4th National Symposium on Biosafety

Occupational Health Programs

Rebecca Bascom, MD, MPH
University of Maryland
10 South Pine Street
Room 800
Baltimore, MD 21201
410-706-2169

The occupational health care (OHC) activity is one of five key activities that comprise a program of occupational health and safety in a research animal facility. The principal objective of the overall program is to reduce to an acceptable level the risk associated with using materials or systems that might have inherent danger. The objective of the OHC activity is to provide a complementary, multifaceted service that supports the overall occupational health and safety program. The OHC activity must interact continually with environmental health and safety, research activities, animal care and use, and administration on management.

The OHC activity is complementary, meaning that it recognizes that the primary control strategy in any workplace is to control or eliminate a hazard. Premorbid case detection, case finding and disease management are secondary and tertiary levels of control. The service is multifaceted, providing diverse elements outlined in this presentation. However, the occupational health care activity is not general health insurance. Occupational health services are targeted at orkplace risks, and thus differ from usual primary care.

The determination of the need for health care services should be based on the nature of hazards at a specific worksite and the intensity and frequency of exposure to the hazards for the individual employee. Additional factors to consider include the susceptibility of the individual employee, and any disability that may poses a direct threat to the employee's health and that can or cannot be reasonably accommodated.

EMPLOYEE

For the purposes of this presentation, the term employee will refer to all personnel involved in the care and use of research animals, regardless of their employment status. A program needs to provide for participation of all personnel involved in the care and use of research animals on the basis of the risks encountered, regardless of their employment status.

THE OCCUPATIONAL HEALTH CARE ACTIVITY

The OHC activity has the key task of verifying the presence or absence of employee health, and of determine whether alterations in employee health reflect workplace hazards, or non workplace exposures. This task necessitates conveying unwelcome news to employer and employee alike, when work-related illness or injury occurs. It is essential that the employer support the highest degree of professionalism among occupational health care providers, and also provide timely and accurate information about workplace stressors. Tours of the worksite with members of the environmental health and safety team and regular interaction with the occupational health and safety group are essential to acquiring the knowledge necessary to provide quality service.

The service will contribute to the hazard assessment in the workplace, the risk profile and the priority list. The OHCS also needs accident and injury investigation data, the Occupational Safety and Health Administration 200 log data, risk assessment data and worker compensation data. These data are used to tailor the health evaluations and surveillance schedules to the needs of the workplace.

The OHCS will perform health evaluations, maintain health surveillance schedules, and assemble health surveillance data. In order to perform these functions the OHCS service needs to provided with a list of employees at risk, employment risk-indicators, exposure and monitoring data, a job profile and material safety data sheets.

A careful history is the principle OHC tool. The history, taken by an occupational health care provider with a specific knowledge of the workplace, will provide key information about a worker's exposures and risk reduction practices. It will also elicit symptoms that may indicate early work-related disease. Diagnostic evaluations will be guided by the particulars of the presenting complaint and the differential diagnosis.

Physical examinations and serum collection are typical, but usually neither helpful nor cost-effective for protecting the health and safety of most employees who have contact with research animals. There is arole for objective measures in occupational health care. However, each measure should be chosen in the context of the information it is likely to provide for the surveillance program. For example, serial tuberculosis skin testing could be undertaken if the program policy was the skin test conversion signaled a need to begin prophylactic medication or be removed from work in the primate colony. Serum collection could be undertaken if chain of command and custodial issues were addressed, and follow-up assessment for a specific pathogen were planned. Spirometry could be performed if a worker was entering a risk are for laboratory animal allergy, and if repeat spirometry were part of the evaluation of respiratory symptoms in this risk group.

The occupational health care service (OHCS) will participate with the work group to establish measures of program effectiveness. Since many measures of success will be estimates of health status, OHC input is essential.

OHCS KNOWLEDGE BASE

The medical information required to provide occupational health care services in a research animal facility is not provided in the usual primary care, specialty or subspecialty training programs. Consultants can inform an institution of occupational health and safety fact that provide clear direction for program development. Consultants can also point out gaps in occupational health and safety facts that must be filled by considered judgment. However it is difficult for consultants to acquire and maintain the detailed knowledge necessary to a program.

Institutions should provide resources to train in-house or contract health care providers in the areas of expertise required at their worksite. There is no substitute for a detailed knowledge of the particular workplace, and training should include walkthroughs at the job sites. Consultation with appropriate specialists and attendance at professional meetings should be supported by the institution. Specialist input may be needed from infectious disease, immunology and allergy, pulmonary, orthopedics, physical therapy, and ophthalmology.

HAZARD ASSESSMENT

Hazard assessment is led by the environmental health and safety(EHS) activity in a workplace. There is great value in having occupational health care service personnel present during walkthroughs. The health care service people will contribute their knowledge of th workplace gained during clinical evaluations of workers. Their knowledge of the nature of the illnesses and injuries will assist the EHS activity in understanding exposure pathways, or susceptibility factors that should be considered. The health care providers can also be more effective in their employee assessments and recommendations for protection and/or accommodation if they have a clear picture of the workplace.

DEVELOPMENT OF CONTROL STRATEGIES

Exposure control is led by the environmental health and safety activity in a laboratory animal facility. Once again, active participation by occupational health care services, research, animal care and use, and administration and management is essential.

Engineering controls may include product substitution, barriers, filtration and ventilation. Occupational health care input may assist in recognizing the benefits and hazards of products or barriers under consideration.

Work practice controls can reduce the number of employees at risk through restricting access or contact with the hazardous source. Reductions in exposure via the percutaneous route, or by ingestion or inhalation can occur through attention to personal hygiene, housekeeping and waste management. Alterations in animal handling and transport may substantially reduce exposure. Occupational health care services can use the surveillance history to assess personal behaviors and events (e.g. bites)that indicate exposure risk and efficacy of work practice controls.

Personal Protective Equipment can also be used to reduced exposure. Protection can occur through the use of gloves, uniforms, gowns, safety glasses, steel-toed boots, and respirators. The occupational health care service needs to be involved in the selection and application of personal protective equipment. Employees must receive medical clearance to wear a respirator. The "respirator physical" should not consist simply of auscultation of the chest and spirometry. The medical evaluation should encompass a review of the workplace exposure prompting the need for a respirator, the personal risk profile of the employee, the cardiorespiratory status of the employee, and finally assess the ability to wear the respirator, and the likelihood of having the respirator function as intended. A common source of respirator failure is when it is worn part-time, when a worker performs an at-risk task. However, the agent may persist in the environment or adjacent workers may generate a similar hazard when the worker is not wearing respiratory protection.

TRAINING

Training is a function typically led by environmental health and safety. Occupational health care services may contribute presentations explaining the symptoms or warning signs of adverse health effects.

WORKPLACE HAZARDS FROM AN OHCS PERSPECTIVE

Workplace hazards include hazards intrinsic to the research animals themselves, and hazards that are extrinsic to the animals, but occur as a result of the research protocol. Categories of hazards will be discussed below, and include physical hazards, chemical hazards, protocol hazards, zoonotic (infectious) biological hazards, and sensitizing (allergic) biological hazards.

Quaternary prevention has been coined to describe an important workplace risk reduction strategy. It involves using sentinel events (such as incidents, adverse health reactions, etc.) as triggers for review of workplace conditions. It is effective to have a mechanism in place at the worksite for the occupational health care service to request consultation from environmental health and safety or animal care and use when a hazard is suspected.

PHYSICAL HAZARDS

Physical hazards are common in the research animal facility. Animal cages are bulky, machines use electricity and are noisy, and animals may bite, scratch and kick. One study showed that 35% of veterinarians have required stitches for animal bites. Animals in that study included rodents, cats, dogs, non human primates, reptiles, marine animals and arthropods.

When an employee is bitten, a series of actions typically ensue. First, the incident is recorded. Second, prompt medical management begins, including examination of the wound, checking the tetanus status, and beginning antimicrobials or antivenins as indicated. In addition, evaluation of the animal may be needed, such as following primate bites (see B-virus below). Complete wound healing should be documented.

In addition to providing proper medical care, an occupational health and safety program should review the incident. Was there secure animal housing? Was noise or pain the stimulus to the animal? Did an untrained individual enter the flight zone? Was the employee wearing adequate protective garments?

Finally, the incident review should lead to a decision whether or not to modify current procedures. After a bite, control strategies such as chemical immobilization may be considered, or worker training may be undertaken. These feedback loops are examples of quaternary prevention.

A similar approach works for other physical hazards. For example, if a burn occurs, the incident review should determine whether the hazard was recognized and properly labeled. When backs, wrists, elbows or bursae are injured, the incident review should seek an unrecognized ergonomic hazard where materials movement occurred that was too heavy or too frequent. Was housekeeping deficient, leading to a spill, or was lighting inadequate? After a needle stick injury, the incident rview should determine whether disposable containers were available, and whether recapping procedures were followed.

CHEMICAL HAZARDS

Chemical hazards may be encountered in uses such as disinfecting and cleaning surfaces, anesthetizing animals, and processing tissue samples. The toxicity of a chemical is its least predictable property. To manage chemical hazards, it is useful for the OHCS to categorize them as carcinogen, allergen, asphyxiant, corrosive, hepatoxicant, irritant, mutagen, neurotoxicant or teratogen. This type of categorization is followed in the National Institute for Occupational Safety and Health handbooks, and leads to rational medical surveillance.

Burns and skin irritation are the most common chemical injury encountered in animal care and use. Waste anesthetic gases also require attention because of demonstrated health effects including an increased risk of spontaneous abortion, birth defects among offspring, increased cancer rates among women and liver disease among men and women. In animal facilities, a common source of uncontrolled waste anesthetic gases are gas delivery equipment that does not fit the animal. Since susceptibility to reproductive hazards occurs before pregnancy is confirmed, the OHCS will need to offer risk communication and counseling to all employees of child-bearing age. The institution needs to decide on its control strategies for potential reproductive hazards, including decisions about the availability of alternate work sites.

Protocol hazards introduce toxic chemicals, human pathogens and radioactive materials into animals and their waste streams. In one study, 17% of laboratory-acquired infections were associated with experimentally infected animals, and 3% were due to a bite or scratch by an experimentally infected animal. Trained scientific personnel and technicians were most likely to be infected.

If chemical toxicity testing or infectivity studies are planned, collaborative assessment by the investigator, animal care supervisor and veterinarian will guide rational control strategies. The OHCS can identify whether specific health surveillance is indicated. If the toxicity of the agent is unknown, prudent practice is to handle it as if it were toxic.

The agent should be tracked through its entire pathway. In ingestion studies, agent exposure through dermal and respiratory routes may be possible via the feed. Excretion of the agent will lead to contaminated bedding. In dermal studies, exposure of employees may occur via vaporization of the agent during application, with subsequent exposure with animal handling, clipping of hair, changing of bedding, or sweeping the floor. Anticipated routes of exposure should be communicated to the OHCS.

ZOONOSES

Zoonoses, or human infections acquired from animals, are well-recognized risks in the research animal facilities. These infections are presented in detail elsewhere at this conference. Categories of infectious agents include bacteria, chlamydia, fungi, parasites, protozoa, rickettsia and viruses. Specific agents include sporothrix schenckii, microsporum and trichophyton, brucella (B. abortus, B.canis, B. melitensis, B. Suis), chlamydia psittaci, francisella tularensis, leptospira interrogans, legionella pneumophila, mycobacterium tuberculosis, salmonella spp., shigella spp., streptobacillus moniliformis, coxiella burnetii, hepatitis A virus, herpes virus simiae, Lymphocytic choriomeningitis virus, Simian immunodeficiency virus, and vesicular stomatitis virus.

To provide occupational health care services for zoonoses, it is necessary to determine available information about reservoir and incidence, mode of transmission, clinical signs, susceptibility and resistance to the infection, and approaches for diagnosis, treatment and prevention. In general, transmission of zoonotic disease in a research animal facility that involves naturally infected animals (unrelated to an experiment) is rare. This is due to provision of high quality animals by industry, and comprehensive institutional programs of veterinary care. Exceptions to this general rule include Q fever and lymphocytic choriomeningitis.

Rats can be a source of zoonoses. Sporothrix schenckii was transmitted by a bite from an experimentally infected animal. Leptospira and salmonella infection may result from contact with either experimentally or naturally infected animals. Infection with shigella and streptobacillus moniliformis has also occurred following contact with experimentally infected animals.

Pathogens transmitted by experimentally and naturally infected mice include microsporum and trichophyton, leptospira interrogans, salmonella, spp., and lymphocytic choriomeningitis. Mice experimentally infected with shigella species have also transmitted this pathogen to humans.

Non human primates can be a source of pathogens. Infection with mycobacterium tuberculosis can results from contact with experimentally and naturally infected animals. Infection with shigella species can results from contact with experimentally infected animals, while infection with herpes virus simiae can result from direct contact either with experimentally or naturally infected animals. Handling of blood from experimentally infected animals can result in infection with simian immunodeficiency virus.

B virus

"B-virus" is a zoonosis that requires particular attention from occupational health care services. B virus is a cercopithecine herpes virus 1 (CHV 1). Its reservoir is the macaques, 100% of whom become seropositive at one year in captivity. The virus may cause oral or genital ulcers in macaques 7-14 days after infection, and then be latent in sensory ganglia. Recurrent viral shedding occurs in the genital and mucous membranes, possibly associated with stress. Transmission to hmans may occur from asymptomatic animals, most commonly through exposure to contaminated saliva with a bite or scratch. Infection via needle stick injuries, exposure to infected tissue, contaminated cages, and human to human transmission have also occurred.

In humans, the incubation period for B-virus is 230 days. In some humans, the infection is asymptomatic, and sequelae are unknown. In other humans, a herpetiform vesicle develops at the inoculation site, followed by a prodrome of fever headache, myalgia and fatigue. A progressive neurologic disease then develops characterized by numbness, hypesthesia, paresthesia, an ascending flaccid paralysis, diplopia, ataxia and urinary retention. Ventilatory failure may require intubation.

OHCS treatment of macaques bites consists of prompt wound care, and the collection of swabs and serum samples from both the human and the macaque. At the present time, samples are analyzed by Dr. Julia Hilliard (NIH B Virus Research Laboratory, San Antonio, 1-210-674-1410). Symptom onset should result in intensive care unit admission and treatment with Acyclovir and Gancyclovir. The duration of antiviral therapy is not established. Limited experience has shown that serologic titers rise when the medications are stopped. The Herpes virus branch of the Centers for Disease Control should be contacted for the most recent information on therapy.

Prevention of B-virus consists of wearing protective clothing at all times. Limited protection such as wearing only latex gloves should be used only if the macaque is in "full chemical restraint".

Other viruses

Ebola hemorrhagic fever caused by filoviruses. The African monkey is the reservoir for Ebola Sudan/Zaire, a virus that is transmitted by body fluid, but not droplet aerosols. The human disease is characterized by multiorgan failure, visceral effusions, and hemorrhagic shock. Ebola Reston is a virus for which the reservoir is unknown. In an outbreak, Philippine monkeys died, and aerosol transmission was suspected. Humans had only sub clinical seroconversion. At present, no drugs or vaccines are available for either of the Ebola viruses.

Another zoonotic disease is Marburg virus disease. There have been a total of 4 human outbreaks with a 25% overall mortality. The disease occurred in laboratory workers handling African green monkey tissue, not animal care staff. The human disease begins after a 4-16 day incubation period with a prodrome of fever, myalgia, headache and conjunctival suffusion. After 2-3 days, nausea and vomiting develop as well as low platelet and white blood cell counts, pancreatitis, orchitis, liver cell necrosis, a maculopapular rash, and disseminated intravascular coagulation. Diagnosis is made by isolation of the virus from blood and/or tissue, or an immunofluorescent antibody test.

ALLERGENS

Allergic sensitization may occur as the result of exposure to research animals, or to products used during experimental protocols. The mechanism of allergic reactions is a multistep process. Allergen exposure of susceptible individuals results in asymptomatic immunologic sensitization. This preclinical state of sensitization can be determined by the absence of symptoms, but by the presence of specific Immunoglobulin E in the serum to the allergen, or by positive prick or intradermal skin tests. Continued exposure of the sensitized individual to the allergen will result, in some workers, in the development of clinical disease. Workers with allergic disease due to a workplace exposure may report symptoms due to one or more organ systems. Contact urticaria will manifest with red, itchy skin with welts and hives. Conjunctivitis will manifest as red, itchy eyes. Rhinitis presents with sneezing as well as nasal itching and congestion and clear drainage. Asthma presents with cough, wheezing, shortness of breath and chest tightness. The most severe disease is anaphylaxis. This systemic allergic reaction begins with itching of the skin, hives, throat tightness, eye or lip swelling. More serious manifestations include difficulty swallowing, hoarseness and asphyxiation. Also serious are fainting, nausea, vomiting, abdominal cramps, diarrhea sometimes associated with shock and death.

The risk of developing allergic disease as a result of exposure to laboratory animals varies depending on characteristics of the employee. Employees who have no history of allergic disease and no history of symptoms when around laboratory animals will have a 10% chance of developing symptomatic allergic disease from laboratory animals. Employees who have a history of allergic disease unrelated to laboratory animals will have a 30% chance of developing allergic sensitization and symptoms. Employees who are asymptomatic but have specific IgE to animal proteins have a wide range of estimated risk of developing allergic disease, with risk estimates ranging up to 100% (for one or more diseases including dermatitis, rhino conjunctivitis or asthma). Employees who have allergic symptoms when exposed to animal proteins and who have specific antibody to the animal protein are 100% likely to continue to have allergic disease, and 10% will develop occupational asthma.

There are now well-established clinical approaches to the diagnosis of allergy due to laboratory animals, and to non-occupational allergens. There is a brief, standardized questionnaire for asthma (The IUATLD Asthma Questionnaire) that has been validated by methacholine challenge testing. Standardized, well-characterized quality of life indices exist for asthma and ,rhinitis, developed by Dr. Elizabeth Juniper. Allergy skin testing has good sensitivity when the new purified antigens are used. Purified allergens associated with specific animal allergy are identified below.

Laboratory animal allergy occurs most commonly with rodent exposure. The allergen for rats is rat n IA (pre-albumin), and Rat n 1B (euglobulin). Sources of allergen exposure include urine and contaminated litter. Exposure is proportional to the number of animals in the facility. If many rats are present, as many as 127 air changes/hour may be needed to control airborne allergen. Animal cage technicians receive the highest exposure to rat allergen. Cage cleaning results in mean allergen levels of 21 ng/m3 and maximum levels of 310 ng/m3 . Handling rats results in breathing zone allergen concentrations of 12 ng/m3, while surgery and sacrifice of rats results in exposure to allergen concentrations of 3 ng/m3.

The mouse allergen is Mus m 1, a liver protein that is excreted in the urine at 100 fold higher levels than in the serum. Males excrete four-fold higher levels than female mice. Airborne allergen levels have been measured at 1.8 - 825 ng/m3, with levels related to the number of mice in the room and the intensity of the activity in the room. Smaller particles, in the respirablerange of <1 um, become airborne during cage cleaning.

The cat allergen is the protein Fel d 1, which is present in cat saliva, is produced by the skin, and coats the hair shaft. Many cat allergen particles are less than 0.25 um, so materials remain suspended in the air for long periods of time. Cat protein is sticky, so that hands, clothing and other materials are important allergen reservoirs. Dog protein Can f I , contains 35% albumin, and is present in the saliva, hair and skin of the dog.

Allergy can occur with exposure to other animal proteins as well. Insectory workers become allergic to the insect products, fish and crab processors become allergic to fish proteins, and frog protein allergy has also been documented. Horse allergy cross reacts with deer allergy, although allergy is uncommon to non-human primates or sheep. Fifteen to twenty percent of dairy farmers are sensitized to cattle allergen. Reactions that occur in swine confinement rooms are thought to be due to endotoxin and other biologically active, non-allergenic components of swine room dust.

Hypersensitivity pneumonitis is another, less common type of immunologic respiratory disease that may result from exposure to laboratory animal proteins. This disease is characterized by the proliferation of lymphocytes against the antigen, and the large-scale production of IgG antibody against the antigen. The site of disease is the lung parenchyma and small airways. The clinical presentation varies from acute flu-like symptoms beginning hours after the exposure, to cough and shortness or breath, to an insidious wasting illness. A restrictive pattern on lung functions and abnormal chest radiographs may be present.

The approach to controlling laboratory animal allergy follows the same hierarchy of control strategies that applies to other workplace hazards: primary prevention first, followed by secondary and tertiary prevention. The first control strategy is to reduce exposure, using approaches such as increasing relative humidity, using ventilated hoods for cage cleaning and emptying, using ventilated hoods or racks, applying filters to the top of cages and using absorbent pads under the cages. Personal protective equipment may be considered as a temporary control strategy. At risk workers may be counseled through educational programs and teaching codes of practice to limit allergen exposure.

Secondary prevention of laboratory animal allergy includes serologic or skin testing and counseling of sensitized, asymptomatic workers. This group is at increased risk of developing symptomatic disease, and additional exposure reduction measures including the use of personal protective equipment may be of value.

Tertiary prevention includes case finding and exposure avoidance. Once allergic disease has developed, modest efforts at exposure reduction are typically unsuccessful. A dust-mist respiratory or filtered airhood may be used for brief periods. In other industries, use of a respirator while continuing in a high allergen zone was associated with disease persistence or progression. An Epi-pen should be provided to employees with a history of anaphylaxis. Immunotherapy is of unproved benefit.

Case management of occupational illnesses and injuries is now recognized to reduce lost time and associated employer medical and lost time costs. The success of case management underscores the fundamental need for close interaction between the five activities of occupational health care, environmental helth and safety, researchers, animal care and use, and administration and management in the diagnosis and management of occupational illness and injury.

SUMMARY

Occupational health care services are a complementary, multi-faceted activity that contribute to a successful occupational health and safety program. The occupational health care service should contribute to hazard assessment, the development of program priorities and selection and implementation of control strategies. The health care service is primarily responsible for the development and completion of employee health assessments that are targeted to the hazards of the particular workplace. The health care service will maintain high ethical standards in patient/employee interactions.

Providers of occupational health care services to research animal facilities should be expected to develop the specialized, detailed, hands-on knowledge of workplace hazards at each site they serve. This knowledge is outside the realm of usual medical and occupational health care training and institutions should fund and support the acquisition of this knowledge.

The occupational health care service will work to meet the overall program goal which is :reduce to an acceptable level the risk associated with using materials or systems that might have inherent danger. When an occupational illness or injury occurs, the occupational health care service will provide compassionate, first-rate medical care, and will work to return the employee to health and productivity.

The health care service will communicate information about adverse health effects and suspected or known workplace hazards to the other activities in the occupational health and safety program. It will therefore work to prevent future occupational illness and injury through continually interacting in the process of recognizing and reducing workplace hazards.

Occupational Health Programs Breakout Session
Rapporteur: Gregg Kasting, MD Medical Director, Occupational Health Clinic Centers for Disease Control and Prevention 1600 Clifton Road, MS A-29 Atlanta, GA 30333 404-639-3385

First of all, many voiced concern about over enthusiastic ALAC inspectors who do not recognize that medical surveillance programs do not come in one size fits all institution type units. Differences in mission, budgets, philosophy, and cultural values exist and should be accomodated to some degree.

Secondly, several folks spoke echoing Dr. Barkley that routine, non-incident related periodic physical exams are warranted in few if any situations. Having said this though, all of us should not forget the positive aspects of yearly visits to the occupational health clinic which are perhaps: A)They provide the opportunity for the exchange of information between the worker and health care providers either in the form of standardized questionnaires or informal exchange of information; B) They provide the opportunity to reinforce important safety information; and C) They reinforce the message that management is concerned about the health and safety of the employee.

Third, serum banking sparked a great deal of discussion. I heard at least two, probably three different definitions of serum banking and, as other people have said, its important to get clear on your definitions. Version A is simply to store pre-employment or pre-placement serum; version B is to store "acute and convalescent" sera at the time and some time after a potential exposure to a biological agent; and version C is the periodic, on-going collection and storing of serum (which has been advocated for some time now). The latter seems not to be advocated at least on a universal basis.

Many people voiced concerns about the technical difficulties, the expense, informed consent issues, chain of custody, legal admisability, and the potential misuse of specimens for non-related research. Still a number of us felt that version A, pre-employment banking, is advisable and a small minority of us felt that there are still some situations where periodic on-going storage of specimens should be done. I would just suggest to Dr. Richmond that this issue might warrant revisiting in future meetings.

Four, it was noted that some institutions exclude students who have significant animal exposure from the usual array of medical surveillance programs. I don't see how this can be justified logically or from any ethical perspective.

Five, several people speaking from the podium here and also in the breakout sessions noted the similarities and differences between the philosophical and practical goals of the occupational health programs that cover animal care personnel and the the analogous programs that cover health care workers, or as we could call them, human primate caretakers. They have noted the often stark differences in risk acceptance in the two areas: low, perhpas too low, in the case of animal care worker safety, and high in the case of helath care.

I think this diffence flows from the two ifferent traditions. I can speak from personal experience, and its also been noted by some people in the medical literature, that exposure of health care workers to infectious agents has historically been accepted. I think my colleagues at NIOSH and other groups concerned with health care worker safety feel this has been a significant hurdle in getting better protection for these workers. While I would agree that there are over zealous regulations and regulators, I don't think those in the field of biosafety and animal research should strive to emulate this history of acceptance of work place infections in animal care. I'm sure most if not all of you don't believe that a research protocol should ever accommodate either consciously or by oversight the infection of the animal care staff.

Six, Doctor Nesby urged me to restate the concern that the occurrence and reporting of safety incidents must not become something we don't want to hear about or an occasion to "shoot the messenger" even when the messenger is the person who messed up. If we all can't remain objective and supportive in such circumstances, human nature will take over and incidents simply won't be reported.

And finally the last impression I was left with is the same as the first one: one size does not fit all when it comes to medical surveillance programs or occupational surveillance programs. All of us would urge those who review animal care programs to keep this in the front of their minds.

Office of Health and Safety, Centers for Disease Control and Prevention, 1600 Clifton Road N.E., Mail Stop F05 Atlanta, Georgia 30333, USA Last Modified: 1/2/97
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