PARTNERS IN HEALTH AT WORK Editors: Damir Mazlagic, M.D., M.P.H., Medical Director; Patricia Haner, Practice Manager Contact: Berkshire Occupational health, 165 Tor Court, Pittsfield, MA 01240; Telephone: 413 447-2684; e-mail: Phaner@bhs1.org April - June 2007 WELCOME NOTE Dear friends, We are excited about starting this new way of communication with you, our valued clients and partners in providing healthy and safe work environment for your employees. This bulletin is intended to be your quarterly resource of additional news and information from the world of occupational and environmental health. We hope that you find both this issue s format and the information useful. Your feedback and comments would be greatly appreciated and addressed in our future bulletins. Sincerely yours, BOH Team BERKSHIRE OCCUPATIONAL HEALTH Berkshire Occupational Health (BOH) is a hospital-based occupational health program committed to identifying the workplace health and safety needs of both the business community and its employees. Based at the Hillcrest Campus of Berkshire Medical Center, our team has recently welcomed two new physicians: Damir Mazlagic, M.D., M.P.H. and Jean Culver, M.D., M.P.H. They joined Kenneth Stein, M.D. in providing occupational health services to businesses and municipalities throughout Berkshire County and the surrounding region. All three physicians are Board certified in either Occupational Medicine or one of the primary care specialties, or both. Two physicians are certified Medical Review Officers, responsible for both regulated and non-regulated drug-testing programs. Dr. Stein has recently become a Federal Aviation Administration (FAA) designated aviation medical examiner for medical certification of all three classes of pilots (private, corporate, and airline pilots). You can get more information about our physicians at: http://www.berkshirehealth systems. com/physican_search.asp. The rest of the team consists of three nurse practitioners, and nine other team members. We have recently joined efforts with Berkshire Health System (BHS) Wellness program to provide you with an integrated health management and to help your employees stay healthy and your business viable. Page 1 of 5 PARTNERS IN HEALTH AT WORK, April - June 2007
NEWS & REGULATIONS OSHA UPDATES GUIDE AGAINST AVIAN FLU In the recent past, some of you have expressed the need for a guidance in regard to preparedness for pandemic flu. Here are some helpful pieces of related information. The Occupational Safety and Health Administration (OSHA) has released an updated safety and health guidance that alerts employees and employers to the hazards of occupational exposure to avian influenza (flu) from infected birds, and provides practical recommendations on ways to avoid infection. The publication, OSHA Guidance Update on Protecting Employees from Avian Flu Viruses, is available in English and Spanish and updates the previous guidance issued by OSHA in 2004. It provides separate recommendations for poultry employees, those who handle other animals, laboratory employees, healthcare personnel, food handlers, travelers, and US employees stationed abroad. OSHA also published the Guidance on Preparing Workplaces for an Influenza Pandemic. The guidance categorizes workplaces and work operations into four risk zones based on the likelihood of employees occupational exposure to pandemic influenza, and recommendations for employee protection are presented for each of the four levels of anticipated risk. More information available at: OSHA Avian Flu Guide (English Version): http://www.osha.gov/oshdoc/data_avianflu/avian_flu _guidance_english.pdf OSHA Avian Flu Website: http://www.osha.gov/dsg/guidance/avian-flu.html OSHA Pandemic Flu Guide: http://www.osha.gov/publications/osha3327pandemi c.pdf FDA APPROVES FIRST U.S. VACCINE FOR HUMANS AGAINST THE AVIAN INFLUENZA VIRUS H5N1 On April 17, 2007 the U.S. Food and Drug Administration (FDA) announced the first approval in the U.S. of a vaccine for humans against the H5N1 influenza virus (see the picture below), commonly known as avian or bird flu. The vaccine could be used in the event the current H5N1 avian virus were to develop the capability to efficiently spread from human to human, resulting in the rapid spread of the disease across the globe. Should such pandemic occur, the vaccine may provide early limited protection in the months before a vaccine tailored to the pandemic strain of the virus could be developed and produced. While there have been no reported human cases of H5N1 infection in the U.S., almost 300 people worldwide have been infected with this virus since 2003. More than half of them have died. The vaccine is intended for immunizing people 18 through 64 years of age who could be at increased risk of exposure to the H5N1 influenza virus. Immunization consists of two intramuscular injections, given about one month apart. The vaccine has been purchased by the federal government for inclusion within the U.S. Strategic National Stockpile for distribution by public health officials if needed. More information can be found at the FDA web site: http://www.fda.gov. Page 2 of 5 PARTNERS IN HEALTH AT WORK, April - June 2007
FEDERALLY MANDATED DRUG AND ALCOHOL TESTING RATES The US Department of Transportation (DOT) has released the federally mandated drug and alcohol random testing rates for 2007 for agencies covered by 49 CFR Part 40. The DOT s Office of Drug and Alcohol Policy Compliance (ODAPC) has listed those rates as follows: Federal Aviation Administration (FAA) Drug 25%, Alcohol 10% Federal Motor Carrier Safety Administration (FMCSA) Drug 50%, Alcohol 10% Federal Railroad Administration (FRA) Drug 25%, Alcohol 10% Federal Transit Administration (FTA) Drug 25%, Alcohol 10% (This is a significant reduction in random drug testing rate, which was 50% in 2006.) Pipeline & Hazardous Material Safety Administration (PHMSA) Drug 25%, Alcohol N/A United States Coast Guard (USCG) Drug 50%, Alcohol N/A Employers must use the MIS Data Collection Form and instructions, which are available on the ODAPC s website. NAIL-GUN INJURIES TREATED IN EMERGENCY DEPARTMENTS ( 01-05) Speeds, ease of use, and ready availability have made pneumatic nail guns a common tool used in work settings such as residential construction and wood-product fabrication. The CDC s (Centers for Disease Control and Prevention) report from April 13, 2007, indicates that during the 5-year period 2001-2005, an average of approximately 37,000 patients with injuries related to nail-gun use were treated annually in EDs across the US, with 40% of injuries (14,800) occurring among consumers (non-work related). During the same period, work-related nail-gun injuries ranged from 19,300 to 28,600, with an annual average of 22,200. In 2005, nail-gun injuries among consumers were approximately three times higher than in 1991 (4,200). Work-related nail-gun injuries were identified as those involving pneumatic nail guns and excluding heavy-duty staplers, rivet drivers, and electric or powder-actuated tools. A radiograph shows six nails embedded in the skull of a construction worker, who fell from a roof onto another worker who was using a nail gun. The patient was expected to make a full recovery. Injured workers had a median age of 27 years, and consumers had a median age of 35 years. For both consumers and workers, the diagnosis associated with 87% of the nail-gun injuries was either wound with a foreign body (i.e., open wound with retained nail or other object) or puncture wound. Certain puncture wounds resulted from a nail going through construction material into a person; in others, a nail was shot completely through a body part, or a person removed the nail before seeking treatment. Injuries to upper extremities accounted for 66% of all Page 3 of 5 PARTNERS IN HEALTH AT WORK, April - June 2007
worker nail-gun injuries, while lower Graph 1 extremities injuries accounted for 24% of Positive urine drug test by testing category 2002- worker injuries. Positive urine drug test by testing category 2002- Additional measures are needed to prevent nail-gun injuries among both workers and consumers. Reference: MMWR (Morbidity and Mortality Weekly Report), April 13, 2007 / 56(14); 329-332 DRUG ABUSE TRENDS Employed drug abusers cost their employers about twice as much in medical and worker compensation claims as their drug-free coworkers. The good news is that monthly drug use rates among workers decreased from nearly 17 percent in 1985 to 7 percent in 1992 and have remained at that lower level. The Substance Abuse and Mental Health Services Administration (SAMHSA) reported that 77 percent of illicit drug users in the United States are employed. That s 9.4 million people. A survey by the federal government showed full-time employees who admitted to being current illicit drug users tend to be: between the ages of 18 and 25, less educated, male, divorced or never married, white, low paid. Of all urine workplace drug tests performed by Quest Diagnostics during 2006 for the combined U.S. workforce, 3.8 percent had positive results, compared to 4.1 percent in 2005 and 13.6 percent in 1988 (Graph 1). Industries with the highest rates of illicit drug use are: food preparation workers, waiters, waitresses, and bartenders, other service occupation workers, construction workers, workers in transportation and material moving. 2006 (Quest Diagnostics, Inc.) 2006 (Quest Diagnostics, Inc.) 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006 Positive Rates of Drug Testing (Berkshire Occupational Health) 4.07% 5.53% 3.70% 2003 2004 2005 2006 Year Federally-Mandated, Safety-Sensitive Federally-Mandated, Safety-Sensitive General U.S. General U.S. Combined U.S. Combined U.S. Of all urine workplace drug tests performed through Berkshire Occupational Health* from 2003 to 2006 for both DOT-regulated and non-regulated testing, an average of 4.54 percent of tested individuals had positive results (see Graph 2). The highest rate of positive urine drug tests was noted in 2004 (5.53), and the lowest one in 2005 (3.70 percent). Graph 2 4.86% * Berkshire Occupational Health urine drug tests are performed by several laboratories, including Quest Diagnostics. Page 4 of 5 PARTNERS IN HEALTH AT WORK, April - June 2007
WELLNESS & PREVENTION MARCH 2007 WAS A NATIONAL COLORECTAL CANCER AWARENESS MONTH Colorectal cancer facts: second leading cause of cancer-related deaths in U.S. 55,783 adults died of colorectal cancer (27,990 men and 27,793 women) in U.S. in 2003 third most commonly diagnosed cancer in U.S. in 2003, it was diagnosed in 143,945 adults (73,182 men and 70,763 women). estimated 50%-60% of colorectal cancer deaths would be prevented if all adults aged >50 years were routinely screened approximately one half of U.S. residents at average risk in that age group have not been screened for colorectal cancer U.S. Preventive Services Task Force colorectal cancer screening guidelines Recommended screening tests for all adults aged 50 or older are: Fecal occult blood test - every year checks for hidden blood in three consecutive stool samples Flexible sigmoidoscopy - every 5 years physicians use a flexible, lighted tube to inspect visually the interior walls of the rectum and part of the colon Double-contrast barium enema - every 5 years series of X-rays of the colon and rectum (after the patient is given an enema, followed by an injection of air in the colon) Colonoscopy - every 10 years a flexible, lighted tube is used to inspect visually the interior walls of the rectum and the entire colon during the procedure, samples of tissue may be collected for examination, or polyps may be removed it can be used as follow-up diagnostic tool when the results of another screening test is positive People at higher risk of developing colorectal cancer (e.g. family or personal history of colon cancer) should begin screening at a younger age, and may need to be tested more frequently. Reference: MMWR, March 16, 2007 / 56(10); 227-228); http://www.cdc.gov/cancer/colorectal COMMENTS/SUGGESTIONS E-mail: Phaner@bhs1.org (Patricia Haner) Mail: Berkshire Occupational Health, 165 Tor Court, Pittsfield, MA 01201 (attention Patricia Haner) Page 5 of 5 PARTNERS IN HEALTH AT WORK, April - June 2007