On October 24, 2006, Gold Coast Ingredients, Inc. requested a Health Hazard Evaluation (HHE) for medical screening for occupational lung disease at their Commerce, California plant. The company was participating in a voluntary special emphasis program called the Flavoring Industry Safety and Health Evaluation Program (FISHEP). In 2006, this program was initiated by the California Department of Health Services (CDHS) and the California Division of Occupational Safety and Health (Cal/OSHA) to identify workers with flavoring-related lung disease such as bronchiolitis obliterans (BO) and institute preventive measures in the California flavoring industry. Under FISHEP, companies must report to CDHS the results of employee medical screening and worksite industrial hygiene assessments, and implement control measures recommended by Cal/OSHA. During the initial walkthrough of the plant, the NIOSH medical officers noted workers in the production areas wearing various respirators including full-face, half-face, and N-95 filtering facepiece respirators. Production workers wore the full-face and half-face respirators with NIOSH-certified organic vapor cartridges but not always with particulate filters. Some 3 production workers were not wearing respirators while co-workers performing the same tasks were wearing respirators. Pouring of liquid ingredients was observed in the corridor (pre-production area) outside of the liquid production area. Management stated its policy was to require respirator use when acetoin, acetaldehyde, diacetyl, acetic acid, and benzaldehyde were used. Management stated that qualitative fit testing was done with isoamyl acetate (banana oil). No quantitative fit testing had been done. During the walkthrough on November 1, 2006, production had ceased for the day. All of the workers performing cleaning activities in the production areas wore half-face or full-face respirators with organic vapor cartridges. Some had particulate filters, as well. During the walkthrough on March 13, 2007, no production activities were occurring. All workers in the production rooms were wearing full-face respirators with organic vapor cartridges, and some had particulate filters. All the current production workers, except for one worker and the production manager, had been quantitatively fit tested for a Survivair Opti-Fit full-face respirator. Mention of company names or products does not constitute endorsement by NIOSH. We found 2 workers with production work history that had fixed airways obstruction. The very severe case was not previously able to wear a respirator and had been transferred to a job with less exposure to flavoring chemicals. Such cases are sentinels of risk to co-workers. The second case evolved during FISHEP participation and demonstrates the importance of: 1) mandatory use of appropriate fit-tested respirators with both organic vapor/acid gas cartridges and particulate filters; and 2) implementation of engineering controls to lower exposure in plants with cases of fixed airways obstruction. This second case had an extreme drop in lung function into the abnormal range within a 4.5 month period of time and without symptoms. In this facility, current production workers did not have an excess of chest symptoms compared to other workers, although the two cases developed during production work. When sick workers transfer to less physically demanding work or leave employment altogether, the remaining workers can look "healthier" in comparison to the rest of the workforce. This effect is common in cross-sectional studies and such findings should not be interpreted as an absence of risk in production workers. In this facility, the sickest employee transferred out of production, and thereby contributed his/her symptoms to a nonproduction employee grouping in Table 1. Considering the results of both spirometry surveys, the two cases of fixed obstruction arising in production employment are consistent with flavoring exposure being associated with risk. Whether restrictive abnormalities are related to flavoring exposures remains unclear. No flavoring-exposed workforce studied to date has had a statistically significant excess of restrictive spirometry. However, individual cases with restriction have occurred in the microwave popcorn industry without explanation or alternate diagnosis (11,12). Longitudinal follow-up may clarify whether cases of restriction are coincidental, a stage of flavoring-related abnormalities, or a less common response to flavoring exposure. Similarly, longitudinal follow-up may establish whether borderline obstruction seen in two workers in production indicates higher risk of progression to fixed airways obstruction of bronchiolitis obliterans syndrome.
Region-9; Food-additives; Food-processing; Food-processing-industry; Food-processing-workers; Respiratory-function-tests; Respiratory-protective-equipment; Respiratory-system-disorders; Pulmonary-system-disorders; Pulmonary-function; Pulmonary-function-tests; Exhaust-hoods; Exhaust-systems; Ventilation-hoods; Ventilation-systems; Airway-obstruction