1. Protecting Workers Exposed to Respirable Crystalline Silica William Perry, CIH Directorate of Standards and Guidance OTI Education Centers Program November 20, 2013

2. OSHA’s Proposed Rule  Two proposed standards: –One for General Industry and Maritime –One for Construction  Offer common sense, flexible approaches for employers

3. Public Participation  OSHA welcomes and encourages public input on the proposed silica rule. –Written comments –Public hearings –Post-hearing comments  Comments and testimony are carefully considered  OSHA’s final rules are based on evidence in the record as a whole

4. Dates  December 12, 2013 – Notice of intention to appear due  January 27, 2014 – Written comments due  March 18, 2014 – Public Hearing

5. Exposure and Health Risks  Exposure to respirable crystalline silica has been linked to: –Silicosis; –Lung cancer; –Chronic obstructive pulmonary disease; and –Kidney and immune system disease

6. Health Benefits of Rule  Nearly 700 fatalities avoided annually - Lung cancer:165 - Silicosis and other non-cancer lung diseases:381 - End-stage kidney disease:153  Over 1,600 non-fatal silicosis cases avoided annually

7. Some Reasons for the Proposed Rule  Current Permissible Exposure Limits (PELs) are formulas that many find hard to understand  Construction/shipyard PELs are obsolete particle count limits  General industry formula PEL is about equal to 100 µg/m 3 ; construction/shipyard formulas are about 250 µg/m 3

8. Most Important Reason for the Proposed Rule  Current PELs do not adequately protect workers  Extensive epidemiologic evidence that lung cancer and silicosis occur at exposure levels below 100 µg/m 3

9. OSHA’s Proposed Rule (cont.)  Establishes new PEL of 50 μg/m 3, AL of 25 μg/m 3  Includes provisions for: –Measuring worker exposures to silica; –Limiting access to areas where workers could be exposed above the PEL; –Use of dust controls; –Use of respirators when necessary; –Medical exams for highly exposed workers; –Worker training; and –Recordkeeping.

10. Permissible Exposure Limit  Proposed PEL is 50 µg/m 3 8-hour TWA for respirable crystalline silica  Includes both quartz and cristobalite  Residual risk still significant  Technologically feasible based on extensive data on dust control technology effectiveness –Data covering 23 general industry sectors and 12 high-risk construction operations

11. Methods of Compliance  PEL must be achieved with engineering and work practice controls.  Respirators permitted where PEL is not met or under other limited circumstances  Construction employers can choose to implement dust controls specified in Table 1 of the proposed rule. Exposure monitoring not required in this instance.

12. Flexibility for Dust Controls  Employers can use any dust or work practice controls to protect workers, such as: −Water sprays −Enclosures −Vacuum dust collection systems −Prohibiting dry sweeping

13. Exposure Assessment  Initial assessment where there is potential for exposure (construction exception above)  Periodic assessment for exposures above action level of 25 µg/m 3  Twice per year at or below the PEL  Quarterly above the PEL  Performance alternative – assess as necessary to adequately characterize exposures

14. Sampling and Analysis  Monitoring to be conducted using OSHA, NIOSH, or MSHA methods  Flexibility in using dust samplers – any that are designed to conform to ISO-CEN  Analysis by XRD or IR  Use of accredited labs that follow certain quality assurance procedures

15. Medical Surveillance  Covers workers exposed above PEL for 30 or more days per year  Initial exam followed by periodic exam every 3 years  Obtain written medical opinion on health condition as it relates to silica exposure  Referral to board certified pulmonary specialist if diagnosed with silicosis or if otherwise appropriate

16. Content of Medical Exam  Medical and work history, general exam  Chest X-ray interpreted by B-reader, or equivalent diagnostic study  Pulmonary function test administered by NIOSH-certified technician  Test for latent TB (initial exam only)

17. Other Proposed Provisions  Regulated areas or written access control plan to limit access where exposures > PEL  Hygiene practices and housekeeping  Respiratory protection (follows 1910.134)  Hazard communication and training (follows 1910.1200, GHS)  Recordkeeping (follows 1910.1020)

18. Additional Flexibility for Construction Employers  Table 1 in the construction standard matches tasks with effective dust control methods and respirators.  If employers choose to follow Table 1: –They would not have to determine worker exposures to silica –They would have to offer medical exams to workers doing tasks that require respirators for more than 30 days a year

19. Table 1 Example Table 1. Exposure Control Methods for Selected Construction Operations Operation Engineering and Work Practice Control Methods Required Air- Purifying Respirator (Minimum Assigned Protection Factor) ≤ 4 hr/day > 4 hr/day Using Stationary Masonry Saws Use saw equipped with integrated water delivery system. (Plus additional specifications) None Half- Mask (10)

20. Employer Obligations by Exposure Level Provision Exposure Level ≤AL≥AL but ≤PEL>PEL (d) Exposure assessment Initial assessment if employees reasonably expected to be exposed ≤AL OR Follow Table 1 (for construction) Initial assessment if employees reasonably expected to be exposed ≤AL Periodic monitoring every 6 months OR Performance option OR Follow Table 1 (for construction) Initial assessment if employees reasonably expected to be exposed ≤AL Periodic monitoring every 3 months OR Performance option OR Follow Table 1 (for construction) (e) Regulated areas and access control None Establish and implement regulated areas OR Establish and implement written access control plan

21. Employer Obligations by Exposure Level (cont.) Exposure Level Provision ≤AL≥AL but ≤PEL>PEL (f) Methods of compliance None Use engineering and work practice controls where feasible OR Follow Table 1 (for construction) (g) Respiratory protection None Provide respiratory protection to workers when exposures >PEL OR Follow Table 1 (for construction)

22. Employer Obligations by Exposure Level (cont.) Exposure Level Provision ≤AL≥AL but ≤PEL>PEL (h) Medical surveillance None Provide initial exam within 30 days of assignment Provide periodic exams every three years (i) Hazard communication Provide information and training (j) Recordkeeping Maintain exposure assessment records Maintain exposure assessment and medical records

23. Consistency with Consensus Standards  Industry has recognized the need for comprehensive standards addressing the hazards of crystalline silica.  Voluntary consensus standards have been adopted for general industry (ASTM E 1132 – 06) and construction (ASTM E 2626 – 09).  These voluntary standards include provisions for exposure measurement, use of dust controls, respiratory protection, medical surveillance, and training.

24. Estimates of Those Affected by Proposed Rule  2.2 million workers −Total of 1.85 million in construction and 320,000 in GI and maritime −1.3 million in small establishments −580,000 in very small establishments  534,000 establishments −Total 477,000 in construction and 7,000 in GI and maritime −470,000 small establishments −356,000 very small establishments

25. Monetized Benefits and Costs Per Year  Costs: $ 663 million annually –Construction – $495 million –General industry – $168 million  Net Benefits: $2.8 to $4.7 billion annually over the next 60 years

26. Silica Web Page http://www.osha.gov/silica

27. Other Standards Activity

28. Final Rules  Electrical Transmission and Distribution (Subpart V)  Walking/Working Surfaces (Subparts D&I)  Revocation of Periodic Records (Power Presses DFR)

29. Proposed Rules and Pre-Proposal Actions  Beryllium (Proposal)  Recordkeeping Modernization (Proposal)  Permissible Exposure Limits (Request for Information)  Chemical Safety and Security (Request for Information)

30. SBREFA Actions  Injury and Illness Prevention Programs  Infectious Diseases  Combustible Dust

31. Process Safety Management  EO, Improving Chemical Facility Safety and Security  Charges DOL to publish an RFI to modernize the PSM and other standards  With DHS, EPA, engage stakeholders and develop options to improve chemical safety

32. Occupational Exposure Limits Web Page Side-by-side comparison of OSHA PELs, Cal/OSHA PELs, NIOSH RELs, and ACGIH® TLVs® Direct links to source of OELs https://www.osha.gov/dsg/annotated-pels

33. Safer Chemicals Toolkit Compiles existing tools and methods to help employers effectively accomplish elimination and substitution https://www.osha.gov/dsg/safer_chemicals

34.  Interagency agreement  Develop products in three areas:  Injury and illness “factbook”  Injury and illness prevention programs (I2P2)  Safe patient handling  Goals: build momentum and drive results OSHA-CMS Partnership

35.  Goals:  Illustrate that hospitals are currently unsafe workplaces and make the case for action.  Facilitate conversation between administrators and safety staff. Prompt administrators to ask for metrics and other information that will reveal how well the hospital is really doing with safety.  Show that solutions exist that will reduce employee injuries, save money, and reduce patient harm, too.  Products:  Factbook executive summary  Complete factbook  Initial evaluation tool Injury and Illness Factbook

36.  Goals:  Engage top management. Spark their interest and motivate them to explore further. Make the case for action.  Demonstrate that I2P2 involves familiar concepts and that hospitals may already have many of the elements in place.  Describe the six core elements of I2P2 and provide strategies for how they can be implemented in a hospital setting. Use site visit success stories.  Products:  I2P2 business case  I2P2 / Joint Commission standards crosswalk  I2P2 gap analysis/ benchmarking tool  I2P2 roadmap - learning and implementation tool  Best practices forum (via CMS) Injury & Illness Prevention Programs

37.  Goals:  Engage top management and convince them to investing in a SPH program.  To provide useful resources that will help a SPH champion establish / maintain a successful program.  Products:  SPH business case  SPH program roadmap - learning and implementation tool  SPH myth busters  SPH best practices/lessons learned check list  Patient room wall poster  Best practices forum (via CMS) Safe Patient Handling