Technician Safety: Best Practices in the Fab Lab

O&P fabrication labs are noisy, dusty, and often smelly. The tools of the trade can cut, grind, burn, and bruise. For some, such working conditions might seem intolerable. Many O&P technicians, however, would tell you that there is no place they'd rather be than working on the bench. Every day, technicians sand, mix, heat, and rivet to fabricate devices that will help patients with amputation and functional impairments to be more mobile. It's rewarding work, but accidents happen, and the possibility exists that at any moment a technician could be injured, sometimes seriously. Greg Mattson, CPA, CTPO , president and CEO of Fabtech Systems, Everett, Washington, says injuries can happen when people take shortcuts. "It's easy when you're working in production to have the mentality, 'I just need to get this done,' so you start to cut corners.... You'll be cutting something on the bandsaw, and, well, I've been in that room when a guy cut his thumb off." The most common accidents reported by the fabrication professionals interviewed for this article involve cuts, abrasions, burns, eye injuries, and back injuries. Typically, these incidents are minor, needing nothing more than use of a first-aid kit. Occasionally, however, a trip to an urgent care facility for stitches is required. Other hazards create health problems over time. Ed Grace , president of Grace Prosthetic Fabrication, New Port Richey, Florida, says he is particularly careful about airborne hazards. "Back when I started in 1979, we really didn't pay attention to how bad these resins were for you," he recalls. "Now I have asthma, and I attribute it to not wearing a dust mask and not wearing the respirator." [caption id="" align="alignnone" width="250"] Fabrication technicians like Ian Nause now have access to adhesives and resins made with less hazardous materials. Many come in packaging that reduces the need to handle the material. Photographs courtesy of Greg Mattson.[/caption] Given the hazards inherent to the industry, fabrication lab managers are keenly aware of workplace safety regulations set by city, state, and federal government agencies, such as the Occupational Safety and Health Administration (OSHA). But Brad Mattear, CPA, CFo , of Cascade Orthopedic Supply, Chico, California, says it's uncommon for any regulatory body to inspect fabrication facilities consistently, so it's up to owners and managers to ensure all employees follow established safety protocols. (Editor's note: The American Board for Certification in Orthotics, Prosthetics & Pedorthics is introducing a Central Fabrication Accreditation program. It is scheduled to be available in June 2013. For more information, read " Central Fabrication Accreditation: Has the Time Come? " in this issue. Safety standards are expected to be a component of that accreditation process.) Primary safety considerations include a careful review of fabrication materials, facility equipment and layout, processes and procedures, protective equipment, and safety training. Fabrication Materials Chemical exposure via fumes and liquids is a common concern for fabrication technicians. Julie McCay, CP, LP , took a detailed look at these chemicals in her 2001 residency research paper, "Safety in the Prosthetics Workplace." While McCay, who now works at the Scheck & Siress patient care facility in Oak Park, Illinois, says the industry is generally slow to change, the use of safer chemicals has been an exception. Resins and adhesives used today as part of the O&P fabrication process have become safer. "There are new things on the market now that are not so volatile," she says. "We see improvements in quick-setting resins and adhesives, where in the past we would use something lovingly called 'gunk.' The new resins don't throw off the volatiles [volatile organic compounds], and they aren't as messy either, so there is less chance of it coming into direct contact with your hands. Although they are more expensive, in the long run I think they are worth it." Chemical exposure is a major concern for Fabtech Systems, owing in part to Mattson's personal experience. "I was poisoned 20 years ago while working with chemicals we didn't know were harmful at the time," he says. "It opened my eyes, and I started looking at MSDS [material safety data sheets]. It made me look at chemicals like MEK [methyl ethyl ketone]—these things are really bad. I've seen technicians not wearing gloves, and they're touching it every day and not realizing what they're doing.... This stuff is building up over 30 years, and it's not good for you." Mattson's research about these chemicals led him and Fabtech Systems to look for less harmful chemicals. Not finding suitable alternatives on the market, Mattson began developing epoxies and adhesives that are free of volatile organic compounds (VOCs), as well as a nontoxic, biodegradable solvent wipe so technicians can reduce their use of acetone. Facility Equipment and Layout Air quality is a significant safety concern for fabrication facilities—not just from VOCs but also from particulates when grinding, sanding, and cutting. Tony Wickman, CTPO , president of Freedom Fabrication, Havana, Florida, says that his technicians rarely complain about dust and fumes. His facility "has a pretty bodacious dust collection system with carbon-charged air exchanges that take out the stink," he explains. The Freedom Fabrication lab area is about 3,000 square feet, and the HVAC system exchanges air at a rate of about 3,000 cubic feet per minute. His 150-square-foot lamination area features an air exchanger that filters 900 cubic feet of air per minute down to 0.5 microns. If you're not sure your system is doing an adequate job removing fumes, McCay suggests using a 3M™ Organic Vapor Monitor to measure the amount of chemical exposure in a room. An employee can wear it all day and then send it to the company for analysis. The machines that generate dust also create noise, so Mattson's warehouse has specific rooms to contain these machines and their related processes. For example, one large room houses all the CAD/CAM carvers. "That's where all the cast cutting goes on," he says. "All the assembly pieces—the clean things—happen outside of that room." Not every fabrication lab has the luxury of building its own facility, but Grace says doing so allowed him to create a safer environment for his eight technicians. In Grace's previous facility, vacuum hoses on the floor were a tripping hazard. Now, his facility has an HVAC system with all vacuum and air lines located under the floor and in the ceiling. PVC pipe installed in the ground houses the hoses and allows easy access for maintenance. Additionally, Grace says every machine has a dust collector. Processes and Procedures Injuries occur when employees use the wrong tools and unsafe methods. Wickman says he had two technicians fail to use best practices with X-ACTO knives, and they stabbed themselves in their stomachs. "If you're trimming leather sole material and you draw the knife toward you...you see how that can happen," he says. Fortunately, the wounds weren't deep and didn't require a trip to the emergency room. Wickman says the most effective way to prevent these injuries is to be vigilant in correcting unsafe behavior and establishing and enforcing best practices for each step of the fabrication process. In Wickman's case, that meant instructing technicians to always cut away from their bodies. [caption id="" align="alignnone" width="250"] Technician Andy Veals is required to wear safety glasses while in the lab, even if he is only doing finishing work.[/caption] Most of the companies we talked to said that to avoid back injuries they have a two-person rule for lifting heavy objects, and they teach proper lifting techniques. Both of these best practices get the job done quickly and safely. When using machines such as bandsaws, the dangers are obvious, and Grace says his technicians always use a push block instead of their hands. "The bandsaw is one of those things that you really have to respect," he says. "I think my guys all understand that. Being in this field, a lot of times we're making a partial hand and that's what has happened- someone ran their hand through a bandsaw." Mattson and Fabtech Systems practice lean manufacturing, a production practice that looks for ways to cut waste and increase efficiency and safety. Fabtech Systems' facility has workstations that are designed around a task rather than each technician having his or her own bench. So, for example, if a technician needs to cut out a cast, he or she does it at a specific station where all the tools and protective equipment for that task are stored. "We designed different production techniques and manufacturing techniques to eliminate a lot of these safety issues for us," Mattson continues. "For example...we look at a lamination process and say, 'Well, why am I doing this? Let's talk to the customer. 'Hey, do you really care if the distal section is built out and smooth here with foam, or would you mind if it looked like this?' And we show them an example without the use of a foam build-up. We found out that patients really didn't care. So that extra step removed us from having to use the isocyanate foam in 90 percent of our laminations. And we had a side benefit too because it improved efficiency and speed." You never know when a contaminated cast might come in, so Mattson advises all fabrication facilities—regardless of size—to use universal precautions. Fabtech System's production managers wear gloves when processing incoming casts, and when they find a contaminated cast, the cast is treated with bleach, and employees are required to use universal precautions when handling it. Technicians at Scheck & Siress made heat gun holders to avoid accidental burns. "You need to be careful where you place the heat gun after you use it," McCay says. "We put the guns in them when we're done using them so we don't accidentally hit them while they are still hot." Protective Equipment After reducing the need for hazardous materials and using safety protocols around dangerous equipment, OSHA guidelines note that the use of personal protective equipment (PPE) is the last line of defense. Gloves, chemical splash goggles, safety glasses, respirators, particle masks, and earplugs are just some of the equipment necessary to keep technicians safe and on the job. McCay says that while HVAC systems have improved, technicians still need to use particulate or half-face-mask respirators to prevent breathing particle dust and chemical vapors when doing tasks that create those hazards. Grace adds that it's important to find masks that won't cause a technician's safety eyewear to steam up when exhaling. He has found the KLEENGUARD® M20 works best for his technicians. [caption id="" align="alignnone" width="350"] Technician Brandon Fuchs strings resin while wearing latex gloves.[/caption] McCay also recommends that technicians wear chemical-resistant gloves when handling chemicals such as acetone and other solvents. Not all gloves are created equal, so the type of glove should be chosen based on the chemical being used. The butyl glove is her choice for acetone, and nitrile for MASTERS® All-Purpose Thinner. Heat-resistant gloves are necessary when using heat guns and handling hot plastics. Mattson says he likes his technicians to use latex or nitrile gloves when laminating, but sometimes the gloves interfere with the process. "Technicians don't want to wear gloves when laminating, so generally I have them wear gloves throughout the mixing process and when initially pouring the resin," he says. "Then they can take them off once they've got it going. It is challenging to string resin and work with loose gloves flopping around." In the machine room, Grace says he provides earmuffs rather than earplugs because they're more comfortable and technicians are more likely to wear them. He also says eyewash stations are essential because even if you provide safety glasses and goggles, you can't guarantee the technician will wear them all the time. "The only time we had to take someone to the hospital was when they splashed resin in their eye when they were laminating," Grace says, adding that after the physician washed the employee's eye out, "everything was fine." Safety Training Grace's example illustrates that even if you provide protective equipment and reduce hazards in the workplace, accidents can happen when employees don't wear PPE or don't use best practices. Both Grace and Wickman say they constantly watch for teachable moments and correct technicians when they observe unsafe behavior. As the saying goes, "an ounce of prevention is worth a pound of cure," so perhaps the most important best practice a fabrication facility can follow is to provide rock-solid, ongoing safety training. Typically, safety training happens when a new employee is hired. Mattson says that employee training is challenging because every company has employees at different skill levels. New hires at Fabtech Systems receive the company's safety manual and go through a four-hour safety orientation program. During the orientation, Mattson evaluates the employee's skill level and instructs him or her on the proper use and safety of each machine. He has a checklist of topics to discuss, such as where first-aid supplies are located, how to report injuries, how to use a dust mask, and how to work with and use chemicals safely. At the end of the orientation, Mattson requires the technician to sign a document indicating that he or she has attended this training. He also addresses safety in daily morning meetings and by requiring weekly facility inspections. Each week, a different employee completes the inspection so everyone develops a safety-conscious eye. Mattear also stresses the importance of documentation. For example, he encourages the use of injury logs not only to ensure employees are properly treated but also to protect the employer from possible lawsuits from injured employees. An injury log can be as simple as a quick note—dated, signed, and filed in the employee's personnel record—about why the employee needed a Band-Aid. "From the point of view of an attorney...the first questions they ask are: 'Does that technician have the proper training to operate this device? Who trained them? Do you have a training log? How do I know he got the proper training because he says he didn't,'" Mattear says. "The lawyers will just eat you apart.... I've been in that situation and it's not a great situation whatsoever." He adds that safety programs need to be enforced. If a technician fails to wear a respirator when required, there should be a reprimand. "There needs to be some teeth there," he says. "If I were to give any professional advice to the labs across America," Matter concludes, "it is to embrace the opportunity to start a thorough safety program. Reach out to your friends in the field and find out what they have in place. This doesn't have to be high tech.... Just get something going. Because when that lawyer finds out that you have nothing, you're going down a different road than if you had something." Linda M. Hellow is a freelance writer in Centennial, Colorado. She can be reached at lindahellow@gmail.com

Technician Safety: Best Practices in the Fab Lab

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DJO Global Announces 1Q 2013 Financial Results

“Smart Skin” Could Provide Sense of Touch to Prostheses

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