Executive Summary

The Committee on Occupational Health and Safety in the Care and Use of Nonhuman Primates was appointed by the National Research Council (NRC) in response to requests from the National Institutes of Health, the Centers for Disease Control and Prevention, and the Food and Drug Administration to address the risks associated with occupational exposure to nonhuman primates and suggest practical and efficacious ways of minimizing these risks. Specifically, the committee was asked to:

  1. Identify hazards associated with using nonhuman primates in research.

  2. Assess the degree of risk of these hazards.

  3. Suggest options for managing the risks including engineering controls, personal protective equipment, and worker training.

  4. Outline the institutional management of workers after a suspected occupational exposure.

  5. Provide sample illustrative occupational health and safety plans for personnel working in large and small nonhuman-primate facilities.

The Committee on Occupational Health and Safety in the Care and Use of Nonhuman Primates drew from the experiences of a number of experts, including infectious disease clinicians, primate veterinarians, primate caregivers, and occupational health professionals during a workshop held at the outset of the project (See Appendix A for a list of participants). These experts agreed that the most effective way to identify and



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Executive Summary The Committee on Occupational Health and Safety in the Care and Use of Nonhuman Primates was appointed by the National Research Council (NRC) in response to requests from the National Institutes of Health, the Centers for Disease Control and Prevention, and the Food and Drug Administration to address the risks associated with occupational exposure to nonhuman primates and suggest practical and efficacious ways of minimizing these risks. Specifically, the committee was asked to: Identify hazards associated with using nonhuman primates in research. Assess the degree of risk of these hazards. Suggest options for managing the risks including engineering controls, personal protective equipment, and worker training. Outline the institutional management of workers after a suspected occupational exposure. Provide sample illustrative occupational health and safety plans for personnel working in large and small nonhuman-primate facilities. The Committee on Occupational Health and Safety in the Care and Use of Nonhuman Primates drew from the experiences of a number of experts, including infectious disease clinicians, primate veterinarians, primate caregivers, and occupational health professionals during a workshop held at the outset of the project (See Appendix A for a list of participants). These experts agreed that the most effective way to identify and

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manage hazards associated with nonhuman primates is through the development and implementation of an institutionally specific occupational health and safety program (OHSP). This report discusses in detail the building blocks of a successful OHSP, namely identification of hazards, risk assessment, identification of applicable safety regulations, risk management, and personnel training. It also emphasizes the importance of a strong institutional commitment to an OHSP and the clear delegation of responsibility, authority, and accountability at all stages of development, implementation, evaluation, and re-evaluation of the OHSP. The National Research Council developed a document on occupational health and safety for animal research facilities (NRC 1997), which has served as a guide for the management of an OHSP and has provided a foundation for the development of an institutional OSHP where none exists. The present report attempts to aid in the development or improvement of OHSP at nonhuman-primate facilities or facilties that use nonhuman-primate blood or tissue and is not intended to duplicate the scope or content of the previous document. Rather, its goal is to complement that publication and expand on topics that are particularly relevant or specific to facilities where nonhuman-primate species are housed. This report has also attempted to address the meaning and implications of uncertainty in risk management. This report is intended as a reference for vivarium managers, veterinarians, researchers, safety professionals, and any other persons who are involved in developing or implementing an OHSP dealing with nonhuman primates. The diversity of institutions, research programs, and animal colonies makes it impossible to encompass all the details of a complete institutional OHSP in this report. Instead, it attempts to list the important features of an OHSP and provide the tools necessary for informed decision-making in developing an optimal program that meets all particular institutional needs. The Committee identified and assessed numerous risks, infectious and noninfectious, of working with nonhuman primates or their blood or tissues. Significant risks included ergonomic injuries and illnesses caused by shigella, tuberculosis, and B virus infections. These risks can be effectively dealt with using a layered approach to exposure control. Engineering controls are an essential mode of exposure/injury control and include facility design and specialized equipment such as biosafety cabinets. Work practices within the facility provide another modality in exposure/ injury control, but can be most important. Development of standard operating procedures that are universally followed and are integrated into employee training can effectively mitigate many hazards. Another important element in exposure/injury control is the use of personal protective equipment (PPE). PPE for use in nonhuman-primate

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facilities should minimally include dedicated clothing, gloves, and mask. The Committee stresses that PPE should only serve as a safety net if engineering and work practices should fail. But in light of the potentially fatal risks associated with B virus and other viral exposures, the appropriate use of PPE is a particularly important issue. The Committee concluded that because of the risk of B virus infection, the use of eye and face protection should be mandatory for individuals working with macaques. The Committee also recommended that eye and face protection be used when working with any Old World primate, due to the potential for infection by other primate viruses such as simian immunodeficiency virus. For other nonhuman-primate species, the Committee recommends that the use of eye and face protection be determined locally, based on risk assessment and management processes outlined in this report. Appropriate medical care after a suspected occupational exposure to a zoonotic pathogen is another area where specific guidance has been lacking in spite of various federal regulations and guidelines. The Committee determined that the first and often most critical step in developing an OHSP is the establishment of a relationship with a pre-designated occupational health care provider. Involving the designated medical providers in determining exposure risks before an incident occurs may lead to quicker and more efficacious post-exposure management. In this report, the Committee makes specific recommendations for medical management following exposure to or injury from nonhuman primates. The field of occupational health and safety constantly changes, especially as it pertains to biomedical research. The emergence of new hazards presents diverse challenges to employers who must ensure the safety of their employees. New infectious hazards are of particular importance at nonhuman-primate facilities. For example, the discovery that B virus can be transmitted via a splash on a mucous membrane raises new concerns that must be addressed, as does the discovery of the Reston strain of Ebola virus in import quarantine facilities in the United States. The risk of such infectious hazards is best managed through a flexible and comprehensive OHSP that can identify and mitigate potential hazards. It is incumbent on those responsible for nonhuman-primate research facilities, from the senior institutional officer to the facility manager to line supervisors, to develop, improve, and implement such a program.