BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 2272|
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THIRD READING
Bill No: AB 2272
Author: Thurmond (D)
Amended: 8/15/16 in Senate
Vote: 21
SENATE LABOR & IND. REL. COMMITTEE: 4-1, 6/22/16
AYES: Mendoza, Jackson, Leno, Mitchell
NOES: Stone
SENATE APPROPRIATIONS COMMITTEE: 5-2, 8/11/16
AYES: Lara, Beall, Hill, McGuire, Mendoza
NOES: Bates, Nielsen
ASSEMBLY FLOOR: 49-23, 5/19/16 - See last page for vote
SUBJECT: Occupational safety and health standards: plume
SOURCE: California Nurses Association/National Nurses United
DIGEST: This bill requires the Division of Occupational Safety
and Health to convene an advisory committee to develop a
regulation regarding the protection of health care personnel and
patients from exposure to vaporized human tissue, defined in
this bill as "plume." Requires the regulation include a
requirement for employers to provide training to employees that
may be exposed to plume on its nature, risk, and methods to
avoid exposure. Requires the proposed regulation be submitted to
the Occupational Safety and Health Standards Board for
consideration and subsequent adoption by July 1, 2019.
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ANALYSIS:
Existing law:
1)Establishes the Occupational Safety and Health Standards Board
(Board), within the Department of Industrial Relations, as the
standards-setting agency for the Division of Occupational
Safety and Health (Cal/OSHA). The Board promulgates and
enforces occupational safety and health standards for the
state including standards dealing with toxic materials and
harmful physical agents (Labor Code §140, §142.3, and §144.6).
2)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 (Labor Code §144.6).
This bill:
1)Requires Cal/OSHA, by June 1, 2017 to form an advisory
committee to develop and submit to the Board by June 1, 2018,
a regulation to protect health care personnel and patients
from plume (see below) exposure through the use of plume
scavenging systems. This will be accomplished by requiring
health facilities to use these plume scavenging systems in all
settings that could create plume.
2)Defines "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 plume-generating devices are
also defined.
3)Defines "plume scavenging systems" as devices including smoke
evacuators, laser plume evacuators, plume scavengers, and
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local exhaust ventilators that capture and neutralize plume at
the site of origin and before plume can make ocular contact or
contact with the respiratory tract of employees.
4)Allows the Cal/OSHA advisory committee to include health
facilities, practicing physicians and surgeons from affected
specialties, registered nurses and other affected health care
personnel, labor and specialty organizations representing
affected registered nurses and health care personnel, and
other stakeholders.
5)Mandates that in developing this regulation, the Cal/OSHA
advisory committee consider, and evaluate as a benchmark,
preexisting plume-related standards including those adopted at
the federal Occupational Safety and Health Administration and
the National Institute for Occupational Safety and Health, as
well as other private groups such as the International
Organization for Standardization.
6)Creates a plume, and plume exposure prevention training
requirement, including the use of plume scavenging equipment
and systems utilized by health facilities, to be provided by
employers for all workers who may encounter plume.
7)Requires that by July 1, 2019, the Board must adopt the
proposed regulation.
8)States that its provisions do not alter or affect general room
ventilation standards in any way.
9)Stipulates that the use of surgical masks do not qualify as
protection against plume.
10)States that the use of respirators does not qualify as
protection against plume except when, due to medical
necessity, a plume scavenging system is not able to be
located where it captures plume effectively.
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11)Specifies that the regulation shall not limit the authority
of Cal/OSHA or the Board to develop or adopt regulations that
are broader in scope or application than those set down in
the bill.
Comments
Background on Plume - 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.
Sources to Be Considered in Developing a Plume Regulation - This
bill specifies that in developing the plume regulation, the
Cal/OSHA advisory committee must consider the benchmarks
developed or adopted by the International Organization for
Standardization, the CSA Group, the federal Occupational Safety
and Health Administration (OSHA) and the National Institute for
Occupational Safety and Health (NIOSH). As such, a brief
description of these entities follows below.
The International Organization for Standardization and CSA are
independent, non-governmental organizations that give
specifications for products, services and systems in the health
care industry among others, to ensure quality, safety and
efficiency. Both have developed standards for equipment designed
to evacuate plume generated by medical devices. They offer
guidance on the purchasing, installation, testing, use,
servicing and regular maintenance of systems that collect and
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filter plume.
NIOSH is a part of the Centers for Disease Control that conducts
research and makes recommendations for the prevention of
work-related illnesses and injuries. NIOSH has conducted
research that suggests airborne contaminants generated by these
surgical devices can be effectively controlled through
ventilation and specific work practices. NIOSH's recommended
ventilation techniques include a combination of general room and
local or portable exhaust ventilation. In terms of work
practices, health care personnel would follow established
procedures and protocols when using these systems. Personnel
would also use control measures or precautions required by the
OSHA Blood-Borne Pathogen standard.
Currently OSHA has no specific standards for plume hazards,
however they make recommendations that could aid in minimizing
plume exposure. They include the use of smoke evacuators and the
observance of the precautions mentioned above which include the
appropriate disposal of all tubing, filters, and absorbers used
during smoke-generating surgical procedures, like those involved
in the creation of plume.
Need for this bill? The author believes that by adopting
regulations to remove plume before it is dispersed into a
surgical suite and surrounding areas, California could be a
leader in the reduction of surgical site infections. The author
contends that this bill is consistent with the Legislature's
occupational protection of health care workers in a number of
areas including occupational exposure to blood-borne pathogens.
The author states that the privately-run Joint Commission on
Accreditation of Healthcare Organizations and the federal NIOSH
have called for the reduction of plume exposure to health care
workers and yet neither a state nor a federal legislative
mandate exists. In developing a standard for California, the
author believes that the state can limit the exposure of health
care personnel to the pathogenic bacteria and live viruses that
plume can contain.
FISCAL EFFECT: Appropriation: No Fiscal
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Com.:YesLocal: Yes
According to the Senate Appropriations Committee, the Department
of Industrial Relations 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.
SUPPORT: (Verified6/22/16)
California Nurses Association/National Nurses United (source)
American Lung Association in California
California Labor Federation, AFL-CIO
Service Employees International Union
The International Council on Surgical Plume
OPPOSITION: (Verified6/22/16)
California Hospital Association
California Association of Health Facilities
ARGUMENTS IN SUPPORT: Proponents state that surgical plume
contains carbon, cellular debris, viral particulates, toxic
gases such as carbon monoxide and benzene, and a number of
carcinogenic and mutagenic substances. They also state that
plume affects any person entering or working in the enclosed
space of an operating room where these procedures are occurring.
Health care workers who are exposed, often complain of burning,
watery eyes, coughing, sore throat, asthma, allergy reactions,
nausea, headaches, as well as more serious long-term health
problems.
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Furthermore proponents argue that, aside from their personal
health hazards, if doctors and nurses are affected with these
symptoms, they cannot care for patients in the operating room
during their most vulnerable times. They state that a broad
range of plume scavenging devices is available that are simple
to obtain and use. They state that these plume scavenging
devices yield great health benefits to everyone in the operating
room. While there are a number of standards, guidelines, and
recommended professional practices currently published relating
to plume, proponents contend that they fail to have a meaningful
impact on practice because these standards are not mandated by
law. Accordingly, proponents believe that this bill is necessary
to develop and codify these health and safety standards.
ARGUMENTS IN OPPOSITION: The California Hospital Association
states that surgical plume is recognized to be a complex mixture
of particulates, gases, and vapors. CHA has been unable to
identify the source of the 95 percent benchmark required by the
bill for capturing and neutralizing plume, and are unclear as
to which of the plume components this 95 percent benchmark would
apply. CHA is also unclear as to how a hospital would
demonstrate achievement of any numeric benchmark. CHA is also
concerned that directing Cal/OSHA to utilize specific guidance
is too prescriptive, particularly where the guidance referenced
is from a non-traditional source. Also CHA believes that the
bill is too broad in that it does not distinguish between
procedures where plume may be generated in a cavity, and thus
there is minimal if any exposure, and where it is generated in
the open.
CHA also states that the equipment at issue in this bill
directly implicates patient care decisions. The hospital's
ability to impact decisions made by physicians in the operating
room may be limited and could interfere with patient care.
Finally, CHA believes that the punitive approach taken by this
bill conflicts with the national trend in health care to improve
safety through a "just culture" approach. A collaborative and
educational approach is more consistent with the trend to
support a blame-free "just culture" environment where employees
are encouraged to raise patient and employee safety concerns.
ASSEMBLY FLOOR: 49-23, 5/19/16
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Page 8
AYES: Alejo, Arambula, Atkins, Bloom, Bonilla, Bonta, Brown,
Burke, Calderon, Campos, Chau, Chiu, Chu, Cooley, Cooper,
Dababneh, Dodd, Eggman, Frazier, Cristina Garcia, Eduardo
Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Roger
Hernández, Holden, Irwin, Jones-Sawyer, Levine, Lopez, Low,
Medina, Mullin, Nazarian, O'Donnell, Quirk, Ridley-Thomas,
Rodriguez, Salas, Santiago, Mark Stone, Thurmond, Ting, Weber,
Wood, Rendon
NOES: Achadjian, Travis Allen, Baker, Bigelow, Brough, Chávez,
Dahle, Beth Gaines, Gallagher, Grove, Harper, Jones, Kim,
Lackey, Maienschein, Mayes, Melendez, Obernolte, Olsen,
Patterson, Steinorth, Wagner, Wilk
NO VOTE RECORDED: Chang, Daly, Hadley, Linder, Mathis, McCarty,
Waldron, Williams
Prepared by:Brandon Seto / L. & I.R. / (916) 651-1556
8/15/16 19:39:46
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