BILL ANALYSIS Ó AB 2272 Page A CONCURRENCE IN SENATE AMENDMENTS AB 2272 (Thurmond) As Amended August 15, 2016 Majority vote -------------------------------------------------------------------- |ASSEMBLY: |49-23 |(May 19, 2016) |SENATE: |25-13 |(August 24, | | | | | | |2016) | | | | | | | | | | | | | | | -------------------------------------------------------------------- Original Committee Reference: L. & E. SUMMARY: Requires the Division of Occupational Safety and Health (DOSH) 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," among other things. Specifically, this bill: 1)Requires that by July 1, 2019, the Occupational Safety and Health Standards Board (Board) adopt the proposed regulations from the advisory committee. 2)Allows the DOSH advisory committee to include health facilities, practicing physicians and surgeons from affected AB 2272 Page B specialties, registered nurses and other affected health care personnel, labor and specialty organizations representing affected registered nurses and health care personnel, and other stakeholders. 3)Mandates that in developing this regulation, the DOSH 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. 4)Stipulates that the use of surgical masks do not qualify as protection against plume. 5)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. 6)Defines "plume" 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. 7)Defines "plume scavenging system" as smoke evacuators, laser plume evacuators, plume scavengers, and local exhaust ventilators that capture and neutralize plume before it can make ocular contact or contact with the respiratory tract of health care personnel or patients. The Senate amendments: AB 2272 Page C 1)Require DOSH, 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 exposure through the use of plume scavenging systems, as specified. 2)Require that by July 1, 2019, Board consider and adopt the proposed regulations. 3)State the proposed regulations/standards shall include a requirement that employers provide training to all health care personnel involved in procedures creating exposure to vaporized human tissue. 4)Specify that the regulation shall not limit the authority of DOSH or the Board to develop or adopt regulations that are broader in scope or application than those established in the bill. 5)Make clarifying changes. 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 standards dealing with toxic materials and harmful physical agents. FISCAL EFFECT: According to the Senate Appropriations Committee, the 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 AB 2272 Page D plume, as specified, would be within the scope of existing workload, and thus absorbable. However, DIR's DOSH would incur unknown enforcement costs once the standards have been developed 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 Occupational Safety and Health Administration (OSHA) can cite hospitals for not making an effort to 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. ------------------------- <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 E 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. Analysis Prepared by: Lorie Alvarez / L. & E. / (916) 319-2091 FN: 0004407