air or SCBA Necessary?

• Donning and Doffing


Step 1: Determine Type of Risks Present (Draft)

BSL Description Example Activities

Group 1 Agents are not associated with disease in healthy adult

humans.

∙ Mold Remediation

∙ Category 3 water damage out side of a health care facility.

∙ Mitigation of an agent that does not present an environmental health risk.

Group 2 Biological agent risk that can cause human disease and might

be a hazard to workers; it is unlikely to spread to the

community; there is usually effective prophylaxis or

treatment available;

∙ Blood and Trauma Mitigation

∙ Category 3 water damage inside or downgradient from a health care facility.

∙ Zoonotic Waste Mitigation and Remediation

∙ Diarrhea and loose stool cleanup

Group 3 Biological agent risk that usually causes serious human or

animal disease, or which can result in serious economic

consequences but does not ordinarily spread by casual

contact from one individual to another, or that can be

treated by antimicrobial or antiparasitic agents.




∙ Spore forming Bacteria viruses

∙ Clandestine and Illegal drugs

Group 4

©

Biological agent risk that causes severe human disease and is

a serious hazard to workers; it may present a high risk of

spreading to the community; there is usually no effective

prophylaxis or treatment available.




∙ Spore forming Bacteria and viruses

∙ IDLH Clandestine and Illegal Drugs


Step 2: Identify the Area Risk Group

Identify the locations of all groups/spaces that are potentially impacted from

the project. This should include all areas surrounding the project. If there is

more than one risk group that will be affected, use the higher risk group.

• Low Risk: No occupancy. No body fluids present. No Demolition

Required

• Medium Risk: Space is occupied. Body fluids present. No Demolition

Required

• High Risk: Demolition or invasive activities required to mitigate

©


Step 3: Determine Class (I-IV) of Risk Mitigation Measures Required (Draft)Project Type

All projects that require Class II, III or IV risk mitigation measures will require approval of a contaminant control plan prior to the start of work.

BSL Risk Group Group A Group B Group C Group D

Low Risk I I II IV

Medium Risk I II III IV

High Risk

©

II III/IV III/IV IV

All projects that require Class II, III or IV risk mitigation measures will require approval of a contaminant control plan prior

to the start of work.


Step 3: Risk Group Identified I, II, III, IV

Once the Risk Group has been identified, a basic scope of work can be

developed to guide the field techs toward the risks presented a the site,

training, and equipment needed to complete the job.


Step 4: Risk Mitigation Guidelines (Draft)Class During Project Suggested PPE

I1. Charge single use microfiber cloths with a mild detergent or cleaner.

2. Wipe down surfaces and touch points with single use Microfiber clothes folded in 4 sides. Wipe down 2-3 ft of

each side of hard surfaces.

3. Follow up by spraying surfaces and touch points with a disinfectant that has a Viricidal Claim.

4. Discard cloths when visibly soiled or you have touched 12sf.

5. Remove gloves and wash your hands prior to eating or leaving the site.

∙ Safety Glasses

∙ N-95 Mask

∙ Nitrile Gloves

II1. Set up exclusion zone and start donning PPE.

2. Contain any pooled-up body fluids and apply a solidifier.

3. Charge single use microfiber cloths with a mild detergent or cleaner.

4. Clean up gross contamination.

5. Examine if any staining has occurred that can not be removed by chemical or manual labor. (If materials are

stained or soaked see Class III.)

6. Follow and clean path of extraction and inspect all surfaces leaving the scene utilizing an ATP luminometer.

7. Follow up with an application of a disinfectant that has a viricidal claim.

8. Decontaminate workers and personnel and doff PPE.

9. Box and manifest all soaked contaminated rags and PPE as medical waste.

∙ APR with HEPA OV Filters

∙ Coverall – ANSI Standard for

blood borne pathogens.

∙ Inner Nitrile Gloves

∙ Outer Nitrile Gloves

∙ Booties

©


Step 4: Risk Mitigation Guidelines (Draft) - Continued

III1. Isolate HVAC system in area in consultation with Engineering & Maintenance where work is being done to prevent

contamination of duct system or adjacent spaces.

2. Set up Exclusion zone and place sticky mat at entrance and exit of work area and replace or clean start donning PPE.

3. Containment Installation - critical barriers i.e. plastic (6 mil poly) or portable containment units, to seal area from non-

work area.

4. Maintain negative air pressure (>0.01” water) within work site utilizing HEPA equipped air filtration units or other

methods to maintain negative pressure.

5. Re-circulating HEPA units may supplement dust control measures inside the work area.

6. Use only designated route/elevator to transport.

7. Set up designated personnel decon area.

8. Charge single use microfiber cloths with a mild detergent or cleaner that deactivates drug residue as applicable.

9. Contain any pooled-up body fluids and apply a solidifier for gross contaminant removal.

10. Wipe down surfaces and touch points with single use Microfiber clothes folded in 4 sides. Wipe down 2-3 ft of each

side of hard surfaces. Starting at the back of the room to the front of the room.

11. Cut out all body fluid-soaked materials or OPIM in pieces small enough to fit into a Biohazard Waste Box and stage for

transportation.

12. Follow and clean path of extraction and inspect all surfaces leaving the scene utilizing an ATP luminometer.

13. Follow up with an application of a disinfectant that has a TB or 6-Log sporicidal claim if necessary or required

application for drug deactivation.

14. Decontaminate all equipment used on site.


∙ APR with HEPA OV Filters or

PAPR with HEPA OV Filters.

∙ Coverall – ANSI Standard for

blood borne pathogens.



∙ Latex Booties

©


Step 4: Risk Mitigation Guidelines (Draft) - Continued

IV1. Isolate HVAC system in area in consultation with Engineering & Maintenance where work is being done to prevent

contamination of duct system or adjacent spaces.

2. Set up Exclusion Zone and place sticky mat at entrance and exit of work area install three stage personnel

decontamination unit with disinfection - start donning PPE.

3. Containment Installation - critical barriers i.e. plastic (6 mil poly) or portable containment units, to seal area from

non-work area.

4. Install Biological Indicators for sterilization assurance 1 per 100 sf of dwelling space.

5. Maintain negative air pressure (>0.01” water) within work site utilizing HEPA equipped air filtration units or other

methods to maintain negative pressure to prevent air-borne cross-contamination. Note: Static conditions will

be required for 6-log sterilization cycles see section 11.

6. Re-circulating HEPA units may supplement dust control measures inside the work area if demolition is required.

7. Use only designated route/elevator to transport.

8. Contain any body fluids and apply a solidifier for removal.

9. Cut out all body fluid-soaked materials or OPIM in pieces small enough to fit into a Biohazard Waste Box and stage

for transportation

10. Follow and clean path of extraction and inspect all surfaces leaving the scene.

11. Decontaminate all equipment and stage for room space sterilization.

12. Follow up with an application of a 6-Log EPA registered sporicide for room space sterilization or proper application

for IDLH drug deactivation.

13. Exit the exclusion zone via the three-stage decontamination chamber. A decontamination attendant will walk you

through each stage.


15. Upon confirmation of sterilization via Biological Indicator analysis, re-enter the space to remove all remaining

equipment.

∙ Infectious Disease Hooded

PAPR with HEPA or HEPA OV AG

Filters

∙ If IDLH – Supplied Air SCBA

∙ Inner - Coverall – ANSI BBP

rated

∙ Outer Coverall - Tyvek QC for

liquid splashes.



∙ Latex Booties

©


Identifying Work

Hazards in Crime and

Trauma Cleanup


Clandestine Drug Residue


Hazards


Hazards

Bodily fluid contaminated structure. If not repaired, it immediately presents a risk to First Responders.

Puncture Risk - Glassware in lab with Infectious Agents


Hazards

HIV – Student went crazy and started throwing HIV Vials of Blood all over the lab. Sharps and HIV hazard.

Just hire a carpet cleaner?


Hoarder

Large Man Died of C. Diff. Melted through the hoard.


Mass Casualty Events


PTSD Risks – Employees

• Crime scene cleaners and disaster restoration technicians go into the

worst areas and deal with individuals on their worst day every day.

• The stress and pressure from that alone is enough to push many

person over the edge.

• Now combine that with calls at all hours of the day and night.


PTSD Risks – Employees

• A typical scenario: You have just gotten home from a 12-hour day

cleaning a homicide and you’re drifting off to sleep as the phone

rings. You have to go from zero to 100 instantly to close the job and

you are back into the truck again to face the latest horror. After

driving in the middle of the night for two hours you arrive. The wife of

the deceased is inconsolable, you are asking her to sign papers and

authorizations and now you have to don your bio suit. It is 90? out

and 120? degrees in your suit and now you spend the next eight

hours wiping away the horror for this family. Tomorrow, you’re going

to do it all over again.


PTSD – Employee Debriefing and

Access to Help

• Debrief after every call on the way home

• Have a trained counselor on staff/Retainer to assist employees and our

customers in dealing with their loss.

• Prepare your employees for what they are about to see. Studies show

33% less trauma when persons are braced for a job. If you see signs of

the employee having difficulty on the scene, immediately remove the

individual from the stressful situation.

• Screen your job candidates well. Do you have any experience with suicide

or trauma?


Questions We Get!

“Uh, I work for (blank) disaster cleaning company. We do a lot of flood

clean-ups but my boss got a call to clean up this murder scene. My

employer gave me gloves but I really didn’t know what I was doing and

now I can’t get the thought of the scene out of my mind. Can I get sick

from what I just did?”


Questions?

Scott W. Vogel

ABRA Certified Bio Recovery Master

This presentation has been developed for

education purpose with the assistance of the

American Bio Recovery Association…