Monday, February 3, 2014

OSHA Respiratory Standards

Found this today.

Occupational Safety and Health Standards, Personal Protective Equipment, Respiratory Protection, Part number 1910.



An excerpt...

Permissible practice.

1910.134(a)(1)

In the control of those occupational diseases caused by breathing air contaminated with harmful dusts, fogs, fumes, mists, gases, smokes, sprays, or vapors, the primary objective shall be to prevent atmospheric contamination. This shall be accomplished as far as feasible by accepted engineering control measures (for example, enclosure or confinement of the operation, general and local ventilation, and substitution of less toxic materials). When effective engineering controls are not feasible, or while they are being instituted, appropriate respirators shall be used pursuant to this section.

What good will come of all this?

Today has been a very depressing day for me. I won't say how much, but I was really down this afternoon. I guess force of habit causes me to try to find a silver lining to this cloud of what could be considered gloom.  So I ask myself, what good might come from all of this? Does God have plans for a higher good to come of this?
  • I now have a knowledge of the disease I didn't have before.
  • Perhaps DOC might actually train their staff and/or write policy dealing with airborne pathogens, treating them with the same precautions as liquid contaminants.
  • Perhaps I'll have an opportunity to be a trainer for DOC in this area.
  • Perhaps I'll get some sort of pay raise or financial compensation because of it all, as this will affect the rest of my life and career.
  • Perhaps this could open up a new ministry for me.
  • Perhaps somewhere in the world someone could use this new insight I've gained, and I can be of some good elsewhere.
Am I being overly dramatic?

Sunday, February 2, 2014

What's really bugging me...

What is really bothering me about this whole event is:

  • At work we have to follow policy and procedure on everything, and there is one on handling blood-borne pathogens.  I've never seen or heard of one on airborne contaminants.  Since prison is one of the most common locations for TB exposure, why not?
  • We check and report multiple times per shift on mechanical rooms and tool inventories.  Who is accountable for making sure the negative rooms are functioning properly?
  • As soon as I was found to be a positive carrier for TB, they gave me a mask and told me to go get a chest x-ray.  Why didn't they have concern for my family or others who I was in contact with?
  • When did the negative pressure rooms actually fail?  How long were workers and staff exposed?
  • The night they sent me home, they provided face masks to all the staff for protection.  Why not the inmate workers in the Palliative Care Unit?
  • Is the Department of Corrections prepared for this disease I now have, I have for life?  My Maximum Medical Improvement date is now Nov. 1, 2014.  Is that a realistic date, or will these latent granulomas be part of me forever?

Latent TB May Not Be So Latent

See article from Medical News Today, published Dec. 19, 2013...

Lung lesions of TB variable, independent, whether infection is active or latent

For the complete article, click here.

An excerpt...

When the lungs become infected with M. tuberculosis, the body's immune system walls off the bacteria into lesions called granulomas, explained co-senior investigator JoAnne Flynn, Ph.D., professor of microbiology and molecular genetics, Pitt School of Medicine.

"It's long been thought that the patient with a weakened immune system or some other immune vulnerability was more likely to develop active disease," Dr. Flynn said. "But to our surprise, our study showed that every infected individual has a collection of granulomas, some containing live bacteria and some that are sterile because the immune system has killed all the bacteria. So in this sense, there's no such thing as a latent or active granuloma."

This was a study done by Sarah Fortune, M.D. (et. al), of Harvard University, funded in part by the Bill & Melinda Gates Foundation.

Not such good news.

Saturday, February 1, 2014

Worldwide Shortage of Isoniazid (INH)

The CDC announced Jan. 28, 2013 that there is a worldwide shortage of INH or Isoniazid.  Wonder if it's still on? Here is the latest I could find.

January 2013 - Recommendations for Drug Allocation, Tuberculosis Prevention, and Patient Care During Isoniazid Shortages, Centers for Disease Control and Prevention.

January 2014 - American Society of Health-System Pharmacists, Drug Shortages (listing Isoniazid)

Treatment for Latent Tuberculosis

From the CDC.  Click here for the full page.  An excerpt...

Treatment for Latent TB Infection

People with latent TB infection have TB bacteria in their bodies, but they are not sick because the bacteria are not active. (see article below) People with latent TB infection do not have symptoms, and they cannot spread TB bacteria to others. However, if TB bacteria become active in the body and multiply, the person will go from having latent TB infection to being sick with TB disease. For this reason, people with latent TB infection are often prescribed treatment to prevent them from developing TB disease. Treatment of latent TB infection is essential for controlling and eliminating TB in the United States.

Because there are less bacteria in a person with latent TB infection, treatment is much easier. Four regimens are approved for the treatment of latent TB infection. The medications used to treat latent TB infection include:

isoniazid (INH)
rifampin (RIF)
rifapentine (RPT)

Certain groups of people (such as people with weakened immune systems) are at very high risk of developing TB disease once infected with TB bacteria. Every effort should be made to begin appropriate treatment and to ensure completion of the entire course of treatment for latent TB infection.

But then there is this from the CDC...

After you take the medicines for about 2 or 3 weeks, you may no longer be able to spread 
TB bacteria to others . If your doctor or nurse agrees, you will be able to go back 
to your daily routine, including returning to work or school . Remember, you will 
get well only if you take your medicines exactly as directed by your doctor or 
nurse .

Think about people who may have spent time with you, such as family members, 
close friends, and coworkers. The local health department may need to test them 
for TB infection. TB is especially dangerous for children and people infected with 
HIV. If infected with TB bacteria, these people need medicine right away to keep 
from developing TB disease.

Link to PDF file, see page 16