[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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