Waste Management – Handling of Harmful Materials (D. Thiele)
Recommendation:That the June 8, 2005, Asset Management and Public Works Department report 2005PWW078 be received for information.
Report Summary
This report responds to questions related to the safeguarding of civic employees who handle harmful materials and to the City seeking designation as a World Health Organization (WHO) Safe Community.
Previous Council/Committee Action
At the February 1, 2005, Transportation and Public Works Committee meeting, the following motion was passed:
1. That the January 17, 2005, Asset Management and Public Works Department report 2005PWW016 be received for information.
2. That Administration prepare a report for the June 14, 2005, Transportation and Public Works Committee meeting on corporate efforts made to address workplace risks of handling improperly discarded waste materials (such as sharp objects, needles and bodily fluids), including:
a. Information on the protocols, policies and preventative measures in place to deal with workplace incidents of handling harmful materials;
b. The number of workplace incidents in the past five years, related to handling improperly discarded waste materials;
c. Costs associated with lost employee time due to those incidents;
d. Recommendations for more aggressive global strategies to deal with workplace risks of handling hazardous materials, including an educational component for the public and City employees.
3. That Administration prepare a report for the Transportation and Public Works Committee meeting, outlining requirements for the City of Edmonton to be designated a Safe Community by the World Health Organization.
Report
Protocols, Policies and Preventative Measures
· Procedures are in place to assist the City workforce to avoid needle stick injuries and to provide guidance for needle sticks or exposure to blood in their line of work. Examples are:
1. The Community Leisure Centres Infection Control Resource Manual that contains preventative measures extracted as Attachment #1.
2. The Waste Management Branch procedure for employees to follow should a needle stick injury occur (Attachment #2).
3. The Emergency Medical Services Branch’s use of a needle free injection method for patient care as a means to reduce potential injury to EMS workers.
· A list of operational policies, protocols and preventative measures currently used to safeguard city employees who handle hazardous materials while at work is included as Attachment #3. The special nature of the services performed by Emergency Medical Services and Fire Rescue Services require an Infection Control Program and dedicated support of an Infection Control Officer. Attachment #4 is the information specific to these services.
· These operational policies, protocols and preventative measures notwithstanding, the City’s Occupational Health Safety Business Plan (OHSBP) is reviewed annually and revised as required by the Occupational Health and Safety Steering Committee. The Committee uses the Provincial Occupational Health and Safety Code and emerging issues to guide it. Needle sticks/sharps were among a number of items identified in 2004 as issues requiring further attention, and action has been taken in this regard as explained later on in this report.
Statistics on Workplace Incidents
· Following are corporate statistics related to needle stick injuries between January 1, 2000, and April 30, 2005. These data represent incidents that are reported by staff.
1. Overall, 42 or 0.55 percent of the total 7,658 injury incidents reported can be classified as needle stick injuries based upon the incident description.
2. AMPW reported five (one in Mobile Equipment Services Branch, one in Lands and Buildings Branch, three in Waste Management Branch).
3. Community Services reported 28 (two in Parkland Services Branch, six in Fire Rescue Services Branch, 20 in Emergency Medical Services Branch).
4. Edmonton Police Service reported nine.
· A breakdown of the 42 incidents follows:
- 'Near Miss' - an event which could have resulted in a work-related injury or illness had the circumstances been slightly different – accounted for one.
- 'No Treatment' - a minor injury or illness was incurred, but the worker did not receive any treatment – accounted for eight.
- 'First Aids'- minor injury or illness was incurred, and first aid was applied (wound dressing etc.) – accounted for three.
- 'Medical Aids'- an event in which medical attention is sought (emergency room, medicentre, trip to a family physician etc.) – accounted for 26.
- 'Lost Time' - an event in which an injury or illness was incurred, and the affected worker did not complete their next scheduled work shift – accounted for four, all from Edmonton Police Service.
Costs Associated with Lost Time
· There is no direct costing information readily available.
· An estimated cost incurred through the Health Care System for testing and treatment after a needle stick is $1,500 to $2,000, based on a negative outcome after one year.
Strategies
· The development of corporate infectious disease protocols is included in the 2005 workplan of the OHSBP. Completion is expected in the spring of 2006.
· In addition, the 2005 workplan of the OHSBP includes the development and delivery of the Safe Needle Disposal and Awareness Plan. This is described in Attachment #5 and is underway.
Safe Communities/World Health Organization
· The first step in receiving World Health Organization (WHO) designation is to become a Safe Community. Once a city or region has operated as a Safe Community for three years, it is eligible to seek WHO designation.
· Criteria for becoming a Safe Community are described in Attachment #6
· Edmonton is well positioned to transition to Safe Community status if funding were made available for a full- time position and promotional materials dedicated to this effort. If office space and administrative support were provided for this position, the budget need for one staff and promotional material could be limited to $100,000 annually for two to three years.
· In addition, Edmonton already has in place a network supportive of Safe Communities, including the Capital Region Health Authority, private businesses, Safer Cities, and Administration.
· A coordinator from Safe Communities is available to assist dedicated City staff to establish contact with key stakeholders, identify existing programs and determine areas of need, and begin development of a business plan (a requirement for Safe Communities designation).
· As information, Calgary City Council passed a proclamation in support of Safe Communities and allocated $200,000 in the first year to facilitate the development and implementation of Safer Calgary.
· At the time of application, the City of Calgary had 24 members on the Safer Calgary Board representing the areas of violence prevention, injury prevention, environment safety and urban safety, with participation from members representing aboriginal persons, persons with disability, elders, youth, children, women, gay and lesbian persons and persons of racial diversity.
· Also at the time of application to become a Safe Community, a City of Calgary Alderman was appointed to chair the organizing committee.
· A similar approach to Calgary - proclamation, chair occupied by Councillor and adequate funding - is desirable if Edmonton were to proceed towards Safe Community status.
Background Information Attached
- Preventative measure
- Needle Stick Injury Procedure
- Protocols, policies and preventative measures
- Emergency Medical Services and Fire Rescue Services Summary Report
- Safe Needle Disposal Awareness Plan
- Safe Communities Criteria
Others Approving this Report
· J. Tustian, General Manager, Corporate Services Department
· D. Kloster, General Manager, Community Services Department
· R. Millican, General Manager, Transportation and Streets Department
(Page 2 of 4)
Attachment 1
Community Leisure Centres Infection Control Resource Manual ……Universal Precautions
Universal Precautions
The concept of `universal precautions"(UP) was developed by the Centre for Disease Control (CDC) in the United States in 1987 to protect health care workers from blood born pathogens, specifically the Hepatitis B and Human Immunodeficiency viruses. This concept was accepted in the same year in Canada by the Laboratory Centre for Disease Control (LCDC), Health and Welfare Canada. "Universal precautions," as defined by CDC, are a set of precautions designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens when providing first aid or health care. Under universal precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, HBV and other bloodborne pathogens. Since medical history and examination cannot reliably identify all patients infected with HIV or other blood-borne pathogens, blood and body fluid precautions should be consistently used for ALL patients. This approach referred to as "universal blood and body-fluid precautions" or "universal precautions," should be used in the care of ALL patients, especially including those in emergency-care settings in which the risk of blood exposure is increased and the infection status of the patient is usually unknown.
Body Substance Isolation (BSI) was introduced in 1987. It is a strategy intended to prevent transmission of potential pathogens between patients using protective barriers and changing workplace design. BSI expands the principles of UP to all fluids. BSI replaces traditional isolation strategies with the exception of isolation for airborne infection.
Infection Control protocols are evolving as the knowledge and awareness of infection control issues increase and the need for better or more complete protocols becomes apparent. In 1994, the CDC put out a draft infectious disease isolation strategy entitled Standard Precautions. Standard Precautions has been proposed as a total system of isolation to replace UP, BSI and all other isolation strategies in the United States. Standard Precautions has not been widely accepted, UP is still the `industry standard. The LCDC m Canada does not endorse Standard Precautions at this time.
Universal precautions do not deal with infectious diseases e.g. meningitis, TB, hepatitis A that can be transmitted by the body fluids that are listed above. As well, the emergency service worker may not always be able to tell if blood is present in a body fluid. FOR THIS REASON, ALL BODY FLUIDS MUST BE CONSIDERED HAZARDOUS.
Body Fluids to Which Universal Precautions Apply
Universal precautions apply to blood and to other body fluids containing visible blood. Occupational transmission of HIV and HBV to health-care workers by blood is documented. Blood is the single most important source of HIV, HBV, and other bloodborne pathogens in the occupational setting. Infection control efforts for HIV, HBV, and other bloodborne pathogens must focus on preventing exposures to blood as well as on delivery of HBV immunization.
Universal precautions apply to semen and vaginal secretions. Although both of these fluids have been implicated in the sexual transmission of HIV and HBV, they have not been implicated in occupational transmission from patient to health-care worker.
Universal precautions also apply to cerebrospinal fluid (CSF)) (surrounds brain and spinal cord), synovial fluid (found inside joints), pleural fluid (found inside chest cavity but outside lung), peritoneal fluid (found `inside abdominal cavity), pericardial fluid (surrounds the heart), and amniotic fluid (surrounds fetus in the uterus). The risk of transmission of HIV and HBV from these fluids is unknown; epidemiologic studies in the health-care and community setting are currently inadequate to assess the potential risk to health-care workers from occupational exposures to them.
Attachment 1 - (Page 1 of 1)
Attachment 1
Community Leisure Centres Infection Control Resource Manual ……Universal Precautions
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Body Fluids to Which Universal Precautions Do Not Apply
Universal precautions do not apply to feces, nasal secretions, sputum, sweat, tears, urine, and vomitus unless they contain visible blood. The risk of transmission of HIV and HBV from these fluids and materials is extremely low or nonexistent.
Saliva of some persons infected with HBV has been shown to contain HBV-DNA at concentrations 1/1,000 to 1/10,000 of that found in the infected person's serum. HBsAg-positive saliva has been shown to be infectious when injected into experimental animals and in human bite exposures. However, HBsAg-positive saliva has not been shown to be infectious when applied to oral mucous membranes in experimental primate studies or through contamination of musical instruments or cardiopulmonary resuscitation dummies used by HBV carriers.
Use of Protective Barriers
Protective barriers reduce the risk of exposure of the lifeguards skin or mucous membranes to potentially infective materials. For universal precautions, protective barriers reduce the risk of exposure to blood, body fluids containing visible blood, and other fluids to which universal precautions apply. Examples of protective barriers include gloves, gowns, masks, and protective eyewear, Gloves should reduce the incidence of contamination of hands, but they cannot prevent penetrating injuries due to needles or other sharp instruments. Masks and protective eyewear or face shields should reduce the incidence of contamination of mucous membranes of the mouth, nose, and eyes.
Universal precautions are intended to supplement rather than replace recommendations for routine infection control, such as handwashing and using gloves to prevent gross microbial contamination of hands. Because specifying the types of barriers needed for every possible situation is impractical, some judgment must be exercised.
Protective Barriers as Part of Universal Precautions
All staff should routinely use appropriate barrier precautions to prevent skin and mucous membrane exposure during contact with any patient's blood or body fluids that require universal precautions.
Gloves should be worn for touching blood and body fluids, mucous membranes, or non-intact skin of all patients, for handling items or surfaces soiled with blood or body fluids.
Gloves should be changed after contact with each patient.
Hands and other skin surfaces should be washed immediately and thoroughly if contaminated with blood or other body fluids. Hands should be washed immediately after gloves are removed.
Although saliva has not been implicated in HIV transmission, to minimize the need for emergency mouth-to-mouth resuscitation, mouthpieces, or other ventilation devices should be available for use in areas in which the need for resuscitation is predictable.
Staff who has exudative lesions or weeping dermatitis should refrain from all direct patient care and from handling patient-care equipment until the condition resolves.
Pregnant health-care workers are not known to be at greater risk of contracting HIV infection than health-care workers who are not pregnant; however, if a health-care worker develops HIV infection during pregnancy, the infant is at risk of infection resulting from Perinatal transmission. Because of this risk, pregnant health-care workers should be especially familiar with and strictly adhere to precautions to minimize the risk of HIV transmission.