S. Azadi, B. Meade, NIOSH, Morgantown, WV.
With allergic and irritant contact dermatitis comprising up to 25% of all reported occupational diseases, there is a need to improve intervention strategies to avoid dermal chemical exposures. Likewise, improved methods for evaluating the efficacy of personal protective devices are needed. To meet this need indicator pads, worn under protective clothing and chemical resistant gloves, are being developed to detect potential chemical exposures. These studies were conducted to evaluate the sensitization potential of chemicals being evaluated for use in indicator pads. Methyl Red (CAS 845-10-3) and Basic Fuchsin (CAS 569-61-9) were evaluated using the local lymph node assay (LLNA) and phenotypic analysis (PA) of draining lymph node cells. Female BALB/c mice (n = 5) were topically exposed on the dorsal ear pinna for 3 (LLNA) or 4 (PA) consecutive days. In the LLNA, mice were injected i.v. with 3H-thymidine on day 6 and draining lymph nodes were radioassayed. For PA, on day 10 post initial exposure, draining lymph node cells were stained with FITC labeled rat anti-mouse IgE or PE labeled rat anti-mouse CD45 B220. Blood was collected at the time of sacrifice for analysis of total serum IgE. Methyl Red tested positive in the LLNA with a calculated EC3 value (concentration required to induce a stimulation index of 3) of 0.2% or 50 礸/cm2. PA demonstrated an elevation in B220+ cells, supporting the LLNA results. No increase in total serum IgE was detected. Preliminary studies testing Basic Fuchsin demonstrated negative results in the LLNA at concentrations as high as 2.5%. These studies indicate the potential for Methyl Red to induce contact sensitization with no evidence of an IgE inducing potential. Although indicator pads contain low concentrations of these chemicals, appropriate care should be taken to avoid dermal contact to minimize the possibility of adverse effects.
G. Owczarek, Central Institute for Labour Protection-National Research Institute, L骴z, Poland.
Thermography is one of the techniques enabling to carry out works in many fields. It can be used in all circumstances, in which thermal radiation carries important information that can be used. The applications of thermography are very extensive, because everything that surrounds us emits thermal radiation. In industry, infrared thermography technique is used, among others, to monitor manufacturing processes and to assess the performance of insulating and power installations. In medicine, infrared thermography is used for noninvasion medical diagnosis. Development of new methods and infrared systems for safety and testing of personal protective equipment (PPE) is the main topic of the article. The authors show some application of infrared thermography to nondestructive testing of protective clothing. The monitoring of break test of PPE against fall down (textile energy absorber) was also described. Experimental results were obtained at Central Institute for Labour Protection-National Research Institute using the ThermaCAM 290E system. The thermal results are useful to optimize a construction of a selected type of PPE.
Z. Zhuang, NIOSH, Pittsburgh, PA; R. Lawrence, D. Campbell, C. Coffey, NIOSH, Morgantown, WV.
The PortaCountTM is a quantitative fit-test instrument which uses ambient aerosol to determine respirator fit. Ambient aerosol concentration levels vary greatly among workplaces. The standard fit test currently uses eight one-minute exercises. Considerable time and financial commitments are needed to select a properly fitting respirator for a given worker. The purposes of this study were to determine: (1) if PortaCount fit factors are affected by ambient aerosol concentration, and (2) if any of the exercises are the most critical in determining the overall fit factor. Fit-test data for 30 elastomeric and filtering-facepiece respirator models from a recent NIOSH study were analyzed. Each model was tested on a 25-subject panel using the PortaCount and seven exercises. The analyses determined: (1) if fit factor varies among five levels of ambient aerosol concentration, (2) the frequency of each exercise having the lowest within-fit-test fit factor, and (3) the average within-fit-test ratio of each exercise fit factor to the highest fit factor among all exercises. Ambient aerosol concentration had no practical effect on fit factor. 揜eading,� 揵ending,� and 搈oving head up/down� exercises had the lowest fit factor in about 66% of the tests. They also had the lowest average within-fit-test ratios of exercise fit factor to the highest fit factor (0.56, 0.62, and 0.67, respectively). Fit factors for each exercise were found to be highly correlated with fit factors for each of the other six exercises. There was no significant fit-factor difference between the first and second normal breathing exercises. We conclude that the fit test pass/fail criterion need not be adjusted for ambient aerosol concentration level and that 搑eading,� 揵ending,� and 搈oving head up/down� are the three most critical exercises in determining the overall fit factor. Further study is needed to determine if fit-test procedures can include only these three exercises.
B. Doney, D. Groce, M. Greskevitch, CDC/NIOSH, Morgantown, WV; W. Hoffman, CDC/NIOSH, Pittsburgh, PA.
The National Institute for Occupational Safety and Health (NIOSH) conducted a nationwide respirator survey through the United States Department of Labor/Bureau of Labor Statistics. The purpose of the survey was to evaluate respirator use and practice as an aid to guiding NIOSH respirator certification and research. The survey was mailed in August 2001 to 40,002 establishments representing all of the private sector major industry divisions. Among other information collected on respirator use and practices, the survey included questions on respirator user instructions and labeling. The survey estimated that 89% of all respirator-using establishments agree that manufacturers� instructions are clear and easily understood; 90% agree that manufacturers� instructions are beneficial in the use of respirators; 84% agree that NIOSH approval labels are clear and easily understood; and 80% agree that NIOSH approval labels are beneficial in the use of respirators. These high levels of agreement were uniform across all industry and establishment size groups. In contrast, however, were the findings from other questions in the survey that indicate apparent widespread inadequacies in the respiratory protection programs offered by establishments. For example, 91% of establishments requiring respirator use had at least one indicator of a potentially inadequate respiratory protection program, while 54% had at least five indicators.
I. Kudla, L. Holness, B. Kosnik, M. Sharma, St. Michael抯 Hospital, Toronto, ON, Canada.
During the outbreak of SARS in Toronto, Canada, occupational health issues for health care workers became paramount. The importance of a multidisciplinary approach including occupational health services, infection control, engineering, housekeeping, hospital administration, and regulatory agencies was clearly highlighted. Occupational health challenges included: infection control procedures, respiratory protection, increased incidence of dermatitis, increased stress levels amongst staff, and health care delivery in general as a result of quarantine measures.
Regarding respiratory protection, the Ontario government issued directives requiring the use of N95 respirators in specific clinical settings. Under Ontario抯 Occupational Health & Safety Act, a respirator protection program including fit testing is required if a N95 respirator is being used in the workplace. St. Michael抯 Hospital, the designated tertiary/quaternary SARS hospital for the second SARS outbreak, developed a plan to fit test 3253 staff over a 4-week period, with an initial focus on workers who would be exposed directly to SARS patients.
Fit testing of large numbers of staff over a short period of time is a formidable logistic problem that can threaten the delivery of health care. For any potential future SARS outbreak or other unknown infectious disease requiring respiratory protection, hospitals need to develop a strategy for fit testing staff as part of a respiratory protection program, including: fit testing as part of new employee orientation, annual fit testing as a regular part of employee health assessments such as TB testing, and ensuring a reliable supply of different N95 respirators.
This poster presentation will attempt to illustrate the lessons learned during the SARS outbreak from the perspective of St. Michael抯 Hospital, in Toronto, a designated SARS hospital.
P. Hand, Clayton Group Services Inc, Edison, NJ.
Elevator pits and sections of heating, ventilation, and air-conditioning (HVAC) units routinely meet the definition of a permit-required confined space as described in OSHA抯 Permit-Required Confined Space Standard. For buildings and facilities management groups where employees are entering many of these spaces each day, compliance with the standard may seem like an overwhelming task.
The Permit-Required Confined Space Standard requires that precautions be taken prior to entry and that documentation of these precautions be provided and maintained by the employer. The precautions must be in the form of lockout/tag out. The documentation, according to the standard must be in the form of a Reclassification Certificate. For employees that enter and service many of these units on a daily basis, completing and filing individual certifications can be a time-consuming task. Building and facility management can find relief from the burden of documentation when they look beyond the standard.
OSHA has published several letters of interpretation that describe conditions when employees can enter these spaces following lockout/tag out techniques and not be required to complete and file certifications described in the standard.
This presentation will describe how elevator pits and HVAC units can meet the definition of a permit-required confined space and under what conditions employees can enter and service these spaces without documentation. Building and facility managers will find that they can provide the appropriate precautions for employees entering these spaces, save time, and be compliant with a key OSHA standard.
S. Marshall, Lockheed Martin Aeronautics, Palmdale, CA.
In 1996, Lockheed Martin Aeronautics in Palmdale, California, faced rising injury and worker抯 compensation rates. In light of new, aggressive corporate injury reduction goals, we determined there was a need for increased employee involvement using behavioral safety concepts. In 1997 we began the Safety Awards For Team Excellence (SAFTE) program. The program抯 purpose was to improve workplace safety, health, and the environment by encouraging teams to reduce workplace accidents, integrate best work practices into daily work, identify hazards, correct hazards before causing harm, and maintain/promote environmental compliance. The program uses small teams of employees competing during 6-month award periods. The program is successful. Since its 1997 inception, SAFTE teams have averaged 42% lower OSHA recordable and 71% lower lost time injuries than eligible participant counterparts. The program also was an important factor in our successful Cal/OSHA VPP certification and recertification process largely because of VPP抯 emphasis on employee-management communication. The most significant SAFTE program benefit is the fact that employees work together not just to identify issues but to correct them. This is different than typical 搑ates only� recognition programs. The abstract summarizes how the SAFTE program works and details how employees: (1) identify potential issues, (2) implement suggested improvements, (3) present improvements to peers and management, and (4) communicate successes throughout the site. The abstract goal is to highlight successful SAFTE program tools and showcase many examples of SAFTE team improvements.
A. Howerton, D. Grote Adams, Safex Inc., Westerville, OH.
Large universities face many of the same health and safety challenges as manufacturers. Identifying hazards, minimizing accidents, reducing workers� compensation costs, and minimizing lost work days are important aspects of a safety program. A large university employing more than 31,000 staff identified wood and machine shops as areas in which insufficient hazard identification existed.
To identify the routine operating hazards in the various engineering, technology, and agricultural shops, a multi-step program was implemented. The program was comprised of (1) reviewing accident records, (2) conducting facility surveys of individual shops, and (3) preparing a report of findings and recommendations.
A search of the accident records was conducted for the period of January 1999 to June 2003. All results were reviewed to identify injury causes and to determine any correlation with shop deficiencies observed during the shop surveys. The reports had been incorporated into a database by university personnel prior to being queried for all shop-related accidents.
The shop surveys were conducted by a team of two health and safety professionals: one university representative and a consultant. The purpose of the surveys was to determine workplace deficiencies relative to the current Occupational Safety and Health Administration General Industry Standards, Agriculture Standards, where applicable, and various consensus industry standards.
The safety inspections included programmatic components such as hazard communication, hazardous energy control, personal protective equipment, and respiratory protection, but a primary focus was given to machine guarding of both metal and wood working equipment. Additional consideration was given to electrical components, chemical and compressed gas storage, and the presence and condition of safety items.
A report summarizing the accident records, observed shop deficiencies, and corrective actions recommended to correct unsafe work conditions or practices was prepared. This information was used to help determine the priority of future university health and safety efforts.
P. Snodgrass, G. Drumm, Unifrax Corporation, Niagara Falls, NY.
At the Unifrax Facility in Tonawanda, New York, above average airborne fiber concentrations were identified during the production of a type of refractory ceramic fiber (RCF) paper. The facility manufactures many types of RCF paper and products with the majority of task exposures well below the RCF industry recommended exposure guideline (REG) of 0.5 f/cc. The RCF industry developed a comprehensive Product Stewardship Program, which requires quarterly industrial hygiene monitoring. High fiber counts were identified during routine sampling of this task. To address this situation as well as deal with other fiber issues, an Airborne Fiber Reduction Safety Subcommittee was formed and has become an integral part of the overall safety program at the Tonawanda facility. The committee is comprised of a number of key employees; Vice President of Engineering, Plant Manager, Health and Safety Engineer, Production Manager, Mechanical Engineer, and Production Personnel have successfully reduced the exposures below the REG. In addition, exposures throughout the plant at different tasks were reduced with a variety of techniques involving administrative and engineering controls.
A. Attias, Petrolera Ameriven S.A., Barcelona, Venezuela.
The Corporate Business Plan (CBP) establishes and outlines the company抯 strategies to achieve its corporate vision. This presentation shows the experience of an oil company after implementing a CBP that was guided, in all its phases, by the company抯 environmental, health, and safety (EH&S) policy.
To guarantee that the EH&S policy served as a guide, the policy needed to be supported by a well-structured EH&S management system (EH&S MS). This EH&S MS, with 17 elements, was discussed and approved by the company抯 management team, and consequently implemented following a plan. This plan is called the Operating Excellence Plan. This is a yearly operational plan that contents the different tactical objectives for each of the EH&S MS elements needed to achieve the goals established by the management team and the CBP.
The EH&S MS implementation has been audited every year and the deviations found were used to correct and modify the EH&S MS to improve next year抯 Operating Excellence Plan. This experience shows that the Operating Excellence Plan adds value to the CBP and can be used as a tool to guarantee that the CBP is implemented following the EH&S policy and the EH&S MS.
E. Snyder, R. Sollberger, L. Tapp, NIOSH, Cincinnati, OH.
National Institute for Occupational Safety and Health (NIOSH) investigators conduct on-site evaluations in response to health hazard evaluation (HHE) requests and provide recommendations to address identified hazards. In 1999, NIOSH began an effort to evaluate the effectiveness of HHEs in improving worker health and safety which includes both process and outcome evaluation components. Data are gathered through a series of questionnaires distributed at randomly selected work sites to assess whether the HHE effort resolved identified problems. Obtaining information through questionnaires, however, has limitations. Because NIOSH relies on reports from various people at the facility, the potential exists for conflicting information to be given. Beginning in 2003, on-site follow-back evaluations were conducted to provide NIOSH a direct method for gathering the information needed to determine if improvements have occurred since the issuance of the HHE report and to validate the information obtained by questionnaire. To the extent possible, the on-site follow-back survey replicates the methodology used during the initial evaluation, including process and facility observation, employee interviews, and review of exposure and health records. By documenting what worked and what did not, NIOSH hopes to produce practical information for improving the HHE program and informing other interested parties. This information then becomes a valuable resource for others who play a role in preventing occupational diseases, including unions and the medical community.
To date, three on-site follow-back evaluations have been completed. Results from these evaluations indicate that NIOSH recommendations were implemented to various degrees. Examples of specific findings from the selected follow-back evaluations include expedited purchasing of new equipment at a metropolitan sewer district, improvement of engineering controls at a neon sign facility, and general increased exposure awareness at all facilities. The follow-back program will continue to evaluate HHE recommendations to validate questionnaire responses and monitor changes in workplace exposures.
M. Rodriguez, M. Kawamoto, NIOSH, Cincinnati, OH.
Hispanics are now the largest minority population in the U.S. and it is expected that the Hispanic population will double by 2020. Hispanics are overrepresented in the most hazardous industries: construction, agriculture, food processing, and apparel manufacturing. These industries have numerous occupational hazards with associated chronic effects. The major obstacle faced by employers and occupational safety and health professionals is a language barrier since many of the Hispanic employees do not speak English.
NIOSH has begun various efforts to inform Hispanic workers about health hazards in the workplace. NIOSH has developed a toll-free information number with English and Spanish response options, a website with information and publications in Spanish and links to other Spanish language websites, and the Health Hazard Evaluation (HHE) Program抯 information pamphlet and request form have been made available in Spanish. NIOSH is exploring Hispanic outreach through radio and television by incorporating health-related plots into programs. The NIOSH Hazard Evaluation and Technical Assistance Branch has developed a pilot project on Hispanic outreach in Cincinnati, Ohio. The objective of this project is to increase awareness about the occupational safety and health issues and resources, particularly the NIOSH HHE program. The outreach strategy involves the participation of local and state government agencies and community-based organizations. Through a coordinated effort, these groups will provide Hispanic workers in the Cincinnati area with information about how to get help on work-related issues.
Hispanic outreach efforts are receiving national attention. NIOSH, OSHA, EPA, and many state and city governments have implemented some form of Hispanic outreach activities. The task is complex, but providing information and access to occupational safety and health services is the first step toward reducing the number of work-related fatalities and preventing work-related illnesses among Hispanic workers.
R. Furr, L. Gibbs, Y. Kim, L. Teng, Stanford University, Stanford, CA.
At Stanford University, the recent construction and development of two large multi-disciplinary research buildings has provided EH&S the opportunity to address safety and compliance problems before they become entrenched. This presentation discusses the steps taken, challenges encountered, and lessons learned in ensuring the safe relocation and start-up of research laboratories in those buildings. Issues covered include the role of an institutional laboratory design guide, large scale chemical transportation and handling, effective managing of unwanted chemicals, tracking of chemical inventory migrations, ensuring good ergonomic setups, and post move follow-up. Differences in ensuring a safe laboratory operation in the traditional laboratory setting versus open, shared laboratory spaces are outlined and the challenges encountered, along with solutions provided, are discussed. Conclusions are drawn as to the importance of building governance in the open laboratory setting and the need for early programmatic planning and involvement by EH&S professionals.
S. Chervak, U.S. Army CHPPM, Aberdeen Proving Ground, MD; A. Yeager, Tripler Army Medical Center, Tripler AMC, HI.
A disproportionately large number of workers at an Army toxicology laboratory were reporting symptoms of cumulative trauma disorders (CTDs).The purpose of the evaluation was to determine whether the current workstation designs could be improved to eliminate discomfort, promote efficiency, and prevent CTDs. After an analysis of the specimen processing procedures, it was determined that most of the laboratory workers� complaints were associated with the preparation segment of the procedure.
The procedure associated with the preparation segment of the process involved the worker removing the lid of the specimen jar, pouring a small amount of the specimen into a test tube, replacing the specimen jar lid, and labeling both the specimen jar and the test tube. The task was very repetitive since the specimen laboratory processed up to 3500 specimens per day. The task was also very labor intensive because each specimen sample needs to be individually prepared. The toxicology laboratory had experimented with mechanized lid removal systems, but these systems were not feasible due to the decrease in productivity that resulted.
The authors developed a prototype lid removal device that uses a battery-operated screwdriver and fixture to remove the lid tops mechanically. The device eliminates the repetitive motion and force associated with removing and installing the specimen jar lid. A fixture was also developed that suspends the lid removal device above the workstation. The fixture eliminates the forces associated with holding the lid removal device as well as any awkward postures associated with reaching for the lid removal device. The implementation of the lid removal device was so effective in increasing productivity rates and reducing complaints of CTDs that four more devices have been built and are currently being implemented.
S. Paik, X. Wu, Abbott Laboratories, North Chicago, IL; J. Park, Seoul National University, Seoul, Republic of Korea.
Guanidine isothiocyanate (GITC) is commonly used in nucleic acid testing (NAT) applications in clinical laboratories as an agent for denaturing proteins and lysing cells or microorganisms. Bleach, with 5% sodium hypochlorite (NaClO) in solution, is often used as a disinfectant and decontamination agent in such laboratories. During cleanup procedures for spilled GITC-containing reagents or treatment of GITC-containing wastes, if bleach is applied, workers in the vicinity of the area may potentially be exposed to toxic gases. This study examined several gases released from the reaction between NaClO and GITC and addressed concerns regarding the safe handling of GITC-containing reagents. A test chamber was constructed to collect the gases with selected adsorbent tubes, using OSHA- and NIOSH-validated methods. To sample the air as completely as possible, the glass chamber was sealed air-tight with three outlets on the top, one for adding bleach into the reagent solution, one for collecting the resultant gases, and the third one for introducing diluent air. By attaching a Tedlar bag at the tip of the diluent air tubing inside the chamber, the resulting air from the reaction between NaClO and various GITC-containing solutions was collected without suffering makeup gas dilution or significant internal pressure reduction. Results show that while the concentrations of all other gases tested (NO, NO2, CO, and Cl2) were either nondetectable or below the applicable occupational exposure limits (OELs), hydrogen chloride (HCl) and hydrogen cyanide (HCN) were surprisingly found in excess levels, possibly exceeding the OELs in the working environment under certain, worst-case scenarios. The concentrations of HCl and HCN were not significantly affected by a nonionic surfactant, present in some of the reagents. The discovery of HCl and HCN in the reaction gases of GITC and NaClO should contribute to the future safe handling of GITC-containing reagents in NAT laboratories.
C. Stanion, G. Dear, G. Tencer, C. Burton, Duke University Medical Center, Durham, NC.
Since 2001, the Duke Occupational and Environmental Safety Office (Duke OESO) has worked to reduce anesthetic gas exposures associated with a dermatology procedure performed on anesthetized children. This procedure involves laser treatment of facial (and other) birthmarks, and often requires lifting the anesthesia mask to access the face, allowing anesthetic gases to escape.
Duke OESO monitored baseline anesthetic gas exposures during these procedures on four mornings. Six nitrous oxide personal samples ranged from 37.5 ppm to 160 ppm over an average of 176 minutes. In comparison, 24 samples in other operating rooms were between 2 and 14.3 ppm (average sample 535 minutes). The room ventilation was subsequently increased, but this did not control exposures. The procedures were then moved to a new room, where baseline exposures (on one day only) ranged from 52 to 100 ppm over approximately 1.5 hours.
Since general ventilation alone was unlikely to control exposures, the authors and the Duke Medical Center Instrument Shop developed a custom funnel attachment for the medical vacuum. The funnel was designed to hold different sizes of masks when they are not in use, and to fasten to the patient stretcher. The vacuum captures anesthetic gases, reducing fugitive emissions.
Duke OESO monitored on two days with the funnel in use (four people per day). Nitrous oxide exposures ranged from undetectable to 26 ppm (average: 7 ppm). On the second day, it was apparent that the dermatologist had also changed his work practices, working under the masked area last and instructing the anesthesia provider to turn off the anesthetic gases before removing the mask from the face.
In conclusion, a simple custom funnel device attached to existing medical vacuum, coupled with conscientious work practices, can dramatically reduce anesthetic gas exposures from anesthesia masks used during procedures on the face.
L. Caskey, D. Hurley, R. Liguori, Wake Forest University, Winston-Salem, NC.
Problem: The Occupational Safety and Health Administration Technical Manual section entitled, Controlling Occupational Exposure to Hazardous Drugs, states that 損reparation, administration, and disposal of hazardous drugs may expose health care workers to potentially significant workplace levels of these chemicals.� 揂s a result, it is difficult to set safe levels of exposure on the basis of current scientific information.� However, 搈any hazardous drugs are known human carcinogens for which there is no safe level of exposure.�/p>
The focus of this study was to assess environmental contamination during the preparation and mixing of cytotoxic agents (5-Fluorouacil, etoposide, cyclophosphamide, and ifosfamide) to the nursing staff. Through literature review, recommendations to improve the safe work practices to reduce the exposure were suggested to the nursing staff.
Method: The method used to assess the potential exposure to chemotherapy agents was wipe samples. Fifteen wipe samples were taken from the various clinics that prepare and mix the chemotherapy agents. The wipe samples were taken from five biosafety cabinets, the floor underneath the biosafety cabinets, and surfaces. The wipe samples were analyzed for 5-Fluorouacil, etoposide, cyclophosphamide, and ifosfamide.
Results: Based on initial wipe sample results, there is a potential that employees may be exposed to cytotoxic agents. The results indicated that there is a potential exposure to 5-Fluorouacil, cyclophosphamide, and ifosfamide. However, there was no evidence of environmental contamination to etoposide.
Based on surface contamination found in the chemotherapy mixing/preparation areas sampled, the following recommendations were suggested:
R. Collum, University of Alabama at Birmingham, Birmingham, AL.
Cyclophosphamide (CP) is a frequently used and highly toxic antineoplastic agent administered to cancer patients around the world. CP is also a known human carcinogen and requires the use of safe work practices and engineering controls to prevent exposure to health care workers. Until now no consistently reliable and easy method had been developed for the analysis of cyclophosphamide contamination on surfaces. This preliminary study used a new analytical method developed at the University of Alabama at Birmingham to evaluate surface contamination of cyclophosphamide in a hospital pharmacy. Wipes were taken in eight locations in the pharmacy using Whatman #42 filters. Six of the locations were inside the chemotherapy preparation area and two were outside the preparation area. The samples were desorbed using a special mixture of acetonitrile, methanol, and water and analyzed using reverse phase HPLC. The method revealed definite contamination of some areas and possible contamination of additional sites. Further studies are planned to refine the sampling technique and compensate for potential interferences.
Posted May 30, 2004