BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                    AB 2272


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          Date of Hearing:  May 4, 2016


                        ASSEMBLY COMMITTEE ON APPROPRIATIONS


                               Lorena Gonzalez, Chair


          AB  
          2272 (Thurmond) - As Introduced February 18, 2016


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          Urgency:  No  State Mandated Local Program:  YesReimbursable:   
          No


          SUMMARY:


          This bill requires the Occupational Safety and Health Standards  
          Board (Board) to adopt standards to protect healthcare personnel  
          and patients from noxious airborne contaminants "plume"  
          generated during specified medical procedures.  Specifically,  
          this bill:










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          1)Requires the Board to adopt by June 1, 2018, an occupational  
            safety and health standard requiring a health facility, to  
            evacuate or remove plume through the use of a plume scavenging  
            system in all settings that employ techniques that involve the  
            creation of plume.


          2)Requires the Board to take into consideration and use as a  
            benchmark, specific standards adopted by the International  
            Organization for Standardization (IOS) and the Canadian  
            Standards Association (CSA). If the Board determines  
            recommendations of the federal Occupational Safety and Health  
            Administration or National Institute for Occupational Safety  
            and Health are more effective in the evacuation of plume and  
            would be more protective of occupational health than the ISO  
            or CSA standards, the board must use those federal  
            recommendations as the mandated requirement for plume  
            scavenging systems.


          3)Authorizes the Board to consider input from health facilities,  
            practicing physicians from affected specialties, labor and  
            specialty organizations representing affected registered  
            nurses, labor and specialty organizations representing other  
            affected health care personnel, and other stakeholders.


          4)Specifies nothing in this bill alters amends, expands, or  
            reduces existing general room ventilation standards or  
            requirements. These plume scavenging standards are in addition  
            to general room ventilation standards or requirements.  
            Prohibits the use of surgical masks or respirators to satisfy  
            the requirement of this bill.


          5)Defines the following for purposes of the bill:


               a.     "Plume" to mean noxious airborne contaminants  








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                 generated as byproducts of the use of energy-based  
                 devices, electrosurgical devices, electrocautery devices,  
                 or mechanical tools during surgical, diagnostic, or  
                 therapeutic procedures.


               b.      "Plume scavenging system" to mean smoke evacuators,  
                 laser plume evacuators, plume scavengers, and local  
                 exhaust ventilators that capture and neutralize at least  
                 95 percent of plume at the site of origin and before  
                 plume can make ocular contact or contact with the  
                 respiratory tract of health care personnel or patients


          


          FISCAL EFFECT:


          The Occupational Safety and Health Standards Board indicates the  
          costs associated with the development of a standard requiring a  
          health facility to evacuate or remove plume, as specified, would  
          be absorbable and within the scope of existing workload.  The  
          Board would rely on the recommended benchmarks developed by the  
          CSA and ISO to guide their work. 


          Unknown enforcement costs to the Division of Occupational Safety  
          and Health (DOSH) once the bill is implemented. 


          COMMENTS:


          1)Purpose. According to the sponsors, the California Nurses  
            Association/National Nurses United, operating room nurses are  
            at significantly higher risk of severe persistent asthma as a  
            result of occupational exposure to the dangerous and  








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            infectious materials that can be found in surgical plume  
            smoke.  Information from the sponsor states, for example,  
            surgeons are using smoke evacuators for laser procedures but  
            not electrosurgery, which is actually more dangerous because  
            this procedure emits more particulates. Adopting standards to  
            remove these infectious airborne contaminants before they are  
            dispersed into the surgical suite and surrounding areas, could  
            make California a leader in the reduction of hazardous  
            exposure to surgical plume which could prove beneficial both  
            to health care providers and their patients. 

          2)Background. California would be the first state to create a  
            standard related to plume exposure and removal if this bill  
            were enacted. Both the privately run Joint Commission on  
            Accreditation of Healthcare Organizations and federal NIOSH  
            have called for the reduction of plume exposure to healthcare  
            workers.  



            This bill recommends the Board consider recommendations made  
            by the CSA and the ISO. The CSA is a nationally recognized  
            testing laboratory involved in a wide range of testing and  
            standards drafting in the areas such as construction,  
            automotive, aerospace, and personal protective equipment. The  
            ISO is an independent, non-governmental international  
            organization that provides specifications for products,  
            services and systems, to ensure quality, safety and  
            efficiency. The ISO has published more than 19,000  
            International Standards and related documents, covering almost  
            every industry, from technology, to food safety, to  
            agriculture and healthcare. 

          3)Opposition. The California Hospital Association, is opposed to  
            this bill.  It states the hospital, together with physicians,  
            select devices that may generate plume as well as devices that  
            could minimize exposure to plume because of the patient care  
            considerations.  The association is concerned that directing  
            the Board to utilize specific guidance is too prescriptive.








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          Analysis Prepared by:Misty Feusahrens / APPR. / (916)  
          319-2081