Super Bugs and Other Emerging Hazards

NFPA 1999, with its 2008 edition just released, covers protection from new hazards that include MRSA and H5N1.

It seems that each year, new hazards in the home, workplace, and community are identified that endanger our health and well-being. Bloodborne pathogens such as bird flu and the mutant bacterial staph, MRSA, continue to threaten our health. New toxicity hazards have been discovered in chemicals that have been used for decades. We must constantly be aware of the hazards and take the proper precautions, both professionally and personally.

News of pathogenic microorganisms that threaten our existence is reported globally each day. Although avian influenza, the H5N1 virus, has not yet mutated into a form that is contagious in humans, it still wreaks havoc in many countries around the world. The World Health Organization has recorded outbreaks in about 60 countries that have affected bird populations and have killed 232 people. The countries with the highest numbers of deaths have been Vietnam and Indonesia, with 155 deaths.

A mutated form of the common bacteria, staph, is spreading throughout the United States. MRSA, Methicillin Resistant Staphylococcus Aureus, has emerged after decades of prescribing penicillin-based antibiotics. This Super-Bug that is very difficult to kill has emerged and is spreading.

What is MRSA?
The U.S. Centers for Disease Control and Prevention estimates MRSA will cause more deaths than AIDS this year. This shocking statistic, which CDC published recently, emphasizes the changing face of our health concerns and the need for constantly monitoring and educating the public about emerging trends in toxicity and infectious diseases. Staph is a common bacterium that is carried by 25-30 percent of the population and lives on their skin or in their noses.

Years of prescribing and overprescribing prescription antibiotics have resulted in mutation of staph into a virulent form that resists common antibiotics and causes severe, sometimes disfiguring skin infections that can spread to other body systems and may cause fatal infections. Hospital Acquired (HA-MRSA) has been a problem in hospitals and nursing homes for years. Community Acquired MRSA has now surfaced and is in the headlines every day.

Clusters of cases of MRSA outbreaks have been reported in athletes, military recruits, children, and certain ethnic groups. Law enforcement personnel who deal with homeless people, illegal immigrants, and prison inmates are at risk of acquiring MRSA.

What does it look like, and how is it prevented?
MRSA infections are commonly mistaken for spider bites, boils, or pimples. They spread and can be disfiguring and require surgery, or even amputation, to stop. Systemic involvement can result in death. MRSA can penetrate through a scrape, pimple, or sore. Most MRSA is spread on hands to different surfaces.

Proper hand washing is the most important step in preventing transmission and infection by MRSA. You should never share personal items such as towels and razors or touch anyone’s bandages or wounds. Towels and gym clothes should be washed in hot water and dried in hot dryers, not air-dried. Surfaces should be wiped down with alcohol-based disinfectants that are known to kill MRSA. Hand sanitizers that are alcohol based and proven to kill MRSA should be used to prevent transmission and infection.

Does anything treat MRSA?
Some antibiotics such as Vancomycin are effective for treating MRSA, but common penicillin-based antibiotics are not effective. You should contact your doctor if you suspect you have MRSA as soon as possible. Earlier diagnosis is the key to successful treatment.

Personal Protective Equipment and NFPA 1999 Compliance
Writing professional standards designed to protect workers and communities from exposure to chemical and biological agents is a time-consuming and laborintensive process that is not for everyone. It is comforting to know that certain standards- writing organizations have the foresight to have addressed many of these issues before they arise.

NFPA 1999 is an example. Even protection from new hazards such as MRSA and avian influenza hazards is covered by NFPA 1999, Standard on Protective Clothing for Emergency Medical Operations, which was originally written to address the protection of first responders such as firefighters and emergency medical operations personnel from exposure to bloodborne pathogens. All of the PPE covered in the standard was required to provide the minimal level of protection from bloodborne pathogens and included gloves, garments, faceshields or masks, eye protection, and mouth pieces or other ventilation devices.

In February 2006, the U.S. Department of Homeland Security recognized the necessity of standardization of the PPE for first responders that is purchased using DHS grant money. Five existing NFPA standards were accepted as the minimal criteria for protective equipment; one of these accepted standards is NFPA 1999. It was written referencing 21 different ASTM performance standards. For gloves, the standard includes rubber properties, puncture resistance, viral penetration resistance, and protein levels. This is the only industry standard that requires that latex proteins be below 50 micrograms per gram.

In order to pass the testing for compliance with NFPA 1999, protective items including gloves must pass ASTM F 1671, Standard Test Method for Resistance of Materials Used in Protective Clothing to Penetration by Blood-Borne Pathogens Using Phi-X174 Bacteriophage Penetration as a Test System. Bacteriophage Phi- X174 is the model viral particle utilized for testing for protection from bloodborne pathogens. This model virus is 27 nanometers in size and is in fact much smaller than anthrax, MRSA bacteria, SARS, HIV, H5N1 avian influenza, and even Hepatitis B virus. This tiny nanoparticle is the ideal choice for testing whether bloodborne pathogens will penetrate personal protective equipment because of its size and the fact that it is a nonpathogenic viral entity.

Gloves and MRSA Transmission
It should be noted that an item such as a disposable glove will protect the wearer from exposure of the hands to MRSA bacteria. However, MRSA can contaminate the outer surface of any glove and be transmitted to other surfaces. The wearer can wipe the glove surface with hand sanitizers that kill MRSA to prevent transmission of MRSA on the surface of the glove. You must be certain you are using a hand sanitizer that has been proven to kill MRSA and that the sanitizer is not degrading the glove that is worn so that the barrier efficacy is compromised. Also, gloves provide protection from bloodborne pathogens and are an integral part of a protection ensemble for contact with MRSA, whether treating patients or cleaning up facilities, but they should not be the sole item of PPE chosen for such virulent pathogens.

NFPA 1999’s 2008 Edition
The latest version of NFPA 1999 has just been published and includes revisions, addition of more requirements, and more PPE items.

The 2008 edition still has all of the requirements of the old version and now includes the addition of reusable PPE performance and certification requirements. The reusable PPE must pass more stringent physical testing than the disposable, single-use items, such as multiple washing in addition to the viral penetration resistance and physical properties. Footwear performance has also been added, as have respirator requirements and helmets. The 2008 edition references 37 ASTM test methods for performance requirements, two European tests, four American Association of Textile Chemists and Colorists tests, and three ANSI tests.

The new version of the standard also addresses PPE for first responders and first receivers from exposure to CBRN agents. This Chemical, Biological, Radiological, and Nuclear protection is included to equip the firefighters and emergency medical personnel who are first responders in the event of a terrorist attack.

This article originally appeared in the April 2008 issue of Occupational Health & Safety.

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