Download Sept 2012 Safety Awareness WITH NOTES

Reducing Risks in the Field
Safety Awareness for Environmental Health
Professionals
CIT
September 2012
Nancy Deal
Non-point Source Pollution Program Coordinator (EPA319)
Onsite Water Protection Branch
919-710-4188
[email protected]
1
Mission Statement
To safeguard life, promote human health and
protect the environment through the practice
of modern environmental health science, the
use of technology, rules, public education and
above all, dedication to the public trust.
2
Overview
General safety for all disciplines
Authorization-specific safety
Pathogens
3
Questions and comments…
…are welcome
4
Safety
Safety is a culture: It starts at the top
and filters down.
– The boss must buy into the concept
– Each worker must also take responsibility
Safety
When safety is the most important goal
on the job,
everyone gets to come back to work
the next day.
Safety
An accident is an unforeseen incident that
occurs while following established protocol
instead of an incident resulting from an
unsafe condition.
You must plan to be safe!
Why do accidents happen?
Eyes not on Path
– Slips, trips and falls
Eyes not on Task
– Impact injuries
Line of Fire
– Exposure to liquids by “splash back”
Rushing
– Slow and steady is better
So…
Don’t get in a hurry
Pay attention
9
First aid and emergency response
Emergency phone numbers
Cell phones are great, but
– Got a signal?
Where is the nearest help?
– Know how to get there?
First aid and emergency response
Keep a well-stocked first aid kit handy
Know your co-workers or employees’
health issues
– Diabetes
– Anaphylaxis
– Heart conditions
First aid and emergency response
The first 15 minutes is critical
– Precious time is lost if you cannot make a
decision to act
Get safety training, including CPR!
– Your health department
– Red Cross
– Extension
– Department of Labor
– OSHA
On-site safety equipment
First aid kits
– In the truck
– On the wall
13
On-site safety equipment
AEDs
14
On-site safety equipment
Fire extinguishers are specific to the source
of combustion
A
B
C
D
K
– Class A: ordinary combustibles, many plastics
– Class B: flammable liquids, grease and oil
– Class C: wiring, other electrical sources
– Class D: Chemical fires
– Class K: Cooking oils (commercial settings)
Use appropriate equipment!
16
Personal Protective Equipment
(PPE)
What to wear and when to wear it
– Steel-toed shoes
17
Personal protective equipment:
Gloves
Latex for potential
contact with
– Effluent
– Bodily fluids
– Other unpleasantries
Gauntleted overgloves
– Sewage applications
Personal protective equipment:
Eye Protection
Safety glasses
Face shields as
appropriate
Personal protective equipment:
Hearing protection
Around heavy
equipment
Industrial settings
Hearing protection: “4 C’s”
Clean hands
– Before inserting to avoid infection
Consistent use
– When noise levels exceed 85 db (A)
Correct insertion
– NIOSH recommendation
The Roll, Pull, Hold method
Comfortable fit
– Or they will not be worn
21
Personal protective equipment:
Hard hats and high-vis vests
Required by OSHA if loads
will be lifted overhead
Personal protective equipment:
Inhalation protection
For hazardous
atmospheres
Should be
precisely fit
23
Personal protective equipment
Wooded sites
– Long sleeved jackets
– Snake boots
– Chaps
Messy sites
– Coveralls
– Tyvek® suits
Personal protective equipment
What must the employer provide for you?
– Generally, anything that is not specific to the
user
Boots, prescription safety glasses would be your
responsibility
Check your employer’s policies
Personal protection: hygiene
Hand-washing - soap or waterless hand
sanitizers
– After toilet use
– Before breaks and lunch
Keep hands and fingers away from eyes,
ears, nose, and mouth.
Wear rubber gloves that are “fit for use.”
Personal protection: hygiene
Clothing may be contaminated
– Do not store personal clothes with work
clothes.
– Wash work clothes separately.
Conclusion –
and point of beginning…
To STAY SAFE:
Each person is responsible for his or her
own safety and thus the safety of those
around them
Know how to be safe
Know how to respond to an emergency
Authorization-specific safety
Water wells
Wastewater
Food/Lodging/Institutional
Pools
Tattoo parlors
Child Health Protection
29
EH DISCIPLINE
Hazard
F/L/I
Pools
Tattoo Parlors
Wells
Lightning
x
x
x
x
x
x
Rain
x
x
x
x
x
x
Excessive heat
x
x
x
x
x
x
Excessive cold
x
x
x
x
x
x
x
x
Excessive Noise
Wastewater Child Health Prot
Electrical
x
x
x
x
x
x
Chemical
x
x
x
x
x
x
Bugs
x
x
x
x
x
x
x
x
Snakes
x
Pathogens
x
x
x
x
x
x
Slips, trips and falls
x
x
x
x
x
x
Human threats
x
x
x
x
x
x
Burns
x
x
x
Confined Space
x
30
Water wells and Onsite
31
Safety concerns:
Water Wells and Onsite Wastewater Programs
Weather
– Lightning
– Excessive heat and cold
– Excessively wet or dry soils
Site hazards
– Uneven topography
– Equipment
Excessive noise
32
Noise
• Noise levels on a typical
water well worksite.
• Noise levels above
90dB(A) within 6 meters
of the rig, particularly
near the compressor.
• Wear hearing protection
• Avoid standing in these
areas if not required to
conduct a work task.
33
General site issues
Electronic devices are a distraction
– Cell phones
Concentrate on the job
– Personal music devices
Are NOT designed for hearing protection
“Biological” hazards
35
Snakes: whether venomous or
not…
Surprise!
36
Creepy crawlers – and fliers
Ticks
– Wear white
– Tuck pants in shoes
– Use DEET
– Keep duct tape handy
Bees, wasps and hornets
– Look for their nests
– Carry your EPI pen if you are allergic
– Benadryl is a decent alternative
37
Black Widows
ALWAYS present in valve boxes, tank risers, well
houses, etc.
Vegetation
“Widow makers”
Briars, etc.
Walking too
closely behind the
person in front of
you - branches!
Vegetation
40
Newly-cleared land
What are the hazards?
– Fire ant nests
– Yellow jackets
– Stump holes
– Carrying equipment
41
Aggressive domestic animals
Aggressive livestock
Watch out if you are in a pasture
– Goats and bulls can make life interesting
43
Angry owners and tenants
44
Electric fences
Do you believe the person when they tell
you it is OFF?
How do you check it?
45
Safety concerns (cont.):
Water Wells and Onsite Wastewater Programs
Waterborne pathogens
– We’ll get your attention on this later…
46
Safety concerns (cont.):
Water Wells and Onsite Wastewater Programs
Ergonomics
– Road warriors
– Extensive deskwork
– Lifting
47
Personal protection: ergonomics
Lifting
– Use tools
– Get help
“Buddy system”
– Legs, not back
Good footing
Close to load
Back straight
Incorrect!
Better, Much Better!
Dum..
Dee
..Dum
Two working
together is always
better than one!
HEY, BUDDY! A
LITTLE HELP
WOULD BE NICE!!!
Equipment or component hazards
Disinfection components
– Chlorine and UV
Electrical systems for components
52
Before you probe or dig…
Margin of error
Homeowner installed
utilities
Is it a straight line?
Where are shut-off valves
for gas and water lines?
Electrical hazards
Proper training and/or licensure to perform
repairs to electrical systems
Lock-out/tag-out procedures
– All workers should be familiar with these
– Get training!
Electrical hazards: basics
Be aware of the potential hazard at all
times.
Do not use metal ladders.
Never override any electrical safety
device.
Check extension cords for abrasion and
breaks as well as for missing grounding
prongs
Electrical hazards: basics
Use only grounded or insulated (UL
approved) electrical equipment.
Energize AC-powered equipment through
a connection with a ground fault circuit
interrupter (GFCI).
Excavation and trench
safety measures
For excavations > 4 feet deep that workers
will enter
While excavation is open and while
workers might be in it, proper safety
precautions must be observed
There must be a ‘competent person’ on
the site
Competent person
By way of training and/or experience, is…
– Knowledgeable of applicable standards,
– Capable of identifying commonly foreseeable
workplace hazards,
– Designated by the employer, and
– Has authority to take appropriate actions.
Can even shut down the job if conditions are
unsafe.
Requires special training.
Competent person
Excavation and trench safety
Competent person
Soil classification
Protective measures
and equipment
Access and egress
Stability of nearby
structures
Water accumulation
Clear line of sight
Spoil pile
Re-inspection
Consider:
Most trench fatalities occur in trenches
5 to 15 feet deep
One cubic yd of soil = about 3,000 pounds
Confined space
What is it?
– Limited ingress and egress
– Not designed for continuous human occupancy
http://www.osha.gov/SLTC/confinedspaces/index.html
62
Confined Space
New Installations
– Any tank is a confined
space
Repairs, systems in
use.
– Lack of oxygen
– Hydrogen sulfide gas,
methane
– Respiratory stress or
arrest.
– First aid
To safely and
legally enter a
tank, one must
have proper
training and
equipment
This is an unsafe practice. Your head,
body, etc. should never be in a
confined space.
Hazardous atmospheres
Where a hazardous atmosphere exists
or could reasonably be expected to
exist:
Atmospheres shall be tested before
employees enter excavations greater than
4 feet in depth
If atmospheres contain less than 19.5%
oxygen
– Provide ventilation/respiratory protection
Hazardous atmospheres
Where might there be one?
Landfill or dumping area.
Chemical or hazardous waste recycling or
collection, storage center
Water/wastewater treatment sites
Inside any tank – new or used
Hazardous conditions
can develop quickly
Heavier-than-air gases can render a safe
site unsafe quickly
– Equipment exhaust
– Carbon dioxide
– Propane
– Etc.
Hazardous atmospheres
Emergency rescue equipment on site if
hazardous atmospheres could exist:
– Breathing apparatus
– A safety harness and line
– A basket stretcher
Food, Lodging and Institutional
Inspections
70
Safety concerns:
Food, Lodging and Institutional Program
All of the above, plus…
Slips, trips and falls
Burns
71
Safety concerns (cont.):
Food, Lodging and Institutional Program
Equipment
– Do not break it down
Recalled food
– Safe handling instructions
72
Inside the facility
Where is the First Aid Kit?
How about the fire extinguisher?
Do you know how to get out?
73
Safety concerns (cont.):
Food, Lodging and Institutional Program
Wash/sanitize hands!
– Regularly
– Risk of dermatitis
74
Institutional issues
Isolation areas
– Watch for signage
Soiled linens and furniture
– Where are your gloves???
75
Safety concerns:
Child Environmental Health Branch
Contaminated surfaces – inside and out!
– Don’t take it home to your family!
76
Safety concerns:
Pools
Weather
Slips, trips and falls in wet areas
Spiders and snakes
– Storage areas
– Skimmer covers
77
Safety concerns:
Pools
Chemicals
– Mixing two types of chlorine tablets can be explosive!
Trichloroisocyanuric acid for pools
Calcium hypochlorite for water and wastewater
– Storage areas
Leaking containers
– Equipment
Electrical
– Proper pump ground – a REAL hazard in these wet areas
78
Safety concerns:
Pools
Can you swim???
79
Safety concerns:
Tattoo Parlors
Equipment
– Needles, etc.
Contaminated inks
Chemicals
– Disinfection chemicals
– Equipment
Clientele???
80
Safety concerns:
All disciplines
Methamphetamine labs
– Often discovered through
Septic tank investigations
Lead investigations
Complaint investigations
– Trash accumulation
– Odors
– Excessive traffic
– Typically rental properties but not always!
Hotel-based enterprises
81
Methamphetamine labs
Associated dangers
– Firearms
– Booby traps
– Vicious dogs
– Volatiles used in ‘cooking’ process are
flammable
– Improperly stored or used chemicals can
explode
82
Methamphetamine labs
If you suspect you have found one
GET OUT and call the law
83
Pathogen Hazards
84
Pathogens
Infectious agents that can cause disease
Contact with such agents is to be
expected in our line of work
– A fundamental part of protecting public and
environmental health
85
“Knowledge is the only thing
you can give away and still
keep” Scott Hutchinson
“Whoever said that never heard of
infectious disease” J. Hoch
86
Good Bugs : Water Microbiology
Many are part of the natural soil/water ecology and crucial
to biogeochemical cycles
87
Waterborne diseases
Results from contact with pathogencontaminated water
Annual occurrence of diarrheal disease
– 4.1% of daily global disease
– 1.8 to 5 million people per year
Most concentrated in children
88
Categories of Pathogens
Bacteria
Viruses
Fungi
Parasites
Protozoa
Pathogen group: Viruses
Very small microbe
– 20 -100 nanometers
Dependent upon a
host cell to replicate
Resistant stages
Persist from months
to years
bacteriophages (indicators )
from Cells Alive
poliovirus
from Big Virology Web
90
Virus
Enteroviruses
Reovirus
Coxackie A, B
Hepatitis A
Adenovirus
Rotavirus
Parvovirus
Norwalk virus and Norovirus
Astrovirus
Cacivirus
Coronovirus
Associated disease
Gastroenteritis
Meningitis
Respiratory infections
Respiratory infections
Meningitis
Infectious hepatitis
Respriatory disease
Eye infections
Gastroenteritis
Gastroenteritis
Gastroenteritis
Gastroenteritis
Gastroenteritis
Gastroenteritis
91
Pathogen Group: Bacteria
Primitive organism
1-3 micrometers
Can reproduce in soil
and wastewater
Some form spores
Persist from days to
weeks
fecal bacteria on Millipore filter
Kunkel : Colorized SEM
92
Bacterium
Associated disease
Shigella
Shigellosis (dysentary)
Salmonella typhi and paratyphi
Typhoid fever
Salmonella (>1,000 serotypes)
Salmonellosis
Vibrio cholerae
Cholera
Escherichia coli
Gastroenteritis
Yersinia enterocolitica
Yersiniosis/Gastroenteritis
Leptospira spp.
Leptospirosis
Campylobacter jejuni
Gastroenteritis
Clostridium perfringens
Gastroenteritis
93
Pathogen Group: Fungi
Micrometers to millimeters
in size
Live on decaying matter
Can form spores
Airborne (aerosols) or
waterborne
Aspergillus
cosmic light web
Candida
10 micrometers av
Www.meddean.luc.edu
94
Fungi
Associated disease
Aspergillus fumigatus
Respiratory infections
Candida albicans
Skin and membrane
infections
95
Pathogen Group: Helminths
Roundworms
Egg: 35 to 60
micrometers
Adult ½” to 16”
Eggs are resistant stage
Persist from months to 7
years
Tapeworms
Egg: 35 to 45
micrometers
Adult: inches to feet (!)
Eggs are resistant stage
Persist from months to
years
anterior end “holdfast”
Helminth
Associated disease
Effect
Ascaris lubricoides (Ascarid)
Ascariasis
Rob nutrition, Intestinal
blockage, Mortality
Ancylostoma duodenale
(hookworm)
Hookworm
Anemia, hemorrhage
intestines
Necator americanus (hookworm)
Necatoriasis
Anemia, hemorrhage
intestines
Trichuris trichiuia (whipworm)
Trichuriasis
Rob nutrition
Toxocara (roundworm)
Toxocariasis
Rob nutrition
Taenia saginata (tapeworm)
Taeniasis
Rob nutrition
Taenia soleum (tapeworm)
Taeniasis
Rob nutrition
Vampyrolepis (tapeworm)
Worm Infection
Seizures (Brain)
Hymenolepis nana and H. diminuta
(tapeworm)
Worm Infection
Seizures (Brain)
97
Pathogen group: Protozoa
Single celled organism
10 to 100’s of micrometers
Reproduce via host
organism
Cryptosporidium
Can form cysts
Persist up to 23 months
oocyst (5-7microns)
Giardia
(cysts:10-14 micrometers)
98
Protozoan
Balantidium coli
Associated disease
Dysentary
Gastrointestinal ulcers
Cryptosporidium parvum
Diarrhea/nausea/fever
Entamoeba histolytica
Amoebic dysentary
Giardia lamblia
Giardiasis (diarrhea)
99
Special focus on Crypto
Extremely persistent – nearly 2 years
Resistant to disinfection
Short Life Cycle: <1 day life cycle within one host
Many (fecal – oral) routes of infection
–
–
–
–
–
–
–
Day care (diaper changing rules)
Family
Drinking water
Contact with infected animals
Contaminated food (e.g. Cider, lettuce, chicken salad)
Contaminated soils (risk assessment USGS)
Recreational water (Pools, fountains, water slides…)
100
Crypto
Largest waterborne illness outbreak
– Wisconsin in 1993
– Flood-contaminated drinking water
Toll
– 400,000 infected
– 4,000 people (1%) hospitalized
– 104 died
101
Crypto
Host list is growing
– Humans, cattle, swine, geese, oysters
High mortality especially if immunocompromised
No effective cure
102
Pathogens in Wastewater
Any pathogen in fecal material can be
present in wastewater!
Estimated viruses concentrations in septic
tanks
– Range from 107 to 1010 virus particles per liter
of wastewater if residents are ill
Canter and Knox (1985) and Charles et al. (2003)
Wastewater pathogens
Septic tank provides limited pathogen
inactivation
Effluent
– Fecal Coliform counts 5 X 10 6/liter
– Bacteria can reproduce here
– Some viruses not significantly inactivated
Sludge
– Protozoan/ worm eggs attached to floc
104
Limited documentation of health
effects from onsite systems
TYPICALLY, there is something wrong if
exposure occurs
– Surfacing effluent
– Inadequate separation
– Improper installation and leaking components
105
Improperly managed
wastewater treatment systems
May contaminate
– Drinking Water
– Recreational Water
– Irrigation Water
– Food
– Land
– Environmental Surfaces
– Air (as aerosols)
Physical
Factors
affecting
persistence of
pathogens in
soils
–
–
–
–
Temperature
Water holding capacity
Light
Soil Texture
Chemical
– pH
– Cations
– Organic matter
Biological
– antagonism
– predation
Bitton 1999 (Bitton and Gerba 1984)
Pathogen persistence in
biological aerosols
Travel
– Initial shock and desiccation
– Slow decline thereafter
Specific characteristics
• Viruses – enteroviruses hardier than bacteria or
coliphages
• Bacteria - encapsulated survive better than nonencapsulated
• Fungal - can travel great distances (Aspergillus)
(Bitton, 1999)108
Environmental survival factors
on surfaces
Attachment of viruses and bacteria
Moisture
Temperature
Presence of organic matter food source
Routes of transmission
Fecal/oral transmission
Hand to mouth
Ingestion in food and water
Inhale and swallow
Fomites - e.g., Coated on solid objects
Contact transmission through
Cracks and cuts
Mucous membranes
Skin
Vector transmission via
Filth flies and beetles
Two- and four-legged creatures
Vector transmission
relevance to exposed sewage
Documented occurrence of fecal pathogen transport on
houseflies & “filth flies” (nonbiting flies)
Viruses
polio (1943)
Bacteria
Vibrio cholerae(1983)
Shigella (1983)
E. coli 157(2000)
Antibiotic resistant - Salmonella (2002)
Protozoa
Worms
Cryptosporidium (1997 .2000. 2001. 2002 NC)
Hookworm larvae (1999)
Note: Found on and/or in flies
111
Occurrence of wastewaterrelated illness
Pathogen must be present in the
population to be present in the wastewater
It must survive the treatment process and
persist in the environment
In a susceptible host population
Exposure at the infectious dose range
Infectious dose range
Viruses
Bacteria
Protozoa
Helminths
10-100s particles
Shigella
10 to 100 cells
Cholera
1,000 to 10,000,000 cells
Campylobacter
100 to 1,000,000 cells
Cryptosporidium
1 to 10 oocysts
Giardia
10 to 100 cysts
roundworms
1 to 10 eggs
Tapeworms
1 to 800 eggs
Occupational health issues
Inexperienced people working in sewagerelated jobs
2-4 times higher rate of gastrointestinal
illnesses
Higher viral antibody titers
Occupational health issues
In general, WWTP workers
Viral, bacterial, and chronic helminth infestations
Well-documented risk for Hepatitis A & Leptospirosis
Inconsistent results for parasites
Increase in nonspecific illnesses – nausea, fatigue,
headaches….
More dermatological complaints
Respiratory – allergens – biosolids – insects
Urine mutagens higher in ST workers
Protect yourself, your co-workers and
your family
– Vaccinations
– No regulations but probably LHD requirements
– At a minimum, Tetanus
– Probably Hepatitis
– Do Not Wear contaminated clothing home if
possible
– If you do, wash it separately
Now that we have your
attention…
Let’s wrap it up!
Safety as a State of Mind
There is no substitute for common sense.
 Be aware of potential hazards
 Stay alert
 Be prepared
 Have and use proper equipment
 Practice good safety habits
 Get good information and training
119
Safety resources
NC Safety Handbook
OSHA
CDC
120
Staying safe: SIPDE
Scan
Identify
Predict
Decide
Execute
Safety FIRST, never last.
Have a future, not a past.
Questions?