As if promoting, enforcing, maintaining, and ensuring safety in the fabrication laboratory weren’t challenging enough by itself, the emergence of the COVID-19 virus brought further complications to O&P operations. We asked industry experts to share their insights and observations regarding what can be done to address safety concerns raised or exacerbated by the virus. We found that, in some respects, many O&P fabrication labs were well prepared for a viral invasion, since most expressed a strong pre-existing commitment to keeping their staff and patients protected and healthy, in a safe work environment.
Safety Improvements Prior to the Pandemic
Tony Wickman, CTPO, CEO, Freedom Fabrication, Havana, Florida, a 35-year veteran technician, points out that the Occupational Safety and Health Administration (OSHA), government, and industry in general have been studying noise level, air quality, chemical exposure, and other safety concerns for generations. “This is something we’ve been paying attention to for certainly as long as I’ve been in the industry,” he notes. “We’ve always had a strong HVAC system here, and I haven’t seen any substantial advancements in clean air technology in the last 20 years, so we really didn’t have to change much [due to the virus]; I have not required masks in the building. We do have some fine dust that isn’t caught by our ventilation, so most of the techs will wear dust masks when the situation requires it; and when I spray, I wear a respirator.”
Rubber gloves are worn, and incoming materials are hosed and scrubbed. At other labs, protective masks, respirators, and gloves are also staples already in everyday use.
Technical consultant Steve Hill, BOCO, CO, Delphi Ortho, Asheville, North Carolina, who has been teaching lab safety at tech programs and workshops for 20 years, points out that “when the facility’s technicians are valued and have input, HEPA filters are the filtration of choice. You see technicians wearing masks, and more aggressive dust collection and ventilation when they’re grinding sockets previously worn by patients. Since grinding means putting into the air small particles, which have been in contact with patients, extra effort is made to mitigate potentially contagious dust.”
Wickman describes dangerous chemicals like methyl ethyl ketone (MEK) and acetone that were once in common use. “We basically washed our hands with acetone; MEK is a carcinogen, but we didn’t know that. Modern epoxy-based resins are much less harmful than they used to be.
“When I started work as a tech in 1984, we didn’t have MSDS [material safety data sheets]—we didn’t know what was dangerous. When the boss said, ‘Wipe that up,’ we just wiped it up,” he says.
“Nowadays, most of the people in the lab are pretty savvy. It’s a new generation of techs who understand that not everything is as benign as we used to think it was.”
“Since we learned about the detrimental effects of methyl ethyl ketone (and others), and realized that it can give you cancer,” Hill says, “we tend to, at the very least, suit up against it—or stop using it altogether. There’s a whole new industry now of safe organic alternatives to the dangerous chemicals that we’ve used in the past. The laminating materials that most people use now are a lot safer than they’ve ever been before.”
Julie McCay, CP/L, SRT Prosthetics & Orthotics, Fort Wayne, Indiana, says the addition of bonding agents that are “a safe replacement for the siegelharz or ‘gunk’ of the old days, with no fumes and less exposure to toxic substances,” are a major improvement in the last few years and cites the Fabtech Plus Series adhesives as an example.
Hill reports that the natural evolution of machines makes them run smoother to be more efficient and last longer—which in turn usually has the side benefit of being quieter, as well. No one replaces a piece of equipment just because it’s noisy—and sometimes not even because it’s also inefficient. Instead, he explains, the recognized need for noise mitigation takes the form of separating the noisy equipment from where the people are.
“Most places, for example, have done something with the air compressor—they’ve put it outside under a little roof, or in a separate room where they try to noiseproof it a little bit—but many labs don’t have that luxury.”
Tom Tillges, Tillges Certified Orthotic Prosthetic (TCOP), Maplewood, Minnesota, points to advances in filtration equipment and dust collection equipment. “We do a lot of carbon fiber grinding here. Carbon fiber dust is classified as explosive dust, so we implemented proper shut-off valves and smart computer systems to where it will basically contain any explosion, if one were to happen—and from returning into the building and jeopardizing any of our employees.
“I think dust collection is a big concern that every O&P should look at. There’s very good equipment out there, and it’s not very expensive.”
Perhaps TCOP’s most significant progress toward lab safety is the automated robotic solution that now does a bulk amount of their grinding. “It’s allowed us to take our employees out of that dusty area and let the robot grind in a totally enclosed room. The room is connected to a primary dust collector, which collects the dust as it operates. This has been a big move forward in terms of just reducing exposure to dust.”
Despite previous advances in lab-focused safety measures, increasing virus defenses overall has taken a steady toll, requiring unprecedented safety measures including social distancing, masks, and self-isolation that resulted in a costly slowdown of productivity.
Wickman reported in late May that his business was operating at 60 percent below normal capacity. “It’s been a big hit. We’re doing everything we can to keep employees safe and happy, but we’ve had to shorten our hours, and we’ve had several three-day work weeks.”
McCay reports that although their work volume decreased initially, as people feared to leave their homes, business has now picked up. She and her SRT colleagues are wearing N95 masks when working with patients or their devices. Employees and patients both get their temperatures taken when entering the building.
“At least during the pandemic times, I think we should be taking everybody’s temperature,” Hill agrees. “When they come in in the morning, shoot everybody’s forehead; I think that and the masks are a wise practice—at least at work.”
SRT’s updated procedures include cleaning patient rooms between appointments, McCay notes. “We have also made efforts to clean the patients’ devices if removing them from the patient room to take back into the lab. We did have difficulty obtaining cleaning supplies and masks at first but seem to have an ample supply now.”
Mike Tillges, CPO, TCOP, reports that although their patient count dropped, their multiple outreach clinics have just reopened in June after a two-month shutdown, and in the interim they’ve stayed busy with prosthetics, and domestic and international central fab work. “As parts of the country begin to open, we see that reflected in the influx of central fab jobs coming in.”
Their widespread revamping to address the pandemic includes social distancing even in the lab, where technicians’ work benches are spaced a minimum of six feet apart, and a split shift structure limits the number of bodies within the lab to 11 or 12 instead of 23-24.
“Just in case someone contracts COVID-19 within the workplace, we’re not taking out our entire workforce,” Tom Tillges explains. “We’d still have a backup team.”
Although employees work different hours, their hours per week remain the same. “We’re finding tasks for them to do when they’re not in the lab; watching educational and technical training videos remotely, logging in from home; basically all our shifts are 30 hours at the office and ten working off-site at home or elsewhere.”
Their patients can take advantage of expanded ten-hour days and flexible Saturday hours when high-risk patients can more easily maintain social distancing.
SRT has also expanded service hours and initiated split shifts for employees, with each team working alternate weeks to reduce the chance of exposure, McCay explains.
Patient braces coming into the TCOP lab for adjustments now go through a sterilization process on their way to a technician’s bench. A three-minute treatment with an inexpensive locally acquired chemical solution kills the virus and other surface contaminants, says Mike Tillges, who explains that spraying the braces also helps to slow things down and separate multiple patients into fewer patients in the practitioner area.
Tom Tillges recalls that experience with the bird flu and SARS in the early 2000s prepared them to stock up early on masks and PPE. Everything is kept in a locked room and dispensed as needed, and Mike Tillges notes that extra gloves and other PPE are no longer kept in patient care rooms where they could disappear. Stocks are supplemented with 3D-printed face masks and in-house fabricated sneeze guard screens that have been installed to protect practitioners and administrative staff.
TCOP follows the Centers for Disease Control and Prevention recommendations, released in a series of flyers and posters that describe steps to protect staff and patients: How to clean and sanitize the workplace and how to sterilize equipment, and what chemicals are appropriate for effectively killing the virus.
Tom Tillges notes, however, that since there’s no established policy to follow yet, they are recording and documenting everything they are doing. “We keep very diligent logbooks on temperature checks and patient screening—in case any policy may roll out in the future from OSHA or ABC.”
In the Wake of the Virus
Most agree that the aftereffects of the COVID-19 virus are likely to influence the way O&P professionals do business for many years to come.
Hill notes that the pandemic precipitated the O&P profession’s rush to embrace the advantages of telemedicine. “We’ve already been sliding in this direction, but there’s been no push to make it go the rest of the way before now. Telecommunication enables the practitioner to spend more quality time face-to-face with a patient, without having external distractions—and also enables them to see more patients within a shorter time frame. In O&P of course there’s a point where we have to touch the patient—but there’s an awful lot we can do prior to that point.”
Tom Tillges points out that if a second wave of the virus comes, we’ll all be better prepared. “If we need to get back to these hours and split shifts and employee separation, we’re going to have those policies and procedures in place—and better actionable plans moving forward, if needed.”
Wisdom for Tomorrow: A Safety Checklist
Wickman warns that better safety depends on knowledge. “Get a material safety data sheet for every piece of material, every chemical, everything you bring into your lab. And read it! Some MSDS sheets are pretty shocking, so you’ve got to know what you’re working with—and how to handle it. Polypropylene is deadly if you burn and inhale the vapors, but it’s what your milk comes in.”
He also cautions techs wearing earbuds in the lab. “I keep telling them to keep the volume low enough so when I say their name, they turn around. Because I might be saying ‘Hey, Patrick, your pants are on fire!”‘
McCay’s concerns extend to the overall noise levels in the labs. “I don’t feel noise levels have reduced over the 20 years I’ve been practicing. I’d like to continue to stress the importance of wearing hearing protection, because hearing damage really is cumulative. Yet I continue to see many disregarding this safety precaution.
“I’d also stress using the correct tool for each job, and protecting your body,” McCay continues. “Our job is hard on the hands, shoulders, knees, etc. Use leverage when possible and the correct tools to protect yourselves.”
The most common mistakes Hill sees people make in the lab involve ignoring things they’re already aware of, like eye protection. “Students have an instructor standing over their shoulder, making sure they put on eye protection and their mask. But pretty much everything you grind or sand can be airborne, so you should be wearing some sort of protection.
“Another mistake is wearing the wrong mask,” Hill says. “Cloth masks are for particulate matter; a respirator is needed when you’re working with chemicals and fumes.
“And the use of safety glasses is shockingly rare in most labs. The average technician wears hardly any protection—especially not on his eyes—just because the lenses fog up when you get hot, they get dust on them, it makes it hard to see. But that dust that makes it hard to see through the lenses is proof that they need them.”
Therefore, enforcement of safety rules by a boss or manager is essential, he concludes.
Tom Tillges cautions that having proper dust collection and PPE is essential for everyday jobs, even if it’s hard to come by.
“Be aware of state and federal regulations as well as OSHA requirements that pertain to your lab; and listen to your techs. Every employee should stand up,” he encourages. “They’re the ones that are working with conditions day to day, in the front lines. If they notice a safety concern or issue, it should be brought up and resolved as quickly as possible.”
The best advice about safety is useless, everyone agrees, if no one pays attention. So be aware and be compliant.
Judith Philipps Otto is a freelance writer who has assisted with marketing and public relations for various clients in the O&P profession. She has been a newspaper writer and editor and has won national and international awards as a broadcast writer-producer.