National Nurses United

5 National Nurses United Legionnaires' disease: Legionella bacteria is found naturally in freshwater environments, but can grow and spread when building water systems (e.g., indus- trial cooling towers, fountains, plumbing systems) are not properly maintained. If Legionella is growing and multiplying in the building water system, then water droplets containing the bacteria can spread and people can breathe in the bacteria. Breathing in Legionella bacteria can cause infection in the lungs and may result in Legionnaires' disease, which can be severe and fatal in some individuals. There is at least one recorded case of person-to-person transmission of Legionella. The CDC reports that Legionaires' disease cases have been increas- ing since 2000. See Figure 2. Figure 2: Legionnaires' Disease is on the Rise, 2000- 2016. https://www.cdc.gov/legionella/images/nation- al-incidence.jpg In addition to this list and many other known pathogens, emerging diseases are likely to become an increasing challenge. Since 1975, over 30 new diseases have appeared, including AIDS, Ebola, Lyme disease, Legion- naires' disease, and antibiotic-resistant organisms. Most of these new infections are caused by pathogens already present in the environment but infecting a new host or different population. Rarely, new pathogens may evolve to cause a new disease. New or newly noticed diseases are not the only concern. Old diseases, like malaria and cholera, have made come- backs. Underfunded, declining public health programs and crowded poor urban environments foster the trans- mission of diseases that spread through social contact between people, like tuberculosis and diphtheria. Vec- tor-borne infections have also reappeared due to climate change and human disruption of ecosystems, e.g. 2016 Zika virus outbreaks. Arboviruses, spread by mosquitoes and ticks, are responsible for more than 130 human dis- eases and the ranges of the vectors are rapidly expanding. Climate is impacting many of these infectious diseases of concern. For example, a recent study examined antibiotic resistance data from 41 states across the U.S. When the researchers compared antibiotic resistance data to local temperature data, they found that higher local tempera- tures were significantly associated with more and stron- ger antibiotic resistance. Increases of 10 degrees Celsius in average local temperatures were associated with 4.2% increase in antibiotic resistant strains of E. coli, 2.2% increase in resistant strains of K. pneumoniae, and 3.6% increase in resistant strains of S. aureus. This study also found that increases in population density were also associated with an increase in antibiotic resistance in E. coli and K.pneumoniae. Climate and environment impact health. Employers are Required to Provide Safe and Healthful Working Conditions The Occupational Safety and Health Act of 1970 estab- lished in law the requirement that employers must protect employees from workplace injuries and illnesses. This Act was the result of decades of organizing, cam- paigning, and advocacy to protect U.S. workers from high rates of injury, illness, and death at and as a result of work. Many people joined this movement because they believed that everyone should be able to go home from work the same way they came to work. No one expects to be injured—or worse—while at work. OSHA requires that "each employer shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or likely to cause death or serious physical harm to his employees." OSHA has created several specific stan- dards about how employers must deal with particular workplace hazards, such as the Respiratory Protection Standard and the Bloodborne Pathogens Standard. OSHA enforces these requirements by following up on complaints from workers about health and safety issues, conducting onsite inspections, and other programs. In terms of infectious diseases, OSHA's most applicable standard is the Bloodborne Pathogens Standard. This Standard was passed in 1991 in response to organizing and advocacy by health care workers and their unions. It requires that employers protect all employees who may be exposed to blood or other potentially infectious material (certain bodily fluids) while doing their jobs. The Standard applies not just to health care workers but to all workers who may encounter blood and other bodily fluids, such as workers who clean airplanes and police officers. Employers of employees who may be exposed to blood and other bodily fluids must develop policies, procedures, engineering controls, and personal protec- tive equipment (PPE) to prevent employees from being exposed. The Standard has many requirements, such as mandating that employers provide handwashing facil- ities, safety protections to prevent sharps injuries and needlesticks, and engineered sharps injury prevention. OSHA has begun some work on developing an Infectious Diseases Standard. OSHA acknowledges the significant occupational exposure to infectious diseases that health care workers face. OSHA states:

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