1. 1 Improving Personal Protective Technology Workplace Practices Maryann D’Alessandro, Ph.D. Associate Director for Science PPT Program Coordinator NIOSH, National Personal Protective Technology Lab Council of State and Territorial Epidemiologists (CSTE) David L. Lawrence Convention Center Pittsburgh, PA 15222 June 12, 2011

2. 2 Overview  NPPTL and PPT Program Overview  PPT Workplace Practice Studies  Roadway Construction  Agriculture Pesticide Handlers  Healthcare  Summary

3. 3 NIOSH Program Portfolio NORA / NIOSH Industry Sectors (10) NIOSH Cross Sector Programs (24) Agriculture, forestry, and fishing Construction Healthcare and social assistance Mining Public Safety Oil & Gas Extraction Manufacturing Services Transportation, warehousing, and utilities Wholesale and retail trade Personal Protective Technology (PPT) Health hazard evaluation (HHE) Hearing loss prevention Respiratory diseases Traumatic injury Authoritative recommendations and development Cancer, reproductive, and cardiovascular diseases Communications and information dissemination Emergency preparedness and response Global collaborations Immune, dermal and infectious diseases Musculoskeletal disorders Radiation dose reconstruction Training grants Work organization and stress-related disorders Economics Exposure assessment Engineering controls Total Worker Health (Formerly WorkLife initiative) Occupational health disparities Small business assistance and outreach Surveillance Nanotechnology Prevention through design

4. 4  Office of the Director, NIOSH  National Personal Protective Technology Laboratory (NPPTL)  Office of Mine Safety and Health Research (OMSHR)  Office of Extramural Programs  Division of Respiratory Disease Studies (DRDS)  Division of Safety Research (DSR)  Health Effects Laboratory Division (HELD)  Education and Information Division (EID)  Division of Applied Research and Technology (DART)  Division of Surveillance Hazard Evaluation and Field Studies (DSHEFS)  Division of Compensation Analysis and Support (DCAS)  Research to Practice (r2p)  Spokane Research Laboratory NIOSH Divisions & Laboratories

5. 5 An estimated 20 million workers use PPE on a regular basis to protect themselves from job hazards. NIOSH PPT Program and NPPTL Mission The VISION is to be the leading provider of quality, relevant, and timely PPT research, training, and evaluation. The MISSION of the PPT program is to prevent work-related injury, illness and death by advancing the state of knowledge and application of personal protective technologies (PPT).

6. 6 PPT Program Goal Interactions PPE Workplace needs Surveillance Communications Surveillance Communications

7. 7 PPT Program Workplace Practice Industry Focus  Roadway Construction  Agriculture Pesticide Handlers  Healthcare

8. 8 PPT Surveillance and Intervention Studies in Roadway Construction 360,000 road and transportation workers nationwide 90% establishments <20 employees 25% of workforce is Hispanic Transient highly variable work practices and exposures Heavy dependence on PPE compared to general industry - Silica - Asphalt fumes - Diesel exhaust Sources: 1) BLS, 2006 2) NIOSH, National Occupational Respiratory Mortality System (NORMS)

9. 9 PPT Surveillance and Intervention Studies Roadway Construction Objectives - Evaluate and identify methods to improve respirator use and the interfaces of respirators with other PPE 2005 – 2007 – Assess roadway construction practices 2007 – 2012 - Identify shortcomings in current respiratory protection programs and develop interventions 2008 – 2012 - Evaluate interventions for utility and acceptance as judged by contractors/workers

10. 10 PPT Surveillance in Roadway Construction Findings Assessed airborne hazards and exposure control methods Identified barriers to using respiratory protection Use and design factors Comfort, interfaces, communications Management factors Enforcement, proper storage and cleaning Worksite factors Worker turnover, short duration projects Worker factors Training, facial hair, non-English speakers

11. 11 PPT Surveillance in Roadway Construction Partnerships  Key Partners  American Road and Transportation Builders Association (ARTBA)  ARTBA sites visited throughout the country  Stakeholders  National Demolition Association  OSHA  ISEA and manufacturers  Construction workers  Laborers International Union of North America  Center for Construction Research and Training

12. 12 PPT Surveillance and Intervention Studies in Agriculture Pesticide Handlers 23,200 Pesticide Handlers Nationwide 1998 – 2005: 3,281 cases of acute occupational pesticide poisonings among farm workers 81% of farm workers reported Spanish as their native language Sources: 1) BLS, 2010 2) National Agricultural Worker Survey (NAWS)

13. 13 Agriculture Pesticide Handlers PPT Surveillance and Intervention Studies Objectives - Understand PPT practices and barriers among agricultural pesticide handlers and their employers over time and develop interventions to address PPT barriers to best practices  2009 – 2010 - Assess current surveillance studies  2010 - 2011 - Develop and pilot data gathering strategies  2011 – 2012 - Implement questionnaires and focus groups  2013 – 2015 - Develop and implement interventions

14. 14 PPT Surveillance in Agriculture Findings Worked with partners to assess barriers Identified barriers to using PPT Use and design factors Comfort, interfaces, hinders job performance Pesticide label challenges (too technical, vague requirements) Management factors Difficulty obtaining PPT, proper storage and cleaning Fear of retaliation, low perceived risk Worker factors Limited knowledge (i.e. training on use), non-English speakers

15. 15  Key Partners  EPA, OSHA and Oregon OSHA  State Cooperative Extension Services, Departments of Health and Agriculture: WA, PA, AZ, FL, OR, NC, IA  NIOSH Ag Centers including PNASH  Pesticide and PPE Manufactures and Suppliers  Stakeholders  Agricultural Pesticide Handlers (workers who mix/load/apply pesticides)  Employers of agricultural pesticide handlers PPT Surveillance in Agriculture Partnerships

16. 16 PPT Initiatives in Healthcare Fastest growing industry sector About 17 million workers (11% US workforce) 2 nd with over 30% of all lost time nonfatal occupational illness and injuries Pandemic preparedness has been priority since 2004 H1N1 influenza pandemic provided opportunity to focus efforts

17. 17 Public Health Practice Study of 16 California facilities selected by stratified random sample Objective: Describe extent to which hospitals in California have implemented required elements of RPPs for H1N1 Influenza Opportunity to assess Healthcare workers during pandemic operations: Barriers to proper respirator use Knowledge, attitudes, and beliefs regarding N95 respirators Workplace safety climate

18. 18 Interviews and observations conducted at 16 hospitals  Interviews: At each hospital, 15-21 interviews conducted from Jan 20 – Feb 23, 2010 Hospital Managers in Nursing, Employee Health, Infection Control Unit Managers in Emergency Dept., ICU, Pediatrics or Medical/Surgical units 3-5 HCWs in each of the 3 units  Observations: HCW N95 respirator use/non-use observed when in close contact with patients on airborne precautions  Respiratory Protection Program Assessment

19. 19 Most Deficient Areas of Written Programs (n=16)

20. 20 Improving Respiratory Protection Programs in Hospitals - Summary Many hospitals rely on staff with no formal training in OHS to administer their RPP User-friendly interventions to develop and implement RPP in hospitals needed Best practice interventions based on the results of pilot testing and stakeholder input developed Widespread distribution of RPP Toolkit throughout California Interventions to be made available for modification and implementation nationwide Parallel efforts underway in 5 states (NY, NC, MN, IL, MI) Attend Tuesday’s session to learn more: Occupational Health Session, B. Materna : 2:30 – 3:00, Room 315

21. 21 Demonstration and Sentinel Surveillance System of PPE Usage in US Healthcare Workers Objectives: Determine the feasibility to identify, describe, develop, pilot, monitor and evaluate PPE surveillance systems used in a medical center setting.  Develop data collection points at VUMC (PPE usage, types, selection, fit-test, clearance, compliance, resources, recalls, outcomes etc.)  Pilot System at VUMC in 2011  Use data to Establish “Best Practices”  Develop a National PPE Usage Surveillance System Attend Tuesday’s session to learn more: Poster Board #108, M. Yarborough : 10:00 – 10:30 am

22. 22 Project BREATHE - Better Respirator Equipment using Advanced Technology for Healthcare Employees Objective - Improve respirator use compliance among healthcare workers (HCW) by developing information products, respirator performance requirements, and advanced technologies for the next generation of HCW respirators that are more comfortable and tolerable. Comfort & tolerability research and test method development (underway) Respirator clinical effectiveness study (underway) Partnership / prototype development (underway) Prototype lab & field trials Commercialization / standards development

23. 23 Vanderbilt CDPH BREATHE Identification of best practices Improved respirator designs and Development of National Surveillance System Improved respirator designs and Development of National Surveillance System Early intervention response and Improved Workplace Practices Early intervention response and Improved Workplace Practices

24. 24  Unique hazards across industry sectors  Common barriers across industry sectors  Opportunities for collaboration in all sectors described across all states Summary

25. 25 Quality Partnerships Enhance Worker Safety & Health Thank you Visit Us at: http://www.cdc.gov/niosh/programs/ppt/http://www.cdc.gov/niosh/programs/ppt/ http://www.cdc.gov/niosh/npptl/default.html Contact information: bpj5@cdc.gov Disclaimer: The findings and conclusions in this presentation have not been formally disseminated by the National Institute for Occupational Safety and Health and should not be construed to represent any agency determination or policy.