Animal Hazards Program

 

The Occupational Health Program Coordinator can be contacted at (520) 626-5735 or francesd@email.arizona.edu.

 

Complete instructions for Occupational Safety Designees (OSDs) and non-OSDs, and the log-in are available at the Animal Hazards Program website.

 

The purpose of this policy is to reduce the health risk of using animals in research and teaching to an acceptable level.

 

Many different kinds of physical, environmental, or biological hazards are associated with the use of animals in teaching or research (Table 1).

 

Requirements for an occupational health program for personnel working with laboratory animals are found in Biosafety in Microbiological and Biomedical Laboratories published by the Centers for Disease Control and Prevention (CDC) and the National Institutes for Health; Code for Federal Regulations, Title 10, Part 20 and Title 29, Part 1910; the Public Health Service Policy on Humane Care and Use of Laboratory Animals that codifies the Guide for the Care and Use of Laboratory Animals (Guide) published by the National Research Council; and Occupational Health and Safety in the Care and Use of Research Animals published by the National Academy of Sciences. A description of the occupational health program must be included in the Assurance of Compliance that is required by the National Institutes of Health. The Association for the Assessment and Accreditation of Laboratory Animal Care (AAALAC), International conducts triennial inspections to assure compliance with all applicable occupational health and safety standards. Under standards outlined in the Guide, the program components must include:

The Occupational Health Office of the Campus Health Service (CHS) conducts the medical surveillance portions of this program for the University, particularly focusing on items 1 and 6 as relates to immunizations, testing, and treatment and follow up of exposures. The Institutional Animal Care and Use Committee (IACUC) and University Animal Care provide support for items 2, 3, 4, and 5. However, the IACUC, University Animal Care and CHS are involved to some degree with all aspects of this program. Other University departments also provide assistance in meeting the requirements for occupational safety and training, including Risk Management and Safety, the Office of Radiation Chemical and Biological Safety and others. Any regulatory penalties or medical costs resulting from noncompliance with this policy or established procedures will be charged in accordance with standard University policy.

 

Personnel required to participate in the Animal Hazards Program are those involved in the direct care of animals and their living quarters and those individuals who have direct or environmental contact with animals (live or dead), their viable tissues, body fluids, wastes or cell lines.

This includes:

Non-University of Arizona students, consultants, volunteers and visiting scholars who will be performing animal work as defined above at the University of Arizona must also comply with this policy.

 

Prior to exposure to animals, their viable tissues, body fluids, or wastes, you must have obtained IACUC certification, which includes submission of the Risk Assessment Questionnaire (RAQ) to the Occupational Health Service (OHS).

 

Every lab/department must appoint one individual that serves as the OSD. This individual, along with the Principal Investigator (PI), is responsible for occupational safety concerns for their research group/department (see Figure 1). IACUC protocol forms provide a space for PIs to indicate their OSD. Any protocol submitted without a specified OSD will not be routed for IACUC review. The PI may also serve as the OSD.

 

Regular health and safety inspections are an effective tool in the hazard identification process. Together with accident investigation, these inspections form the main thrust in good occupational health and safety management. Not only do they provide an opportunity to identify the sources of potential hazards, but can be used to monitor occupational health and safety policies and procedures and determine how effectively these are translated into the workplace. The inspection process allows a full examination and report on the status of occupational health and safety performance in a work area.

 

Essentially, it allows one to:

As a bonus, it has a noticeable effect on communication in the work area and thus helps to improve and facilitate industrial relations and enable the whole University community to play a more significant role in the maintenance of a healthy and safe work environment. However, it must be recognized that the full benefit of the inspection process cannot be realized if action is not taken based on the data collected.

 

To achieve the University's goal to provide and maintain the highest standard of health, safety and welfare for its staff, and in accordance with this Animal Hazards Program Policy, systems must be in place to identify hazards in the workplace in order to allocate appropriate resources and implement effective control strategies. The University recognizes that regular health and safety inspections are effective mechanisms for identifying workplace hazards. The Animal Hazards Program requires each animal use unit to:

These inspection reports will provide a monitoring system for OSD's of units.

The OHS is available for advice and assistance, but is not charged with the responsibility to accompany inspection parties. The following guidelines have been developed to assist Units in the inspection process and may be adapted to suit individual areas. In addition, the IACUC requires all participants to complete the OSD Certification module, which includes a segment on inspection procedures.

 

 

The inspection team should be comprised of at least two individuals. The OSD and one of the following:

The Principal Investigator of the unit should be immediately notified of any and all discrepancies noted during the inspection so that the appropriate corrective action may be taken.

 

 

A joint inspection of the type described above must be done at least on a bi-annual basis before the semi-annual IACUC Fall and Spring inspections, and is recommended on a quarterly basis depending on the area. However, the OSD or supervisor should monitor the workplace on a daily basis (i.e., housekeeping, observation of behavior trends) and more formally on a weekly/biweekly routine, checking such things as environmental conditions, etc. Any identified hazardous situations should be closely monitored at all times, particularly while awaiting the implementation of effective control measures.

 

The times of the inspection should be varied to assure is capturing the true workplace behavior (i.e., unprepared).

 

 

The inspection team should immediately analyze the report and develop an action plan according to agreed priorities.

 

All participants will be queried via the University of Arizona's Risk Assessment Questionnaire (RAQ) regarding anticipated exposure to animals. The OSD in each lab/department will complete the demographic and exposure sections; the participant will complete the confidential medical information. Both the OSD's portion and the participant's portion of the RAQ is available online and should be submitted electronically. The OSD generally submits their portion of the participant's form first, the participant will then be sent the link via email to complete their portion (or they may log on to the web site and initiate the form). For participants who are not able to submit their forms electronically, please contact the Occupational Health Program Coordinator at (520) 626-5735 or francesd@email.arizona.edu.

Complete instructions for OSDs and non-OSDs, and the log-in are available at the Animal Hazards Program website.

 

 

An Occupational Health provider will review the RAQ when both portions are received. Participants are assigned a category(ies) that reflect the general surveillance needs of the individual based on real or potential occupational exposure to specific species of animals (Table 2).

 

The assessment of risk will also be based upon frequency of contact, intensity of exposure, hazards associated with the animals being handled, hazardous properties of agents used in research, the susceptibility of individual employees, the hazard-control measures available, and the occupational history of individual employees. After review, the participant will be sent an email acknowledging receipt and advising of any follow up that is needed. The OSD is copied on most correspondence.

 

The RAQ must be updated whenever an employee changes/adds protocols, exposures or animal species, or has a change in their health status. When the Animal Hazards Program office needs an update, you will receive an email request from the Occupational Health Animal Hazards Program office or from your OSD. You may also submit an update any time you feel your exposures or health in relation to animal work should be re-evaluated. Notify the Animal Hazards Program Coordinator that you need to update your RAQ and the link to the form will be emailed to you.

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There are a number of personal hygiene issues that apply to all workers who are exposed to animals.

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Requirements and guidelines for establishing and maintaining an occupational health and safety program for those who work with field wildlife animals are found in the Guidelines of the American Society of Mammalogists for the Use of Wild Mammals in Research; the National Wildlife Health Center; and, occupational health and safety standards for all classification of animals are specified in the Occupational Health and Safety in the Care and Use of Research Animals.

 

 

When working in a natural environment (e.g., woods, field, or water), the environment itself can present some unique risks. Examples consist of the following possibilities:

 

The animals themselves present risks such as:

Potential hazards from field work are summarized in Table 3.

 

 

Completion and submission of the Risk Assessment Questionnaire is required in order for the Occupational Health professional to analyze and prevent hazards that are based on the individual’s unique health profile and by providing preventative medications, such as vaccines.

Recognize, treat, and manage illnesses or injuries

PPE required for field studies can range from nonexistent (e.g., for a study of the migratory patterns of hawks) to comprehensive (e.g., a project evaluating the presence of Ebola virus in cave-dwelling bats). Recommended PPE are:

Personal hygiene

Equipment

 

The appropriate type of personal protective equipment (PPE) depends on the nature of the research and is specific to each laboratory or work area. Each laboratory or department should have Standard Operating Procedures (SOPs) to address the required types of PPE that are to be used during various activities.

 

Resources are available to help OSDs and Supervisors assess their areas for risks and determine the PPE that is needed. You can contact the Risk Management and Safety Office or the Occupational Health Office (520) 626-5735 or francesd@email.arizona.edu).

 

 

The following exemptions may be granted after submission of the RAQ:

 

Provider recommendations for immunizations/tests will be based on the functional requirements of the position, the type of animal contact, and the individual's medical history. Any person declining to obtain recommended inoculations or testing is required to sign a Medical Surveillance Program Declination form. The IACUC, the OSD or supervisor will be informed of all declinations. The IACUC, OSD or supervisor will determine if the declination places the participant in an unsafe work environment and will address that issue directly with the participant.

 

In some cases, immunizations or tests are required for a position and cannot be declined. For example, those working with (or in the rooms with) nonhuman primates must have biannual TB screenings (TST). Also, those working with the rabies virus must have the rabies immunizations and subsequent titers.

 

For participants who do not wish to utilize the medical services offered by the program, and are not required by their position to obtain immunizations/testing, there is a Medical Surveillance Program Declination form, which allows them to opt out of the program completely. The RAQ must be submitted prior to submitting this Declination. The IACUC, OSD or supervisor will be notified of all medical surveillance program declinations. They will determine if the declination places the participant in an unsafe work environment and will address that issue directly with the participant.

 

 

Refusal to comply with any of this policy or the accompanying procedures will result in denial of facilities access, a hold being placed on protocols for animal ordering, or withdrawal of protocol authorization or participation.

 

 

After reviewing the RAQ, the Occupational Health provider may request a clinic visit, depending on level of risk or in accordance with specific job requirements, to address health issues listed, or if immunizations/tests are needed. If not specifically required in their position, individuals may decline the clinic visit, but must file a formal Medical Surveillance Program Declination with Occupational Health. This information will be forwarded to IACUC, the OSD and/or supervisor for their records.

 

The recommendations made by the provider at the visit will be based on the functional requirements of the position, the type of animal contact, and the individual's medical history. Anyone declining to obtain recommended immunizations or testing will be required to sign a Medical Surveillance Program Declination form. IACUC and the OSD or supervisor will be notified of all declinations.

Participants, depending on their specific exposures, will have the following vaccinations documented:

 

 

The Public Health Service Advisory Committee on Immunization Practices (ACIP) recommends immunization against tetanus every 10 years for everyone. It is also recommended if a particularly tetanus-prone injury occurs in an employee where more than five years has elapsed since the last immunization. Every employee should have up-to-date tetanus immunizations.

 

Any wound may potentially serve as a source from which tetanus may result. A trained health care provider will evaluate all wounds to assess contamination and likelihood of infection, as well as determine proper treatment. If a wound occurs, persons who have previously received a full primary series of tetanus immunizations may not require a booster if less than 5 years has elapsed since the last immunization. This is dependent, however, upon severity of the wound, degree of contamination, and circumstances surrounding the injury. It is strongly recommended that all wounds be seen and treated despite the person's status of tetanus immunization.

 

 

Rabies is a relatively rare and devastating viral disease that can result in severe neurological problems and death. Most cases of rabies occur in wild animals although any mammal can contract the disease. The disease is virtually unheard of in common laboratory animals. All bites of any type must be reported immediately to your supervisor.

 

Rabies is an endemic disease in Arizona, especially in skunks, foxes, and bats. Sporadic cases have been well documented in other species of wildlife, as well as domestic animals. Animals and animal tissue field-collected in Arizona should be handled with care. Precautions should take into account that infected animals may shed the virus in the saliva before visible signs of illness appear, that a bite is not required to contract rabies - contact with saliva may be sufficient, and that rabies virus can remain viable in frozen tissues for an extended period.

 

Based on current ACIP recommendations, rabies pre-exposure prophylaxis (Table 4) human diploid cell rabies vaccine (HDCV) is provided to the following employee groups:

Category of risk is determined by the category of animal contact you have been assigned to and review of the animal protocol you have submitted to IACUC. Anyone having exposure, or suspected exposure, to a rabies positive animal or tissues; or contact from a suspect animal that cannot be tested, or quarantined, for rabies, will undergo post exposure prophylaxis therapy.

 

It is the responsibility of the OSD to monitor the risk to students, student teachers, and lab workers and obtain the appropriate immunizations for them BEFORE exposure occurs.

 

If there is any question as to whether someone should be immunized, contact the OHS. Table 5 has information on post-exposure prophylaxis.

 

Serologic monitoring and booster doses:

At the University of Arizona, the "CDC Frequent Exposure" classification is applied to all members of these categories. In reality, many or most have only "Infrequent Exposure". These exposures are based more on the prevalence of rabies in the Southern Arizona fauna than on actual human exposure to the virus. Field workers are occasionally exposed to rabies, but laboratory and animal care workers are not. Dogs and cats used in research are vaccinated. Bats and certain other wild animals transmit the vast majority of rabies. Only under exceptional circumstances is a wild animal present in a University of Arizona facility.

 

Farm animals are monitored, protected and in some cases vaccinated, however are subject to attack by bats as well as other wild and domestic rabid species. Field researchers, while not always working directly with rabies prone species, are at increased risk due to greater environmental exposure. Veterinary Diagnostic Laboratory workers, veterinarians and researchers that utilize the rabies virus in their protocols are at "Frequent or Continuous" risk of rabies exposure. These groups need to be immunized against rabies.

 

For these reasons, the Animal Hazards Committee, in its January 24, 2007 meeting, elected to suspend routine rabies immunization and serology for all participants except:

 

Based on CDC recommendations, all individuals who will have contact with birds or poultry, or who will be working with the influenza virus in a laboratory setting, should receive the annual influenza immunization.

 

For those working with birds or poultry, currently available "Flu" vaccines do not directly protect humans from acquiring avian influenza. However, individuals that work with birds could acquire both avian flu and human flu, concurrently. The result could be potentially life threatening AND the affected individual could become a human incubator offering the two viruses the opportunity to combine into a new, devastating human influenza.

 

 

Participants in categories 3, 5, 6, 8 and 10 (and potentially 2) of Table 2 will have either biannual or annual TB testing documented. To avoid misinterpretation of what is known as a "boosted reaction", a two-step TST may be required for those beginning a tuberculosis screening program or who have not had a TST within 12 months.

 

A chest X-ray and QuantiFeron blood test are performed at an initial positive TST reading or if there are symptoms indicated on the Positive TB Questionnaire, or as recommended by the CDC. If the chest X-ray and QuantiFeron blood test are both negative, the participant will no longer receive a TST but will complete the Positive TB Skin Testing Questionnaire on either the biannual or annual schedule, as appropriate. They are cleared to work without restrictions.

 

If the chest X-ray is negative and the QuantiFeron blood test positive, they will be referred to their primary care physician or the Pima County Health Department for treatment for Latent TB.

 

The participant will no longer receive a TST but will complete the Positive TB Skin Test Questionnaire on either the biannual or annual schedule, as appropriate. They are cleared to work without restrictions. They should report any health changes to the CHS Occupational Health physician as soon as possible.

 

If the chest X-ray is positive and the QuantiFeron blood test positive or negative, they will be referred to a Pulmonary or Infectious Disease doctor and report to the Pima County Health Department. They may not return to work until cleared by the CHS Occupational Health physician.

 

 

Other immunizations and tests may be recommended as determined to be needed by the Occupational Health provider.

 

 

Participants may be asked to participate in other worker protection programs, such as the Hearing Conservation Program and the Respiratory Protection Program. Table 6 lists the guidelines for respirator use based on exposures. The University Risk Management and Safety Department manages these programs.

 

 

Allergy to animal hair and dander is common and therefore one of the more important occupational problems occurring in workers exposed to animals. Allergies can be manifested in a number of ways, including: allergic rhinitis (a condition characterized by runny nose and sneezing similar to hay fever); allergic conjunctivitis (irritation and tearing of the eyes); asthma; or atopic dermatitis (a skin condition which is caused by contact with a substance to which an individual is allergic). Allergy to animals is particularly common in workers exposed to animals such as cats, rabbits, mice, rats, gerbils, and guinea pigs. Allergic reactions can be caused by exposure to dander and debris from the skin and fur of an animal, urine, saliva, or fecal matter. Exposure to animal urine or feces may occur either through direct urine contact with skin or more commonly by inhaling dust from the bottom of a cage that has been contaminated with urine or fecal material.

 

People who have a prior personal history or family history of hay fever or eczema will be more likely to develop asthma after contact with animals. These people do not seem any more likely to develop rhinitis and conjunctivitis than do those without such personal or family history. Everyone should exercise certain precautions to attempt to prevent animal allergy. These attempts should not be focused only on people with an atopic or allergy history. Symptoms can develop anywhere from months to years after a person begins working with animals. However, a majority of the individuals who are going to develop symptoms will do so within the first year. It is extremely unusual to develop symptoms after more than three years of animal contact. Certain procedures should be routinely followed in order to prevent the development of animal allergy. Animals should be worked with in well-ventilated areas to prevent buildup of various particles in the air.

 

Workers may want to wear gloves to prevent direct exposure to animals - this applies to animal urine and feces as well as to animal dander. In order to prevent inhaling contaminated material, cages will be changed frequently and within an exhausted enclosure. If an enclosure is not available respirators should be worn during the changing of cages. Dumping of bedding is not allowed in a lab. Dirty cages will be taken to UAC and exchanged for clean cages. If an enclosure is not available for cage changes, respirators will be worn during cage changes.

 

Despite the best preventive techniques some individuals will develop an allergy after contact with laboratory animals. Rarely, this will be so severe that a person is forced to change their line of work. More commonly, this can be controlled with the increased use of respirators while working with animals and possibly medication. Desensitization therapy (allergy shots) has been successful for some individuals. Employees will be queried on allergy risk.

The CDC website has more information on allergies.

 

Q fever is a disease caused by the microorganism Coxiella burnetii which can be acquired by exposure to placental membranes and fetuses from infected sheep or goats. There is an especially high concentration of these infected materials in animals at the time that the animals give birth, so particular care needs to be used in handling newborn animals, placental tissues, and other products of conception. This would include the placenta, amniotic fluid, and blood or soiled bedding. In addition, individuals who handle young sheep or goats up to six months of age are at higher risk, as are individuals who participate in the routine care of sheep or goats such as the animal care workers. This infection is extremely contagious and is reportedly spread by aerosol.

 

It is extremely important that, should an employee who works with sheep or goats develop an influenza type infection, he/she mention to their physician the possibility of Q fever. Q fever is something that would not routinely be thought of and this diagnosis is often missed.

Individuals with congenital heart disease, prior valvular heart disease, pregnant women, or who have a chronic immunocompromised state should not work with infected animals at the time of animal parturition (birth process), and it is best that they not work with sheep and goats at all (determined on a case-by-case basis). Immunocompromised individuals would include those with AIDS or a positive blood test for the AIDS virus (HIV), or immunocompromised because of medications or certain chronic diseases.

 

At the time of the enrollment exam, employees are assessed for their likelihood of developing chronic sequelae should they acquire Q Fever. Those employees with valvular or congenital heart defects, or those who are receiving immunosuppressant drugs, or who have been splenectomized, or pregnant women, are advised of the potential risks involved.

 

Pregnant women should be cautioned about working with cats in the laboratory setting. Pregnant animal technicians who have been assigned to cat husbandry duties should be reassigned to other jobs during pregnancy unless titers are sufficient. Pregnant women who are exposed to cats in other ways would be best to avoid this exposure. There is no vaccine to protect humans.

 

Toxoplasmosis antibody titers are determined on any female employee of childbearing capacity who is occupationally exposed to cats or their feces. Females of childbearing capacity who lack immunity and plan to work with cats are informed of their susceptibility and provided additional educational information on toxoplasmosis. Their supervisor will be advised (if requested by the employee) to consider arranging a temporary job reassignment while a susceptible employee is pregnant. When this is not possible, consultation with the OHS will be encouraged to identify alternative methods of employee protection.

 

A large number of illnesses can be passed from nonhuman primates, such as monkeys, to humans and from humans to nonhuman primates. Because of this, it is extremely important that employees exposed to or handling monkeys exercise particular caution. Protective clothing should always be worn, especially when confronting primates. Awake animals (not used to being handled) should be handled only while wearing bite proof gloves. Ideally, animals should be sedated before procedures are performed.

 

Employees who are ill should not work with monkeys since they may transmit diseases to the monkey. Personal hygiene must be scrupulously maintained by all those exposed to nonhuman primates. Any scratch, bite or eye exposure must be immediately treated in accordance with instructions contained in monkey exposure kits in the lab or animal room and then reported to the supervisor.

Final recommendations for BOHC will be based upon individual risk assessment and may vary from the above.

 

 

Participants are periodically recalled for medical follow-up depending on the specific type of animal exposure and their particular BOHC protocol. Employees and students (participants) who are enrolled in the Animal Hazards Program are periodically recalled for medical follow-up depending on the specific type of animal exposure. See Table 2 for basic recall schedule. Email notices for recall appointments (or questionnaire completion) are sent to the employee with a copy to the OSD or supervisor.