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