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#61: On the Frontlines of COVID-19
97 Plays5 years ago
In this episode of the podcast, series host Jill James speaks with Mark Catlin. Mark has previously been a guest for episode 11 and also our Special Dedication Episode to Dr. Eula Bingham. Mark is an Industrial Hygienist with MDC Consulting and Training in Maryland. Like many, Mark has been on the front lines throughout this pandemic, utilizing his talent, training and expertise to protect essential workers.
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Transcript
Introduction to Accidental Safety Pro Podcast
00:00:10
Speaker
This is the Accidental Safety Pro brought to you by Vivid Learning Systems and the Health and Safety Institute. This is a special edition of the podcast and was recorded on June 18th, 2020. My name is Jill James, the Health and Safety Institute's Chief Safety Officer. Today, I'm joined by my friend and now perennial favorite to the podcast, Mark Catlin. Mark has been a guest for episode 11 and also our special dedication episode
Mark Catlin's Pandemic Role
00:00:36
Speaker
to Dr. Yula Bingham.
00:00:37
Speaker
Mark is an industrial hygienist with MDC Consulting and training in Maryland. Like many, Mark has been on the front lines throughout this pandemic, utilizing his talent, training, and expertise to protect essential workers. I've asked Mark here today to talk about what he's been up to these past months. So welcome back, Mark. Thank you, Jill. It's good to be here.
00:01:01
Speaker
Yeah, so pandemic, industrial hygienist, the work that you've been doing for your your life's work for now what are you in your how many years almost 40 years almost 40 years. Yeah. Yeah. So what has what this what has this pandemic been like for your your career? What have you been up to?
00:01:25
Speaker
Well, I was I was sort of semi retired and doing some consulting work over the past 18 months and and this is sort of. Consulting work that I had scheduled to do in 2020 just simply vanished like for many other folks because you can't go on site anymore. We can't.
00:01:44
Speaker
We can't go out and do things in person. And what it's been replaced with is actually a lot of assistance to folks who are working on the front lines mostly in healthcare but other areas.
00:01:59
Speaker
and doing it via conference call and Zoom and email. And so the work has really changed. I stay isolated in my home because I'm in the high risk categories for COVID-19 and so I'm staying isolated. But happy to be able to do
00:02:19
Speaker
work out of my home to try to help people that are working on the front lines and actually feeling like we're actually making some progress in helping out.
Past Crises Experience
00:02:31
Speaker
So at least do this first wave and hopefully things will be better in the second wave and third wave until we have a vaccine.
00:02:37
Speaker
Yeah. And so, you know, dealing with dealing with a crisis like we're dealing with now isn't something new to your career. You've responded to other crises in your career as well, correct? Yeah, I never planned this at all. But my initial sort of disaster response was in 1989 to the Exxon Valdez oil spill and the health and safety issues around workers and that cleanup.
00:03:05
Speaker
that massive cleanup of over 10,000 workers in Alaska. And so that was my first foray. And at the time I thought maybe my last disaster because they're really hard and you're consumed throughout the disaster. It was a good six or eight months during the Exxon Valdez oil spill. That was everything that I did. But then it turns out years later I was
00:03:32
Speaker
working with the Service Employees International Union in D.C., and that union has lots of health care members, and then H1N1 hit. And then suddenly we were in the sort of, you know, what we thought was a pandemic then, at least an epidemic, for a good six months, and that was pretty all-consuming. And then five years later, the Ebola crisis hit.
00:03:55
Speaker
And although we didn't see a lot of cases in the U.S., there was a huge amount of work to prepare and try to figure out how to deal with that from the health care industry. And so I thought that was like.
00:04:07
Speaker
That was probably like the most intensive work I thought I would ever do. Cause the Ebola work was seven days a week, probably 18 hours a day for six or eight weeks. It was pretty, you know, pretty exhausting. But then now we're in the pandemic and this is a hundred times worse and you know, it affects everybody and everything. And so yeah, you know, I'm looking forward to not having disasters in the future to work on.
00:04:33
Speaker
No
Challenges for Health and Safety Professionals
00:04:34
Speaker
kidding. I've talked to more health and safety professionals who have said that they've never worked harder in their careers. And it's so interesting to think about that. You framed up and talking that you've been working from your home this whole time. And so have many of us, though many more have not.
00:04:55
Speaker
But we're working, myself included, harder than we have in our careers. From whatever station we're doing that work from, we're working really hard. Yeah. And thanks to all of you that are working full time on this. And this work is hard because it's...
00:05:18
Speaker
There's an end point, but it's really uncertain. We're looking at a year or more down the road probably before this really ends. The information is constantly changing. I mean, we went through the initial phase and then we went through the lockdown and now we're, not everybody locked down. Lots of people kept working and now we're back with reopening. So there's lots of, there's a fire hose of information, reports and scientific studies that come out.
PPE Reuse and Solutions
00:05:44
Speaker
and guidance that comes out. And although a lot of the basic CDC guidance hasn't changed dramatically, like the CDC still says healthcare workers need respiratory protection, there's all sorts of caveats that if there's a shortage and if you can't get N95s, then all these other things that we never really seriously thought would take place are taking place, like using surgical masks instead of respirators and trying to act like that's okay,
00:06:14
Speaker
the decontamination of N95 50 cent respirators meant for single time use and the idea that we're gonna people gonna wear these people gonna wear these you know full shift or multiple shifts and then we're gonna decont them you know multiple times and give them back to people I mean this these are things we never
00:06:32
Speaker
never bright. I'm expected to have to see and I hope we get past it and never have to see it again. Exactly, exactly. When Mark, when you and I were talking prior to recording, you had mentioned that you really wanted to find a way to focus on something positive in this pandemic by way of your work and your contribution. And you shared a couple of those things with me and you started talking about it right now with regard to respirators.
00:07:00
Speaker
Yeah, can you talk more about what you've discovered and what you've been working on in that regard? Yeah, yeah. So there's been a couple key areas that I focused on, and I realized early on that it was so overwhelming with what was happening, and I was working primarily with healthcare organizations.
00:07:21
Speaker
it was so overwhelming it was it was just too much and so i realized i needed to sort of focus in on on a smaller number of areas where i could focus and maybe have an impact and so um so it turned out one of the one of the early things that i i had openings and i've continued to work on is is that is trying to trying to encourage health care organizations
00:07:45
Speaker
to switch from N95 respirators, which are both in short supply and have their own other sets of problems, but to switch to elastomeric reusable half-face respirators with P100 cartridges. I've been advocating that on and off for probably the last decade since H1N1.
00:08:07
Speaker
And without much success, when it's not a crisis, people aren't thinking about needing to switch types of respirators. But certainly now it's a more important issue, and we're looking at this for a year or more, so what can we do to help protect healthcare workers?
00:08:28
Speaker
And I presented in 2018 for the Service Employees International Union, who I was the Health and Safety Director at the time, and I presented at National Academy of Science meeting that was assessing the possibility of elastomeric respirators for use in health care, either in normal use or in surge uses like during a pandemic.
00:08:50
Speaker
And, and there was a report that came out, you know, and the panel, the panel did a really excellent report that came out just in early 2019. And it's now getting a lot of attention because we're in the middle of this pandemic, but the idea of
00:09:05
Speaker
of using a respirator that, those of us in industrial hygiene, you know, that's been a standard respirator used in many work sites, both environmental work, construction, industrial work, you know, for decades. But in healthcare, it's only been used by a small number of healthcare systems, and mostly, you know, either healthcare systems weren't aware of it or they dismissed it as not something they needed to think about. And luckily that's starting to change. Sorry.
00:09:34
Speaker
Um, for anyone who, you know, especially if anyone in healthcare is listening right now, and they're not familiar with what an elastomeric respirator is, can, can you kind of draw a picture for people in their minds of what you're talking about?
00:09:49
Speaker
in case they're not familiar. Yeah, sure.
Advocating Elastomeric Respirators
00:09:52
Speaker
So these are a reusable type of respirator. They're a face piece that covers the nose and under the mouth and under the chin. So it fits about half of your face, lower part of your face. And it's a rubberized or polymer material.
00:10:10
Speaker
And it has filters or cartridges that are replaceable. And then it has a harness so that it holds it tightly on your face and tightly against your skin so it protects you. And so these cost between $20 and $40 depending on where you buy them and how many you buy. The filters are a couple dollars a piece. And you can get filters that are
00:10:38
Speaker
that are equal to or better than the N95 filter that is commonly used in healthcare. And these can be cleaned and disinfected readily and then reused. The healthcare environment is not a really heavy duty environment for how these are made.
00:10:59
Speaker
These are often made for industrial and construction use. But in a healthcare environment, these will probably last a year, maybe more. The filters would last at least a few months and maybe even more. In a healthcare environment that's not dirty and dusty, you're only trying to capture the droplets that contain the virus particles out of the air. And so these are a type of respirator that if healthcare institutions would use them,
00:11:26
Speaker
They don't have to worry about stockpiles of N95s and supplies and then not getting supplies, reusing the N95s over and over and over again, trying to decontaminate these again.
00:11:40
Speaker
They don't need to worry about switching from one brand to another and then you have to refit test everybody because everybody would have one respirator and they could use that for an entire pandemic. So I've been really pushing that this would be a really reasonable solution for the healthcare industry
00:12:04
Speaker
for this pandemic and beyond, but certainly during this pandemic to get ready for the second wave and maybe third wave and help us protect healthcare workers and stop the exposures that we're seeing. And are they more comfortable to wear as well, Mark, compared to an, let's say, N95? We've all been looking at pictures of
00:12:24
Speaker
people whose faces have been abraded from trying to get the N95s to fit and fit tightly on their faces, and they're working and sweating in them throughout their work. Yeah. Well, I generally try not to use the word comfortable with a respirator, because anything you wear on your face for half an hour or more, and the longer you wear it, the more uncomfortable it is. But I don't think they're any more difficult to wear
00:12:53
Speaker
than the N95s. I think there's real advantages to them. I think the harnesses and the way that they fit on their face is better and I think that it actually seals over a broader surface so there's less pressure I think on the skin.
00:13:12
Speaker
They fit better, and if you're wearing these half-masked elastomeric respirators, you can do a user seal check really readily on most of them, and so you know when you put it on as a worker that this is seated on your face right, and this is protecting you. That's much harder to do on most of the N95s from my experience.
00:13:32
Speaker
The P100 filters are what we used to call HEPA filters. They're actually better filters than the N95, which is, the N95 is 95% filtration efficiency and the P100 is 99.97%. So it's a better filter. Even though they're given the same protection factor rating, which is a measure of how well they seal on the face, I think most hygienists would agree that the half mask
00:14:00
Speaker
elastomeric respirator seals on the face better than an N95. I mean I feel much more comfortable with N95 on to protect me against airborne hazards than I would an N95.
00:14:15
Speaker
Oh, you mean in a last American, more comfortable? Yeah, last American. I mean, it protects me better, I think. And if you do the qualitative fit test or the quantitative fit testing, you can see that the protection factor, the actual protection of that respirator is generally way higher than what you would see when you do the quantitative fit testing on N95. And the fact that they're
00:14:39
Speaker
that they're reusable and that one per worker would last the entire pandemic, the whole issue of supply problems and shortages, which has been a huge problem. And I know a lot of healthcare industries I talk to there.
00:14:52
Speaker
You know, they have people that are doing nothing but on the phone all day long trying to find supply. You know, if we had these, then that issue is not there. And those several hospitals that have been using Elastomerics, they're not facing supply issues like everybody else. They're able to focus on other issues of worker protection and getting the healthcare work done for the care they provide. So are the Elastomerics readily available?
00:15:19
Speaker
Well, they the one of the problems early on, you know, normally they're readily available. But what happened is many of these many of the manufacturers make their last America in Asia. And so the same issue we had with 95 and other respirators that are that are many of which are made in Asia, the supplies.
00:15:36
Speaker
shut down and but it wasn't shut down as I can see it because they were everybody wanted them they were shut down because of the pandemic and so those factories have now opened up and what I've been hearing even just this week is that is that there seem to be ready supplies of elastomerics available maybe not all the all the manufacturers and all the brands
00:15:58
Speaker
uh... and all the styles but but if you want to last america what i'm hearing now is you can get a last american even by you know even even by a you know hundreds at a time are are now available yeah yeah yeah so mark what has your experience been in terms of in terms of talking with uh... with the health care uh... industry and and other industries of you have you been able to move the needle in your work and and and share news of this kind of respirator as a as a
00:16:26
Speaker
as a better, perhaps, and as an alternative. Yeah. Well, it's been real mixed at this point. There were a couple systems that have been using elastomerics actually for a long time. The University of Maryland Medical System, they started using elastomerics after H1N1 when they started seeing
00:16:47
Speaker
possible supply problems with N95s and they had a CIH Jim Chang who had a lot of experience in other industries and he convinced them apparently to use to try elastomerics and so they've been using elastomerics and N95s but now they're you know they're using elastomerics and that helps them with their supply issues and
00:17:10
Speaker
I've heard him speak. He was fabulous. Yes, and he and Dr. Stella Hines, who's a physician, and they've both been really strong advocates for the use of elastomerics and disinfecting and other use issues. And they've been very generous with going to go public and talk about why they're doing this and encouraging others in healthcare to do it.
00:17:35
Speaker
The other place that has done it, a facility that never used N95s that started back in the late 1990s when hospitals were using N95s for tuberculosis, they went right to Elastomerics. They were at the Texas Center for Infectious Disease. They're in San Antonio.
00:17:55
Speaker
And they're a really interesting facility. They're a state-run infectious disease center. They mostly see TB patients, and this has been their history. And so they have this campus on
00:18:11
Speaker
in San Antonio and so they have a lot of full-time patients who are there getting their TB treatments, but they also do other infectious diseases and they've been seeing COVID-19 patients and they started off, I was lucky enough to go down and visit and they were also incredibly generous about talking about their experience and I was able to visit their campus and meet them and tour what they were doing and so they
00:18:38
Speaker
They said that they never started with N95s, and their issue was cost. They said, when we started looking at how often, because all of our staff are in daily contact with our TB patients, so they would be using lots of N95s. And they said, the cost seemed so large that we found the last Americans, and that it was mostly a cost issue. But they said, once we started to use them,
00:19:04
Speaker
that we found that they were so much better and to use and the worker protection was better that we've never looked back. Yeah, interesting. And they've encouraged other facilities to switch and without a lot of success until recently now with the pandemic. But those two institutions have been incredibly generous with both on the National Academy of Science
00:19:27
Speaker
panel review of elastomerics and since, and especially during the pandemic, generous about sharing their experience and giving advice on what they think other people might do. And there's been a number of healthcare systems that are with the shortages have started to now talk to them and have started to look at using elastomerics either on a pilot basis. And I worked with one hospital in Kentucky and they were happy to try out and to pilot elastomeric use.
00:19:56
Speaker
In their in among their health and among their nursing and physician staff that we're going to be doing intubations. And so that's a high risk procedure. Yes. And you're close to the patient. There's lots of chance for the patient to coffin.
00:20:10
Speaker
and so lots of potential exposure. And so they weren't facing N95 shortages at the time, but they said, this looks like a better idea. And so they were able to, I actually helped them get a small supply of respirators by talking to an environmental contractor that worked with the asbestos workers union that I knew people at, and they were willing to donate.
00:20:39
Speaker
a bunch of half mass to the hospital to help out. And it was funny because the contractor who was great, the owner of the contractor, when I told him what I wanted, he said, well, we've already donated N95s to the hospitals. He said, we never had a mass for elastomerics. And I said, well, here's a little short history about that. He goes, well, this makes a lot more sense. He says, we don't use N95s much in our work. We use elastomerics as our bottom line respirator.
00:21:09
Speaker
Yeah, so it was really wonderful to connect those people together and and so, you know, the last I've heard they were doing fine and, you know, I hadn't heard that they had expanded to a larger group, but but since then the the other hospital that I've done a little bit of work with is that I've helped with is.
Transition to Elastomeric Respirators
00:21:29
Speaker
the Allegheny Health Network around Pittsburgh. And they've actually switched, they're switching over to a last American half mass in the last month or six weeks because of the shortage issues. And I believe MSA has their headquarters there and MSA has been working with them to help
00:21:48
Speaker
help them do the transfer. Will it supply? Yeah, sure. And there's an article coming out that some of their medical folks have just written about the experience of transferring over to Alaska Americans. And I haven't seen the published article yet, but it sounds like they have some really positive things to say about. And again, being willing to share their experience of how they as a health care institution
00:22:13
Speaker
um you know looked at this and how they've how they've adapted this you know some of the issues are how do you do proper clean and disinfecting both between patients and at the end of the shift yeah that's what i was just going to ask what is the utility of that what are people discovering works yeah
00:22:29
Speaker
Well, the use of these half masks, they can be easily cleaned at the end of the shift and they can be dismantled. So the key is to take out and to remove the cartridge, the filter, the P100 filter. Because if that filter gets wet, then that filter is no good anymore.
00:22:51
Speaker
You don't need to replace that filter all the time. The filters, what you need are the filters that have a hard plastic case. Some filters have a covering that are designed to go over the filter. If you have one of those, you can clean the case or the filter itself. You don't need to get the filter wet. You can clean that with disinfecting wipes that are commonly used in healthcare. It's kind of like bleach wipes that all the rest of us use.
00:23:16
Speaker
And then you can just take the rest of the face piece and you can wash it in soap and water, just standard soap and water. And then there's a bleach solution or other solution to disinfect it in. And so it's been shown in a number of studies, including the work at the University of Maryland, that these can be readily both cleaned and
00:23:37
Speaker
disinfected so that you're not spreading any infection by using it. Between patients what they have is a multi-step process of using disinfecting wipes to wipe off the respirator so that
00:23:53
Speaker
a healthcare worker wearing this between patients can do a quick and dirty disinfecting, but it seems to be effective. It stops this. It doesn't allow for spread of COVID. And so it's not a hard thing that you can train workers to do and that workers can easily do.
00:24:10
Speaker
And then one of the big questions that comes up is, how do you handle the end-of-shift clean and disinfecting and inspection? And so the Texas Center for Infectious Disease, they make that an individual responsibility, and they provide the supplies. I was just going to ask. OK. Now, they're a smaller facility with probably 150 staff, I recall.
00:24:34
Speaker
And so what they present the respirator is, and it's what I've seen in my environmental construction work, is they treat it as a tool that you as a worker get as part of your job. And then you're trained to take care of it, you're given supplies and the time to do it. And then because that's your respirator and it protects you, most of the time people do a really top-notch job of taking care of it because you're the one who suffers if you don't.
00:25:02
Speaker
But then they have at the Texas Center, they have in-house staff in their respiratory division that does pulmonary function and other stuff. They've become the respirator experts, and they're readily available. Everybody knows who they are, and if you have any questions or issues, you go talk to them, and then they help you. And if you need a new respirator, they'll get that for you. They do the fit testing. They do the medical evaluations and all that.
00:25:28
Speaker
So that's their model that seems to work really well for them. The University of Maryland Medical System, they have workers clean the respirators in between patients, but at the end of the shift then they collect these to a central point where they're cleaned and disinfected and inspected and put back together the next day.
00:25:46
Speaker
Sure. Probably similar to any other medical instruments that need to be cleaned. Right. Right. And so, you know, those are kind of the two basic ways that when I talk to facilities, it's usually like that's usually a big question is how do we do that? And right now that brings up issues of how does your workflow, how, you know, how much storage do you have? You know, one of the downside staffing to clean. Yeah. One of the issues that I think resonates with
00:26:15
Speaker
healthcare workers when I talk to them about elastomerics is they like the idea that they could get their own respirator and that they would take care of it themselves and that that's they're the only one who puts it on their face and so if you use the centralized method
00:26:31
Speaker
it would be better if you had a way to ensure that those workers who turned a mask in got the same one back. But that doesn't, you know, if you've done a proper job of disinfecting cleaning, you don't need to do that. But what I found is workers often are much more favorable if they know it's their mask that they're putting in and they're not sharing masks between people.
00:26:52
Speaker
Yeah, increases the comfort. Yeah. And so if people aren't familiar with the fit testing that's required for those, can you walk through just a little bit about that Mark in terms of, you know, is this something an entity can do on their own if they have never done that before?
00:27:10
Speaker
Yeah, it's the fit testing for an elastomeric can be done exactly the same way as the fit testing for an N95. So there's OSHA has a specific protocols that are required to be followed and that's in the respirator standard. And there are qualitative methods where you
00:27:30
Speaker
where you test someone's fit to the respirator using a test agent that they can smell and taste while they do a series of exercises. And so you can do that. It's the same protocol whether you're wearing an Elastomeric or an N95. And so you can do that. Then there's also quantitative methods using a machine and a computer that actually measures the fit and the seal of the respirator on their face.
00:27:55
Speaker
Port account is the primary manufacturer that makes that. There's a negative pressure unit that's also available. So you can use either method, but you can use either method on an N95. But my experience is the Elastomerics are easier to fit tests because they tend to fit people better.
00:28:13
Speaker
And there are hospitals that have actually had problems with different N95 styles where they can't get a lot of their staff to fit because a lot of the staff are women and their faces are smaller and the respirators are trying to fit them. The N95s are sort of designed for a male industrial workforce and so they just don't tend to fit as well.
00:28:34
Speaker
The Alaska Americans tend to have a much easier time fitting to the, you know, you might do, most people will fit on the first try with the first selection, and if not, usually the second try. Most people will, you'll be able to find a smaller, larger size, so. Yeah, and they generally come in how many sizes, Mark?
00:28:53
Speaker
The elastomerics usually come in two or three sizes for each model, so there's usually a small, medium, large, or a small, medium, and medium, medium, small, depends on the manufacturer. So the main objection to these, the two main objections in healthcare that we saw at the National Academy of Science
00:29:14
Speaker
review was that one was how they look that they just looked weird to have these bigger face pieces on people's face and they're usually in black and they look sure they look more imposing and so you know that was one objection that it would it would put off patience and
00:29:31
Speaker
And that's sort of not an issue anymore, I don't think, because we're in a pandemic and I don't think there's any question about whatever people have on their face, no one's going to raise a ruckus about it. The other issue was, could you disinfect these so that you don't spread infection through a facility? And I think we've been able to see with the work from the Texas Center for Infectious Disease and the University of Maryland
00:29:55
Speaker
and NIOSH has done some work on this, that these things can be cleaned and disinfected and used in healthcare without becoming a source of infection. And especially when we're looking at the reuse of N95s or the extended use of N95s or the DECON and reuse of N95s, I think this is a much better choice to protect healthcare workers.
00:30:19
Speaker
Yeah. It sounds like the thing I'd want. Yeah. Are you seeing it being used in other industries as well to protect from the virus? I know you had mentioned it's very standard kind of respirator to be used in industrial settings, but outside of healthcare right now to protect from the virus, who else are you seeing using?
Beyond Healthcare: Elastomeric Respirators
00:30:40
Speaker
Well, as places are opening back up, I think that we're seeing the use of certainly in construction, I think. It's one that they can use in building trades workers and other people that do building maintenance, who probably historically have used these respirators for lead prevention, protection, and asbestos work.
00:31:04
Speaker
you know this they can you know i i don't think they they realize early on that they could just use the same respirator and so it needs to be mentioned that this is a that you don't need to go find n95 that you can use these and they're actually better um and so i i suspect there's going to be other you know i haven't done a lot of work in industrial sites yet
00:31:22
Speaker
during the pandemic, but I suspect lots of industrial sites could get in use these respirators because it would fit with other protections they would need to provide anyway, right? Because we can't forget about all the other hazards that people face on their normal jobs. People who are exposed and working.
00:31:40
Speaker
I mean in health care we have to keep remembering that it's not just you know COVID-19 is the focus but we still have blood-borne pathogen issues and needle stick issues and we have safe patient handling problems and lifting and we you know back injuries and we have workplace violence which is showing up in some places so there's all these other issues that we have to deal with
00:32:01
Speaker
in a normal work are that much worse now because everybody's focused in on the COVID-19, people are exhausted and tired, work has changed. And so there's an unsettled, there's lots of people that are unsettled in what they're doing. And so I think all these health and safety issues during disasters get worse in addition to- Yeah, amplified for sure. Yeah. Yeah, yeah.
00:32:27
Speaker
Mark, I know that you've also been doing some work trying to raise awareness on infectious disease standard and some work that California has been underway with for quite some time.
California's Infectious Disease Standard
00:32:41
Speaker
Do you want to talk about that? Yeah, thanks. So the other kind of work I've been doing that really feels like I'm doing something positive is work with health care organizations in California.
00:32:56
Speaker
And in California, many people are not aware of this, but California has a state OSHA plan. So they have, you know, they do their own enforcement, but they also can set their own standards. And so federal OSHA doesn't currently have an infectious disease standard for respiratory disease. They have the bloodborne pathogen standard.
00:33:14
Speaker
But in California, after the SARS, the original SARS outbreak in Toronto and Asia in 2003, there was an interest from the healthcare employers and there were also concerns about TB. There was an interest from healthcare employers
00:33:29
Speaker
on on doing something about fit testing and use of respirators because it was at that point it was new to many of those healthcare sectors and so they came to Kalosha and they asked was there some way they could figure out a way to get some relief from fit testing requirements for respirators and the Kalosha staff to their great credit they said well
00:33:51
Speaker
They didn't just say no, they said maybe, but we need it in the context of a comprehensive infectious disease standard for infectious disease. And so what they then did is they pulled together stakeholders and they have a process in California with a standards board that's really good. And so they pulled together with the CAOSHA staff and they pulled together a meeting of
00:34:13
Speaker
of healthcare and other employers that might be affected, labor organizations of which I was working for the Service Employees International Union, and community groups and public health folks. And they brought people together over several years in lots of meetings to talk about what might this standard look like. And they ultimately came out with a standard in May of 2009
00:34:37
Speaker
Now May of 2009 was the May 21st was the date. It was my birthday and I remember that forever. And I flew to San Diego where the standard board meeting was and they were going to have their final vote with the board of the it's a publicly appointed board by the governor with
00:34:53
Speaker
representatives across the employers, employees, public sector, public health. And so their board had to vote to adopt or not adopt the standard. And so we had heard lots of good, everybody was feeling pretty good about the standard.
00:35:08
Speaker
And there had been a lot of good compromise, like you need to get a standard pass. And essentially what the standard did, it was a little more than this, but essentially they took a lot of the CDC guidance from 2007, which was the latest update on their infection control procedures for healthcare. And they put those procedures, they put those CDC guidance, which are voluntary, into the occupational health framework
00:35:35
Speaker
of a standard written in a typical way we see standards, right? Like the bloodborne pathogen standard. So there's an exposure control plan and there's a section on PPE and there's a section on- Post exposure follow-up. Post exposure follow-up and training education and record keeping. A typical standard that we occupy in patient health see. But it was gonna become mandatory. So it would be the minimum requirements for all healthcare institutions in California. And it also covered nursing homes,
00:36:07
Speaker
Public safety officials police and fire department paramedics, you know, it covered some high risk populations like prisons and. Drug treatment centers and TB clinics and people that do.
00:36:21
Speaker
public health people that do outreach and testing, which has been really helpful for the pandemic because of all the testing that's going on. And so at that final standard board meeting, I was never at an OSHA hearing like this. Everybody from our side on the unions to public health, to the employers, all praise the state, all praise the staff. The staff got a standing ovation and it was passed unanimously.
00:36:50
Speaker
And what the employers all said was, we can do this because we already comply with CDC guidance and better. And so there's not a problem. This is fine. And so we got this occupation. So Cal OSHA got an occupational health standard that deals with droplet and airborne spread diseases that became in effect during H1N1. It was in effect
00:37:13
Speaker
during Ebola. It covered Ebola. It was in effect during various whooping cough and measles outbreaks they've had and other infectious disease outbreaks and tuberculosis. So it's been around over a decade and it's had an impact on
00:37:28
Speaker
It's not perfect like no standard is and employer compliance hasn't been perfect, but it's a good model and it actually is the model for the draft federal OSHA infectious disease standard that's currently kind of sitting out there waiting. We're hoping it'll go into effect at some point.
00:37:47
Speaker
How long have we been waiting on the federal end? Well, Federal OSHA started working on their infectious disease standard about a year or two after the Cal OSHA finished their ATD standard. It's gone through the early regulatory process, it's gone through the small business subrifah process, and from what I've heard, it's not that far from being finished if the agency is simply told we need a standard and it could be
00:38:18
Speaker
you know, it could be out quickly and it would be out and the way it's been talked about is it would be out as a temporary emergency standard quickly within a timeframe for making it permanent, but the temporary emergency standard would get us through the pandemic.
00:38:35
Speaker
And then there could be, you know, then there'd be more time to think about, okay, what worked, what didn't work, how do we revise it, how do we make it work better? And, you know, the hope would be it could be as successful as a bloodborne pathogen standard, which is, which in its 30 years in existence has had an amazing, amazing success at reducing bloodborne pathogens, especially hepatitis B in healthcare workers from, we used to have 300 or more healthcare workers a year die from hepatitis B, and now almost nobody dies from hepatitis B in healthcare.
00:39:05
Speaker
Needle sticks have been reduced and lots of other positive. I don't think anybody or few people in healthcare would say, let's get rid of the bloodborne pathogen standard. But they didn't want it. Employers don't like standards. They don't like requirements. There was a lot of opposition to it, but now it's become
00:39:23
Speaker
it really transformed the industry and Dr. Michaels, who was the head of OSHA under the last administration, used to point to the bloodborne pathogen standard as the best example of OSHA driving a sector into better health and safety and really driving the industry in a better direction. And I think a national infectious disease standard could do the same thing with all the issues we're running into.
00:39:49
Speaker
Yeah, so Mark, how is the California standard working right now? I mean, is it being utilized? Is it being enforced during this pandemic? What's happening? Well, that's one of the frustrations I've had is the standards on the books, it covers the COVID-19 as an airborne and droplet spread disease. And so there's a comprehensive standard. Employers are required to have covered employers, hospitals, nursing homes, others are required to have
00:40:18
Speaker
a comprehensive exposure control plan that is sort of like the, you know, it's a diversion of the plan like they have for bloodborne pathogens. So they write their own site specific plan following the requirements of the standard and then they have to follow it. And then the CAOSHA can then enforce that standard, you know, that they've written for themselves. The downside is that since the early in the pandemic,
00:40:43
Speaker
the governor of California put all the regulatory agencies in California on voluntary compliance mode, which is not uncommon during disasters. Federal OSHA has done it. State OSHA programs have done it. But because of that, Cal OSHA is not focused on
00:41:04
Speaker
issuing citations or issue on trying to help employers meet the you know the ATD standard and other standards for the for the pandemic. So many unfortunately many many employers that I've talked with are ignoring the standard and they're actually what they say is we're following CDC guidance or the World Health Organization guidance
00:41:24
Speaker
And I always retort and say, well, that's fine as long as that guidance meets or exceeds the ATD standard. In most cases, it doesn't. The ATD standard has better protections for workers. But there are some employers who are trying to do the right thing, but the vast majority of them are probably not as organizations. Part of that's driven by the kind of overwhelming nature of the pandemic. Part of it's driven by the lack of N95
00:41:54
Speaker
respirators and other protective gear, the shortages that people run into or the blockages that people run into. And so I, you know, my hope is that I've been pushing and working, we've been doing training with workers and unions about the standard. And, you know, I think Kalosha is now actually gearing up to do some more enforcement in the more egregious situations where
00:42:19
Speaker
workers, healthcare workers have actually died because the standard wasn't being followed. And so I hope I have is that when we get to the second wave, third wave or further into this long pandemic that there'll be better compliance and employers will look at the standard not as a burden, but as something that really going to help them do better.
00:42:38
Speaker
Yeah. And just for people listening who aren't from California or maybe haven't heard of California's ATD standard, we'll include that in the show notes along with a guide that you've told me about, Mark, that's easy to consume.
00:42:54
Speaker
Um, a little bit different than reading a regulation as well. So if, if people want to see what's out there, they can. Um, a question for you, I guess, you know, if you want to comment, you had mentioned that, um, federal OSHA has the ability to put something together in an emergency situation. Um, and they could in this regard, um, you know, with what they have got in draft, if safety and health professionals listening to this want to advocate for that, what, where would they bring their voices?
00:43:22
Speaker
Well, I think the first place would bring it to your professional associations because I think there's been some support among the health and safety professional associations that there's a need for OSHA to be doing more than they're doing. And having an infectious disease standard would set at least minimum guidance for employers
00:43:44
Speaker
like health care, food processing, others who never shut down, but with the reopening,
Federal Safety Standards
00:43:50
Speaker
you know, and all this massive, you know, programs that try to figure out how to reopen in the time of COVID, to give some minimum guidance to employers would be really helpful. And, you know, instead of everyone just sort of making everything up.
00:44:03
Speaker
And the thing I keep going back to is the CDC has been putting more guidance up on their website and some other federal agencies and some state health departments. But the problem is those are all voluntary. They're all guidances. So no employer has to follow those.
00:44:20
Speaker
uh unless they want to and so um you know it's like everything prior to 1970 exactly i mean i've i've had times and you probably felt the same way in the past few months where i i think to myself oh this is what it was like before osha when employers didn't have minimum requirements
00:44:36
Speaker
And it was hard for us to push back, you know, whether you're a consultant or working on staff or working with the union. I mean, you're really facing trying to get the organization to do the right thing from a health and safety point of view. And as much as we might not like or not think the OSHA standards are good enough in some areas, they were always a minimum floor that we could point to to at least push our profession and push the health and safety protections for workers. And that's really needed now.
00:45:07
Speaker
I mean, I think back to the fact that we have in this country, we don't even have a good number for it, but it's been estimated between 500 and 1,000 healthcare workers have died from the COVID-19. I mean, what type of occupational disease where that many workers are affected in such a short period of time and there's essentially nothing
00:45:30
Speaker
or little done from Federal OSHA. I mean, it's really- As a dramatic reaction. Yeah, absolutely. It's really stunning. And to see, you know, and it's not all employers, but to see many employers either
00:45:45
Speaker
ignore guidance that they know is out there for whatever reason they're deciding to do that or to have what I've been working more with some small employers or small businesses where they're really struggling because they don't have the expertise and experience and so they really need those minimum guidances to help them get started. They don't really even know where to get started.
00:46:08
Speaker
And if there's a framework, people should be able to have it and have access to it. And then the other part is, with the small businesses, they look at a lot of the checklists from CDC and I try to remind them that that's the minimum requirement. That you could probably do better and do more and be more protective or be ready in case something changes in the future.
00:46:32
Speaker
by being and build in the creativity of your own experience at your own at the work site that you know so well as opposed to generic guidance from CDC or someone else and and get them to think more creatively about that because i've seen that in my career be really where people move forward on safety and health and so i think a minimum standard would be a way to help get people further along yeah
00:46:55
Speaker
Right, right. Yeah. And Mark, you've also been doing some advocacy, some education rather around reopening with some smaller entities as well and trying to do some education with them. Can you talk about some of the things that you've been sharing? Yeah, I've been just do through
00:47:16
Speaker
to folks I've worked with over the years, I'm getting pulled in like most of us into questions about reopening and how to use the hierarchy of controls in our profession to think about that. But I actually had this really sort of interesting work that we're just finishing is actually my wife and I, my wife is an acupuncturist and she's a sole practitioner. She runs her own practice and I'm in Columbia, Maryland and she works out of our home now. She used to work out of a clinic.
00:47:45
Speaker
And so never expected our two professions would intersect, but it turns out with the reopening, a lot of, she closed her practice down early on and as did most of her colleagues.
Training Acupuncturists for Safe Reopening
00:47:58
Speaker
And now with the reopening across the country, a lot of her colleagues were starting to think about how to reopen and they were
00:48:06
Speaker
They were talking about their profession being a low risk profession, and they were talking about using KN95 respirators as if they were real respirators. We have all that controversy. So I ended up offering to say I'd offered a volunteer to do some training for a few people if they wanted to think about how we in occupational health do this. These are people that have never done occupational health work. They've not had to deal with these issues.
00:48:36
Speaker
You know, they're small. You might not know what OSHA is. Yes, they're small businesses. They're typically not covered by OSHA or they're less than 10 employees. But they were interested because it's protecting their health and their patients. And so they, you know, their patients are important to them. And so my wife put out on the listserv, we said, well, we'd be willing to do a class thinking maybe 10 or 15 people would say yes, and we'd do something informal. Well, two days later, over 100 people had signed up.
00:49:05
Speaker
And so we ended up doing a series of five training courses, two and a half hours each over Zoom, which has its own challenges. I got support from one of the NIHS worker training program grantees at UCLA, the Labor Occupational Health Program, was very generous. And they said, we can support this work. And we're trying to do reopening and thinking about how to reopen. So this will be a useful kind of focused work.
00:49:33
Speaker
uh if you think about it uh acupuncturists are are sort of an allied health profession and there are probably you know 15 or 20 million people who who have small businesses or sole practitioners who do this kind of work i mean everybody from massage therapists to physical therapists and you know all sorts of of of other professions where they see people in a you know you know in a close setting they have small offices and so you know so as
00:50:02
Speaker
I do it myself, Mark, in my non-safety world as a Reiki practitioner. Yeah, so I'm listening. And the goal was not to tell people whether they should open or not or how to do it. The goal was to explain from an occupational health point of view, given the experience of our profession. We've helped industries from construction industries learning to deal with asbestos and other chemical exposures.
00:50:31
Speaker
And, you know, industrial industries had to deal with silica dust and these things that they hadn't dealt with in the past. So, so we had that experience kind of in a focused way. So, you know, I framed it around the, we framed a class around the hierarchy of controls.
00:50:46
Speaker
and how to think about layers of protection that you could figure out for your work site, you know, with engineering controls and then work practices and then PPE last. And how you could, so if you can't get N95s because they were in short supply, what could you do to reduce exposure to the aerosol spread in your, you know, by having fewer patients or using more rooms and fewer patients per room? How could you set up temporary ventilation between patients that might help clear out the space?
00:51:15
Speaker
all sorts of things that people hadn't been thinking about. So we ended up doing these five classes. They were really wonderful.
00:51:26
Speaker
I feel bad at times because the practitioners didn't want to hear about aerosol spread because that was something they hadn't heard before and that made this reopening harder. They wanted to hear that KN95 respirators from China were equal to N95. Many of them had purchased those respirators from suppliers under the
00:51:48
Speaker
recommendation that they were respirators, but of course we know they're not. So I had to give people bad news, but what I really was encouraging is that people needed to be thinking and creative and that this was something that could be done if not easy. It took work and you have to practice and you have to be ready to revise and practice again.
00:52:10
Speaker
You could do it, but you needed the framework to think about it. I think the industrial hygiene hierarchy of control framework was perfect. It really resonated. I've gotten a lot of good feedback from those practitioners who now understand what the hierarchy of controls is, who didn't know what that was six weeks ago.
00:52:30
Speaker
That's so awesome. I think it's an interesting model, not just for the work that my wife does, and I'm an acupuncture patient, so I would think about it as, well, I'm the patient. I want you to be protected because I don't want you to make me sick, right, if I'm going to come see you. Right, exactly. And you at the Reiki and your patients, the same thing.
00:52:48
Speaker
But I was really thinking that there really are a lot of people who are small businesses who are trying to think through these issues. And so I was really trying to learn for myself, what lessons can I learn from this work with acupuncturists that I could broaden out to help other small businesses? And so I'm now working with the Loash group at UCLA and others, and we're thinking about how to broaden out these principles and do this as part of the work of our profession to help
00:53:16
Speaker
with the reopening and if people are going to go down that road. And at some point people are going to have, you know, everybody's probably going to reopen at some point before we have a vaccine.
00:53:26
Speaker
Yeah, yeah. Well, how what a wonderful contribution that is.
Podcast Conclusion and Reflections
00:53:32
Speaker
And I know you and I have talked about the possibility of perhaps maybe you'd be able to capture some of those best practices you're talking about as a guest blog, that we'd be happy to happy to socialize to small businesses like you're talking about right now. I think that'd be I think that'd be a great contribution and help to people. Thank you, Joe. I'd be I'd be glad to do that. And thank you for the offer.
00:53:55
Speaker
Yeah, you're welcome. Mark, this has been such a pleasure. And thank you for bringing, as you said, something positive to focus on. And the work that you're doing is definitely having an impact. And I'm sure people listening to this episode will be, you know, these are things they hadn't thought of before, you know, and especially any audience, particularly in health care who hasn't heard of the last America respirators before.
00:54:22
Speaker
or didn't know that California has had a standard for 10 years that people could be using as a guide right now. How powerful is that? And so I'll include that information in the show notes as well. Really appreciate it and thank you for the tireless work.
00:54:40
Speaker
After 40 years and you think maybe this is going to be the coast and all of a sudden it picks up speed like never before. Well, thank you, Jill. It's always wonderful to talk to you and sort of talk about these issues. And yeah, I'll be happy when the pandemic's over and we're past this and we can all go back to quote unquote normal.
00:54:59
Speaker
And I can go back to my historical film channel and just kind of work on history of our profession. Absolutely. And there's going to be a lot, yeah, there'll be a lot more history to talk about after this as well. And my great admiration for everybody, all of your listeners who are working in this field, either in healthcare or in Satan Health, that are working so hard on doing this. So stay safe and keep up the good work, everybody. It's so important these days.
00:55:26
Speaker
Thank you. Thank you. And thank you all for spending your time listening today. And more importantly, thank you for your contribution, making sure your workers, including your temporary workers, make it home safe every day. If you'd like to join the conversation about this episode or any of our previous episodes, you can follow our page and join the Accidental Safety Pro community group on Facebook.
00:55:48
Speaker
And if you're not subscribed yet and want to hear past or future episodes, you can subscribe in iTunes, the Apple Podcast app, or any other podcast player that you'd like. You can also find all of our episodes at vividlearningsystems.com slash podcast. We'd love it if you could leave a rating and review us on iTunes. It really helps connect the show with more and more safety and health professionals.
00:56:09
Speaker
like Mark and I. If you'd like a suggestion for a guest, including if it's you, you can contact me and make that suggestion at social at vividlearningsystems.com. Special thanks to Will Moss, our podcast producer. Until next time, thanks for listening.