The Industrial Hygiene Hazards after Katrina Disaster - Essay Example

Katrina Disaster & Hospital Recovery The Industrial Hygiene Hazards for Hospitals and Hurricane Induced Hygiene Hazards Lecturer: Thispaper explores the guidance provided by an Industrial Hygienist of the hospital to the Incident Commander of a Large New Orleans Hospital on safe entry, safe clean up procedures, appropriate protective equipment for all rescue workers and hazard assessment after the building was hit by Hurricane Katrina and subsequent flooding caused by damaged levee. The paper is based on industrial hygiene hazards for the hospital as well as those induced by the hurricane, how the rescue teams detect, face and remove those hazards to make the environment safe and operational. The paper addresses planning and implementing of the rescue work, workers safety and hazards, equipment and protective gear required, hazardous materials inside the hospital and their removal. Keywords: Personal Protective Equipment – PPE, The National Institute for Occupational Safety and Health - NIOSH, Federal Emergency Management Agency – FEMA, High efficiency particulate absorbing – HEPA, Occupational Safety and Health Association - OSHA, contaminants, hazards, hygiene. SCENARIO Evaluation of a large New Orleans Hospital after Hurricane Katrina and resultant flooding is taking place directed by Incident Commander, lead by Industrial Hygienist of the hospital with a team comprising of Hospital’s Safety Supervisor (Programs & Training), the Environmental Manager (physical plant, wastes and regulatory issues), two technicians (IH and environmental sample collection and testing) and 25 other employees. The recovery team is given the name ‘Rescuers”. Teams would be organized by phases in the recovery mission. Phase one would be to make second floor safe and clean for working environment as per set standards. Second phase would be initial evaluation of the building further breaking down into sub-phases according to building levels. Then third phase would be removal of hazardous material from basement and 1st level. Fourth phase would be reconstruction and rehabilitation of the floors. Final phase would be testing and monitoring for safety prior to opening the hospital fro operation. ASSUMPTIONS Team would be housed on site in Federal Emergency Management Agency (FEMA) trailers powered by generators. Team’s offices would be on the 2nd floor of the building (since below levels are waterlogged) along with surgical suites, clinical laboratory and pharmacy. Pharmacy has been looted and trashed. Since communication means through land line is impossible and few cell phone networks are working, hence radio satellite would be installed for reliable mean of communication. First floor and basement are under 6 feet water level where main administration, emergency operating rooms, cafeteria / kitchen are located. PROTECTION OF THE RESCUE WORKERS FROM HYGIENE AND SAFETY HAZARDS Rescuing staff should be trained in hazard assessment and equipped with the right PPE (Workplace Health and Safety Act, 1995) to enter the hospital building. Prior to that they would be given necessary shots and increased risk of infections and diseases prevalent in a contaminated environment. Intake of vitamins and proteins would be ensured through extra dosage during recovery work to boast immune systems. Items needed to assure safety of the workers include hardhats (to be worn to protect from head injury from falling debris), water tight boots with steel toe and insole (no joggers or sneakers allowed on site since they cannot prevent punctures, bites or crash injuries), puncture resistant gloves (to protect hands from injuries), safety glasses (to protect eyes from debris and contaminated water), HAZMAT Suits (to prevent body from exposure to environmental hazards such as toxic mold, dust, chemicals, infections, germs, water, sludge etc). Proper PPE equipment including NIOSH approved respirator (NIOSH N-95) is required when entering the building, especially the flooded areas), high power flashlights (only use of flash lights is advisable since flammables can be found), clean water, first aid treatment kits, adequate amount of fire extinguishers, portable ground-fault circuit interrupters (GFCIs) for wet locations, poles and wooden stick for probing the floor should be made available. These are main PPE required for most of the recovery and assessment work. However, this PPE would also be required in addition to other protective gears for the long run when proper reconstruction and re-installation of utilities and hospital equipments are to be done. TESTING EQUIPMENT The testing equipment required by the inspection team includes, IAQ sampling pumps and timers, hand held particle counters or portable laser particle counters, portable gas detectors and fixed gas monitors, calibration gas monitors, mold test kits, hygrometers (humidity sensors), temperature sensors (contact or non-contact), thermal readers, infrared cameras, infrared laser thermometers (that measure moisture, humidity, temperature) and heavy duty water pumps. Syringes, cylinders, containers, and other sampling equipment would also be required. MAIN INDUSTRIAL HYGIENE CONCERNS In the flooded and damaged building of the hospital rescuers would find numerous hazards in form of air contaminants, chemical, biological, physical and ergonomic hazards. In order to ensure safety of the rescuers flooded floors should be ventilated with portable heavy duty fans at least 30 minutes before entering the area. Mostly all of the items present in a flooded area are contaminated with mosquitoes and insects, bacteria, viruses, toxic molds and chemicals from flood water mixed with sewage as well as hospital waste and germs. Hospital chemicals, drugs and elements mixed in the flood water or airborne contamination may have either acute or chronic effects on the rescue workers that come in contact with them accidently. Hence proper PPE and its maintenance are of utmost importance in this rescue operation since such toxic substances can be entered in a body through routes including intact skin, respiratory system, inhalation and ingestion, eyes, accidental needle puncture etc. These harmful chemicals / elements may include asbestos, mercury, isopropyl alcohol used as antiseptic and disinfectant, chlorine, ethylene oxide, iodine etc (NIOSH, 1988). These elements are found throughout the hospital and can be harmful to human health if intake exceeds norms under a contaminated environment though air or water. Overexertion of workers should also be avoided by planning out appropriate shifts and rest breaks in between. Lifting of water laden objects would be done only if the item is light enough otherwise specialized equipment would be used for lifting. Due to no electricity the environment would be hot and suffocated hence breaks and availability of clean water, sunscreen and first aid kit should be ensured. Floor damage should be assessed through wooden stick or pole to check for pits, holes and protruding objects before entering flooded areas. Ladders and stairs should be tested and made secure before using, During rescue work, rescuers need to be careful of the electrical aspect and condition of the place to avoid accidents. All cord-connected, electrically operated equipment should be grounded or double insulated by using GFCIs. Generator should be started only once main circuit breaker is off and locked out preventing rescue workers from possible electrocution. If damage to an electrical system is suspected (for example, if the wiring has been under water, sparks or flares are seen or burning insulation detected) qualified electrical help should be sought and power should be turned off. Back injuries can also occur while lifting heavy equipment. Another serious threat can be faced due to gas leaks or compressed gas cylinder causing blasts and severe damage. Widely used compressed gases in a hospital are anesthetic gases, hydrogen, ethylene oxide, chlorine, helium etc. Areas of the hospital where such inventory items are kept or used should be inspected with utmost care and careful environment monitoring for gas levels should be done. Equipment present in the hospital may also subject the rescuers to radiation leakage. Similarly utmost care should be taken when entering the kitchen area of the hospital for inspection since electrical and gas leakage can be a possible threat as well as physical hazard from utensils. HAZARDOUS MATERIAL REMOVAL Removal of hazardous equipment and waste is the second most important step after inspection and is extremely important for recovery of the building and its environment (Luther, 2008). Powerful water pumps need to be utilized to remove water logged in the basement and 1st floor. Water taken out should be stored in special water tankers assigned for hazardous material removal. After water is removed, sludge and debris need to be removed completely through specialized lifting equipment and support by FEMA. Water damaged and bacteria infected items such as books, boxes, papers, mattresses, linen, towels, pillows, upholstered furniture, false ceilings, floor / wall coverings, carpets, curtains, insulations, all kitchen utensils etc should be disposed off since they cannot be washed off to remove 100% bacteria. Disinfection can be done by following strict standards and tests afterwards to assure desired results. Items that can be disinfected include solid wood furniture, ceilings, walls, floors, counters, shelves, non-wooden kitchen utensils etc. Broken glass and broken wirings need to be carefully removed from site, handled and disposed off. All water supply system need to be washed and renovated to remove signs of biological contamination, waste contamination from flood and sewage waters. These hazardous materials should be collected and disposed off with the help of FEMA and their authorized drop off or collection sites (Luther, 2008). AIR MONITORING REQUIRED Constant air monitoring would be required for all floors and basement during and after the completion of recovery work since it would be the main & first hazards assessment and prevention step taken. IAQ monitoring would be done through laser particle counters, humidity sensors, temperature sensors and infrared laser thermometers to detect any influx of contaminant in the environment. DETAILS Worksite analysis is to be conducted for the 2nd floor first by an exterior makeshift stairs entering through a huge window. Team should include the Industrial Hygienist, Safety Supervisor, Environmental Manager, One technician and 3 other trained workers all equipped with proper PPE discussed above. This team would be the worksite inspection team and recovery team would comprise of Safety Supervisor, Environmental Manager, one technician and 25 workers. Recovery team would report to the Industrial Hygienist. Hence the preliminary worksite inspection would verify the stability of the second floor. Floor and wall inspection would be done by probing through a pole or wooden stick to check for pits, holes and unstable / weak surfaces. Air monitoring would be done and swaps would be taken to send for testing for contaminants. All testing analysis would be done by laboratories accredited by the American Industrial Hygiene Association (AIHA) and monitoring of the levels of contamination would be done as established by OSHA. In the mean while initial inspection of the basement and first floor would also be done by highly experienced technicians for taking air and water samples. Once results are obtained rescuers equipped with relevant PPE would enter 2nd floor to remove debris and make the floor’s air conditioned by establishing containment barriers with negative air and monitor it closely throughout the project. Negative air shall be exhausted through HEPA filter (Filt-Air, 2007). Broken windows and roof damage would be stabilized by using shrink wrap process to seal the floor. Once the work area is well under safety control, cleaned and required equipment there, water pumping from first floor would commence first and then from the basement. Once water is gone, equipments, debris, furniture, carpets and other items would be removed from the building. They would be assessed depending upon their condition and standards and sorted out for disposal. Although most of medical and administrative record recovered would be destroyed or severely damaged whatever could be recovered would be sent off-site due to confidentiality issues. Salvageable hospital equipment would be relocated for renovation and repairs. Repair works would commence after removal of equipment with constant environmental monitoring to avoid hazards. First electricity would be restored, then plumbing and sewerage, then gas and telephone lines respectively. Back-up generator system of the building would also be restored and made workable to ensure non-stop power supply while recovery work is underway. Next step would be adding furniture and equipment. Then resources and supplies would be re-stored and hospital can start operations once the final environmental and hazard testing is cleared for the renovated hospital. References Filt-Air (2007). HEPA Filters. Retrieved from Fletcher, Laurel E., Pham, Phuong, Stover, Eric & Vinck, Patrick (2006). Rebuilding after Katrina: A population based study of labor and human right in New Orleans. Retrieved from Gray, Bradford H. and Hebert, Kathy (2006). After Katrina: Hospitals in Hurricane Katrina. Washington: The Urban Institute. Herman, Alexis M. (1998). Informational Booklet on Industrial Hygiene OSHA 3143. Retrieved from Luther, Linda (2008). Disaster Debris Removal after Hurricane Katrina: Status and Associated Issue - CRS Report for Congress. Retrieved from National Institute for Occupational Safety and Health NIOSH (1988).Guidelines for Protecting the Safety and Health of Health Care Workers. NIOSH Publication. (88-119). Retrieved from Occupational Safety and Health Administration OSHA (2003). OSHA FACT Sheet. Retrieved from Queensland Parliamentary Council (2011). Workplace Health and Safety Act 1995. Retrieved from Wright, Wade (2002). The Hospital and Industrial Hygiene. The American Journal of Public Health. Retrieved from Read More