Health Hazard Assessment
Hazard Category - Biological Substances 


PATHOGENIC ORGANISMS – BLOODBORNE

Data Requirements and Initial Recommendations.
(1) Guidance in Title 29, Code of Federal Regulations (CFR), Part 1910.1030 is applicable to situations where employers anticipate workers will be exposed to blood and other potentially infectious materials while carrying out their job duties (reference 1).  Provide the key provisions including scope (who is covered), exposure control plans, methods of compliance, HBV vaccine, post-exposure evaluation and follow-up, bloodborne pathogen information and training, and record keeping to the U.S. Army Public Health Command to complete a health risk assessment. 

(2) Ensure that the user identifies risk for occupational exposure(s) and the appropriate administrative controls (i.e., standard/universal precautions), engineering controls, safe work practices, and personal protective equipment needed to eliminate/control occupational exposures to bloodborne pathogens, and include these safeguards in appropriate technical manuals (TM) and training materials. 

(3) Design any patient compartments, related medical equipment, and other hardware to facilitate decontamination and the temporary storage of regulated medical waste.

Health Effects.
Emergency responders (fire and police), ambulance operators, paramedics, healthcare workers, persons designated to render first aid, biomedical equipment personnel, mortuary affairs personnel, regulated medical waste handlers, housekeeping, and maintenance personnel have the potential for exposure to a variety of bloodborne pathogens (i.e. disease producing organisms).  Potential exposures may result from patient care, cleaning/disinfection, maintenance, and improper disposal of contaminated medical equipment, supplies, blood or other potentially infectious materiel.

Medical Criteria.
(1) Employers must ensure that personnel use standard/universal precautions whenever exposure to bloodborne pathogens is anticipated and follow federal laws, Army regulations, and acknowledged infection control guidelines when developing comprehensive Bloodborne Pathogen Programs.  Comprehensive programs must identify risk and the key precautions that will be used to prevent occupational exposures to bloodborne pathogens, such as engineering and administrative controls, personal protective equipment, safe work practices, and proper handling and disposal of regulated medical waste (RMW).

(2) Generation of RMW is expected.  Classify RMW, segregate it from general waste and stow it as appropriate for the materiel type (emergency response vehicle, evacuation aircraft, etc.).  Provide proper packaging and adequate space to store of contaminated clothing, equipment, and RMW until it can be properly disposed (reference 1).

(3) Decontamination is defined as the use of Environmental Protection Agency (EPA) approved physical or chemical means to remove, inactivate or destroy bloodborne pathogens on a surface or item to the point they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use or disposal.

References.
(1) Title 29, Code of Federal Regulations (CFR), Part 1910.1030, Bloodborne pathogens, U.S. Department of Labor (DOL), Occupational Safety and Health Administration (OSHA), www.osha.govexternal link .

Supplemental References.
(1) Army Regulation (AR) 385-10, The Army Safety Program, 3 Sep 09.

(2) Department of the Army Pamphlet (DA PAM) 385-10, The Army Safety Program, 5 Aug 09.

(3) Army Regulation (AR) 40-5, Preventive Medicine, 25 May 07.

(4) Department of the Army Pamphlet (DA PAM) 40-11, Preventive Medicine, 19 Oct 09.

(5) U.S. Army Center for Health Promotion and Preventive Medicine Technical Guide (TG) 190, Guide to Managing Occupational Exposure to Bloodborne Pathogens, Apr 04.

(6) U.S. Army Center for Health Promotion and Preventive Medicine Technical Guide (TG) 195, Mortuary Affairs:  Infectious Materials and CBRN Handling, 7 Jul 09.

(7) U.S. Army Medical Command (MEDCOM) Regulation 40- 35, Management of Regulated Medical Waste, Jul 08.

 

PATHOGENIC ORGANISMS – WATERBORNE

Data Requirements and Initial Recommendations.
(1) Provide any water treatment, handing or storage information to include designs, specifications, materials, chemicals used, and processes to the U.S. Army Public Health Command to support a definitive HHA.   

(2) Provide administrative, design and engineering controls used to prevent occupational exposures to waterborne pathogens.  For example, clearly labeling all raw water equipment and systems as non-potable to avoid accidental cross-contamination or interchange and control the spread of biological pathogens, or use of personal protective equipment. 

(3) Provide intended use of each water source and test results of system performance to include analysis of product water for microbial pathogens, disinfectant residual, as well as nuclear, biological and chemical contaminants outlined in tri-service standards as defined in Technical Bulletin Medical (TB MED) 577 (reference 1).

(4) Ensure water generation systems are capable of producing acceptable water quality within the span of operational scenarios.  Assess function of materiel during extreme conditions such as temperature, shock, vibration and dustiness.

Health Effects.
Raw water sources and wastewater can contain microbial pathogens such as bacteria, protozoans, and viruses from excreta, or toxic organic or inorganic substances from pollution sources that can pose potentials threat to human health.  Exposure to pathogenic organisms can occur by inhalation, ingestion, or absorption.  Effects of contact with a pathogenic or toxic agent can result in a number of illnesses such as gastroenteritis, skin or eye infections, hepatitis, occupational asthma or leptospirosis (reference 2).

Medical Criteria.
(1) Basic personal protective equipment (PPE) such as hip waders, rubber gloves, rubber apron or other waterproof clothing, and eye protection will provide protection to the operators from pathogenic organisms. 

(2) Routine personal hygiene, such as frequent hand washing, showering, avoiding the use of tobacco, food and drinking while operating water production materiel will help minimize the potential exposure to pathogens (reference 3).

(3) If intended use of water supply is for personal hygiene, heating the water to 95-105 degrees Fahrenheit (F) will promote personal hygiene and aid in the prevention of the spread of biological pathogens. 

(4) Water equipment should be cleaned routinely to remove any mold, mildew or bacterial growth.  Tanks, hoses and other equipment should be disinfected before use (reference 1).

References.
(1) Technical Bulletin Medical (TB MED) 577, Sanitary Control and Surveillance of Field Water Supplies, 15 Dec 05.

(2) Field Manual (FM) 21-10, Field Hygiene and Sanitation, 21 Jun 00.

(3) Field Manual (FM) 4-02.33, Control of Communicable Diseases, 18th Edition, 01 Jun 05.

Supplemental References.
(1) Technical Bulletin (TB) 43-0153, Water Supply Afloat, 01 Sep 02.

(2) Army Regulation (AR) 40-5, Preventive Medicine, 25 May 07.

 

SANITATION

Data Requirements and Initial Recommendations.
(1) Provide the U.S. Army Public Health Command with the detailed drinking water, waste holding system design, foodservice, anticipated type of rations served, laundry, shower and toilet facility information to include construction, cleaning, storage and maintenance details to support the preparation of a definitive HHAR on this materiel. 

(2) Potable water.

     (a) Provide manufacturer specifications of water distribution systems and storage tanks.  Equipment must be National Sanitation Foundation (NSF) certified and conform to the Uniform Plumbing Code (UPC).

     (b) Show documentation demonstrating the potable water storage tanks and outlets are of adequate numbers and sized to support user populations during all operational scenarios.

     (c) Outline disinfection procedures for the potable water and distribution system prior to and during use. These procedures shall be in accordance with Technical Bulletin Medical (TB MED) 576 and/or TB MED 577 (references 1 and 2).

     (d) Provide documentation of a comprehensive cross-connection control survey on the potable water system, in accordance with Environmental Protection Agency (EPA) guidance (reference 3) and American Water Works Association Guidelines (reference 4).

     (e) Supply manufacturer operation and maintenance specifications of reverse osmosis elements and/or bromination system where applicable.  Provide justification for use of bromine disinfectant and OTSG approval if necessary.

(3) Waste disposal.

     (a) Provide documentation demonstrating that the wastewater disposal system is sized to support user populations during operational scenarios as well as associated health and safety operating procedures (references 5 and 6).

     (b) Provide a description and specifications of any waste incinerator to include operating procedures.

     (c) Provide documentation of the required user and 1st echelon maintenance of waste disposal systems including sewage and other waste systems.

(4) Foodservice sanitation.

     (a) Provide verification, final design, construction, cleaning, and maintenance specifications of foodservice equipment, facilities or materiel to determine compliance with the requirements in TB MED 530 (reference 7).  Non-field foodservice equipment must be also be NSF listed.  Field foodservice equipment must meet the general requirements for food equipment. 

     (b) Provide a description of the menu, additional non-food service equipment, hand washing and ventilation systems used in food service operations. 

(5) Condensate. Provide details on any condensate drainage systems and procedures to prevent accumulation of stagnant water.

(6) Toilet facilities. If equipped, provide detailed system design, construction, cleaning and maintenance information to support a definitive HHAR.  Facilities should be sized so capacity meets requirements of total number by sex of crew and passengers for required mission duration.  General information on toilet facilities can be found in Title 29, Code of Federal Regulations (CFR) 1910.141 (reference 8).

(7) Shower facilities.  If equipped, provide detailed system design, construction, cleaning and maintenance information to support a definitive HHAR.  Facilities should be sized to meet the maximum anticipated bather load.

(8) Laundry. If equipped, provide verification of countermeasures to prevent human exposure to laundry and cross-contamination of clean laundry (reference 9).

(9) Pest Control. Provide validation that all occupied structures and waste collection areas include screens, air curtains (food service), or other pest exclusion devices (reference 10).

Health Effects.
Ingestion, inhalation, or absorption of pathogenic microorganisms, their toxins, and enzymes can cause a variety of illnesses.  Contaminated water or exposure to excreta can result in conditions such as Hepatitis A, dysentery, cholera, or other diarrheal diseases.  The presence of chemicals in water supplies can lead to acute or delayed toxicity.  Insect vectors can transmit malaria, encephalitis or leishmaniasis causing significant temporary or permanent conditions.  Poor solid waste disposal can magnify the potential for exposure to disease causing organisms.

Medical Criteria.
(1) Potable water. An adequate supply of potable water is essential to health and well-being.  Army materiel will use the policies and procedures in preventive medicine guidance to provide and maintain a safe potable water supply (references 2 and 11).  Substandard facilities for water distribution or storage may adversely affect the quality of the water being supplied even though it leaves the treatment facility at satisfactory chemical and microbiological quality.       

(2) Waste disposal. The Army policy is to dispose of all classes of waste (water, solid, and hazardous) in a manner that protects the environment and preserves human health (reference 11).

(3) Foodservice facilities. Foodservice facilities must meet certification requirements of the NSF International, Underwriter’s Laboratory, Inc., or other laboratory or national consensus standards acceptable to the Surgeon General (reference 7).  Layout of kitchen equipment must consider workflow and be designed to minimize the potential for contaminated items to contact clean surfaces, equipment, utensils and food to help prevent the spread of food-borne disease.

(4) Condensate.  The water vapor that condenses from cooling coils is a potential medium for microorganisms.  These microorganisms can become aerosolized and entrained in the air supply and cause a range of illnesses.

(5) Toilet facilities. Facilities must have convenient provisions for hand washing devices or sanitizing body contact surfaces on the toilet.  These provisions help to prevent/control the spread of disease. 

(6) Soldiers and maintainers of Army equipment must be protected against exposure to infectious diseases.  Provisions must be made for personal protective equipment as well as other procedures to protect the workers and crew from biological agents.

References.
(1) Technical Bulletin Medical (TB MED) 576, Sanitary Control and Surveillance of Water Supplies at Fixed Installations, 15 Mar 82.

(2) Technical Bulletin Medical (TB MED) 577, Sanitary Control and Surveillance of Field Water Supplies, Dec 05.

(3) Environmental Protection Agency (EPA) Cross-Connection Control Manual, EPA 816-R-03-002, Feb 03.

(4) American Water Works Association (AWWA), Recommended Practice for Backflow Prevention and Cross-Connection Control (M14), 04.

(5) Title 40, Code of Federal Regulations (CFR), Part 243.200-1, Guidelines for the Storage and Collection of Residential, Commercial and Institutional Solid Waste. 

(6) American National Standards Institute (ANSI) Standard A119.2, Recreational Vehicles, 02.

(7) Technical Bulletin Medical (TB MED 530), Occupational and Environmental Health Food Sanitation, 30 Oct 02.

(8) Title 29, Code of Federal Regulations (CFR), Part 1910.141, Sanitation, 01 Jul 03.

(9) Field Manual (FM) 10-280, Mobile Field Laundry, Clothing Exchange and Bath Options, 02 Dec 83.

(10) Technical Bulletin Medical (TB MED 561), Pest Surveillance, 01 Jun 92.

(11) Army Regulation (AR) 40-5, Preventive Medicine, 25 May 07.

Supplemental References.
(1) Technical Bulletin (TB) 43-0153, Water Supply Afloat, 30 Aug 03.

(2) Field Manual (FM) 10-52, Water Supply in Theatres of Operation, 11 Jul 90.

(3) Field Manual (FM) 10-52-1, Water Supply Point Equipment and Operations, 18 Jun 91.

(4) Field Manual (FM) 21-10, Field Hygiene and Sanitation, 21 Jun 00.