B5-BIOLOGICAL AGENTS

Question 1

A large livestock farm employs a number of people who are involved in caring for animals, cleaning out animal enclosures and disposing of waste materials.

The farm manager has identified that during such work employees may
be exposed to zoonoses.

(a) Give the meaning of the term ‘zoonose’. (2)

Answer 1

A ‘zoonose’ may be defined as an animal disease or infection that may be transmitted
to humans. Whilst the disease or infection will cause ill-health to humans, it may not
necessarily cause ill-health in animals.

Question 2

(b) Cryptosporidiosis and Leptospirosis are two commonly occurring zoonoses.

Outline how and when the farm employees are likely to be exposed to EACH of these. (6)

Answer 2

farm employees are likely to be
exposed to cryptosporidiosis when in contact with cattle or sheep.

The exposure may occur via ingestion following hand to mouth transmission, through contact with surfaces or footwear contaminated with faeces while clearing out enclosures, and when there is a poor standard of personal hygiene such as a failure to carry out regular hand washing.

As for leptospirosis, exposure may take place after contact with cattle or rat urine via broken skin such as cuts or grazes, or via the mucous membranes in the eye, nose or mouth when cattle urine has splashed into an
individual’s face.

Question 3

(c) Outline a range of practical control measures that should be
used to minimise the risks associated with exposure to zoonoses. (10)

Answer 3

the necessity for employees to practise a high standard of personal hygiene;

the provision of rest areas away from the animals provided with clean drinking water and separate hand washing facilities including hot water, soap and paper towels or a hand
drier so that employees may wash their hands and arms before eating and drinking;

avoiding the use of tools or equipment likely to damage the skin and if damage should occur, covering the resultant cuts or grazes with waterproof dressings;

maintaining good standards of hygiene in livestock areas by regular cleaning and
disinfecting and the removal of faeces;

wearing suitable personal protective
equipment such as gloves and overalls, eye and face protection to avoid urine
splashes and respiratory protective equipment to avoid aerosol inhalation;

leaving work wear and personal protective equipment at the workplace for cleaning;

controlling the disease in the animals for example by vaccination;

and

ensuring that all employees are made fully aware of the risks of exposure to the disease when handling cattle and the precautions that must be observed.

Question 4

(d) Identify TWO other zoonoses that employees working on the farm could be exposed to. (2)

Answer 4

a list comprising bovine tuberculosis, salmonella, streptococcus suis, orf, psittacosis, Q fever and ringworm.

Question 5

(a) The risk of contracting Weil’s Disease (Leptospirosis) is a concern to windsurfers at a local water sports centre.
(i) Outline the ill-health effects associated with this disease (2)

Answer 5

flu-like symptoms - headaches / myalgia of lower back and legs / fever / nausea / sickness / vomiting + diarrhoea / skin rash / conjunctival haemorrhage / liver failure / jaundice / meningitis / death

Question 6

(a) The risk of contracting Weil’s Disease (Leptospirosis) is a concern to windsurfers at a local water sports centre.
(ii) Outline why windsurfers might be at risk (2)

Answer 6

windsurfers may be at risk because:

• presence of rodents around water courses
• rat urine carries bacterial agent leptospira ichterohaemorrhagia
• bacteria remains viable in water • windsurfers spend prolonged periods of time in water
• bacteria can enter skin through cuts / abrasions / mucous membranes - nose / eyes
• infection also possible via ingestion - swallowing water

Question 7

(b) The risk of contracting Weil’s Disease (Leptospirosis) is a concern to windsurfers at a local water sports centre.

Outline the practical steps instructors can take to minimise the risks to themselves (6)

Answer 7

risks to instructors can be minimised by:

• minimising water contact where practicable - conduct tuition from boat
• hygiene - washing hands / showers after water contact and before eating etc
• covering cuts with waterproof dressings
• disinfecting equipment after use
• wearing full dry (wet?) suit and footwear
• ensure appropriate training and information provided on health risks and control measures
• display warning signs
• carry medical information card for GP
• report rodent sightings etc and institute pest control
• minimise foodstuffs / debris around area

Question 8

a) Summarise the specific criteria that should be applied when provisionally classifying a biological agent in accordance with the Control of Substances Hazardous to Health Regulations 2002. (4)

Answer 8

Biological agents are allocated to Hazard Groups 1 (least hazardous - not covered by COSHH) to 4 (most hazardous) in accordance to the WHO classification criteria - these being:

• how easily the agent can infect an individual (individual risk)
• how severe the resulting disease / adverse health effect is (severity)
• how easily the disease is transmitted to others (community risk)
• how easily the disease is treated (availability of treatment / prophylaxis)

Question 9

(b) Outline the design requirements for a research laboratory that undertakes activities involving a Group 4 biological agent. (6)

Answer 9

The design requirements for a lab dealing with HG 4 pathogens include:

• restricted entry to nominated personnel only via pass / key
• posting of biohazard signs
• lab at negative pressure to outside environment (leaks inward); airlock entry system
• provision of appropriate secure storage cabinets
• provision of microbiological safety cabinets / LEV
• changing facilities / segregated areas
• surfaces to be sealed and impervious to assist cleaning and disinfection
• surfaces to be resistant to acids / alkalis etc
• safe disposal facilities for contaminated waste - segregated containment
• provision of hygiene facilities - showers, sinks, anti-bacterial soap, hot water
• equipment / machinery to be fixed - not removable
• viewing window to lab from exterior

Question 10

A large livestock farm employs a number of people who are involved in caring for animals, cleaning out animal enclosures and disposing of waste materials.

The farm manager has identified that such work employees may be exposed to zoonoses.

(a) Give the meaning of the term “zoonose”. (2)

Answer 10

Disease / infection that can be passed from animal to human (may not cause illness in animal but does in human

Question 11

A large livestock farm employs a number of people who are involved in caring for animals, cleaning out animal enclosures and disposing of waste materials.

(b) Cryptosporidiosis and Leptospirosis are two commonly occurring zoonoses. Outline how and when the farm employees are likely to be exposed to each of these. (6)

Answer 11

Leptospirosis: via open cuts / wounds following contact with / splash of rat or cattle urine containing leptospira bacteria;

sometimes through splash to mucous membrane - nose/ eye.

Cryptosporidium: via ingestion following contact with contaminated sheep / cattle dung / bedding etc
(poor hygiene / no washing / eating / fingers in mouth etc) or via ingestion of contaminated water.

Question 12

A large livestock farm employs a number of people who are involved in caring for animals, cleaning out animal enclosures and disposing of waste materials.

(c) Outline a range of practical control measures that should be used to minimise the risks associated
with exposure to zoonoses. (10)

Answer 12

the necessity for employees to practise a high standard of personal hygiene;

the provision of rest areas away from the animals provided with clean drinking water and separate hand washing facilities including hot water, soap and paper towels or a hand
drier so that employees may wash their hands and arms before eating and drinking;

avoiding the use of tools or equipment likely to damage the skin and if damage should occur, covering the resultant cuts or grazes with waterproof dressings;

maintaining good standards of hygiene in livestock areas by regular cleaning and
disinfecting and the removal of faeces;

wearing suitable personal protective
equipment such as gloves and overalls, eye and face protection to avoid urine
splashes and respiratory protective equipment to avoid aerosol inhalation;

leaving work wear and personal protective equipment at the workplace for cleaning;

controlling the disease in the animals for example by vaccination;

and

ensuring that all employees are made fully aware of the risks of exposure to the disease when handling cattle and the precautions that must be observed.

Question 13

A large livestock farm employs a number of people who are involved in caring for animals, cleaning out animal enclosures and disposing of waste materials.

(d) Identify two other zoonoses that employees working on a farm could be exposed to. (2)

Answer 13

Bovine TB; Orf; Q fever; psittacosis; ringworm

Question 14

Street cleaning operatives working for a local authority can be at risk of exposure to the Hepatitis B virus.

Outline a range of practical control measures that could be used to minimise the risk of exposure to hepatitis B. (10)

Answer 14

the use of litter picking sticks to minimise the risk of puncture wounds;

the prohibition of eating and drinking during normal periods of work;

the use of personal protective equipment
such as goggles, gloves and footwear;

covering up wounds with waterproof dressings;

the safe disposal of sharps in a suitable container and frequent hand washing.

In addition to these practical controls, candidates could have mentioned the need to
provide information and training to the employees on the nature of the risk and the
precautions to be taken together with the introduction of procedures for the collection
of contaminated waste such as body fluids, blood and contaminated clothing;

for cleaning up body fluids and blood and for the action to be taken following a needle
stick injury such as the encouragement of bleeding and rinsing the wound under warm
water before covering it with a dressing.

Question 15

A company that operates hotels and health spas recognises the risks associated with the legionella bacteria.

(a) Identify specific locations where there may be growth of or potential exposure to legionella for employees and guests. (5)

Answer 15

Potential locations of growth or potential exposure to legionella include:

hot and cold water storage and transfer systems where the water temp is between 25-40C and contaminated water droplets / aerosols are generated - eg taps, shower heads, saunas, spa baths, hot-tubs, whirlpools, “jacuzzis”, steam rooms, laundry rooms, fountains, ornamental water cascades, fire sprinkler systems, garden
sprinklers, wet or condenser air conditioning systems , cooling towers etc and any areas where there is stagnant water / deadlegs.

Spa bath temperatures (30-40C), presence of dead skin cells / hair etc (nutrient supply) and agitation of water (air jets etc) create ideal conditions for legionella proliferation and increase the risk of inhalation.

Question 16

(b) Outline the control measures that this company should implement to minimise exposure to
legionella bacteria. (15)

Answer 16

Requirements for managing the risk from legionella are set out in the ACOP Control of legionella bacteria in water systems (L8).

These include:

appoint a competent / responsible person to manage the water system;

replace wet air-conditioning systems with dry if RP;

design the system to minimise
deadlegs and stagnant water;

avoid use of rubber / wood etc (materials that harbour bacteria and are difficult to clean effectively);

regular water treatment / disinfection / use of biocides, chlorination etc of spa pools and other systems;

regularly check / inspect / test / sample water to monitor biocide levels, pH, flow rates, temperature and bacterial levels (dip slides sent to lab for analysis);

regular cleaning & disinfection of storage tanks, heaters and calorifiers;

remove slime, mould, biofilms;

inspection of storage tanks for signs of contamination - algae / debris etc;

keep hot water temp above 60C (but risk
of scalds) and cold water temp below 20C;

train employees in hazards / risks / cleaning procedures / dosing procedures / hazard recognition / keeping records;

cleaning taps / sprinklers / shower heads - removing scale / slime;

running infrequently used taps / showers for several minutes to flush system; ;

running taps / showers for several minutes immediately before occupation of a room; use of drift eliminators on cooling towers.

Question 17

According to current veterinary and medical opinion the bacterium E.Coli 0157 should be assumed to be carried by all ruminants (cattle, sheep, goats, deer).

In addition, this bacterium can exist for long
periods of time outside of the animal (in soil and faeces).

(a) Identify ways in which children making an educational visit to an open farm might be exposed to E.Coli 0157 bacteria. (4)

Answer 17

Transmission is via ingestion (NOT via cuts / abrasions) so generally arising from hand-mouth contact.

Therefore exposure could occur via touching, stroking, petting, kissing animals - or touching
fences, enclosures, soil, animal bedding, contaminated footwear etc. - followed by eating / drinking / biting nails / sucking fingers without thoroughly washing hands.

Question 18

According to current veterinary and medical opinion the bacterium E.Coli 0157 should be assumed to be carried by all ruminants (cattle, sheep, goats, deer).

In addition, this bacterium can exist for long
periods of time outside of the animal (in soil and faeces).

(b) Explain a range of practical control measures that should be put in place in order to reduce this risk of exposure. (6)

Answer 18

Practical controls include:

briefing / information to schools / parents / children prior to visit; induction
session on arrival (+ brief details);

restricted access to animals / segregation of animals - barriers / fencing;

hygiene arrangements - regular cleaning of animal pens;

hygiene facilities located before entry to segregated eating areas;

washing hands before eating etc; signs / warnings;

supervision of children.

Comment: Suggestions for full PPE / RPE, perspex screens between animals and children and substitution with stuffed or robotic animals were not considered appropriate!

Question 19

(a) Explain how, in a working environment, the Hepatitis B virus may be transmitted to employees, Identifying the types of occupation that present a particular risk. (5)

Answer 19

The hepatitis B virus (HBV) may be transmitted through direct contact with infected blood or body fluids.

Such contact may arise from infected instruments (eg. needles) or through broken or damaged skin.

Also by splashes of infected blood (or other body fluids) to the eyes, nose and mouth.
Occupations at risk include healthcare workers (medical / dental / paramedics / first aid), emergency services, those involved in the provision of social care, refuse or cleaning services, grounds
maintenance staff, any groups where there may be contact with discarded syringes.

Question 20

(b) As the Health and Safety Adviser to a local authority, prepare a short report for departmental managers that:
(i) outlines with relevant examples a strategy of measures to minimise the risk of Hep B infection (12)

Answer 20

To all managers:

As a Local Authority we have a legal responsibility (reference to HSWA, MHSWR and COSHH) to reduce the risk of employees being infected by biological agents.

The following sets out the key points
of the Authority’s strategy on controlling risks from Hepatitis B:

High risk groups (vulnerable employees) will be identified - for instance, those involved in refuse collection, street cleaning, building maintenance, park maintenance, sewer work and social services.

Safe systems of work will be introduced (since control measures higher up the general control
hierarchy - eg. elimination and substitution - are not really applicable in this situation) SSW will include

• eg. the use of litter-picking sticks that would minimise the risk of puncture wounds, prohibition of eating / drinking where there is a risk of contamination.

Hygiene arrangements will be put in place - washing, soap, water, hand wipes, covering of wounds etc.

Suitable waste disposal procedures will be introduced - bagging of waste materials, bodily fluids / blood / contaminated clothing etc; provision of sharps bins.

Procedures for decontamination and responding to needle-stick injuries and similar situations will be developed eg encouraging wound to bleed, rinsing with warm water, covering with clean dressing.

Information on Hepatitis B and training in safe systems of work and emergency procedures will be provided to all relevant staff; additional training programmes will meet the needs of particular categories of workers eg first-aiders in relation to use of mouth shields.

Appropriate PPE - gloves, goggles / visors, footwear will be issued and arrangements made for its safe use, maintenance and storage.

An immunisation programme will be developed for particularly vulnerable employees.

Procedures and documentation for monitoring levels of compliance and recording incidents will be put in place; quarterly reports will be produced by service managers and reviewed at senior management

H&S meetings.

Question 21

(b) As the Health and Safety Adviser to a local authority, prepare a short report for departmental managers that:
(ii) identifies the statutory reporting requirements that are relevant in the case of an employee receiving a needle-stick injury at work. (4)

Answer 21

A needle-stick injury is reportable under RIDDOR as a dangerous occurrence (in relation to biological agents) only when there is a known or suspected exposure to hepatitis (or similar) - for instance, when the needle has been in the possession of someone known to have the disease.

Hepatitis is a notifiable disease and therefore reporting is required under RIDDOR should the victim become infected.

Question 22

In a recent health and safety audit of a company the following data for a cooling tower was analysed.

With specific reference to the data, Identify and explain the range of factors that increase the risk of Legionella proliferation. (20)

Answer 22

Answer involves comparing specific operating requirements with weekly data sheet and identifying anomalies / errors in feedwater temp / flowrate / biocide / softener etc etc - together with an explanation in EACH case of why that error will increase risk of Legionellosis.

For example:

• failure to properly control water temps allows proliferation of bacteria and increase evap /
spray - ie increase risk of exposure

• absence of water softener promotes “rust” which acts as a nutrient for the bacteria etc.
• reduced flow rate can result in stagnant water and build up of scale and algae (nutrient sources) all of which promote bacterial proliferation

• maintenance failures (drift eliminators) allow potential for spray / aerosol drift carrying
Legionella bacteria

• failure to dose with biocide results in lack of control of bacterial levels
• all involve failures of H&S management.

Question 23

Employees can be exposed to corrosive substances.

a) Give the meaning of the term ‘corrosive’. (2

Answer 23

a corrosive substance is a chemical that may rapidly destroy living tissue if it is inhaled, ingested or splashed onto the body.

Question 24

A company that operates hotels and health spas recognises the risks associated with the legionella bacteria.

(a) Identify specific locations where there may be growth of, or potential exposure to, legionella for employees AND guests. (5)

Answer 24

hot and cold water storage and transfer systems (including showers and taps) where the temperature is between 20 and 45 degrees;

spa baths, saunas, steam rooms and
pools in leisure facilities;

water features such as fountains and cascades;

fire and garden sprinkler systems;

laundry rooms;

pipe work where dead legs exist and
stagnation may occur and wet or condenser air conditioning equipment.

Question 25

A company that operates hotels and health spas recognises the risks associated with the legionella bacteria.

(b) Outline the control measures that this company should
implement to minimise exposure to legionella bacteria. (15)

Answer 25

identification of a responsible person to manage legionella control;

regular disinfection of hot water systems with biocides;

annual cleaning and disinfection of calorifiers;

inspection and cleaning of water storage tanks;

avoiding ‘dead legs’ in transfer pipe work;

maintaining hot water storage temperatures
at temperatures greater than 60 degrees C and cold water below 20 degrees C;

keeping shower heads and taps clean and free from scale and running showers and
taps for several minutes each week in unoccupied rooms;

running showers and taps
immediately prior to occupation of a room;

treating spa pools continuously with
chlorine or biocides and cleaning them on a regular basis;

avoiding the use in systems of susceptible materials such as wood or rubber;

training all relevant employees in risk
factors and controls such as monitoring, dosing and flushing through;

minimising biofilm formation, for example by covering water tanks and the use of chemicals, replacing wet air conditioning systems with dry air systems or ensuring their maintenance on a regular basis;

undertaking regular monitoring of temperature and chlorine or biocide levels and periodically sending water samples for analysis.

Question 26

(a) Outline the specific criteria that should be applied when provisionally classifying a biological agent in accordance with the
Control of Substances Hazardous to Health Regulations 2002. (4)

Answer 26

These are set out in Schedule 3 of COSHH 2002 and in ascending order consider the likelihood that the agent will cause human disease;

that it may cause a hazard to employees but is
unlikely to spread to the community;

the severity of the human disease and the
possibility of it spreading to the community;

and

the possibilities available for effective
prophylaxis or treatment

Question 27

(b) Outline the design requirements for a research laboratory that undertakes activities involving a Group 4 biological agent. (6)

Answer 27

the separation of the laboratory from other activities in the same building with access restricted to authorised personnel by means of an airlock;

the filtering of input and output air using HEPA with double filtering of output air;

the laboratory to be under negative air pressure and to be sealable to permit fumigation;

all surfaces in the laboratory to be impervious to water and easy to clean and to be resistant to acids, alkalis, solvents and disinfectants;

an observation window to be provided so that
occupants may be seen at all times or other means of indicating occupation such as
an ‘outside’ light;

the presence of secure storage facilities for the biological agent;

and

the provision of a safety cabinet or isolator for handling infected material and an
incinerator or autoclave for the disposal of waste.

Question 28

(a) Identify the circumstances when health surveillance would be considered appropriate according to Regulation 11 of the Control
of Substances Hazardous to Health Regulations 2002 (COSHH). (2)

Answer 28

where employees are exposed to a substance and engaged in a process which are
both listed in Schedule 6 of the Regulations;

when there is an identifiable disease or
health effect associated with exposure to a hazardous substance and a reasonable
likelihood that the disease will occur and when there are valid techniques for detecting
indications of the disease or health effect which are of low risk to the employee.

Question 29

(b) Outline the arrangements and facilities that an organisation should put in place if they are to carry out health surveillance in accordance with the COSHH Regulations. (10)

the allocation of a suitable room which would ensure privacy, provided with toilet and hand washing facilities and sufficient space to store records.

As for procedures that would have to be introduced, they would include the
carrying out of medical surveillance for Schedule 6 substances by an appointed doctor on an annual basis;

the completion of other health surveillance by a suitably qualified person such as an occupational health nurse or other responsible person under the supervision of a registered medical practitioner;

procedures for assuring the integrity
of any samples taken and their submission to an accredited laboratory;

informing an employee if an adverse health effect or disease is identified during the surveillance;

the maintenance of up to date health records which should be confidential, securely
kept and retained for a period of forty years;

and

arrangements for employees to view
their own health records.

(c) A small engineering company uses metal working fluids which
can cause dermatitis and occupational asthma.

Assuming the engineering company has the necessary arrangements and facilities referred to in part (b); outline the
practical steps this company could take to meet its responsibilities under Regulation 11 of COSHH. (8)

Answer 29

the appointment of a responsible person to oversee health surveillance;

undertaking regular skin inspections of the employees and at the same time monitoring any breathing problems they might be experiencing;

referring those with breathing
problems to occupational health staff for medical assessment;

training employees to undertake their own skin inspections and advising them to report any problems they might have with skin irritation or breathing;

organising and administering the
completion of confidential questionnaires for skin and breathing issues and introducing
a record keeping system for health surveillance information and carrying out a regular analysis both of this information and of sickness absence data.

Question 30

A healthcare research laboratory undertakes work with hazard group 3 biological agents which require containment level 3 controls.

Outline a range of technical controls that should be used to minimise the risks to those working in the laboratory, where elimination or substitution of the hazard is not possible. (10)

Answer 30

the separation of the laboratory from other activities in the same building;

passing extracted air through a HEPA (high efficiency particulate air) filter;

the provision of engineered access to be restricted to authorised persons by means of
a security pass or swipe card;

the workplace to be sealable to permit disinfection and to be maintained at an air pressure negative to atmosphere;

all surfaces to be impervious to water, easy to clean and impervious to acids, alkalis, solvents and disinfectants;

the provision of secure storage for the biological agents;

an observation window to be fitted so that the occupants can be seen at all times;

using a class 111 microbiological safety cabinet with sealed front and glove port access to carry out the 
work; 

a facility such as an autoclave to be provided for rendering waste safe and finally the provision of appropriate and adequate washing and toilet facilities.

Question 31

A company that operates hotels and health spas is looking to minimise the risks associated with the legionella bacteria.

(a) In this scenario identify specific sources of potential exposure to legionella for BOTH employees and guests. (5)

Answer 31

water storage and transfer systems (including showers and taps) where the temperature is
between 20 and 45 degrees;

spa baths, saunas, steam rooms and pools;

water features such as fountains and cascades;

fire and lawn sprinkler systems;

laundry rooms;

pipe work where dead legs exist and stagnation may occur and wet or
condenser air conditioning equipment.

Question 32

A company that operates hotels and health spas is looking to minimise the risks associated with the legionella bacteria.

(b) Describe the control measures that this company should implement to minimise people being exposed to legionella bacteria. (15)

Answer 32

measures which should have been described (and which are explained in ACOP L8) included identification of a competent person for overseeing Legionella control;

regular disinfection of hot water systems with biocides;

annual cleaning and disinfection of calorifiers;

inspection and cleaning of water storage tanks;

avoiding ‘dead legs’ in transfer pipe work;

maintaining hot water storage temperatures
at temperatures greater than 60 degrees C and cold water below 20 degrees C;

keeping shower heads and taps clean and free from scale and running showers and taps for several minutes each week in unoccupied rooms;

running showers and taps immediately prior to occupation of a room;

treating spa pools continuously with
chlorine or biocides and cleaning them on a regular basis;

avoiding the use in systems of susceptible materials such as wood or rubber;

training all relevant employees in risk
factors and controls;

minimising biofilm formation, for example by covering water tanks and the use of chemicals, and introducing regular monitoring procedures and record keeping.

Question 33

Street cleaning operatives working for a local authority can be at risk from exposure to the hepatitis B virus.

Outline a range of practical control measures that could be used to minimise the risk of exposure to hepatitis B. (10)

Answer 33

the use of litter picking sticks to minimise the risk of puncture wounds; the prohibition of eating and drinking during normal periods of work;

the use of personal protective equipment
such as goggles, gloves and footwear;

covering up wounds with waterproof dressings;

the safe disposal of sharps in a suitable container and frequent hand washing.

In addition to these practical controls, candidates could have mentioned the need to
provide information and training to the employees on the nature of the risk and the
precautions to be taken together with the introduction of procedures for the collection
of contaminated waste such as body fluids, blood and contaminated clothing;

for cleaning up body fluids and blood and for the action to be taken following a needle
stick injury such as the encouragement of bleeding and rinsing the wound under warm
water before covering it with a dressing.

Question 34

The risk of contracting Weil’s Disease (Leptospirosis) is a concern to
windsurfers at a local water sports centre. Provide advice to these windsurfers
which outlines:-

(a) the ill-health effects associated with this disease (2)

Answer 34

In most cases the infection causes a flu-like illness with severe headaches and myalgia
(lower back, and legs).

Other symptoms include fever, vomiting, abdominal pain, skin rashes, conjunctival
haemorrhage, uveitis, and Leptospirosis may present as aseptic meningitis.

Question 35

The risk of contracting Weil’s Disease (Leptospirosis) is a concern to
windsurfers at a local water sports centre. Provide advice to these windsurfers
which outlines:-

(b) why windsurfers might be at risk (2)

Answer 35

The bacteria can then enter the

windsurfers’ bodies via cuts to the skin, nose, mouth or other mucous membranes.

Question 36

The risk of contracting Weil’s Disease (Leptospirosis) is a concern to
windsurfers at a local water sports centre. Provide advice to these windsurfers
which outlines:-

(c) practical steps that instructors can take to minimise the risks to themselves. (6)

Answer 36

wearing protective footwear and minimising skin contact by wearing full-body wet suit;

protecting all existing cuts and abrasions with
waterproof dressings;

seeking medical advice and treatment for any cuts or bites received whilst in the water (advising their GP of their occupation to aid in early diagnosis);

washing down equipment and wet suits and reporting any sighting of rats to ensure effective rodent control in and around the water.

showering after being in water and washing hands thoroughly before eating; avoid swallowing water;

Question 37

In a manufacturing process workers use a range of solvents.

(a) Outline the issues that should be considered and the information which
should be consulted when preparing a Control of Substances Hazardous to Health (COSHH) risk assessment for this situation. (6)

Answer 37

reference to COSHH Regulations and ACOP, HSG173 (Monitoring strategies for toxic substances), material safety data sheets;

background information on solvents (types, health effects, target organs, synergistic/additive effects, etc);

working practices, exposure patterns, efficiency of existing controls;

need for monitoring (eg deterioration of controls) and health surveillance;

current exposure limits (EH40);

route/s of entry (inhalation / skin absorption) relevant to how the substance is used and who is exposed (including any vulnerable groups).

The better responses considered atmospheric and biological monitoring within their answers
and referred to the three-stage approach in HSG 173.

Question 38

In a manufacturing process workers use a range of solvents.

(b) Describe an overall monitoring strategy that could be used to assess the actual exposure of the process workers to solvent vapours. (6)

Answer 38

Suitable monitoring strategies
included consideration of:

personal versus static monitoring; biological monitoring (total body
burden v inhalation);

who to monitor, for how long and when;

how to monitor:

grab sampling — stain tubes versus integrated sampling (pump, passive, adsorption tubes etc);

examples of analytical methods; and reference to appropriate MDHS’s.

Question 39

In a manufacturing process workers use a range of solvents.

(c) Explain how the range of data obtained might be interpreted in order to determine the acceptability of such exposures and the adequacy of current controls. (8)

Answer 39

measurements obtained versus work practices (representative, cyclical, etc);

comparisons with exposure standards:

calculations for mixtures, taking into account synergistic/additive effects, etc;

comparisons with biological standards;

comparisons with previous results;

measurements reviewed against LEV performance tests, or PPE selection and usage, or results of health surveillance.

Question 40

According to current veterinary and medical opinion the bacterium E.Coli O157
should be assumed to be carried by all ruminants (cattle, sheep, goats, deer).

In addition, this bacterium can exist for long periods of time outside of the animal (in soil and faeces).

(a) Suggest ways in which children making an educational visit to an open farm might be exposed to E. Coli O157 bacteria. (4)

Answer 40

in soil or faeces. With that understood, there should have been no difficulty either in suggesting how children on a visit to an open farm might be exposed to the
bacteria or in explaining control measures that should be put in place.

The children’s hands could be contaminated by touching animals, touching surfaces
contaminated by faeces such as gates and fences and coming into contact with
contaminated footwear during its removal.

The transfer of the bacteria to the mouth could
take place during eating or drinking before hands had been thoroughly washed or from
putting fingers near or in the mouth for any other purpose (as young children often do).

Question 41

According to current veterinary and medical opinion the bacterium E.Coli O157
should be assumed to be carried by all ruminants (cattle, sheep, goats, deer).

In addition, this bacterium can exist for long periods of time outside of the animal (in soil and faeces).

(b) Explain a range of practical control measures that should be put in place
in order to reduce this risk of exposure. (6)

Answer 41

It would be important before the visit took place to brief schools of the precautions to be observed so that the children could be advised of what they should and should not do once they arrived at the
farm.

On the farm, contact with animals should be restricted to specified areas and arrangements put in place to clean, disinfect and remove faeces from these areas on a
regular basis.

Hand washing facilities should be provided, ideally placed at the exits from contact areas and before entrance to areas set aside for taking refreshment and it would be
sensible for children to be advised on thorough hand washing techniques at the start of the visit.

The animal areas should be segregated from areas set aside for eating and signs
warning of the risks of contamination and the precautions to be taken placed in strategic
positions.

Finally the farm management should ensure that there is an adequate number of staff on duty to supervise and advise visitors in the contact areas.

Question 42

(a) The risk of contracting Leptospirosis is a concern to windsurfers at a local
water sports centre. Provide advice to these windsurfers which outlines:

(i) the ill-health effects associated with this disease; (2)

Answer 42

Leptospirosis causes a flu-like illness with severe headaches and myalgia in
the lower back and legs.

Other possible ill-health effects include fever, vomiting, abdominal pain, skin rashes and conjunctival haemorrhage.

The more severe form of the disease causes jaundice and liver damage which may end in death.

Question 43

(a) The risk of contracting Leptospirosis is a concern to windsurfers at a local
water sports centre. Provide advice to these windsurfers which outlines:

(i) the ill-health effects associated with this disease; (2)

Answer 43

Leptospirosis causes a flu-like illness with severe headaches and myalgia in
the lower back and legs.

Other possible ill-health effects include fever, vomiting, abdominal pain, skin rashes and conjunctival haemorrhage.

The more severe form of the disease causes jaundice and liver damage which may end in death.

Question 44

(a) The risk of contracting Leptospirosis is a concern to windsurfers at a local
water sports centre. Provide advice to these windsurfers which outlines:

(ii) why windsurfers might be at risk. (2)

Answer 44

The bacteria can then enter the windsurfers’
bodies through cuts or abrasions to the skin and through mucous membranes, and
particularly if water is swallowed.

Question 45

The risk of contracting Leptospirosis is a concern to windsurfers at a local
water sports centre.

(b) Outline the practical steps that the centre’s instructors can take to minimise the risks to themselves. (6)

Answer 45

Practical steps which the windsurfers should take must be aimed at preventing water
entering the body.

They include measures such as maximising dry training to limit the potential contact time;

showering after being in water and washing hands thoroughly before eating;

taking care not to swallow water;

wearing protective footwear and minimising skin contact by wearing a full-body dry suit; protecting all existing cuts and abrasions with waterproof dressings;

seeking medical advice and treatment for any cuts or bites received whilst in the water;

washing down equipment and dry suits and reporting any sighting of rats to ensure effective rodent control in and around water.

Question 46

(a) Outline the source and symptoms of MRSA. (4)

Answer 46

SA is widespread in human population - MRSA in approx 30% of healthy people (asymptomatic = colonisation).

Symptoms: local skin infection, boils, serious wound infections (necrotising faciitis), high
temperature, pain and body aches.

Question 47

(b) Outline control measures to minimise the risk of MRSA in a hospital environment. (6)

Answer 47

taking swabs on admission - laboratory analysis to identify carriers;

treating with antibiotics prior to
admission;

cleaning clinical areas and equipment;

hand washing - soap, water, alcohol hand gel (staff and visitors);

protective gloves, aprons