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Introduction and Overview

The field of occupational health and safety (OHS) has become a topic of increasing importance over the last 30 years. The establishment of the Occupational Safety and Health Administration (OSHA) in 1970 reflected the recognition that safety in the workplace is a basic expectation for all employees. Originally addressing concerns in industry and hazards associated with mechanical injury, the field of occupational health and safety has expanded to almost every workplace environment, from the office to the airplane, as well as to the laboratory and the vivarium.

The issue of OHS is clearly relevant to biomedical research and extends to the use of animals in biomedical research (NRC 1997). As with any laboratory environment, facilities that house nonhuman primates have a variety of mechanical, chemical and infectious hazards. With new developments in research technology, there is the potential for a variety of real and perceived unique hazards that could make the management of OHS in this type of workplace a challenging endeavor.

A review of safety records pertinent to animal care occupations demonstrates that many of the health hazards encountered when working with nonhuman primates are not unique. A survey of accidental injuries associated with nonhuman primates at two national primate research centers documented a list of occupational injuries including bites, animal-inflicted scratches, needle sticks, cuts, and mucous membrane exposures (bin Zakaria and others 1996). Similarly, surveys of injury reports of



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1 Introduction and Overview The field of occupational health and safety (OHS) has become a topic of increasing importance over the last 30 years. The establishment of the Occupational Safety and Health Administration (OSHA) in 1970 reflected the recognition that safety in the workplace is a basic expectation for all employees. Originally addressing concerns in industry and hazards associated with mechanical injury, the field of occupational health and safety has expanded to almost every workplace environment, from the office to the airplane, as well as to the laboratory and the vivarium. The issue of OHS is clearly relevant to biomedical research and extends to the use of animals in biomedical research (NRC 1997). As with any laboratory environment, facilities that house nonhuman primates have a variety of mechanical, chemical and infectious hazards. With new developments in research technology, there is the potential for a variety of real and perceived unique hazards that could make the management of OHS in this type of workplace a challenging endeavor. A review of safety records pertinent to animal care occupations demonstrates that many of the health hazards encountered when working with nonhuman primates are not unique. A survey of accidental injuries associated with nonhuman primates at two national primate research centers documented a list of occupational injuries including bites, animal-inflicted scratches, needle sticks, cuts, and mucous membrane exposures (bin Zakaria and others 1996). Similarly, surveys of injury reports of

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employees at veterinary clinics indicate that the most common injuries were animal bites and kicks, needle sticks, and crushing injuries, and that over 50% of the respondents had at least one injury incident over a 3-year period (Poole and others 1998, 1999). The important message from these comparisons is that any animal care occupation has a wide variety of workplace hazards. Once the hazards are identified, the same safety-driven approaches that are used to reduce employee risk in other fields of animal care and use, as well as in other workplace settings, are likewise applicable to people working with nonhuman primates. OCCUPATIONAL HEALTH AND SAFETY PROGRAM Every organization uses a variety of tools to achieve institutional goals, including business plans, strategic plans, and long-range development plans. The goals of an organization’s OHSP are as follows: to identify hazards in the workplace and determine the risk associated with them, to design the facility and management program to reduce risks associated with the hazards, and most importantly, to communicate hazard identification, risk assessment, and appropriate safety measures to all employees. An OHSP integrates the efforts of management, administration, employees, and health care professionals in an active, evolving program that promotes a culture of safety in the workplace. The challenge of providing a safe work environment is best met with the development of an OHSP that provides a foundation for a culture of safety and makes worker safety a central mission for all employees of an institution. Inclusion of safety in the development of a new institution is generally easier than integration of safety into long-established programs. There is always the concern that worker safety and the attendant OHSP expenses will have adverse effects on finances and process efficiency. Although economics will have an impact on any animal care and use program, cost alone must not dictate the scope or relevance of the OHSP implemented at an institution. The simple trade-off is that employee welfare and reduction in the loss of work time due to workplace injury will improve employee satisfaction and performance. It is important for staff to know that management is concerned about their welfare. For both new and long-established institutions, there is value in having a reference document, such as this volume, that provides a ready source of information for creating an OHSP. The intent of this report is to provide the proper tools to identify and manage human health hazards associated with nonhuman-primate research. The National Research Council developed a document on OHS for animal research facilities (NRC 1997), which serves as a guide for management of an OHSP and provides a foundation for developing a pro-

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gram if none exists. The present report is aimed at developing an OHSP at nonhuman-primate facilities or facilities that use nonhuman-primate blood or tissue and is not intended to duplicate the scope or content of the previous document. Instead, its goal is to complement that publication and expand on topics that are particularly relevant or peculiar to animal programs that involve nonhuman-primate species. The Committee on Occupational Health and Safety in the Care and Use of Nonhuman Primates has also attempted to address the meaning and implications of uncertainty in risk management. OVERVIEW This report is organized to address the various considerations in the development of an OHSP for nonhuman-primate facilities. The report follows a logical progression to facilitate its use in OHSP development, but each chapter can be used as an individual reference document. The second chapter provides a background for the use of nonhuman primates in research, education, and testing and discusses the goal of this report—promoting OHS in nonhuman-primate facilities. To ensure that OHS issues bridge academic or departmental divisions, this chapter also highlights the importance of the Institutional Animal Care and Use Committee (IACUC) in implementing and monitoring the efficacy of the OHSP. Finally, this chapter addresses the taxonomic and behavioral diversity of the primate order. Understanding differences in behavior between species and individual animals can assist personnel in predicting an animal’s actions and identifying potential hazards associated with them. The third chapter addresses potential zoonotic hazards that may be encountered in a nonhuman-primate facility or at a facility that uses nonhuman-primate blood or tissue. The chapter is organized by type of disease agent—viral, bacterial, protozoan parasitic, metazoan parasitic and other agents. For each agent, there is a description of the disease profile in nonhuman primates, mode of transmission, incubation period and clinical signs, and diagnosis and prevention. Chapter 4 identifies and describes the noninfectious hazards that are specific to facilities and research involving nonhuman primates. This chapter emphasizes that the identification of noninfectious hazards must involve a qualified health and safety professional who is trained in ergonomic hazards. This chapter also addresses potential hazards associated with allergies to nonhuman primates, heat stress associated with the personal protective equipment used when interacting with nonhuman primates, volatile anesthetics, and disinfectants commonly used in nonhuman-primate areas.

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The fifth chapter discusses risk assessment as a powerful tool that provides a rational framework for designing and managing OHSPs in institutions that care for nonhuman primates. The Committee examines risk assessment as a process of collecting and analyzing scientific data to describe OHS risks. It identifies four steps to successful risk assessment: hazard identification, dose response assessment, exposure assessment, and risk estimation and characterization (NRC 1983; Samet and Burke 1998). Chapter 6 discusses the identification of pertinent OHS regulations and recommendations, the final step undertaken before a risk management strategy is developed. It notes how this aspect of the process can be challenging because of the multiple agencies or regulations that may be applicable in the same facility and identifies the most widely relevant US federal regulations. The committee also discusses oversight responsibility and identifies important reference material and organizations that provide additional assistance and frameworks for developing an OHSP. Chapter 7 reviews the steps necessary to formulate and implement a course of action to manage hazards identified during the risk assessment process. This course of action or risk management is the core of an OHSP. The chapter is divided into nine key areas through which hazards can be effectively managed, and each area contains a checklist of considerations to address for large and small institutions. The nine areas are: administrative procedures, facility design and operation, exposure-control methods, education and training, occupational health, equipment performance, information management, emergency procedures, and program evaluation. Chapter 8 identifies the need for institutions to implement an inclusive training program for all personnel who interact with nonhuman primates, and a policy of continuing education to ensure that employees are informed and knowledgeable about hazards in the workplace. This chapter addresses critical issues in training programs that are designed to provide effective hazard communication to all employees regardless of educational level. The importance of worker orientation, standard operating procedures (SOP), and training evaluation is emphasized. The final chapter presents an overview of medical management of persons involved in a nonhuman-primate-related injury or exposure. Establishing a working relationship in advance with a health-care professional is critical to determine what is an exposure, what is appropriate emergency treatment, and what are the options for postexposure prophylaxis.

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CONCLUSION The following chapters provide the foundation for the development of an OHSP at institutions engaged in the care and use of nonhuman primates. The Committee encourages program managers to utilize other resources as well, in particular the 1997 NRC document Occupational Health and Safety in the Care and Use of Research Animals and the 1999 CDC Biosafety in Microbiological and Biomedical Laboratories. The actual development and implementation of an OHSP must be adapted to the individual needs and functions of an organization. One common theme is that effective communication of hazards, risks, and safety measures to all employees is a vital element in the success of any program.