embalming lab week 2

hazard communication standards

• OSHA regulation that deals with identifying/limiting exposure to occupational hazards

• Two areas of OSHA standards that apply in the prep room as occupational exposure as

  • An upper limit on the acceptable concentration of a hazard substance in workplace air for a particular material or class of materials

  • Reasonably anticipated skin,eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties

    • Requires employers to

      • Obtain and maintain MSDS (SDS)

        • Material safety data sheets

        • A form that must accompany a hazard product

        • Also required by department of labor

          • Label hazard material

            • Any agent/material exposing one to risk

          • Provide employee info and training on hazards in the workplace

            • At the time of their initial assignment

            • Whenever a new hazard or type of exposure is introduced

          • Provide docs proving the above are in compliance

          • The procedure for completing must be put down in  a written plan called the written hazard com program 

formaldehyde rule

• OSHA regulation limiting the amount of occupational exposure to formaldehyde gas

• In May of 1998, OSHA revised the hazard communication standard specifically concerning exposure of formaldehyde

  • This revision providing the following areas to the standard

PEL

permissible exposure limit (PEL)

• The max legal limits established by OSHA for regulated substances

• 0.75 ppm over an 8 hour time weighted average

  • Ppm

    • A method of expressing low concentrations of a chemical in the air

      • Defined as the number of parts of chemical per million parts 

TWA

• An evaluation of exposure that is time-weighed over an established period

• It allows exposure levels to be averaged generally over an 8 hour time period

  • If this limit is exceeded, employers must take proper steps to reduce employee exposure

STEL

• Legal limits established by OSHA to which workers can be exposed continuously for a short period time

• 2 ppm over a 15 minute exposure

  • Shouldn’t be done more than 4 times per day 

AL

• This level is established to ensure adequate protection of employees at exposures below the osha limits, but to minimize the compliance burdens for employers whose employees have exposures below the 8 hour limits

• 0.5 ppm over the 8 hour TWA

  • This is the level at which monitoring is required

Monitoring at AL

• Initial monitoring 

  • Required to identify all employees who are exposed above the action level or the STEL

  • To accurately determine exposure of each employee

• Continued monitoring

  • Required

    • If levels are above AL (every 6 months) 

    • If levels are above STEL (every year)

    • If there are reports of formaldehyde exposure related signs and symptoms 

    • May be discontinued if levels fall below the AL and STEL after 2 consecutive samples taken a week apart

    • Employees must be notified of the results of monitoring within 15 days of receipt 

• Medical surveillance

  • Employee reporting

    • These procedures are to be followed if exposure levels are at or above the STEL and/or action level

    • Employee must be annually offered a medical disease quiz for doctor’s review

      • Employee must report to employer with any signs/symptoms of potential exposure

Potential health hazards of formaldehyde

• Acute effects

  • Ingestion (swallowing) - causes throat irritation, highly poisonous and causes death

  • Inhalation - irritates upper respiratory tract with inflammation of the nose, throat lungs

  • Skin - causes drying, cracking and scaling dermatitis and skin desensitization

• Chronic effects

  • Carcinogenicity - potential cancer in human lungs, nasopharynx, and nasal passages

  • Toxicity - may result in respiratory impairment such as asthma/bronchitis

  • Mutagenicity - genotoxic in several in vitro tests showing properties of mutation

• Signs and symptoms

  • Irritation of the mucosa of the eyes, nose throat

    • Happens at anything above 0.1 ppm

    • Above 100 ppm is an immediate danger to health/life

  • Swelling of the eyelids

  • Respiratory disorders, coughing, shortness of breath 

  • Allergic reactions

  • Frequent headaches, dizzy, drowsy

  • Jaundice

    • Easy bruising 

medical removal protection

• Employees who suffer big adverse effects from formaldehyde must be removed to jobs with less exposure until their conditions improve

  • Employee benefits must continue for up to 6 months or until a doctor determines that the employee will never be able to return 

forms of formaldehyde that are relevant

1. Formaldehyde gas solutions

2. Paraformaldehyde

   1. Solids and mixtures containing HCHO

PPE

• Purpose of PPE

  • For protection against a specific hazard

  • For the embalmer it is to avoid contact with formaldehyde, blood and other body fluids

• Employees exposed to solutions of 1% or greater are required to wear goggles/face shield for protection

• Items to be worn 

  • Face mask -goggles -face shield -gown

  • Shoe covers -head covers -gloves

• Housekeeping

  • Established procedures must be in place for

    • Spill cleanup

    • Decontamination of the work area

    • Proper disposal of contaminated waste

    • Emergency response procedures

      • Concerning overexposure to formaldehyde 

safety and warning procedures

• In areas where the concentration of formaldehyde exceeds any of the exposure limits

  • 1) signs must be posted stating dangers

  • 2) the areas must be restricted to authorized and properly trained personnel 

• Record keeping

  • Records that must be kept by the employer

    • Monitoring results - 30 years

    • Medical surveillance records - 30 years following termination

    • Training records, etc - 3 years

      • Respirator fit testings - until updated (yearly) 

BBP

• re pathogenic microorganisms that are present in human blood and can infect/cause disease

  • Examples: HBV, HIV

• OSHA has determined that certain employees face a significant health risk as a result of occupational exposure to blood and other potentially infectious materials

• To minimize this risk, OSHA issued the occupational exposure to BBP standard

• Scope and applications

  • Employers must identify in writing

    • Tasks and procedures as well as job classifications where occupational exposure to blood occurs

    • Without regard to PPE

    • This plan must be accessible to employees and OSHA people

    • The plan must be reviewed/updated yearly or when new exposures occur

    • Applies to employees with exposure to blood and OPIM

      • This document is called the exposure control plan 

categories of risk by exposure for BBP

• category 1 (high risk)

  • Tasks that include exposure to blood, body fluids, or tissue

    • embalmers/apprentice embalmers

    • removal/first call personnel 

• Category 2 (moderate risk) 

  • Tasks that involve no exposure to blood, body fluids/tissue, but employment may require performing unplanned category 1 tasks

    • FD/apprentice FDs

    • Funeral assistants

    • Housekeeping personnel

    • hairstylist/cosmetologist 

• Category 3 (minimum risk)

  • Tasks that involve no exposure to blood, fluids, or tissue and category 1 tasks that are not a condition of employment

    • Admin staff and clerical support

bodily fluids under OPIM

• Semen -blood products -vaginal secretions -cerebrospinal fluid

• Synovial (joint) fluid -pleural fluid -peritoneal fluid -pericardial fluid

  • Amniotic fluid -urine 

activities requiring ppe

• embalming

• Prep room cleaning

• Cleaning chemical, blood, body fluid spills

• Placing remains in/out of refrigeration 

• All first call procedures

  • Employers must

    • Provide all PPE necessary to perform the task at no cost

    • Clean, repair, replace all safety items when necessary

    • Keep work site clean/sanitary 

    • Arrange for cleaning and treatment of contaminated laundry

      • Laundry that has been soiled with blood or OPIM or that may contain sharps

    • Arrange for disposal of biohazard waste

      • Biohazard - any biological agent or condition that means a hazard to people 

hep b vaccination

• Employers must provide

• Must be offered within 10 working days of initial assignment

• Exceptions are

  • People who already have completed vaccination series

  • When immunity is confirmed through antibody testing

  • When vaccination is contraindicated for medical reasons

  • Employees must sign a declination form if they choose not to be vaccinated

    • They may request and obtain vaccination at any time at no cost

post exposure medical evaluation

• A confidential medical evaluation/follow up must be made available to employees following an exposure inciting

• Exposure through any of the following is considered an exposure incident

  • Eye

  • Mouth

  • Non-intact skin

  • Other mucous membrane 

  • Parenteral contact with blood or OPIM that results from performance of duties

  • Introduced into the body by piercing the mucous membranes, or skin barriers through such events as needlesticks, human bites, buts, abrasions

• Evaluation includes

  • Documenting the circumstances of exposure

  • identifying/testing the source

  • Testing the employee’s blood

  • Counseling

    • Evaluation of reported illness

communication of hazards to employees

• What is required?

  • Labels must be attached to 

    • Containers of regulated waste

    • refrigeration/freezers containing blood

    • Any other containers used to store, transport, or ship blood or OPIM 

  • Labels must include the universal biohazard symbol and the term biohazard

    • Must be fluorescent orange/orange-red color with contrasting color lettering

  • Labeling is not required on

    • Red bags used for regulated waste

    • Waste that has been decontaminated

    • If specimen is placed in labeled outer container

training

• All exposed employees must be trained before exposure begins

• Training must be provided by a person who is knowledgeable in the subject

• There must be no cost to the employee

• It must be conducted during regular business hours

methods of compliance

• Always use universal precautions - assume all bodies are infectious 

• Specific requirements that are most often cited

  • Eyewash station

  • Quick drench shower

  • Record keeping

    • Exposure determination

engineering controls

• Mechanical systems/devices engineered as part of equipment or the architecture of a building that isolates/removes hazards from the workplace 

• Use drain tubes

• Use embalming sink covers to avoid aerosolization

  • Minute particles of blood/water become atomized and suspended in air when water under pressure meets the blood drainage or when flushing an uncovered flush sink 

• Puncture proof sharp containers

• Biosafety cabinets 

• Adequate air exchange

• Keep lid on embalming machine reservoir

• Keep lid on hazardous waste material 

  • Check hoses on injection machines to avoid leakage/spray

work practice controls

• These controls reduce the likelihood of exposure by altering the manner in which a task is performed

• Not bending/breaking sharps

• Washing hands as soon as gloves are removed

• Clean up spills immediately 

• Cap all bottles

• Rinse emptied fluid bottles

• Continuous aspiration of cavity during injection of autopsies

• Clamp all arteries/vein severed during an autopsy to minimize volume 

• Clamp drainage veins as soon as blood has cleared to minimize volumes

  • Allows less HCHO to become airborne

  • Higher intravascular pressure

  • Minimizes chemicals in the waste system

  • DO NOT allow drainage to run over the body/table

  • Continuous water flow on table to dilute and wash away drainage

• Use a closed drainage system from vein to disposal system

• A drainage procedure that limits the exposure of the embalmer to drainage in which tubing is attached to a drain tube allowing drainage to flow directly from the vein into a sanitary disposal system

  • A heart tap works as well for this