I. Introduction II. Principles of Management III. Current Methodologies for Delivery of Intraperitoneal Chemotherapy IV. Clinical Results of Treatment V. Ethical Considerations in Clinical Studies with Peritoneal Surface.Risk Management: The Principles Underlying the Design and Implementation of an Occupational Health and Safety Plan - Occupational Health and Safety in the Care and Use of Nonhuman Primates. Risk management is the process of formulating and implementing a course of action to mitigate the hazards determined in the risk- assessment process to be important (NRC 1. The identification of the hazards is discussed in Chapters 3 and 4, and the process of determining the risk associated with them (risk assessment) is discussed in Chapter 5. Recognized hazards can be managed with a variety of adjustments in work practices, equipment, and facilities. In some cases, key modifications focus on engineering controls (facilities and equipment), in others on administrative changes (such as delegation of decision- making authority to the right level or revision of established safety procedures), and in still others on adoption of new safety- related devices, protective equipment, or research methods. Training programs must be adjusted in concert with these changes to ensure their effectiveness. Clearly, different people must be involved to achieve appropriate advances in the various elements that contribute to improved worker health and safety. Basic and applied research may also be needed to identify, evaluate, and develop the means to deal with specific new hazards and to ensure their practicality and usability in the workplace (Samet and Burke 1. It is important to recognize that many factors influence risk management. Public values, politics, economics, legal issues, and technical concerns can all influence the risk- management process locally (as in adjusting standard operating procedures) or nationally (as in adjusting guidelines and regulations). In some cases, external influences force over- conservative risk- management decisions and actions; more often, these influences, especially fiscal constraints, lead to less than optimal risk- management decisions and actions. To be effective, risk management must have two elements: a specific occupational health and safety plan and an appropriate safety culture and working environment. Safety culture is often taken for granted, although it is critical in building an effective risk- management system and a healthful overall work environment. At a basic level, safety culture is the way the institutional administration and workers in an organization feel about risk; feelings, attitudes, and perceptions about risk will influence how it is managed. The safety culture sets the tone of an organization, influencing the consciousness of its people as they conduct their daily activities. The safety culture encompasses an organization's tolerance of risk in its daily operating activities and decision- making processes. The greater the degree to which the administration recognizes the need for effective risk- management in the organization, the greater will be its commitment to the establishment of standards and protocols for identifying, assessing, and managing risks, and the more beneficial the risk- management program will be. This chapter deals with the foundation of risk management—successful OHSP and possible solutions specifically applicable to work environments involving nonhuman primates are described. While there are no fundamental differences in the OHSP based on the size of a facility, there are some key differences in developing an OHSP for large institutions, such as a primate center, versus a small vivarium that may have only limited numbers of nonhuman primates. The critical differences are likely to be in the inability of smaller institutions to allocate resources and personnel to the OHSP that may be available at larger institutions specializing in nonhuman primates. These limitations can be addressed in part by obtaining the commitment of the institutional official prior to acquiring the animals and presenting a plan to identify the resources that will be required to properly work with the species in question. The allocation of adequate resources also depends on the oversight of the IACUC, which has responsibility for review of occupational health in the vivarium. Housing of nonhuman primates in a conventional research vivarium may require facility modifications and renovations. In some cases, depending on the species in question, it may be possible to address occupational health and safety concerns by use of appropriate personal protective equipment and modifications to existing standard operating procedures (SOPs). All facilities that plan to house nonhuman primates should identify the specific requirements for nonhuman- primate husbandry and incorporate these features into the design and construction of the facility. Business relationship management (BRM) is a formal approach to understanding, defining, and supporting inter-business activities related to business networking. Business relationship management consists of knowledge, skills. Smokefree outdoor public spaces: a community advocacy toolkit physicians for a smokefree canada september 2010 written by janice forsythe cypress consulting, ottawa physicians for a smoke-free. Information: Printable version (PDF) Title Smoke-free Document Number ANUP_011807 Version 1 Purpose The purpose of this policy is to establish the University as a smoke-free environment. The housing of small numbers of primates requires specialized training for employees (relative to the existing training program). Nonhuman primates require a controlled- access space with rigorous attention to SOPs for safe handling and husbandry. In a facility dedicated to nonhuman primates all employees are part of the “culture” of working with primates, while in a traditional vivarium nonhuman primates represent unusual species that may cause increased levels of curiosity among vivarium workers and affiliated research staff. Page 4 of 25 1 Introduction 1.1 What is the purpose of this guidance? The purpose of this guide is to support people who own or look after archive material. It will help you to assess and plan for the care and development of. The establishment of strict SOPs and mechanisms of controlled access are critical to reducing this problem. An occupational health and safety plan must be developed with consideration of the specific nonhuman- primate species in use due to differences in the size and strength of the animals, the special husbandry practices required, and the risk of human exposure to zoonotic infectious agents. These factors all vary with the nonhuman- primate species in use. These considerations ultimately influence the resources required to maintain nonhuman primates and the necessary elements of the occupational health and safety plan. At the end of this chapter are checklists (Tables 7- 1 through 7- 1. The number of elements needed in the plan will depend in part on the size of the institution, the species and numbers of animals housed, and the nature of the research being conducted. It is not essential that each institution have a full- time occupational health professional on staff. It is essential, however, that each institution have an established relationship with a professional who can provide the necessary expertise for plan development and operation. ADMINISTRATIVE PROCEDURESThe complexity of using nonhuman primates in research requires a seamless integration of several institutional positions and programs, including the institutional official, the IACUC, the vivarium management team, the environmental health and safety program, the occupational health and safety program, and the investigator. The close phylogenetic relationship of human and nonhuman primates and the infectious agents endemic in many primate populations require that access to nonhuman- primate colonies be restricted in order to protect both human and animal health. Controlled access depends on administrative support from the institutional official and associated support staff. There must also be administrative support to enable personnel to conduct training and safety programs. Smaller facilities that do not have the resources to support training and safety staff positions should establish effective systems for employee training and safety monitoring. Occupational health and safety and environmental health and safety consultants should be thoroughly familiar with the occupational hazards associated with working with nonhuman primates, particularly with respect to infectious hazards, such as that represented by B virus. Finally the institution should make a commitment to the costs associated with tuberculin testing, employee screening, vaccinations, and health assessment for respirator use when required. These costs may be addressed through a process of direct cost recovery or through the allocation of indirect costs from research grants. The critical point is that the elements of the occupational health and safety plan are incorporated into the costs for the animal care program. Some procedures are required by law; others may be elective, but all are prudent for any comprehensive occupational health and safety plan. Table 7- 1 provides a checklist for essential administrative features of an occupational health and safety plan. Checklist for Essential Administrative Features of the Occupational Health and Safety Program of a Nonhuman- Primate Facility. FACILITY DESIGN AND OPERATIONThe design and operation of a nonhuman- primate vivarium are critical features of an occupational health and safety plan. Although well- trained staff and efficient SOPs can address errors in facility design, such errors can have long- term consequences for cost, efficiency, and, in the most serious outcome, risk to employees. The facility design issues for nonhuman- primate vivariums are, in general, similar to those for more generic facilities, although some aspects require increased attention when larger nonhuman primates are housed. Security is paramount. Controlled access through conventional locks, key cards, or other devices is critical. Entry by personnel who have not completed occupational health screening can present a risk to the animal population, but, more important, can present an immediate risk of physical injury to people unfamiliar with the strength or reflexes of nonhuman primates. Nonhuman- primate species require varying cage sizes and complexity of caging systems. Many of the species used in research require large heavy cages, which can present substantial ergonomic hazards for employees; facility design and caging systems should incorporate features that minimize these hazards. For example, the use of rolling racks and cage elevators for wall- hung cages can help to reduce muscle and back strain.
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