Monday, December 26, 2016

Qualified Safety and Industrial Hygiene Professionals in Healthcare

Note: A version of this post was originally published in in The Monitor, a technical publication of the American Society of Safety Engineers' Industrial Hygiene Practice Specialty, in August 2015.

Healthcare workers have the potential to experience a wide variety of occupational injuries. Under the Occupational Safety and Health Administration (OSHA) Healthcare Safety and Health Topics webpage, OSHA lists the following as potential hazards: blood-borne pathogens (BBP) and other biological hazards, chemical and hazardous drug exposures, waste anesthetic gas exposures, respiratory hazards, ergonomic hazards, laser, hazards, workplace violence, and radioactive and x-ray hazards.

Chemicals such as formaldehyde, glutaraldehyde, ethylene oxide, peracetic acid, ortho-phthalaldehyde (OPA), and environmental disinfectants are sources of potential hazardous exposure for healthcare workers (OSHA, 2015). There is insufficient guidance for healthcare safety personnel to evaluate the risks associated with the use of these chemicals. Research evaluating the potential for synergism among chemicals used in healthcare that may adversely affect healthcare workers is scarce. The heightened awareness of infectious diseases such as Ebola and Middle East Respiratory Syndrome (MERS) has led to increased use of environmental disinfectants throughout healthcare and other workplaces. More research and expertise is needed by qualified industrial hygienists and safety experts to properly recognize, evaluate, and control the hazards present in healthcare.

Despite the improved focus on patient safety, quality control and regulatory compliance, the injury and illness rate from healthcare workers are almost twice as high as the private industry rate. A news release from OSHA on June 25, 2015 explained that OSHA will be expanding enforcement activity in healthcare facilities. OSHA’s enforcement focus will be on preventable injuries, such as those from patient handling, BBP, workplace violence, tuberculosis, and slips, trips, and falls (OSHA, 2015).

OSHA has developed resources, checklists, and guidance for healthcare safety relating to building a culture of safety, injury and illness prevention programs and/or safety and health management systems, infectious diseases, safe patient handling, and workplace violence. The National Institute for Occupational Safety and Health (NIOSH) has also developed resources for healthcare safety relating to hazardous drug exposures, waste anesthetic gases, and latex allergies. Additional guidance is available from accrediting organizations such as The Joint Commission, DNV Healthcare, and Center for Improvement in Healthcare Quality (CIHQ), among others.

So, with all the resources and guidance available, why are the injury and illness rates so high among healthcare workers?

Some safety and health professionals might argue that the healthcare organizations are too focused on patient safety as opposed to employee safety, in order to improve their ratings and popularity. To combat this belief, The Joint Commission developed a monograph entitled “Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation” that explains the methods of coordinating quality improvement activities that will benefit both the patients and the workers. In the Foreword of the monograph, The Joint Commission explains that: “The organizational culture, principles, methods, and tools for creating safety are the same, regardless of the population whose safety is the focus. In fact, the same principles, methods, and tools may be separately used by different groups (clinical, human resource, and general liability personnel) within an organization” (The Joint Commission, 2012). This is not a surprise to healthcare safety personnel who came to the healthcare industry after training in other industries, but may be a pleasant discovery for healthcare safety personnel who were promoted into their position from other clinical or non-clinical jobs.

There is variability in the tasks performed by healthcare safety personnel. Depending on the size of the campus or healthcare organization, healthcare safety personnel may have many other responsibilities beyond occupational and patient safety. Some healthcare safety personnel serve as the Director of Materials Management, Director of Facilities, Risk Manager, or Director of Infection Prevention, and the safety management aspect of their job is only a small portion of their daily responsibilities. Others may also serve as the Compliance and Privacy Officer, Radiation Safety Officer, Laser Safety Officer, and other technical and regulatory required positions.

In a quick internet search of posted jobs for “healthcare safety officer” or “EOC safety officer,” the following job tasks and requirements were listed (not a comprehensive list):

·  Conduct training of staff
·  Know OSHA and EPA regulations
·  Radiation and laser safety knowledge
·  Chemical safety and proper disposal
·  Develop education modules
·  Know NFPA Life Safety Code
·  Emergency management
·  Chair the EOC Committee
·  Conduct fire drills
·  Process improvement
·  Work independently
·  Risk assessment
·  Consultation and assessment
·  Understand project management
·  HICS and HSEEP Exercises
·  5 to 7 years’ experience in safety
·  Manage hazmat program
·  Familiar with ADA compliance
·  Act as community liaison
·  B.S. or M.S. in health sciences or safety
·  Conduct emergency spill response
·  Assist with laboratory safety
·  Provide regulatory oversight
·  Professional certification(s)

Healthcare safety personnel usually serve on a facility’s Environment of Care (EOC) Committee, which is an interdisciplinary team tasked with managing a facility’s physical environment in six functional areas: safety, security, hazardous materials and waste, fire safety, medical equipment, and utilities. The EOC Committee should have representation from clinical staff, security, healthcare administration, biomedical engineering, facilities engineering, infection prevention, employee health, laboratory, and other areas such as research administration that may be applicable to the facility.

Aspects of the Environment of Care are an integral part of the survey instruments used to score hospitals on sites such as Hospital Safety Score or the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS). The results of these surveys are supposed to be used by patients to select hospitals and health systems based on patient safety and outcomes. The HCAPHS survey asks two questions related to the physical environment of the hospital and patient safety (Centers for Medicare & Medicaid Services, 2015):

  • During this hospital stay, how often were your room and bathroom kept clean?
  • During this hospital stay, how often was the area around your room quiet at night?

The Hospital Safety Score provides patients with a score for each hospital in the U.S. on an A through F scale, measuring safe practices such as (The Leapfrog Group, 2015):

  • Leadership structures and skills
  • Culture measurement, feedback, and intervention
  • Teamwork training and skill building
  • Identification and mitigation of risks and hazards
  • Hand hygiene
  • Falls and trauma

In reviewing the job tasks and requirements listed previously for healthcare safety personnel, it quickly becomes apparent that individuals holding a Certified Industrial Hygienist (CIH) or Certified Safety Professional (CSP) designation already have much of the required knowledge, skills, and abilities. Individuals with CIH/CSP designation who have not worked in healthcare before may need to learn more about BBP and infectious diseases, hazardous drugs, medical terminology, ionizing radiation, patient safety, laboratory safety, and the accreditation process.

Having a qualified, certified, and well-trained person at the helm of health, safety, and environmental compliance activities may help healthcare facilities to improve their overall culture of safety – both for patients and employees. In an informal survey of hospitals located within Arizona, 23 hospitals were awarded an “A” or “B” designation by the Hospital Safety Score method in June 2015. After those hospitals were identified, a search of LinkedIn profiles was conducted to evaluate whether the hospital had a qualified and trained safety and health professional serving in a healthcare safety role at the facility.

If the individual held a professional certification such as CIH, CSP, Certified Healthcare Safety Professional (CHSP), Certified Professional in Patient Safety (CPPS), or Certified Healthcare Protection Administrator (CHPA), it was noted in the survey. If the individual had also completed a master’s degree in safety, environmental management, business administration, healthcare administration, or other applicable degree, it was noted in the survey. The size of the hospital – and associated complexity of environmental health and safety management – is indicated by the number of licensed patient beds.

Table 1 details the results of the informal survey of Arizona hospitals with a Hospital Safety Score of “A” or “B” – identifying details such as the hospital name and actual number of licensed beds have been replaced with an identification number and a size range. Hospitals included in this survey range from small hospitals with less than 100 licensed beds, to large hospitals with 700 to 750 licensed beds. If the individual serving as the “safety officer” did so in an ancillary capacity (i.e., job title was Director of Facilities), and did not have any formal safety training documented in their LinkedIn profile, the “Safety Professional” selection was “No.” If the individual performed safety functions as the primary role, the “Safety Professional” selection was “Yes.” An “X” indicates that the individual held the professional designation and/or had a relevant master’s degree. 

Table 1: Informal Survey of Arizona Hospitals with a Hospital Safety Score of A or B (June 2015)

The data from this informal survey has been summarized into Tables 2 and 3 below. Table 2 shows the number of Arizona hospitals with a “Safety Professional” (e.g., a “Yes” answer) as compared with the number of Arizona hospitals with a person who acts as safety officer in addition to their other job duties (e.g., a “No” answer). Table 3 shows the number of Arizona hospitals with a “Safety Professional” holding a CIH/CSP, CHSP/CPPS/CHPA, or relevant master’s degree. The hospital size ranges associated with these trained professionals is also provided in Table 3.

Table 2: Arizona Hospitals with  Dedicated Safety Professional (June 2015)
Table 3: Arizona Hospitals with a Qualified and Certified Safety Professional (June 2015)

Of the 23 Arizona hospitals with an “A” or “B” rating on the Hospital Safety Score site in June 2015, 13 (56.5%) had a dedicated safety professional. One of the smaller hospitals (AZ002) was not able to be included in the survey results due to the lack of information about the hospital’s safety officer responsibilities and lack of presence on LinkedIn. Of the 13 dedicated safety professionals, 10 (76.9%) had obtained a professional level certification or relevant master’s degree. Hospitals employing these trained and qualified safety professionals ranged from small (<100 beds) to large (600 beds). Only 3 (30%) of the trained and qualified safety professionals held a CIH or CSP designation. The remainder of the certifications (70%) were from organizations such as the International Board for the Certification of Safety Managers, the Certification Board for Professionals in Patient Safety, and the International Association for Healthcare Security and Safety.

                Although only 10 (43.5%) of the 23 Arizona hospitals earning an “A” or “B” rating on the Hospital Safety Score site had safety and EOC responsibilities performed ancillary to the individual’s other job responsibilities, many of the hospitals represented in this informal survey are part of regional health systems spanning multiple states. These health systems may have regional or corporate level occupational health and safety personnel who serve multiple healthcare campuses and provide technical support to the facility-specific staff.

                As part of the “Improving Patient and Worker Safety” monograph, The Joint Commission listed several topic areas for targeted interventions with the goal of improving safety. Individuals with CIH/CSP designation that are looking to foray into the world of healthcare safety should research strategies, solutions, and benefits associated with this list. Healthcare systems looking to hire safety officers, safety managers, and directors of safety are looking for healthcare-specific knowledge that is difficult to obtain if you have never worked in healthcare before. An abbreviated and modified list of these topics is included below (The Joint Commission, 2012).

  • Safe patient handling (including use of lifts and slings)
  • Fall prevention (both patient and staff)
  • Sharps injury prevention
  • Infection prevention (including hand hygiene and personal protective equipment)
  • Assault and violence prevention and management
  • Security management
  • Emergency management (including the Healthcare Incident Command System)
  • Exposure to hazardous drugs
  • Surveillance and exposure assessment
  • Environmental hazards
  • Ergonomics and human factors engineering
  • Improving safety culture throughout an organization
  • Safer design of practices and the built environment

Qualified industrial hygienists and safety professionals are needed to take healthcare safety to the next level. With OSHA promising to increase enforcement action, and accreditation agencies like The Joint Commission requiring documented improvements in safety and quality measures, opportunities for solution-oriented and collaborative safety professionals are becoming available. Industrial hygienists are needed to evaluate acute and chronic exposures to workers that may be inadvertently passed on to patients. Safety experts are needed to bring the industry knowledge from manufacturing, aviation, power generation, and other high-risk industries into the healthcare arena.

As Dr. David Michaels, Assistant Secretary of Labor for Occupational Safety and Health, said in the news release from June 25, 2015: “[…] it’s time for hospitals and the health care industry to make the changes necessary to protect their workers” (OSHA, 2015). Let’s accept this exciting challenge and improve safety for all of the people that enter into, or are employed by, healthcare facilities. 


Centers for Medicare & Medicaid Services. (2015, March 20). HCAPHS Online. Retrieved from HCAPHS Survey:
OSHA. (2015, June 27). Healthcare. Retrieved from Safety and Health Topics:
OSHA. (2015, June 25). OSHA adds key hazards for investigators' focus in healthcare inspections. Retrieved from News Release:
The Joint Commission. (2012). Retrieved from The Joint Commission:
The Leapfrog Group. (2015, April). Scoring Methodology. Retrieved from Hospital Safety Score:

Wednesday, December 21, 2016

Overwhelmed by the rising tide of environmental regulations?

I am particularly proud of this postcard mailer I drew and designed for a industrial hygiene colleague in Hawaii in March 2016:

Postcard mailer drawn and designed by the Industrious Hygienist.

The artistic styling for the top half of the postcard is borrowed from Hayao Miyazaki's Ponyo, one of my favorite animated films of all time. The artistic styling for the bottom half of the postcard is, as usual, borrowed from Hiromu Arakawa's Fullmetal Alchemist series. 

I'll only be posting one more manga, the traditional (and final!) Holiday Manga. I'm changing the focus of this blog slightly, and the manga take a significant amount of time that I will be spending on coursework for the doctorate I am hoping to start in March 2017.

Monday, December 19, 2016

How to Study For and Pass the CIH Exam

Note: A shortened version of this article was posted as a blog by ASSE on the Industrial Hygiene Practice Specialty Member Portal. The original, unedited version is below.

There are many different occupational safety and health certifications available to increase your marketability to employers and clients. As part of our efforts to educate and inform our members, the volunteer Advisory Committee of the Industrial Hygiene Practice Specialty is developing a series of articles about some of these certifications. This article focuses on the Certified Industrial Hygienist (CIH) designation from the American Board of Industrial Hygiene (ABIH). In this article, we’ll share some of our study tips, useful free resources on the internet to help with difficult topics, and explain why this certification may benefit your career. Relevant websites are hyperlinked throughout the article.

What is a CIH?

A CIH is someone who has qualified for and passed the CIH exam administered by ABIH. The CIH designation is the premier certification available for practicing industrial hygienists and academic professionals. CIHs work in many fields, from consulting to electronics, pharmaceuticals to oil and gas, public health to wastewater, healthcare to academia, and many more.

Who Can Take the CIH Exam?

ABIH has established clear guidelines to determine your eligibility for the CIH exam, including an Eligibility Self-Assessment Form and a Path to Certification. In order to be eligible for the exam, you must have completed at least a four-year Bachelor’s degree with a science, engineering, safety, or industrial hygiene focus. You must also have at least four years of professional-level, broad-scope industrial hygiene experience. Questionnaires from two professional references are needed; one of them must be a CIH. There are additional requirements for academic contact hours and continuing education, including a 2-hour ethics course requirement. Make sure to review the Candidate Handbook for the most up-to-date information. 

The ethics coursework can be completed from some of the following providers:

Study Tips for the CIH Exam

ABIH has recommendations to help you prepare for the exam. This is a difficult test – you should provide plenty of time for study and review. For some of us, that meant years of studying and multiple tries to pass the exam.  You can take a CIH certification preparation class (there are in-person and online options available from many different providers) to assist you with determining where to focus your studying. The exam is 5 hours and 180 questions, delivered via computer-based testing at a Prometric testing center. If you haven’t taken a computer-based exam in a while, Prometric has a “What to Expect” website to familiarize you with the operations of the testing center. AIHA has developed a 12-step “Preparing for the CIH Exam” guide for students and young professionals. 

Free Resources for the CIH Exam

The Advisory Council developed this list of free internet resources to assist you in studying particularly challenging topics.

General Safety and Health (Multiple Topics)

Air Sampling

Analytical Chemistry

Basic Science

  • Crash Course science episodes on YouTube on chemistry, biology, anatomy/physiology, physics, and math 
  • Khan Academy science resources


Biostatistics and Epidemiology

Community Exposure

Engineering Controls and Ventilation


Health Risk Analysis and Hazard Communication

Industrial Hygiene Program Management


Non-Engineering Controls

Radiation, Ionizing


Other Useful Topics

Certification Preparation Courses/Software

The following CIH certification preparation courses are currently available. 

Good Luck with your Studying!

If you’ve decided to start the process of studying for the CIH exam, good luck! There are many free resources to assist you, and previous test takers are often willing to share their experiences and challenges.

Friday, December 16, 2016

New job, snow, and creativity

It's been a couple of months since my last post.

My reason? I took a new job! I'm now an Assistant Professor in the Safety and Health Management Program (Department of Engineering Technologies, Safety, and Construction) at Central Washington University. At the very end of August, we packed up our meager belongings and Alaskan Malamute and drove up to Ellensburg, WA.

This is Central Washington University (CWU):

Image credit CWU

The campus is gorgeous, with red brick buildings throughout, grassy areas, a canal, several bike paths, and my personal favorite location: a Japanese Garden (video tour on YouTube here). There is also a Starbucks on the edge of campus, so I can walk over within 10 minutes.

Ellensburg is also a spiffy college town - the weekend after we arrived, it was the annual Ellensburg Rodeo for all of Labor Day weekend. This rodeo started in 1923, so it is one of the oldest rodeos. Where we used to live, in Prescott, AZ, they have had a rodeo since 1888 and rock the "World's Oldest Rodeo" vibe throughout town. 

Ellensburg is a town of ~18,000 people and the speed limit around town ranges from 20-35 miles per hour. After our experiences in Phoenix the last few years, with a population of ~1.5 million people and some really aggressive drivers, this has been a nice change. Seattle is about 2 hours away, and Spokane is 2.5 to 3 hours away.

My colleagues and family keep asking how we are adjusting to life in the Pacific Northwest. My answer is usually congenial, something along the lines of: "It's ... fine?" We haven't explored around much and I have been working consistently long hours, as is expected when you are new faculty. Last week, when we had our first real snow, I freaked out a little bit, but have since learned how to drive in snow (with my fancy new snow tires), how to walk in snow (with my fancy new YakTrax), and learned the value of layered clothing. We raided the Columbia outlet in Anthem, AZ on our way out of Phoenix.

The Alaskan Malamute is deliriously happy, building himself little dens in the fresh snow, and bounding inside covered in snow flakes. We are deliriously happy to not have to answer the "How does he do in the summer? Do you shave him?" questions we were asked by everyone in Phoenix. (He did great, he's an inside dog).

Shadow practicing his best "stoic" look in the snow.
I'm preparing some exciting new content for the blog over winter break. But I'm also working on two academic research papers, one on construction project EHS budgets and the optimal budget amount for reduced injury and illness rates (co-writing with two excellent CWU professors), and one on "Practical Tools for Gender Equal Protection in OSH Programs" that will be presented at Safety 2017 in Denver, CO. 

On a professional note, I've had some fun new volunteer experiences arrive this fall/winter: (1) I was elected the Assistant Administrator of the Training and Communications Practice Specialty within ASSE, (2) I was asked to step in as Secretary of the Industrial Hygiene Practice Specialty within ASSE, and (3) I get to serve on the Editorial/Press Advisory Board for the National Safety Council. So things are very busy for the Industrious Hygienist, but as always, I am up for the challenge!