h. CPR and First Aid Training

Effective Date Note: At 63 FR 33466, June 18, 1998, Sec. 1910.151 was amended by revising

the last sentence of paragraph (b) and by adding appendix A to the section, effective Aug. 17,

1998.

The need for access to medical services in emergencies was discussed at some length in

Chapter 1. Prompt action can frequently save an individual's life or can significantly reduce the

seriousness of injuries. Although not intended as an instruction manual, Chapter 1 presented

some first aid procedures for accidents involving chemicals and CPR techniques. It would be

highly desirable for individuals working in facilities where hazards are present to be trained in

both of these subjects. By working carefully so as not to tempt fate too much, and with a great

deal of luck, an individual may go through an entire working career without personally

experiencing an accident or being present when someone else does, but this cannot be counted

upon. Although you cannot perform CPR on yourself, and you may be incapacitated so that even

simple first aid is beyond you, if enough personnel in a laboratory do make the effort to become

trained, it is likely that someone will be available to start emergency aid while waiting for more

skilled personnel to arrive. The institution at which the author worked had an in-house volunteer

rescue squad and the members of this squad as well as the town squad were scattered throughout

the university. Although the rescue squad was normally present within 3 to 4 minutes, on several

occasions these on-scene personnel were instrumental in ameliorating severe accidents prior to

the squad’s arrival. The training for basic first aid and single-person CPR is not difficult, and

everyone should annually devote the few hours necessary to receive and maintain these skills.

Many rescue squads, fire departments, hospitals, and other public service agencies offer the

training at a minimal fee covering only the cost of the manuals and supplies.

i. Vaccinations

All of us as children probably received some vaccinations against a number of diseases. A

number of common diseases afflicting children who were born in the first third of this century

are now decreasing in frequency as a result of widespread vaccination programs. A recent

controversy centered around whether the last smallpox virus in the world, being maintained in

a laboratory, should be destroyed. Yet this used to be one of the world's great killers. Relatively

recently vaccinations for other diseases have been developed, and diseases such as polio and

measles are relatively rare now in the United States, although, unfortunately, there has been a

modest resurgence of these two illnesses. Tuberculosis is also on the rise as a consequence of

the spread of AIDS. It would appear that with the obvious benefit, vaccination against a disease

would be a matter of course, providing that a vaccine exists. This is not necessarily the case.

Several factors need to be considered in determining whether vaccination is desirable or not.

The first clearly is: Does a safe, reliable vaccine exist? At one time, rabies vaccine using duck

embryos was the best available. However, it did not always provide a reliable immunization, and

a significant fraction of the persons on which it was used had reactions, some of which were

neurologically very severe. Now, a much more reliable human diploid rabies vaccine is available

which provides protection for a very high percentage of persons, and the incidence of untoward

reactions is very low. It is probably desirable to mandate vaccination for all personnel who face

a high risk of exposure to rabies, i.e., persons who work directly with animals that might be rabid,

individuals who do necropsies on such animals, and technicians who work with untreated tissue

from potentially rabid animals. The second question is: What is the risk-benefit to the individual

if the disease is contracted? The disease may not be sufficiently serious as to warrant the risk

of a possible reaction to a vaccination. On the other hand, if the disease is sufficiently life

threatening, then the use of a vaccine would be indicated. Third: Is there a satisfactory post-



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exposure treatment? This is really critical for life-threatening diseases. If there is not, and the

exposure risk is significant, the use of even a less than totally satisfactory vaccine might well be

considered. Other considerations would be the state of the individual's health. If the condition

of the person is such that the possibility of an adverse reaction could have a strong negative

impact on the individual, then one would question the desirability of using a vaccine, but one

would also question placing such a person in an environment in which vaccination might be

considered.

Booster injections are needed for some diseases to ensure an adequate protective level of

antibodies. However, some patients may experience reactions to a booster. It is advisable to do

a blood titer test prior to repeat injections. If the titer is adequate, no booster should be

administered.

Although the laboratory supervisor should have considerable input in deciding whether a

vaccine should be used or not, any decision to institute a mandatory vaccination program should

be reviewed by a separate biosafety committee before implementation. Individuals must be fully

informed of any possible risks.



APPENDIX

Materials that should be included in a medical surveillance program. Note that not all of these

necessarily involve laboratory usage of the material, some materials not normally found in the

laboratory are included for completeness.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.



29 CFR 1910.1014: 2-Acetylaminofluorene

29 CFR 1910.1045: Acrylonitrile

29 CER 1910.1011: Aminodiphenyl

29 CFR 1910.1018: Arsenic, inorganic

29 CFR 1910.1111 and 1101 and 1926.1101: Asbestos - nonlaboratory exposure

29 CER 1910.1010: Benzidine

29 CFR 1910.1028: Benzene

29 CFR 1910.1030: Bloodbome pathogens - post exposure

29 CFR 1910.1051: 1,3 Butadidiene

29 CER 1910.1027: Cadmium

29 CFR 1910.1008 and 1926.1127 : bis-Chloromethyl ether

29 CFR 1910.1029: Coke Oven emissions - exposure

29 CFR 1910.1043: Cotton dust - exposure

29 CFR 1910.1044: 1,2-Dibromo-3-chloropropane

29 CFR 1910.1007: 3,3- Dichlorobenzidine and its salts

29 CFR 1910.1015: 4-Dimethylaminoazobenzene

29 CFR 1910.1012: Ethyleneimine

29 CFR 1910.1047: Ethylene oxide

29 CFR 1910.1048: Formaldehyde

29 CFR 1910.120(f): Hazardous waste, emergency response personnel

29 CFR 19 10.1450(g): Laboratory chemicals, exposures above action, PEL levels,

incidents, possible symptoms

22. 29 CFR 1910.25 and 1926.62: Lead

23. 29 CFR 1910.1006: Methyl chloromethyl ether

24. 29 CFR 1910.1052: Methylene Chloride



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25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.



29 CFR 1910.1004: alpha Naphthylamine

29 CFR 1910.1009: beta Naphthylamine

29 CFR 1910.1003: 4-Nitrobiphenyl

29 CFR 1910.1016: N-Nitrosodimethylamine

29 CFR 1910.95: Noise, hearing conservation program required above action level

29 CFR 19 10.1013: Propiolactone, beta

29 CFR 1910.1001 and 134: Respirator use, pulmonary function

29 CFR 1910.1017: Vinyl chloride

29 CFR 1910 Subpart Q: Exposures to welding fumes

29 CER 1928: Particulate respiratory exposures

29 CFR 1928: Pesticide applicators



REFERENCES

1.



Hogan, J.C. and Bernaski, E.J., Developing job-related pre-placement medical



examinations, J. Occup.



Med., 23(7), 469, 1981.

2.



Health Monitoring for Laboratory Employees, Research and Development Fact Sheet, National Safety

Council, Chicago, 1978.



INTERNET REFERENCES

1. http://www.frwebgate.access.gpo.gov/cgi-bin/get-cfr.cgi

2.



http://www.osha-slc.gov/STLC/medicalsurveilance/index.html



E. The OSHA Bloodborne Pathogen Standard: Infection from Work with Human Specimens

OSHA published 29 CER 1910.1030, regulating exposures to bloodborne pathogens on

December 6, 1991. The rule took effect on March 6, 1992. Under the standard, employers affected

by the standard were to be in full compliance by July 6, 1992. An exposure control plan was to

be in effect by May 5, 1992, and employee training made available by June 5, 1992. OSHA has

taken a firm posture on implementation of the rule. OSHA can impose a fine of up to $70,000 per

willful violation.

In the standard, OSHA defines bloodborne pathogen to mean “pathogenic microorganisms

that are present in human blood and can cause disease in humans.” These pathogens include,

but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV). The

emphasis has been on these two diseases, although other diseases may be found in human blood

and tissue and technically are covered. The standard also does not limit itself to human blood

despite the name. The standard includes other potentially infectious materials, which are defined

by the standard to mean (1) the following human body fluids: semen, vaginal secretions,

cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid,

saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body

fluids in situations in which it is difficult or impossible to differentiate between body fluids; (2)

any unfixed tissue or organ (other than intact skin) from a human (living or dead); and (3) HIVcontaining cell or tissue cultures, organ cultures, HIV- or HBV-containing culture medium or other

solutions, and blood, organs , or other tissues from experimental animals infected with HIV or

HBV.

The CDC published guidelines for prevention of transmission of bloodborne diseases and



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identified certain substances in which the potential for transmittal of HBV and HIV was extremely

low or nonexistent. These substances were feces, nasal secretions, sputum, sweat, tears, urine,

and vomitus, unless they contain visible blood.

When the standard was published, it was predicted that the standard would prevent

approximately 9000 infections of HBV and approximately 200 deaths per year from this disease.

Far fewer persons are known to have acquired HIV from occupational activities, less than 100

at the time the standard went into effect. By mid-1998, there have been 54 known cases of

occupationally acquired HIV infection, and an additional 133 possible cases.

1.



Basic Provisions

There are several key components to a program to achieve compliance with the standard:

1. An exposure control plan

2. Exposure determination



The standard identifies several areas in which explicit guides are provided to assure

compliance:

1. General

2. Engineering and work practice controls

3. Personal protective equipment

4. Housekeeping

Other requirements include:

1. HBV vaccination and postexposure evaluation and follow-up

2. Communication of hazards to employees

3. Record keeping

Each of the above areas will be discussed in the following sections.

2. Exposure Control Plan

The exposure control plan is the organization's written statement of how it plans to eliminate

or minimize employee exposure. It must cover each of the broad areas listed in the previous

section.

a. Exposure Determination

The employer must compile a list of job classifications in which (a) all employees in those jobs

have occupational exposures and (b) some employees have occupational exposures. The

employer must identify a list of tasks and procedures or groups of closely related tasks and

procedures in which occupational exposure occurs and which the employees in the first two lists

perform. The lists do not take into consideration any use of personal protective equipment to

exclude personnel.

The first list in which all employees in those jobs do have occupational exposure might

include for any research-oriented organization:

1.

2.

3.

4.

5.

6.

7.



Medical doctor (organization's health service)

Nurse (organization's health service)

Research scientists

Technicians

Glassware cleaners

Laundry staff

Police/security



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