BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          AB 2272 (Thurmond) - Occupational safety and health standards:   
          plume
          
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          |Version: August 1, 2016         |Policy Vote: L. & I.R. 4 - 1    |
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          |Urgency: No                     |Mandate: Yes                    |
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          |Hearing Date: August 1, 2016    |Consultant: Robert Ingenito     |
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          This bill meets the criteria for referral to the Suspense File.


          


          Bill  
          Summary: AB 2272 would require the Occupational Safety and  
          Health Standards Board, by June 1, 2018, to adopt standards and  
          require training and education to protect health care personnel  
          and patients from exposure to vaporized human tissue.


          Fiscal  
          Impact: The Department of Industrial Relations (DIR) indicates  
          that costs associated with the Occupational Safety and Health  
          Standards Board's development of standards requiring a health  
          facility to evacuate or remove plume, as specified, would be  
          within the scope of existing workload, and thus absorbable.  
          However, DIR's Division of Occupational Safety and Health would  
          incur unknown enforcement costs once the standards have been  
          developed. 








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          Background: Current law establishes the Occupational Safety and Health  
          Standards Board (Board), within DIR, as the standards-setting  
          agency for the Division of Occupational Safety and Health  
          (DOSH). The Board promulgates and enforces occupational safety  
          and health standards for the state including standards dealing  
          with toxic materials and harmful physical agents. Additionally,  
          current law stipulates that in promulgating standards dealing  
          with toxic materials or harmful physical agents, the Board shall  
          adopt standards to prevent employees from suffering adverse  
          health effects even if these employees have regular exposure to  
          a regulated hazard.


          Proposed Law:  
          This bill would, among other things, do all of the following:
                 Require the Board, by June 1, 2018, to adopt standards  
               to protect health care personnel and patients from plume  
               (see below) exposure through the use of plume scavenging  
               systems. 


                 Mandate that in developing these standards, the Board  
               will consider the most effective preexisting plume-related  
               standards including those at the federal level. The Board  
               may also consider input from health facilities, physicians,  
               registered nurses, affected health care personnel, labor  
               and specialty organizations representing affected  
               registered nurses and health care personnel, and other  
               stakeholders.


                 Specify the Board to include as part of the standards a  
               requirement for employers to provide training and  
               education, as specified, to all health care workers that  
               will participate in procedures that involve the creation of  
               a plume.


                 Define "plume" as vaporized human tissue or 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. These  








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               plume-generating devices are also defined.


                 Define devices that remove plume from the air as "plume  
               scavenging systems" that include 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 before plume can make ocular  
               contact or contact with the respiratory tract of health  
               care personnel or patients.







          Staff  
          Comments: The heat-generated (thermal) destruction of human  
          tissue via cutting during therapeutic removal and burning  
          (cauterization) is commonplace in a wide range of medical  
          procedures.  When human tissue is destroyed in this way, a smoke  
          byproduct or "plume" is created. The plume can contain toxic  
          gases and vapors such as benzene, hydrogen cyanide, and  
          formaldehyde, biological aerosols (a suspension of living  
          bacteria, viral particles or fungal spores), and viruses and  
          blood fragments containing blood-borne pathogens, including  
          multi-resistant strains.  Surgical plume is also known to  
          contain mutagenic (cancer producing) particles. At high  
          concentrations, plume can also cause ocular and upper  
          respiratory tract irritation in health care personnel.  Under  
          this bill, California would be the first state to create a  
          standard related to plume exposure and removal.
          Any local government costs resulting from the mandate in this  
          measure are not state-reimbursable because the mandate only  
          involves the definition of a crime or the penalty for conviction  
          of a crime.


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