BILL ANALYSIS Ó AB 2272 Page A ASSEMBLY THIRD READING AB 2272 (Thurmond) As Introduced February 18, 2016 Majority vote ------------------------------------------------------------------ |Committee |Votes|Ayes |Noes | | | | | | | | | | | | | | | | |----------------+-----+----------------------+--------------------| |Labor |5-1 |Roger Hernández, Chu, |Patterson | | | |McCarty, O'Donnell, | | | | |Thurmond | | | | | | | |----------------+-----+----------------------+--------------------| |Appropriations |15-5 |Gonzalez, Bloom, |Bigelow, Gallagher, | | | |Bonilla, Bonta, |Jones, Obernolte, | | | |Calderon, Chang, |Wagner | | | |Daly, Eggman, Eduardo | | | | |Garcia, McCarty, | | | | |Holden, Quirk, | | | | |Santiago, Weber, Wood | | | | | | | | | | | | ------------------------------------------------------------------ SUMMARY: Requires the Occupational Safety and Health Standards Board (Board) to adopt standards to protect healthcare personnel and patients from noxious airborne contaminants "plume" AB 2272 Page B generated during specified medical procedures. Specifically, this bill: 1)Requires the Board by June 1, 2018 to adopt standards requiring a health facility to evacuate or remove plume in all settings that employ techniques which create plume. 2)Directs the Board to consider and use as benchmarks standards established by the International Organization for Standardization (ISO) and the Canadian Standards Association (CSA) unless federal Occupational Safety and Health Administration (OSHA) or the National Institute for Occupational Safety and Health (NIOSH) recommendations are more effective in the evacuation of plume and would be more protective of occupational health. 3)Defines "plume" as noxious airborne contaminants generated as byproducts of the use of energy-based devices, electrosurgical devices, electrocautery devices or mechanical tools during surgical, diagnostic or therapeutic procedures. 4)Defines "plume scavenging system" as smoke evacuators, laser plume evacuators, plume scavengers, and local exhaust ventilators that capture and neutralize at least 95% of plume before plume can make contact with eyes or contact with the respiratory tract of healthcare personnel or patients. 5)States the use of surgical masks or respirators do not satisfy the requirements under this bill. EXISTING LAW establishes the Board within the Department of Industrial Relations (DIR) which promulgates and enforces occupational safety and health standards for the state including AB 2272 Page C standards dealing with toxic materials and harmful physical agents. FISCAL EFFECT: According to the Assembly Appropriations Committee, the 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: According to the sponsors, the California Nurses Association/National Nurses United, a Nurses' Health Study found that operating room nurses, "were at significantly higher risk of severe persistent asthma" as a result of occupational exposure to the dangerous and infectious materials that can be found in surgical plume smoke.<1> By adopting standards to remove these infectious airborne contaminants before they are dispersed into the surgical suite and surrounding areas, California could be a leader in the reduction of hazardous exposure to surgical plume which could prove beneficial both to health care providers and their patients. Federal OSHA can cite hospitals for not making an effort to --------------------------- <1> Nurses' Health Studies are among the largest ongoing investigations of factors that influence nurses' health. Started in 1976 and expanded in 1989, the information provided by 238,000 dedicated nurse participants has led to insights on health and disease. AB 2272 Page D control smoke emission in laser or electrosurgical procedures through a clause that covers all hazardous conditions. In Section 5(a)(1) of the Occupational Safety and Health Act, OSHA's General Duty Clause states: Each employer shall furnish to each of his [sic] employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his [sic] employees. However OSHA's limited ability to enforce elimination of unsafe practices involving such surgical procedures has led many to stress the need for a more concentrated campaign. "In many ways, this is an education issue rather than an enforcement issue," says Vangie Dennis, R.N., C.N.O.R., C.M.L.S.O., advanced technology manager, surgical services support, at Gwinnett Medical Center near Atlanta, Georgia. Ms. Dennis says "there are still operating room personnel who are unaware of the issue, who do not realize that they are breathing human body parts. There are surgeons using smoke evacuators for laser procedures but not electrosurgery, which is actually more dangerous because this procedure emits more particulates." In her role at Gwinnett, Ms Dennis, helped transform the way surgical smoke is dealt with at Gwinnett. "In the past, there was inconsistent use of smoke evacuators and no real understanding of the hazards of electrosurgical smoke," she says. "We now use smoke evacuators with any procedure that emits smoke. Getting to that point involved a proactive strategy to optimize workplace safety."<2> Arguments in Support --------------------------- <2> Environment of Care News, September 2007, Volume 10, Issue 9- Joint Commission on Accreditation of Healthcare Organizations AB 2272 Page E The sponsors argue that the Joint Commission on Accreditation of Healthcare Organizations and NIOSH has called for a reduction of plume exposure to healthcare workers and yet a federal legislative mandate has not been forthcoming. California is one of many states that as an OSHA approved state plan that allows for the adoption of occupational standards without having to resort to the onerous federal process. Our state should take the lead on this important issue as it has in areas like occupational exposure to blood borne pathogens, Ebola virus, safe patient handling, and workplace violence standards. Arguments in Opposition The California Hospital Association, are opposed to this bill unless amended, stating "the equipment at issue in this bill directly implicates patient care decisions. 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. Once in the operating room, the physician is in charge. Because most hospitals do not employ their physicians (and most private hospitals are prohibited from doing so) the hospital's ability to impact decisions made by physicians in the operating room may be limited and as noted above, could interfere with patient care." They argue that directing the Board to utilize specific guidance is too prescriptive particularly where the guidance referenced is from a non-traditional source. Guidance can change over time, new guidance could be published before the Board begins its process and/or there may be more appropriate guidance available currently. Lastly, they state it is not operationally feasible to take guidance documents reflecting numerous options and convert those options into mandates. Analysis Prepared by: Lorie Alvarez / L. & E. / (916) 319-2091 FN: AB 2272 Page F 0002844