Abstract
Animal care and use personnel in research laboratory facilities are inherently exposed to a variety of workplace hazards. The health and safety of the workforce working directly with or around research animals is of paramount importance, and as such, an occupational health and safety program for at-risk staff is essential. In order to maximize participation in and the effectiveness of health and safety training and occupational health program enrollment for animal care and use personnel at an academic health sciences university, an innovative annual “health fair” was developed and implemented at The University of Texas Health Science Center at Houston. This event allows personnel working in positions that present exposure risk to research animals to be able to obtain hazard-specific health and safety training, re-enroll in the occupational health oversight program and update their medical history, and participate in the institution’s other safety programs as required by job title or assigned job tasks. By providing a comprehensive health fair that offers convenient access to the necessary safety training and occupational health services in one location during a designated period of time, management and staff are incentivized to participate and have reported satisfaction with and appreciation of the convenient access. Summarized here is how we plan, organize, and effectively execute the annual health fair so that other institutions who might wish to use this strategy can learn from our approach.
Introduction
The care and use of laboratory animals in research settings involves a variety of workers who may be exposed to the risk of injury, ergonomic stressors, zoonotic diseases, animal allergens, nanoparticles, and chemical, biological, or radiological agents depending on the research conducted. At-risk personnel include veterinarians, animal husbandry and technical staff, researchers who directly handle animals, and also support staff who may enter vivarium or laboratory spaces such as facilities maintenance, health and safety professionals, security, animal welfare specialists, contractors, visitors, and others. As such, the Guide for the Care and Use of Research Animals (Personnel Management section, pp. 17–18) specifies that institutions conducting research with laboratory animals must offer all individuals with potential animal exposure enrollment in an occupational health program (OHP) that provides medical consultation, treatment, and care for occupational injuries and exposures and provides appropriate training on workplace health and safety expectations and practices. 1 The establishment and maintenance of these oversight programs is also essential for organizations seeking to obtain (AAALAC)-International accreditation or to maintain their current accreditation. To address this requirement at The University of Texas Health Science Center at Houston (UTHealth Houston), an academic health institution located in the Texas Medical Center, we established an innovative approach using an annual “health fair.” This innovative approach provides convenient access to both health and safety training, OHP annual enrollment, and associated medical services during a single event organized collaboratively by the Environmental Health and Safety (EHS) department and the institution’s OHP medical professionals. Every year, the health fair is held during early December, a period determined by participating department leaders to be a convenient and reasonable time of year that does not conflict with other significant scheduled events or holidays. Using a strategy of maximizing participation and increasing convenience for participation among at-risk personnel, the goal of the health fair is to offer convenient access to a comprehensive menu of training and services in a “one-stop-shop” arrangement. The following describes our process of organizing the health fair, the curriculum included in the event, and the lessons learned from hosting the health fair annually for more than 20 years, so that others who wish to use this strategy might learn from our approach.
Organizing the health fair
To get started each year, representatives from EHS and the OHP initiate health fair planning meetings, typically 3–4 months prior to the health fair event (in August or September) to allow sufficient time to coordinate all features of the event. The initial planning meetings start with discussions about identifying and securing the health fair event date and location. The date and location are important to ensure there are no significant conflicts for health fair organizers and participants, and so that appropriate room location reservations can be made to allow sufficient space for health fair activities and equipment. Once a date and location are set, we develop a list of eligible health fair participants.
To minimize disruptions to both research operations and routine animal care and use activities, we make an extensive effort to work with department management to group health fair participants into small cohorts that are scheduled at intervals throughout the day so that not all individuals participate at the same time. This is beneficial in that it allows supervisors to send their staff to attend the health fair in manageable batches, while still allowing enough of the work force to remain onsite to cover required work duties and minimize operational downtime.
Administratively, we have developed a process to identify the entire at-risk population that should be included in the health fair event. This includes, for example, individuals working on research projects involving direct handling of or exposure to research animals of specific species (e.g., nonhuman primates) or that are exposed to particular hazards (e.g., Risk Group 3 agents), animal care and use program staff, and support personnel with potential exposures (e.g., Facilities, EHS, Security). The process involves collecting up-to-date personnel lists from the supervisors of these departments, as well as from cross-referencing information from protocol approvals of both the Institutional Animal Care and Use Committee and our various safety committees (e.g., Institutional Biosafety Committee, Radiation Safety Committee, Chemical Safety Committee). The annual average number of health fair invitees is approximately 200 individuals. While participation in the annual health fair is technically not compulsory, individuals are strongly encouraged to participate to ensure compliance with safety training and OHP enrollment requirements.
Once these lists are compiled, they are used to distribute invitations to the health fair participants electronically via email (some paper invitations are created and distributed to personnel without email, as needed, by the supervisors of those individuals). The lists are also used to create a roster to document attendance from each invited group during the health fair event—they are printed and used as sign-in sheets on the day of the health fair. Documenting participation is obviously important to understand who participated, but it also allows us to identify individuals who did not participate in the event (e.g., due to scheduled absences, vacations) so that they can be contacted at a later time to ensure they have been provided with the necessary annual health and safety training and to follow any necessary steps for OHP re-enrollment. (Note that OHP re-enrollment is required within our institution, which is satisfied by completion of a re-enrollment form to provide any updates or changes to health status or risk exposure.) Typically, two or three training make-up sessions are scheduled to capture those who missed the original health fair offering.
Management-level support from each participating department is essential for the success of the health fair event. We utilize our institution’s Safety Council, 2 the highest-level campus-wide safety committee at our institution with representation from all schools and administrative units, to both advertise and endorse participation in the annual health fair. Safety Council support is essential for us to leverage participation with department-level managers and leadership to ensure they understand the importance of the event.
Health fair curriculum
The health fair curriculum is collaboratively determined by the EHS and OHP planning team. Every year the curriculum and approach are tailored based on a risk assessment to determine whether any new or modified risks necessitate consideration. For example, information on COVID-19 precautions was recently featured during training to ensure staff understood the recommendations and precautions implemented in the workplace to protect workers from disease exposure. Risk assessments are performed collaboratively with EHS, OHP, and the attending veterinarian to review currently approved research protocols as well as the associated equipment, procedures, and facilities included with these protocols. New or changed risks are identified and highlighted for inclusion in the curriculum. Other drivers for curriculum development include data from recent accident and injury experience, incidents or adverse events that may occur, AAALAC-International findings or recommendations from recent site visits, and/or current trends, emerging topics, or changes/updates to relevant regulations and guidelines. Ultimately, the curriculum must meet the “customer’s” needs, therefore communication with animal care and use department leadership is important to obtain feedback and guidance on the overall curriculum content and direction each year.
Health and safety training
For the health and safety training, which is provided by EHS, the content is designed to review important health and safety information and expectations for working in the animal care and use settings on our campus. Common workplace hazards are reviewed, along with an overview of the typical engineering controls, administrative controls, and personal protective equipment used in our animal housing and laboratory facilities. Accident and injury reporting processes are reviewed and experience data from the previous year is also included to provide awareness of, as well as to drive changes and/or program improvements to prevent accident and injury recurrence. Note that these elements of the training curriculum are included in new employee training as well, so that those who start in their jobs positions at times throughout the year that are not aligned with the health fair are still offered this basic but important training prior to beginning work activities.
Based on institutional accident and injury data or any trends identified by EHS, a deep dive on a particular health and safety topic is featured each year. For example, detailed information on slips, trips, or falls, pinch points, thermal burns, repetitive motion injuries, safe lifting techniques, materials handling, ergonomics, new equipment, and emerging technologies have been highlighted within the training. This deep dive is often carried forward as a “theme” for further training, for example, a hands-on ergonomics training station was previously set up during a recent health fair to allow participants to try different workplace configurations and lifting scenarios to learn more about acceptable and unacceptable ergonomics practices. Common issues noted can include injuries due to lifting and twisting, particularly with concern to lower back, wrist, and shoulder injuries. Proper posture and utilization of tools and equipment to alleviate the ergonomic burden when working in an animal facility are reviewed as part of this hands-on training exercise, especially in high-risk, high-throughput areas such as the cage wash.
Health fair participants are strategically grouped into “batches” so that the health and safety training curriculum can be customized for each group to meet the needs of the different job titles, work activities, and risk profiles. For example, animal husbandry staff receive different targeted information during their session compared to cage wash personnel. EHS, Facilities, and Security personnel receive targeted information, and so forth. EHS and OHP organizers consult directly with animal care and use leadership, including the attending veterinarian, to ensure the curriculum is appropriate.
Fire extinguisher use training
Despite the existence of modern fire safety systems within our buildings and vivarium facilities, the best practice is to be prepared in case of a possible fire or smoke event. As such, training on basic fire and life safety features and emergency egress processes are provided each year during the health fair. This information is contained within the institution’s written emergency management plan, but standard operating procedures for fire and life safety within the vivarium spaces and operations are specifically highlighted. All participating personnel are afforded the opportunity to obtain hands-on fire extinguisher training provided by EHS. This is a simple, yet engaging and effective training that allows individuals to use a real fire extinguisher unit to extinguish a small simulated fire using a professional fire extinguisher training system.
Respirator fit testing and training
Since many persons supporting the animal care and use program require the use of respiratory protection in the workplace, EHS also sets up a station for respirator fit testing and training. Both quantitative and qualitative fit testing options are provided and we have the capability to fit test on a variety of respirator types including N95s, half- and full-face elastomeric respirators, and others as needed. For anyone new in the program, the medical clearance form required for respirator use can be completed, submitted, and reviewed by OHP medical professionals during the health fair event. Fit testing and training are then performed by EHS. For all others who are already enrolled in the respiratory protection program, each individual has the opportunity to speak directly with an OHP team member at the event, if desired, to discuss any questions, concerns, or changes in health status. They can then subsequently obtain fit testing and refresher training on respirator use, which meets the annual requirements.
Safety footwear
Personnel involved in materials handling and other work activities that put feet at risk of injury are given the opportunity to try on and purchase a pair of steel-toed and/or slip-resistant safety shoes for use in the workplace. During the health fair, we arrange for a safety shoe vendor to bring their mobile shoe distribution truck onsite at our facility so that staff can shop for and try on safety footwear. Purchases can be made directly so that the employee walks away with the safety footwear of their choice, which is key to their satisfaction with the products and ensuring they are actually used. In our particular case, the institution pays for one pair of safety footwear at a set price range per qualified staff every 2 years. Therefore, we only bring the safety footwear vendor onsite for the health fair event every other year. If an employee needs safety footwear in the interim period (e.g., new hires, lost/damaged safety footwear), we are able to arrange for the employee to obtain it either at a local brick-and-mortar store or through the mail. Also, if the employee decides to select a higher-priced item for themselves, they are free to do so, but they incur the cost for any overages above the institution’s employee budgeted amount.
Occupational health program
A critical component of the annual health fair is the ability for participants to interact directly with OHP medical professionals. Participants are offered the ability to update information within their occupational health enrollment form to communicate any personal health status changes that could impact the worker. All occupational health enrollment forms are handled in a confidential manner and electronically submitted using the Smartsheet (Bellevue, WA) platform, which is HIPAA-compliant and ensures the protection of health information. OHP services offered include, but are not limited to, obtaining consultation directly from an OHP medical professional, updating their vaccinations (e.g., influenza, COVID-19, or others as indicated by personal health circumstances or any project-specific hazards indicating the need for vaccination), participating in tuberculosis screening (e.g., tuberculin skin testing, QuantiFERON-TB Gold, or TB spot), and completion of respiratory protection medical clearance forms for those who need fit testing and training on respirator use in the workplace. The respiratory protection medical forms were recently transitioned to an electronic format using the Smartsheet platform to ensure a more efficient and user-friendly experience.
In addition to electronic forms, an electronic health record is used to store employee health information including, but not limited to, immunizations, and laboratory results. The electronic health record allows OHP team members to document, track, and report on specific services offered at the annual health fair. Health fair participants can access parts of their medical record through a web-based portal to view certain services provided. The use of electronic forms and an electronic health record at the health fair enables OHP team members to more effectively perform ongoing and future surveillance of at-risk employees.
Finally, institutional resources for employee mental health and well-being are provided during the health fair to make participants aware of these services, which are being continuously added and enhanced.
Discussion
Although health and safety training and OHPs are required for any AAALAC-International accredited animal care and use facility, there is little guidance on a defined process for program enrollment, administration, or maintenance. Therefore, organizations must determine the most appropriate program structure and methods for program enrollment and maintenance. Programs are most effective when institutions are capable of identifying the entire population at risk who should be included in the program, and can ensure participation in an established occupational health and safety program. For organizations that are accredited by AAALAC-International, the OHP is subjected to peer review during accreditation site visits. Given the importance that OHPs serve to keep personnel healthy and safe, AAALAC-International has placed significant focus and scrutiny on these programs to ensure they are both present and effective at accredited facilities. This highlights the importance of maintaining a robust health and safety training and OHP to help ensure continued successful accreditation status.
Based on our experience, the annual health fair approach has served our organization well for a variety of reasons. First, it allows department leaders, managers, and staff to know where to obtain the required health and safety training and OHP re-enrollment on an annual basis. Next, it allows participants to obtain multiple required services in a “one-stop-shop” arrangement that is designed to be as convenient as possible. Finally, by having this event endorsed by the Safety Council, the highest-level safety committee within the organization, expectation for participation is clearly established, which maximizes the time and efficiency of the health fair organizers and participants alike.
By conducting this health and safety fair during normal working hours at times and dates convenient for at-risk staff, and by including each of these important services in a single setting, workers can conveniently complete these required compliance aspects while, very importantly, minimizing disruptions to research animal care and use operations. We have observed participation rates for the annual health fair among animal care and use personnel often exceeding 95%. Support personnel such as facilities maintenance and health and safety staff often exceed 80% participation. These rates represent significant increases compared to the years prior to the health fair when health and safety training was completed individually. EHS staff members also report significant reductions (up to 50%) in the time necessary to organize and deliver the training to this large audience of employees compared to traditional training methods used prior to implementation of the health fair. While participation in the annual health fair is technically not compulsory, individuals are strongly encouraged to participate to ensure compliance with safety training and OHP enrollment requirements. Management-level support is critical to ensure these participation rates are successfully achieved. Priority is currently being placed on improving participation rates at our institution among the support groups (e.g., facilities maintenance, EHS) and researchers to achieve participation rates similar to (or better than) those of animal care and use personnel. We have already observed increases in participation within these support grounds and researchers based on the strategy to leverage the institution’s Safety Council to encourage management- and leadership-level support for participation in the annual health fair.
We are also able to measure tangible outcomes from the annual health fair. For example, due to the implementation of health and safety programs across our institution and the diligent tracking of accident and injury data, we know that injury frequency and severity are low compared to peer organizations and industry averages. This has been showcased through the workers’ compensation experience modifier for our institution (currently listed at 0.068 for FY23) being ranked second lowest among all of The University of Texas System health-related institutions for nearly the past two decades. Workers’ compensation experience modifiers are an important representation of an institution’s overall safety performance based on the historical cost of injuries and future anticipated risk, which are used to set workers’ compensation insurance premium rates for the institution.
We also know through targeted client satisfaction surveys that the annual health fair is viewed favorably by participating staff. During FY21, we specifically asked animal care and use personnel for feedback about their experience and perception of the health and safety programs within our institution. Feedback was primarily positive, and some constructive feedback was provided indicating the need for improvement of the health-and-safety-related training content included in the annual health fair. In the spirit of continuous quality improvement, this feedback was used to prioritize enhancements to training content and delivery during subsequent years. Although we have not conducted these surveys at any regular frequency in the past, we intend to conduct these quality assurance surveys every 3 years going forward.
Importantly, the development, implementation, and ongoing maintenance of the annual health fair requires significant infrastructure and support, including funding. For example, EHS and OHP organizers collectively spend approximately 40 person hours to successfully plan and execute the health fair each year. Also, space commitment and allocation are required. Up to five rooms must be secured and utilized for the health fair event: two rooms for health and safety training, one room for hands-on themed training, another room for fire extinguisher training, and one room for the OHP medical professionals to use for consultations and the administration of necessary vaccines or other services. An additional space is needed every other year for the safety footwear vendor to set up their options for staff to try on and purchase.
As an incentive for health fair participants, light food and beverages are served during the health and safety training portion of the event. Additionally, to ensure participation in all aspects of the health fair event, each participant is provided with a sheet of paper that lists all locations and exercises, which they must take with them and get signed at each location. At the conclusion of the event, those who fully participate are asked to turn in their fully signed papers to receive an incentive gift. Examples of incentive gifts include water bottles, soft-sided lunch coolers, notebook portfolios, and so forth. Anecdotal evidence from the high percentage of participants who enthusiastically claim the incentive gifts indicates that this effort helps to bolster overall participation.
Conclusion
The health and safety of the workforce working directly with or around research animals is of paramount importance, and as such, an occupational health and safety program for at-risk staff is essential. By providing a comprehensive annual health fair that offers convenient access to necessary safety training and occupational health services in one location during a designated period of time, management and staff are incentivized to participate and have reported satisfaction and appreciation for the convenient access. Our institution has benefited from the high rates of participation in the annual health fair, which has been designed to help keep people healthy and safe in our animal care and use facilities and operations. Although we have successfully held the health fair annually at our institution for more than 20 years, we are constantly fine-tuning and improving it based on experience and participant feedback.
Footnotes
Animal ethics statement
The annual health fair described in this manuscript did not involve the use of any animals and therefore ethical board approval was not required.
Acknowledgements
The authors wish to acknowledge the hard work and dedication of each staff member, present and past, who has worked tirelessly to plan, organize, and execute the annual health fair at UTHealth Houston successfully for over 20 years.
Data sharing statement
This manuscript did not involve the collection of any data. For more information or details regarding the annual health fair, please contact the corresponding author, Scott J. Patlovich, at
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
This research was partially funded by the Centers for Disease Control and Prevention/National Institute of Occupational Safety and Health (Award no. T42OH008421) through the Southwest Center for Occupational and Environmental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control and Prevention/National Institute of Occupational Safety and Health.
