39th Annual Meeting – Workshop: From the Lab to Field Choosing and Using Personal Protective Equipment (PPE)

From the Lab to Field Choosing and Using Personal Protective Equipment (PPE)

Dawn Bolstad-Johnson, MPH, CIH, CSP

Chris Stavroudis, Paintings Conservator in Private Practice

So I tried to take down as much information as I could that was presented at this workshop which, by the way, was excellent. There is a LOT of helpful and interesting information that (I hope) will be helpful and interesting to our blog-reading audience.

So, here we go!

Objectives of the Workshop:

  • Determine minimum PPE needed in the lab at disaster scenes
  • Review of Typical Exposures Hazards
  • Routes of Entry
  • Hierarchy of Controls
  • Common PPE
  • Common complacency of not using PPE
  • Health effects from typical exposures
  • Tips to protect yourself
  • How to address situations where all parties are not wearing PPE

Hierarchy of Controls

  • Engineering Controls
    • Local exhaust (e.g. fume hood)
    • Product replacement
  • Administrative Controls
    • Employee rotation for a task which involves the exposure, so that one person is not exposed to the hazard repeatedly
  • PPE is always the last resort
    • Wearing PPE should NOT create a new hazard
      • E.g. fire fighters have to wear it because you cannot engineer or administrate the hazards out
  • OSHA standard 29 CFR 1910.132
    • Employers need to do a hazard assessment to determine if hazards present necessitate the use of PPE
    • Students and volunteers are also included under this as well
    • Employers must certify in writing that the hazard assessment was conducted – job hazard assessment: hazards identified in all parts of the job that needs to be performed e.g. soot cleaning from painting
    • PPE selection must be made on the hazard assessment and affected workers properly trained. Defective or damaged PPE must NOT be used

Routes of Entry

  • Typical Hazards to Conservators
    • Inhalation
      • Particulate
        • Mold
          • Ubiquitous
          • Health concerns arise when the concentration of mold inside the building is significantly higher than outdoor concentrations
            • We are in filtered air inside building which should be lower than outdoor
          • Identifying the concentration of the mold is more important than identifying the actual species of mold
          • “Black mold” scare was the result of a report by the CDC that babies were inhaling stachybotrys and lungs were bleeding from the inside.  The actual truth was discovered in the autopsies: only the upper respiratory tract was affected.  The CDC retracted their statement after discovering the error, but it’s too late and the media has blown it all out of proportion.
          • Sampling techniques
            • Air samples on agar – potato dextrose agar for mold in early 1990s
            • Now with spore traps for air sampling – cover slide inside a cassette – captures live and dead – sample is about 5 minutes of air flow sampled
            • Swab samples also
            • Bulk samples (e.g. sample on wall, ceiling) – culture is performed
            • Need to compare with the OUTSIDE mold spore numbers to get an accurate picture of the problem
            • Where do you take the sample? Take 3 samples in the size of Marriot’s Salon A and 2 samples outside – 2 samples for a smaller space or 1 for a very small space
            • To get rid of it: remove moisture (e.g. dehumidifier); if it’s in the wall and has no way to get out (e.g. electrical outlets, phone jacks), there is nothing to worry about
            • Dry spores are just as harmful as active spores
            • As a practice, in a water soaked facility, check not only artifacts and shelving, but also the walls and the carpeting
            • Dust near water damage could be dry mold and therefore a respiratory hazard
            • Working in fume hood or elephant trunk is advised when working with any type of mold
            • Vacuuming: use HEPA vacuum and throw away the filter in plastic bag
            • Nilfisk’s helpful hint for filter disposal: put plastic shopping bag under the vacuum filter in the vacuum and then when you throw it away, you can bag it and throw it away
          • Facts about mold
            • Classified as viable (live) and non-viable (dead)
            • Both are health hazards if inhaled
            • Mold affects everyone differently
              • Mold growth in the lung is called – aspergilliosis, as aspergillus is the likely culprit
            • Mold can establish itself 24-48 hours following water intrusion
            • Most likely species will be penicillium (aggressive – first one “out of the gate”) and/or aspergillus
            • Presence of penicillium can introduce a musty odor to the environment – indicator
            • Concentration can change from room to room – odor just means a presence not necessarily at a toxic level because toxicity varies from person to person – floats in a “cloud”
            • TANGENT: Fact about cigarette smoke and “smoker’s cough”: Silia hairs in lungs are paralyzed by nicotine; when nicotine wears off, the silia then try to expel smoke by-products aka cough and when the person smokes again, the silia are paralyzed again and the cough goes away
        • Dust
          • When is dust an inhalation hazard?
          • 10 micron size particulate can get into your upper respiratory tract
          • 5 micron size particulate can get into your lower lung
          • What’s in dust?
            • Fire retardants from plastics in our house
            • Nuisance dust not otherwise specified
            • Asbestos fibers
              • Break along both axis making the fibers breathable
              • Asbestos is a natural occurring mineral and is inorganic
              • Our bodies cannot digest asbestos fibers.  When they deposit in your lung, your lung will try to digest the foreign body and it cannot digest it. Scar tissue will form over the fiber causing mesothelioma (cancer of the inner lining of your body only from asbestos – 30 year latency period)
              • Silica fibers do the same thing
            • Fiberglass
    • Should you be concerned with fiberglass exposure? Yes! No regulations for it, but you should be concerned, as it is extremely small shards of glass essentially.
    • Mouse droppings (hanta) – spray with Lysol to prevent particles from becoming airborne and spreading
    • Bird droppings (histoplasmosis)
    • Soot
      • Underwriters Lab – Average home has 1700 lbs of plastic in it
      • NIST Video of room containing legacy (all wood older furniture and natural fibers) versus modern (modern plastics, fabrics, etc.) – modern flashover time 3:40 / legacy flashover time: 30 minutes
      • You could be going into these environments for recovery
      • Modern room = more and more toxic during the fire and after
      • Fire soot contains: AIC Journal article– hydrochloric acid, metals, cyanide salts.
    • OSHA standards are MINIMUM STANDARDS and some have not been updated since 1968! When protecting yourself and others, do better than the OSHA standards
    • Paper masks cannot be used for asbestos (P100, N95)
    • Charlie Morecraft – Exxon – safety videos
  • Respirators
    • Protection Factor of 10 (although she says that the paper disposable ones shouldn’t have that good enough of a seal around the face to provide that amount of protection).
    • Half mask respirator is better than the disposable mask
  • Tyvek suits – plastic guard for asbestos
    • Now breatheable suits are available also made of Tyvek – KleenGuard Select made by Kimberly-Clark
  • Videos for safe removal of PPE e.g. gloves, suits so you don’t contaminate yourself/ skin/ clothes: one example: http://www.youtube.com/watch?v=iHBbWLYpCuU
  • Bootie covers to prevent contamination of shoes
  • Chemicals

    • Absorption
      • Solvent on Hands
        • Includes all solvents you use
        • Isopropyl alcohol to kill mold
        • Chronic use of solvents can often result in the defatting of the skin if proper gloves are not worn
        • Glove limitations
          • One type of glove is not sufficient for all of the different chemicals you may use in your practice
            • E.g. Nitrile gloves are not recommended for Methyl Ethyl Keytone
          • Check with the glove manufacturer for their Chemical Resistance
          • Glove Breakthrough Times – USE CHARTS made by glove manufacturer e.g. Ansell
          • For mixtures of solvents, get a glove that covers all solvents. If not available, use the one that has the highest concentration in the overall mixture
          • Latex – overall poor choice because they are very porous and latex allergy
      • Chemical in the eyes – anything that can splash
        • Amount in container doesn’t matter – if it can splash, it’s an eye hazard
    • Ingestion
      • Studies show that a person raise their hands to their face once every 20 minutes
      • Ingestion occurs from hand to mouth activity
      • Blood contamination
      • Sewage contamination
        • Standing water of unknown origin could be sewage contamination
        • Can be sampled for e-coli – litmus test for sewage – can do this dry – can be there weeks, months later
          • Test results are a week turnaround time – not a quick test
      • Hepatitis B can survive up to 7 days in blood
      • Hepatitis A can survive up to 7 days in sewage
      • Wash your hands A LOT
      • Handwashing: antibacterial soap NOT a good idea because it kills good and bad bacteria – use alcohol-based sanitizer if no handwashing stations available
      • What is proper handwashing? – 15-20 seconds! Sing Happy Birthday twice! Soap up and vigorous rubbing
      • Artificial nails harbor a LOT of bacteria (ewww)
      • CDC has a video on proper handwashing to the tune of Rolls Royce’s “Car Wash” (dance while washing your hands!)
    • Insect Bites
      • Mosquitoes
        • West Nile
        • Malaria
        • Encephalitis
      • Bed bugs
        • Look for in hotel under sheets and mattress pad/ cover– little ink spots from ballpoint pen – fecal matter from the bedbug (ick)
        • Kill with heat treatment!
          • In one instance in a building infestation, propane heaters were placed in the building and heated up to 160F degrees for four hours
          • They apparently have dogs that sniff out bed bugs and mold too!?! Apparently bed bugs give off an odor… eww…
    • Eye injuries
      • Ammonia burn
      • Chemical burn
      • Corneal laceration
        • Eye wash ASAP! FAST!!!
        • Run eye wash 1x / month for maintenance
      • Engineer your hazard out – splash injury – use dispensing bottle, smaller amounts so less risk for splashing
      • Wear goggles with contact lenses – contact lens can fuse to eye
      • New eye protection standards in latest AIC News
      • Common causes of chemical eye burn
        • Ammonia, bleach, and toilet bowl cleaner
        • Vinegar and glass polish
        • Dishwasher detergent, oven cleaner, drain cleaner
        • Contact lens cleaner
        • Car battery fluid
      • PPE for eye protection
        • Goggles
        • Safety glasses and face shield
    • Ergonomics
      • Proper lifting techniques
        • Elbows tucked into torso versus stretched arm
        • Bending at waist to pick up something versus bending legs
      • Reaching techniques
        • Keep load close to your body – no outstretching – same for typing, or reaching for the phone
      • OSHA Zones
        • Green zone
          • Arms tucked tight into your torso biceps doing the work
        • Yellow zone
          • Some extension but not full
        • Red zone
          • Full extension of arms
          • Full extension of torso
          • Back brace serves as reminder to use legs, but does not provide support
      • Seat position: two finger width distance between knee and edge of chair
      • Slide seat panel out for long legs
      • Back support for some chairs – adjustable
  • Minimum PPE for Emergency Response
    • Thin nitrile gloves
    • N95 filtering face piece
    • ½ mask respirator with cartridges
    • Steel toed shoes
    • Safety vest
    • Hard hat
  • How often should you replace PPE?
    • Respirators
      • ALWAYS if the respirator face piece shows any signs of deterioration, cracks, etc. or if the inhalation valves are cracked, warped, or missing
      • Check with the manufacturer for specific shelf-life years
      • Generally speaking they should be replaced every 5 years
    • Glasses
      • Immediately if there are excessive scratches or damage
      • 10 years otherwise
    • Goggles
      • Immediately if scratches/ damaged
      • Every 3 years
    • Gloves
      • Stored in a response bag
      • Replace with new gloves every year
  • During the workshop, they put this phosphorescent powder on our handouts to see how much we touched our faces! LOVE IT!!! I didn’t touch my face because I was so busy typing for this blog…
  • Portable UV light was used to detect powder – UV 5X shortest wavelength (340 nm I think was the shortest wavelength for the light)
  •  

  • Lab Safety
    • She listed the standard “dos and don’ts” that we all know we should do… but often don’t do. Listing the standard dress code, don’t wear open toed shoes, tie your hair back cited the Yale example of the girl who died in the chemistry lab this past year.
    • General safety rules: no food and drink – cross contamination. Know the equipment you’re using, know where all safety gear is, bucket of safety glasses by the door for visitors
    • Health hazards in the lab: organic solvents, chemistry professor died from mercury poisoning after a small drop of dimethylmercury got on her glove.  Post doc wearing wrong glove when working with concentrated sulphuric acid – 2nd degree burns
  • Tips, tricks
    • Electricity
      • Electricity and water don’t mix
      • Is the power off when they told you?
      • Is the power on when they told you?
      • GFCI device
      • Circuit alert non-contact voltage tester – non-contact (device to detect conductivity). Also one for testing the lights in your Christmas lights
    • Wear the right footwear – electrical insulating, steel toe, high enough to keep socks dry
    • Use HEPA filter vacuums ONLY
    • Herd mentality
      • In response stay with the herd, use the buddy system, have a meeting point in case you get separated
    • When people won’t wear PPE:
      • Fire fighters – “like teaching safety in a frat house” (I thought that was HILARIOUS BTW) – SCBA (Self-Contained Breathing Apparatus) needs to stay on because they enter “chemical soups” that our half face masks couldn’t handle
      • Legal issues with handing out masks to laypersons e.g. firefighters handing out masks to homeowners after a fire
      • Think of it this way in terms of people refusing to wear PPE: give people the knowledge and then if they choose not to wear PPE, then they know the risk
      • Responding to after fire, formaldehyde is the biggest danger as a carcinogen. Use CBRN canister (Chemical, Biology,  Radiological and Nuclear) that protects against formaldehyde
  • If you find any errors, spelling errors, etc. please let me know and I will be happy to change them! Thanks so much.