OSHA Respiratory Standards

Found this today.

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

Click here for the entire OSHA Standard

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?

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.

My thoughts after seven days...

It was exactly a week ago I found out I needed to be tested for TB. Now it's a disease that I'm going to have the rest of my life! I realize it's in the latent form, and more than likely won't cause me or anyone near me any more harm. It still makes me mad.

Is this little chapter in my life blog worthy? I don't really think so, but it's an easy way to keep track of events and occurrences, and if someone is interested, I can point them to a link (perhaps someday).

Day 7

January 31, 2014

07:55-Sandy, Amber, Gavin and Aydin (wife, daughter, grandsons) arrived at the Brevard County Health Department for PPD testing. Paid $15.00. They told her they could not give free testing.

10:00- Woke up, took my meds.

11:00- Ate breakfast

12:31- Arrived at Chiron Urgent Care Center to have them correct my DCW-25 form for Workman’s Comp. Dr. Welch gave me new one to include 1) transferring care and service to my Primary Care Physician and to add “(needed for) routine evaluation and management of medication – compliant treating his exposure”. He also moved my anticipated MMI date to 11/01/2014.

13:07- Visited Nurse Rimes, R.N. at the Brevard County Health Department to see why they didn’t give my family free shots like they said they would.1/30/14.

13:20- Visited Royal Oak Medical Center to give Dr. VanEaton a copy of my new Workman’s Comp paper work from Dr. Welsh. Gave paperwork directly to Jo Smith.

13:47- Received a call from Nurse Maura Serrie, R.N., T. B. County Program Manager, from the Brevard County Health Department, Rockledge office. She said my family would not be authorized free of charge PPD testing, because only those who have been exposed to an active TB carrier could receive the testing. My family was exposed to me, a secondary exposure patient, therefore, not eligible. She said Nurse Debbie Rimes in Titusville was not authorized to give my family free testing. Her telephone number is 321-634-3550.


Worked
Location/Provider: AmeriSys, Chiron, Royal Oak
Duration: 3 hours
Mileage:  14.8 miles

Day 6

January 30, 2014

13:15- Met with Debbie Rimes, R.N. Brevard County Health Department, Titusville Clinic, 611 Singleton Avenue, Titusville, FL 32796, Phone: (321) 383-2795, Fax: (321) 269-6368. I told Nurse Rimes my work situation. I asked her some of my questions. She told me all of my family members should be PPD tested, and they would do it at no charge. She also strongly recommended I consult with my family physician. My family members should come in on Monday or a Friday, then two days later for a test reading. The meeting concluded approximately 13:35.

14:30- Met with my Primary Care Physician, Dr. Leonard VanEaton, at Royal Oak Medical Center, Titusville, FL regarding my situation. He answered some of my questions and told me that:

• The TB medication I am taking, Isoniazid, is very hard on the liver and initial liver enzyme tests should be taken prior to taking.
• Additionally liver enzyme tests and monthly evaluations are needed until the treatment is complete.
• He pointed out on my Workman’s Comp form DCW25, my MMI (Maximum Medical Improvement) date is currently Feb. 4, 2014 and that is not correct. My MMI is not achieved until after all of the treatment is completed.
• As a Workman’s Comp (AmerySys) physician, he would be willing to take my case.
• He ordered laboratory blood work and told me to return upon completion.

Day 5

January 29, 2014

13:00- Received AmerySys paperwork in the mail today to return signed to my employer ASAP. My first and last name was misspelled on the forms.

14:03-Called work and spoke with Lt. Tate. Told her I would not be at work or until 2/4. Said I would call Lt. Henry tonight and give him an update on my situation.

14:11-Arrived at Urgent Care Center as directed, they had given me paperwork with missing dates. The completed the forms and returned them to me.

14:31-My case manager Bernice called. Corrected my name in the system over the phone. She said she would be sending me new forms. She also said I would be given a permanent case manager, and she was only temporary. The company handling my prescriptions is Progressive Medical, State of Florida, Tel: 877-835-5879.

14:47- Called Progressive Medical, State of Florida, Tel: 877-835-5879, about my case. I worked with the operator (Name Emanuel) to find me in the system, and have him correct the spelling of my name.

15:20- Picked up my prescription of Isoniazid, and vitamin B-6. Began Isoniazid treatment, took the first pills within 15 minutes.

20:16- Sent Lt. Henry an email with the attached form DC2-588 and DCW25, as per instructed. I copied my work email and Gmail accounts. The PDF files successfully opened on my emails. Printed a copy, filed it.

20:30- Phoned Lt. Henry to touch base and notify him of the email I sent. We confirmed that I would be back to work on Feb. 4, at 7:00pm as scheduled.

20:45-Questions that I have for the doctor:

• Q. Since I was exposed to TB, tested positive and was required to wear a mask, do my family and friends that came in contact with me need to be tested too? 
• Q. Can a chest x-ray really see if I have active TB in my lungs? 
• Q. Am I safe to be around other now with a mask? 
• Q. Is there a more accurate test for me than a chest x-ray. 
• Q. If I have Latent TB, what is the actual level of infection in my body? 
• Q. At work, how long was the air filtration system not working in the Isolation Rooms before it was discovered? 
• Q. At work, what are the safety check and emergency protocols for the system and personnel. 
• Q. Is 5 days on the medication, Isoniazid adequate to make me safe around others? 
• Q. May I switch to a new physician under Workman’s Comp
• 
  

Worked
Location/Provider: AmeriSys, Chiron, CVS, Progressive
Duration: 6 hours
Mileage:  8.6 miles

Day 4

January 28, 2014

13:05- I have not received any missed calls or voice messages regarding an update to medical testing or supplies from either work or Workman’s Comp.

13:43- Was phoned by Urgent Care to come in for a follow up visit. Went to website for more information, which indicates blood tests are needed for diagnosis, and chest xrays only indicate if a pulmonary form has spread to the lungs. http://www.cdc.gov/tb/publications/factsheets/general.htm

13:48-Arrived at Urgent Care Center and met with Dr. John Welsh. He reviewed the x-rays with me and told me no active TB could be seen in my lungs. He indicated that he was going to prescribe me Isoniazid, 300mg to take once a day for 9 months, he also said I should take vitamin B-6 with it, and I should follow up regularly with my Primary Care Physician. He told me, and filled out paperwork for my employer that I should return to work Feb. 4, 2014 with no restrictions.

Worked
Location/Provider:  Chiron
Duration: 2 hours
Mileage:  4

Day 3

January 27, 2014, Monday

12:10- Nurse P. gave me a green face mask to wear, and told me I needed x-rays.

12:25- Sergeant W from the Control Room called me at the nurses station and notified me that the Warden  has been notified of this event, and I would soon be relieved from duty and would be going home. At that point I prepared to leave, making sure the building and inmates were secure. I also made a copy of Post Orders, Procedure 403.004 “Emergency Treatment of Staff and Visitors”, 3/23/2013. I also made a copy of the Bed Book Roster to have the names with me of which inmates were in special isolation rooms.Inmates assigned as Palliative Care Orderlies for the shift include:

12:46- Officer N enters Medical Housing, obtains a stack of 5 or 6 masks and takes them out into the main compound.

01:15- Told to leave duty station and report to Lt. J. Henry, OIC

01:30- Reviewed Workman's Comp paperwork with Lt. Henry

01:45- With Lt. H. in his office with Ofc. Abrue, he calls Workman's Comp. (AmeriSys), to get case number and further instructions. My claim number is 1390005184.

02:00- Sent home from work. Told to wait for a call from AmeriSys.

11:39- From home called AmeriSys, 1-800-455-2079. They told me a nurse would call me back.

11:39-Called AmeriSys for instructions, they said a nurse would call me back.

11:57- Nurse Bernice from AmeriSys called me and told me to report to Urgent Care lab for testing. She took a brief health survey of me over the phone. If I need to talk to her, or report progress, call her directly at 407-215-1522. She said she would mail me report forms.

13:39- Spoke with Ms. Kearney, advised to send Lt. Henry email updates, confirming instructions not to submit an Incident Report.

13:40- Arrived at Chiron Urgent Care Center. Wore mask. Filled out standard office information background history forms. Received chest x-ray. Saw Dr. Richard Krubel, M.D., asked about my cough. Said we needed radiology evaluation.

15:36-Left clinic, was told that I'd be contacted to review the results of the x-ray. Nurse Brian heard my concerns about exposing family, and suggested I wear a mask, but not to alarm other members until test results are in. Dr. prescribed face masks (see photo). Travel to claim, Home-Chiron-Pharmacy-Home. Trip completed at: 6:00 pm, total distance traveled 8.6 miles.n, worked hours 4.15 (1:40pm -6:00pm).

16:25- Arrived at CVS to pick up face masks, Workman's Comp declined payment. Will try again later.

17:07-Bernice at Workman’s Comp is trying to help CVS pay for masks.

20:12- Sent an email to Lt. Henry informing him of the situation up until now. Copied my work and personal Gmail account.

Worked
Location/Provider: AmeriSys, Chiron, CVS
Duration: 6 hours
Mileage:  8.6 miles

Day 2

January 26, 2014, Sunday

18:45- Reported to work, sent to Outside Post duty 7-11 pm.

23:10- Relieved from Post duty, told to report to Medical as Housing Officer.

23:15 Reported to duty station as Medical Officer, present were Nurses P. and C. and Officer N. . Signed in on the Medical Housing Log, completed a walk through security check, verifying locked doors, empty offices and an informal inmate count. Immediately after my security check, Nurse B. wanted to see my arm where the test site was. She examined it by touch and site and indicated she thought it was positive. Immediately she called Nurse M. Carlson over for a second opinion. He wasn't quite so sure, but said it might be. Nurse Paul then said, “Let’s wait until Nurse K. comes in, because he’s much more experienced at evaluating this.” Nurse Carlson concurred. One of the nurses also mentioned that when Nurse K. comes in, he also needs to examine Officer A., whose test also appeared positive. At that point I asked Nurse P. if Lt. H. has been notified, and she said yes.

23:30- Nurse K. came in and Nurses C. and P. called Nurse K. over to examine my TB test site. He did, and said it appeared positive, then K. asked me to follow him into the lab where it brought out a clear vinyl measuring device, placed it on my arm and measured the exact size of the reaction on my arm. He said, “that is definitely a positive reaction.

Day 1

January 24, 2014

18:30- Arrived at work

18:45- During pre-work meeting we were notified that the isolation rooms were malfunctioning, and were not ventilating properly. We would all need to be tested for Tuberculosis exposure that night, and Lt. H. gave us forms to take to medical on that shift.  The Medical Facility also know as Medical, The Palliative Care Unit, or B-Dormitory is staffed by one or two, sometimes three Registered Nurses from Corizon Health and one Correctional or Housing Officer.

18:55- Departed for Outside Post duty. Shift 7-11 pm.

23:00- Relieved from Outside Post duty, was told to report to Medical as Housing Officer.

23:10- Reported to Medical, received equipment, did a security check. Reported to Nurse for TB injection test. It was either Nurse P. or B.

23:15- Noticed a new sign was placed on alarm station for Isolation rooms, that the rooms should be tissue tested every 8 hours for negative pressure.