Embalming Class (Ch. 3)

At what concentration does formaldehyde vapor in a room constitute a potential health hazard to the embalmer?

0.5ppm

What are two primary areas of engineering controls to consider?

1. Adequate ventilation 2. proper plumbing

Training session records must include what four things?

1. the date of each training session 2. a summary of each training session 3. the names of and qualifications of trainers 4. the names and job titles of all persons attending each training session

Hazardous chemical

Any chemical whose presence or use is a physical hazard or a health hazard

what is an example of a book that satisfies OSHA's compliance standards?

Control of Communicable Diseases Manual (Benenson, 1995)

MSDS

Material Safety Data Sheets. Any data sheet that contains information required under many state regulations and Federal Regulations, regarding the physical, chemical, and hazardous properties of a substance or mixture

What did Outside Magazine state in July 1998

Microbes are still the number three killer in the Western world

What constitutes a physical or health hazard?

Mixtures of chemicals with a composition of 0.1% or more of an ingredient classified as a carcinogen, teratogen, or mutagen (or) Mixtures of chemicals which although not being classified as the former have a composition of 1.0% of something classified as a hazardous substance

NIOSH

National Institute for Occupational Safety and Health. Tests and certifies respiratory protective devices and air sampling detector tubes, recommends occupational exposure limits for various substances, and assists OSHA and MSHA in occupational safety and health investigations and research

Embalming has historically encompassed principles and practices that are part of ___________ __________.

Public health

STEL

Short-term exposure limit

Definition of "broad spectrum"

bactericidal, fungicidal, virucidal, and ideally tuberculocidal.

Work Practice Controls

common sense steps taken to avoid unnecessary or excessive exposure to infectious agents

MSDS contains what?

critical information related to the hazards, exposure levels, and symptoms associated with the material or the substance.

Bactericidal

destructive to bacteria

The "at risk" nature of a dead body is for those who have __________ __________.

direct contact

McDonald (1989) reported what?

embalmers face much the same risk of exposure to infectious diseases as clinical pathologists.

Turner and colleagues (1989) reported what?

embalmers in te Boston area were about two times more likely to test positive for HBV infection than a blood donor comparison group. Length of time working also elevated the risk

Beck-Sague and co-workers reported what in 1991?

embalmers were at potential risk of acquiring infection as a result of their frequent contact with blood

What does the Hazard Communication Rule Require?

employers communicate to employees the dangers that exist in the workplace as a result of hazardous substances or materials, and directs employers to train employees in the safe use and handling of hazardous substances or materials.

What is the formaldehyde Standard?

establishes specific limits on the amount of exposure that is allowed. The specific point at which an 8-hour exposure is unsafe is called the action level

What did Williams and associates report (1984)

exposure to formaldehyde, particularly, formaldehyde vapor, is probably the most significant of the chemical exposures to which embalmers are subjected

Asepsis

freedom from infection and from any form of life; sterility

What does the Hazard Communication rule demand of manufacturers and suppliers

inclusion of an MSDS with each shipment

Bacteriostatic

inhibiting the growth or multiplication of bacteria (no destruction of viability implied)

Why should pitted instruments be thrown away?

it is very difficult to disinfect them

PPE is considered to be appropriate only if:

it prevents blood or other potentially infectious substances from passing through, or otherwise reaching, the employee's work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of time and use.

The formaldehyde tests must be conducted in a "__________ __________' environment

worst case

What was reported in the Forum (Dec. 2009)

"The incidences of occupationally-contracted infectious, contagious, or communicable disease are ow in general and somewhat lower for embalmers than for individuals in other fields, such as healthcare. However, when proper protective measures are not used, transmission is possible".

How does the Code of Federal Regulations describe the purpose of universal precautions?

"to prevent parenteral, mucous membrane, and non intact skin exposure"

What is the minimum documentation required for an Exposure Control Plan?

1. Exposure Determination 2. Methods of compliance 3. hepatitis B vaccination 4. Postexposure evaluation and follow-up 5. Hazard communication 6. Record keeping

What two things are employers required to determine?

1. If occupational exposure to bloodborne pathogens exists 2. What types of duties are being performed when occupational exposure to blood borne pathogens occurs

What are the National Funeral Directors Association's set of Environmental Health and Safety Practices (13)?

1. Secure the preparation room 2. Evaluate exposure risks 3. Known the products you are using 4. Prepare for emergencies 5. Limit toxicity and waste 6. Avoid solvents and chlorinated compounds 7. Know how to manage your wastewater 8. Handle sharps carefully 9. Think before you flip the switch 10. Do not just toss it in the trash 11. Recycle 12. Keep it clean 13. Document your work

Hazard Communication training program must meet the following (10) criteria.

1. The employer must identify hazardous substances found in the workplace 2. The employer must identify hazardous substances exposure levels that trigger restrictions 3. The employer must identify the routes of entry, and acute or chronic effects of exposure to hazardous substances 4. The employer must explain the symptoms that accompany exposure 5. The employer must identify and explain other dangers associated with hazardous substances to which the employee is exposed (ex. flammable) 6. The employer must explain emergency treatments what will be employed if there is an exposure incident. 7. The employer must explain to employees the proper use and handling of hazardous substances 8. The employer must explain cleanup procedures for leaks and spills 9. The employer must provide information on the name, telephone number, and the address of the companies that supply the chemicals 10. The employer must inform employees of the existence and location of written materials related to hazardous substances that are found in the workplace

Compliance with the Bloodborne Pathogen Rule is accomplished by the application of what three things?

1. Universal precautions 2. Engineering Controls 3. Work Oractice Controls

The post exposure evaluation and follow-up includes what (6) things

1. a detailed explanation of the events and circumstances of the exposure 2. identification and documentation of the source individual, unless prohibited by law 3. collecting and testing the blood for HBV and HIV 4. taking steps necessary to assist in the prevention of infection or disease 5. offering counseling 6. conducting an evaluation of any reported illnesses.

What are the most notable among the health problems that can result from chemicals in the preparation room?

1. contact dermatitis 2. eye and nose irritations 3. upper respiratory irritations

Formaldehyde danger signs must bear what four things?

1. danger 2. formaldehyde 3. irritant and potential cancer hazard 4. authorized personnel only

What are two major provision of OSHA's Respirator Standard?

1. employees must be fit-tested to see if a respirator is appropriate for them 2. a personal respirator must be fitted to each individual employee, ad refitted regularly

What five things can be done to label or distinguish containers used to store, transport, or ship blood or other potentially infectious agents?

1. fluorescent orange labels 2. orange and red labels 3. predominantly orange and red warning labels 4. labels with letting and symbols in contrasting colors 5. other suitable substitutes for labels, such as red bags or red containers

What are five examples of good work practice controls

1. hand washing 2. proper handling and disposal of contaminated waste and contaminated sharps 3. avoiding splashing, spraying, or splattering when working with potentially infectious agents 4. consistent and proper use of PPE 5. adequate housekeeping

What are three other hazards of embalming aside from biological and chemical?

1. heat 2 ionizing radiation 3. nonionizing radiation

In addition to biological and chemical hazards, what other occupational hazards do embalmers face?

1. heat 2. ionizing radiation 3. nonionizing radiation

What are eight qualities of a good topical disinfectant?

1. it is active, not outdated - should have a long shelf life 2. will not corrode or stain instruments 3. it is effective against a wide range of microbes including viruses and fungi 4. It destroys microbes and their products quickly 5. It is a good deodorant for the body 6. It does not bleach or stain the skin 7. It is not irritating to the embalmer's skin or respiratory tract 8. Is not inactivated by the presence of biological debris

The Hepatitis B Vaccination program must include what four things?

1. offered at no cost to the employee 2. offered at a reasonable time and place 3. performed by or under the supervision of a licensed physician or healthcare professional 4. provided according to the recommendations of the US Public Health Service

If TWA sampling exceeds the STEL or the PEL, the employer must do what two things?

1. place formaldehyde warning signs on areas where the concentration of formaldehyde has exceeded these levels 2. begin medical surveillance of employees who work in areas where the concentration has exceeded the STEL or the PEL

What are the three objectives of the embalming process?

1. preserve 2. sanitize 3. restore

Embalmers could consider what two options for sterilization?

1. steam sterilization or autoclaving 2. immersion of instruments in a suitable cold chemical sterilant

The number of air exchanges per hour may be determined by what four things?

1. the contents of the room 2. whether more than one embalming will be in progress at the same time 3. the shape of the room 4. other factors, such as hot or cold weather or the preference of the embalmer.

If after testing the exposure limit has not been reached, under what circumstances must the environment be retested?

1. the employer receives a report of an employee's symptoms associated with formaldehyde exposure 2. there are any changes in procedure, equipment, chemicals, personnel, or other circumstances that affect the work area

Employers records for each employee with occupational exposure should include what five things?

1. the name and Social security number of the employee 2. a copy of the employee's hepatitis B vaccination 3. results of any examinations, medical testing, and follow-up procedures that occurred as a result of an exposure incident 4. employer's copy of any healthcare professional's written opinion regarding examinations, medical testing, or followup in the aftermath of an exposure incident 5. a copy of the former report.

The embalmer, as a sanitarian, grew out of what two early twentieth century situations?

1. the pandemic flu of 1919 2. almost all embalming was first performed in the home

Topical disinfectants are used for what two things in the prep room?

1. the sanitation of the skin and the hair of the dead human body's external orifices 2. sanitation of exposed tissues as a result of trauma, autopsy, organ and/or tissue donation

What are the two tests that must occur in every funeral home where any formaldehyde is used?

1. time-weighted average (TWA or PEL) 2. short-term exposure level (STEL)

To seek protection from possible infection, an embalmer can do what six things?

1. utilize PPE 2. properly decontaminate infected surfaces 3. properly handle and dispose of infectious wastes 4. apply appropriate measures to control leaks, drips and spills of infectious materials 5. apply proper work practice skills 6. properly handle infected laundry.

Examples of engineering controls that could reduce the possibility of water contamination might include what eight things?

1. vacuum breakers on the main water line leading into the building 2. vacuum breakers on hydroaspirators 3. discharge basins/flush sinks that are in good working order 4. having suitable water source for the preparation table 5. having a proper eyewash station 6. having a proper drench shower 7. having a proper hand washing station 8. having proper shower room facilities for embalmers to use after the embalming is completed

What is a rough rule of thumb for the number of exchanges per hour

12 to 20 per hour (15)

When did the US EPA recognize formaldehyde as a potential carcinogen for tumors in the lung, nasopharynx, and nasal passages

1987

Training records are to be kept for a period of how many years from the date of training?

3

Health Hazard

A chemical for which there is significant evidence, based on at least one study conducted in accordance with established scientific principles, that acute or chronic health effects may occur in exposed employees.

Acute effect

Adverse effect on a human or an animal which has severe symptoms developing rapidly and coming quickly to a crisis

ACGIH

American Conference of Governmental Industrial Hygienists is an organization of professional personnel in governmental agencies or educational institutions who are employed in occupational safety and health programs

Chronic effect

An adverse effect on a human or an animal body, with symptoms which develop slowly over a long period of time or which recur frequently.

What did Nethercott and Holness report? (1988)

Canadian funeral service workers were more likely to complain about irritations of the nose and eyes than were members of a control group. Those funeral service employees who were in contact with formaldehyde were likely to experience skin and mucous membrane irritation

Who reported the first documented case of an embalmer being infected with tuberculosis while embalming a dead human body and where was it reported?

Dr. Timothy Stirling in the New England Journal of Medicine

What does the Bloodborne Pathogen Rule require?

Employers are required to conduct an evaluation of their workplace(s) to determine if employees have occupational exposure to infectious agents regulated by OSHA. If such exposure exists, a written Exposure Control Plan must be developed to control, minimize, or eliminate employee exposure.

What is the formaldehyde rule?

Employers must monitor employees to determine how much exposure exists in the workplace.

With regard to hazardous chemicals, what are the two main requirements of the Hazard Communication Rule?

Identification of hazardous chemicals in the workplace and communication with employees about risks and protective measures

When did the International Agency for Research on Cancer recognize formaldehyde as a human carcinogen.

June 2004

PEL

Permissible exposure limit is an exposure limit established by OSHA's regulatory authority. It may be a time-weighted average (TWA) limit or a maximum concentration exposure limit

Action level

That level at which certain actions must occur. In the Formaldehyde Standard, the level at which periodic monitoring for formaldehyde becomes necessary and at which medical surveillance becomes necessary

Decontamination

The use of physical, chemical, or other means to remove, inactivate, or destroy harmful microbes or chemicals from a surface.

TWA

Time-weighted average exposure is the airborne concentration of a material to which a person is exposed, averaged over the total exposure time.

RISK = __________ x __________

Toxicity x Exposure

Describe the basic premise of universal precautions?

Treating every body as if they are contaminated with a harmful or deadly blood borne or otherwise infectious disease.

Sterilization

a process that renders a substance free from all microorganisms

Hazard Communication rule and labeling

all containers that hold hazardous substances or materials must be properly marked with the name of the product as it appears on the MSDS.

Germicide

an agent, usually chemical, applied either to inanimate objects/surfaces or living tissue for the purpose of destroying disease-causing microbial agents, but usually not bacterial spores

Disinfectant

an agent, usually chemical, applied to inanimate objects/surfaces for the purpose of destroying disease-causing microbial agents, but usually not bacterial spores

Sanitizer

an agent, usually chemical, that possesses disinfecting properties when applied to a reclined object/surface

What is the most important factor in the ventilation system

location of the exhaust (it should be at the foot of the embalming table and below the level of the tabletop)

The Bloodborne Pathogen Rule is directly applicable to whom?

occupations and professions where employees are exposed to infectious agents

In addition to the labeling provisions required by the Bloodborne Pathogen Rule, employers must also do what?

provide information and training to those employees who are exposed to infectious hazards in the workplace.

cleaning

removal of infectious agents by scrubbing and washing, as with hot water, soap, or a suitable detergent

Gershon and colleagues (1998) from Johns Hopkins University reported what?

that the funeral home employees who engaged in embalming were twice as likely to have a positive tuberculin skin test when compared to the funeral home employees who did not embalm bodies.

Terminal disinfection

the cleaning and disinfection of the body, instruments and the embalming room following embalming of the body

Concurrent Disinfection

the cleaning of the body and instruments at the time of embalming the body

What is a good rule of thumb for protective garments?

the embalmer should have no exposed skin

A 1996 CDC study reported what?

there is ample reason for concern about the exposure the embalmers may have to blood borne and airborne pathogens.

Primary disinfection

those disinfection procedures carried out prior to embalming the body. This would include topical disinfection of and washing the deceased human body

Engineering Controls

those mechanical systems and devices engineered into the architecture of a building. Used to provide personal and public health protection.

Universal precautions

to treat all human remains as if they were infected

What are two primary areas of consideration for engineering controls

ventilation and plumbing