Health Hazard Evaluations (HHEs)

(2018) Exposure to a new cleaning and disinfection product and symptoms in hospital employees. (Click to open report)
The National Institute for Occupational Safety and Health (NIOSH) received a confidential employee request to conduct a health hazard evaluation at a hospital. The request cited concerns about exposure of hospital employees to a sporicidal product containing hydrogen peroxide, peracetic acid, and acetic acid and described symptoms experienced by employees. Employee symptoms noted in the health hazard evaluation request included burning eyes, nose, and throat; runny nose; cough; headache; dizzine... (Click to show more) The National Institute for Occupational Safety and Health (NIOSH) received a confidential employee request to conduct a health hazard evaluation at a hospital. The request cited concerns about exposure of hospital employees to a sporicidal product containing hydrogen peroxide, peracetic acid, and acetic acid and described symptoms experienced by employees. Employee symptoms noted in the health hazard evaluation request included burning eyes, nose, and throat; runny nose; cough; headache; dizziness; nausea; nose bleeds; asthma exacerbation; skin burns; and rashes. We performed a walk-through assessment of cleaning product use at the hospital on April 9, 2015, and informally interviewed employees about their cleaning product use and any related health concerns that they may have had. We learned that sporicidal product containing hydrogen peroxide, peracetic acid, and acetic acid was used predominantly by environmental services staff and that nursing and ancillary staff predominantly used PDI or bleach wipes for routine point of care cleaning activities. We observed that the sporicidal product containing hydrogen peroxide, peracetic acid, and acetic acid was the main cleaning product used by environmental services staff for all surface cleaning duties. Environmental services staff were observed occasionally using other asthmagen-containing products including products containing ethanolamines, bleach, or quaternary ammonium compounds when cleaning glass, general surfaces, or bathroom surfaces. Asthmagens are substances capable of causing asthma. On July 29, 2015, we performed a small-scale air sampling and a post-shift survey of environmental services staff. We collected ten samples, including full-shift, task-based, and 15-minute exposure samples, from employees' breathing zones while they performed regular cleaning tasks. All samples were analyzed for the three chemicals found in the sporicidal product: hydrogen peroxide, peracetic acid, and acetic acid. All 15-minute air samples for acetic acid were below the NIOSH recommended short-term exposure limit of 15 parts per million (ppm). All 15-minute and task-based exposure air samples for hydrogen peroxide and peracetic acid were below the limit of detection for the instrument used to detect the analyte. The limit of detection was 4 ug of hydrogen peroxide per sample and 2 ug of peracetic acid per sample. We combined all full-shift time-weighted average samples and post-shift survey results from the small-scale survey on July 29 with the results from our full environmental survey from September 8-11, 2015. We returned in August 2015 and administered a voluntary health and work history questionnaire to 79 environmental services staff and 84 non-environmental services staff for a total of 163 hospital employees. Non-environmental services staff were recruited from the same areas and departments of the hospital where environmental services staff were located. Questions addressed respiratory and dermatological symptoms, asthma and other diagnoses, smoking history, work history and practices, and demographic information. On September 8-11, 2015, we returned to perform full-shift air sampling on environmental services staff performing cleaning activities. We collected 45 full-shift air samples for hydrogen peroxide, peracetic acid, and acetic acid from the daylight, evening, and night shift environmental services staff. We also administered a voluntary post-shift survey identical to the post-shift survey used in July 2015 to all staff who participated in the air sampling survey. We observed environmental services staff while they performed their regular cleaning duties and noted task duration, cleaning product use and duration, and use of any personal protective equipment. We also assessed the ventilation systems in areas of the hospital where frequent cleaning was observed. The highest full-shift time-weighted average exposures to hydrogen peroxide, peracetic acid, and acetic acid were observed in the Womancare Birth Center, Birth Center Triage, Birth Center Operating Rooms, and the Medical-Surgical areas. Full-shift time-weighted average exposure levels for hydrogen peroxide, peracetic acid, and acetic acid ranged from 5.5 parts per billion (ppb) - 511.4 ppb for hydrogen peroxide, 1.1 ppb - 48.0 ppb for peracetic acid, and 6.7 ppb - 530.3 ppb for acetic acid. No full-shift samples were below the limit of detection. All full-shift time-weighted average air samples for hydrogen peroxide and acetic acid were below established U.S. occupational exposure limits. The OSHA permissible exposure limit and NIOSH recommended exposure limit is 1 ppm for hydrogen peroxide and 10 ppm for acetic acid. To date, no full-shift time-weighted average occupational exposure limit for peracetic acid has been established in the United States. The most commonly reported symptoms in the health and work history questionnaire were nasal problems and watery eyes. Forty-two percent of health and work history questionnaire participants reported nasal problems and 40% of all questionnaire participants reported watery eyes. Other commonly reported health outcomes included, asthma-like symptoms (28%), skin problems (19%), and wheeze (16%). Among reported symptoms, some were described to be work-related, as they improved away from the facility. Users of the sporicidal product containing hydrogen peroxide, peracetic acid, and acetic acid reported higher prevalence of work-related health outcomes including cough, shortness of breath, asthma-like symptoms, asthma attack, use of asthma medicine, asthma symptoms, use of allergy medicine, nasal problems, and skin problems, with wheeze and watery eyes being significantly higher in the sporicidal product users than non-users. Nasal and eye irritation were also the most frequently reported symptoms in the postshift survey of acute symptoms. We observed increases in work-related acute upper and lower airway symptoms in employees exposed to hydrogen peroxide, peracetic acid, and acetic acid vapors. Increased exposure to hydrogen peroxide, peracetic acid, and acetic acid was significantly associated with increases in acute nasal and eye irritation. For employees who participated in our air sampling survey as well as the health and work history questionnaire, shortness of breath on level ground was also significantly associated with increased exposure to hydrogen peroxide, peracetic acid, and acetic acid. We provide several means to reduce employee exposure to the sporicidal product containing hydrogen peroxide, peracetic acid, and acetic acid. We recommend that management customize the use of sporicidal products containing hydrogen peroxide, peracetic acid, and acetic acid to areas of high risk for healthcare-acquired infections and minimize the use of sporicidal products on non-critical surfaces and in non-patient areas. We also recommend that management provide workplace accommodations for employees who develop symptoms related to the use of sporicidal and high-level disinfectants. Management should also ensure that all heating, ventilation, and air-conditioning systems are functioning well and meet all applicable ASHRAE standards. Additional details and recommendations to reduce employee exposure to liquids, vapors, and mists from the sporicidal product are provided in this report. (Click to show less)
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(2017) Health hazard evaluation report: evaluation of potential hazards during harvesting and processing cannabis at an outdoor organic farm. (Click to open report)
The Health Hazard Evaluation Program received a request from a union representative to evaluate potential hazards associated with harvesting and processing cannabis at an outdoor organic farm. We evaluated ergonomic, chemical, and microbial hazards and conducted medical interviews with employees about their health concerns. Although employees did not report any work-related health problems, we identified some exposures and conditions that could affect employee health. If hand trimming tasks are ... (Click to show more) The Health Hazard Evaluation Program received a request from a union representative to evaluate potential hazards associated with harvesting and processing cannabis at an outdoor organic farm. We evaluated ergonomic, chemical, and microbial hazards and conducted medical interviews with employees about their health concerns. Although employees did not report any work-related health problems, we identified some exposures and conditions that could affect employee health. If hand trimming tasks are performed for longer periods than we observed, the repetitive hand motions would create a risk for hand and wrist musculoskeletal disorders. Tetrahydrocannabinol, the psychoactive component in cannabis, was detected on all surface wipe samples collected (cannabis processing areas and on hand trimming scissor blades). This indicates the potential for dermal and ingestion exposures. However, the health implications from occupational exposure to tetrahydrocannabinol are unknown. Air samples indicated that Botrytis cinerea, a plant pathogen, was the main fungal species, while actinobacteria, common soil bacteria, was the most frequently identified bacterial phyla. Airborne exposure to actinobacteria and fungus like Botrytis cinerea can increase the risk of allergic and respiratory symptoms. Air samples for endotoxins were all below the occupational exposure limit. We also found that employees used latex gloves, which can cause allergic reactions. Glove use was required for some tasks. NIOSH investigators recommended (1) changing procedures and improving tools to reduce the potential for musculoskeletal disorders, (2) developing a cleaning schedule for work and tool surfaces, (3) training employees on tool cleaning, lubrication, sharpening, and maintenance, and (4) wearing nonlatex gloves when handling cannabis, cannabis products, or equipment that contacts cannabis. (Click to show less)
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(2015) Health hazard evaluation report: evaluation of an unpleasant odor at an aircraft ejection seat manufacturer. (Click to open report)
The Health Hazard Evaluation Program received a request from the employer at an ejection seat manufacturing facility. Employees were concerned about an odor in the facility and health symptoms thought to be related to it. The odor reportedly permeated and remained in materials and goods of employees for weeks after they left the facility. Some employees described the odor as a musty smell and others as a chemical smell. In this facility, stock aluminum is cut and machined into smaller parts in f... (Click to show more) The Health Hazard Evaluation Program received a request from the employer at an ejection seat manufacturing facility. Employees were concerned about an odor in the facility and health symptoms thought to be related to it. The odor reportedly permeated and remained in materials and goods of employees for weeks after they left the facility. Some employees described the odor as a musty smell and others as a chemical smell. In this facility, stock aluminum is cut and machined into smaller parts in fully enclosed computer numerical control (CNC) metalworking machines that use semi-synthetic, water-miscible cutting oils. The manufacturing process also includes painting parts in a down-draft paint booth, sewing, and assembly. We evaluated indoor environmental quality; sampled air for volatile organic compounds (VOCs), metalworking fluid, endotoxin, and microbial contaminants; analyzed metalworking fluid for microbial diversity and endotoxin; and interviewed employees about their work and health during our site visit in May 2014. We found that 2-methoxy-3,5-dimethylpyrazine (3,5-MDMP) was likely causing the odor. This chemical may be produced by bacteria found in the metalworking fluid. The metalworking fluid also contained high endotoxin concentrations. Metalworking fluid exposures in air reached about half of the NIOSH recommended limit. Metalworking fluid was not well contained around the stock metal cutting machine. Additionally, ventilation systems and water diversion systems were not well-maintained, condensation pans in air handling units had standing water and debris, gutters were rusted through, and air recirculation rates were high in some departments indicating poor general ventilation. The most common work-related symptoms reported by employees were fatigue, headache, eye irritation, runny nose or congestion, and cough. Employees who wore gloves used latex gloves when working with metalworking fluid. To eliminate the odor and reduce employee exposures to metalworking fluids, we recommended the employer (1) isolate the CNC department from the rest of the facility with barrier walls or relocate it to a separate room, (2) install a dedicated ventilation system in the CNC department, (3) implement maintenance programs for managing metalworking fluid in the machines and recycling system, (4) develop and carry out a plan for metalworking machine decontamination, and (5) improve metalworking fluid containment at the stock metal cutting machine. We also recommended the employer provide and employees wear non-latex gloves when handling goods or doing tasks that require contact with metalworking fluids, and employees wash with soap and water if they get metalworking fluid on their skin and after removing gloves. (Click to show less)
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(2014) Health hazard evaluation report: evaluation of musculoskeletal disorders and traumatic injuries among employees at a poultry processing plant. (Click to open report)
The Health Hazard Evaluation Program received a request from a poultry processing plant in South Carolina. The United States Department of Agriculture/Food Safety and Inspection Service required the plant to request a NIOSH evaluation in order to obtain an evisceration line speed waiver under the Salmonella Initiative Program. The plant asked NIOSH to identify the potential for increase in musculoskeletal and upper extremities trauma due to the planned evisceration line speed increase. In respon... (Click to show more) The Health Hazard Evaluation Program received a request from a poultry processing plant in South Carolina. The United States Department of Agriculture/Food Safety and Inspection Service required the plant to request a NIOSH evaluation in order to obtain an evisceration line speed waiver under the Salmonella Initiative Program. The plant asked NIOSH to identify the potential for increase in musculoskeletal and upper extremities trauma due to the planned evisceration line speed increase. In response to this request, NIOSH investigators evaluated ergonomic hazards, nerve damage in employees' hands and wrists (known as carpal tunnel syndrome), and traumatic injuries during three visits. We assessed repetition and force in 67 job tasks, and collected medical and personnel records, and logs of work-related injuries and illnesses to evaluate musculoskeletal disorders and traumatic injuries. In an August 2012 baseline evaluation, we gave a questionnaire and tested nerve function for Fresh Plant production line employees and live hang contractors. After our baseline evaluation, two evisceration lines were combined into one resulting in a similar number of birds processed by most employees daily. In a June 2013 follow-up evaluation, we interviewed Fresh Plant production line employees and live hang contractors who had participated in August 2012. We noted changes the plant had made after increasing the evisceration line speed and assessed the effect of these plant changes on musculoskeletal disorders and traumatic injuries among employees. The results of our baseline evaluation indicated that 41% of participants were performing jobs above the ACGIH TLV for hand activity and force and 42% had evidence of carpal tunnel syndrome. The prevalence of hand or wrist symptoms (pain, burning, numbness, or tingling) was similar at baseline and follow-up. Fifty-seven percent of participants reported at least one musculoskeletal symptom (not including hand or wrist symptoms) at both baseline and follow-up evaluations. The Fresh Plant's rate of OSHA recordable injuries and illnesses was higher than the poultry processing industry average for 2009-2012. The most common work-related injuries by cause, for all years, were "cut/puncture/scrape," "repetitive motion," "fall/slip/trip," "cumulative," and "caught in/under/between." To address the potential for musculoskeletal disorders and traumatic injuries among employees, NIOSH investigators recommended the employer (1) implement the 2013 OSHA Guidelines for Poultry Processing and recommendations from poultry industry groups, (2) redesign job tasks so that levels of hand activity and force are below the ACGIH TLV, (3) use a job rotation schedule until the redesign is completed, (4) ensure that the knife change out schedule is strictly followed, (5) provide more than one break during the work shift, and (6) enhance reporting, screening, and medical assessment onsite to improve early intervention of musculoskeletal disorders and traumatic injuries. We recommended the employees (1) report symptoms and injuries as soon as they occur to supervisors and onsite medical staff, (2) use only sharp knives and change knives on a regular basis, (3) make sure the standing platforms are adjusted to the correct height, (4) report potential fall/slip/trip hazards to supervisors so they can be quickly addressed, and (5) follow up with onsite medical staff and your personal doctor if you were found to have an abnormal nerve conduction test result. (Click to show less)
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(2013) Health hazard evaluation report: evaluation of dermal exposure to polycyclic aromatic hydrocarbons in fire fighters (summary). (Click to open report)
The Health Hazard Evaluation Program carried out a study at a fire service training facility to assess exposures to airborne polycyclic aromatic hydrocarbons (PAHs) and other aromatic hydrocarbons. The purpose was to learn whether these substances pass through the skin of firefighters wearing full ensembles. Some PAHs and other aromatic hydrocarbons are known or suspected of causing cancer. The study consisted of two rounds (1 year apart). In each round, five firefighters fought a controlled str... (Click to show more) The Health Hazard Evaluation Program carried out a study at a fire service training facility to assess exposures to airborne polycyclic aromatic hydrocarbons (PAHs) and other aromatic hydrocarbons. The purpose was to learn whether these substances pass through the skin of firefighters wearing full ensembles. Some PAHs and other aromatic hydrocarbons are known or suspected of causing cancer. The study consisted of two rounds (1 year apart). In each round, five firefighters fought a controlled structure burn once a day for 3 days. Firefighters wore new or freshly laundered turnout gear each day and wore self-contained breathing apparatus (SCBA). The burns took place in a timber-framed structure or a metal container; interior walls were covered with drywall. The rooms were set up with typical family room furniture. The burns lasted an average of 22 minutes. Firefighters' activities included an average of 11 minutes watching the fire build, 3.5 minutes knocking down the fire, and 7.5 minutes doing overhaul. We collected air, breath, urine, and wipe samples of the skin (forearms, hands, neck, face, and scrotum) throughout the day. We analyzed the samples for PAHs and aromatic hydrocarbons in the air, PAHs on firefighters' skin before and after firefighting, and PAHs and aromatic hydrocarbons in firefighters' blood and urine before and after firefighting. The air samples showed that all the burns released PAHs into the air. The PAH levels were the same or higher than levels reported in other firefighting studies. The levels of PAHs in air during five burns were higher than the occupational exposure limit. The air levels decreased after knockdown but remained above the occupational exposure limit during overhaul. Firefighters do not always wear SCBA during overhaul. The biological monitoring showed that (1) the PAH levels on fire fighters' necks (least protected body area) were higher right after the burns than before (PAHs were not found on other areas of fire fighters' skin), (2) levels of PAHs excreted in urine 3 hours after firefighting were higher than those excreted just before or just after firefighting, and (3) benzene was the main aromatic hydrocarbon measured in fire fighters' breath at levels that were higher just after firefighting than just before (we detected no benzene in urine after firefighting). HHE investigators determined that the levels of PAHs and benzene in firefighters' bodies were similar to levels in occupational groups with low exposures to these compounds. PAHs and benzene likely entered their bodies through their skin because most fire fighters wore properly working SCBA. The following recommendations were provided: (1) maintain and routinely test SCBA to ensure proper function, (2) require firefighters to wear full protective ensembles, including SCBA, during knockdown and overhaul for all fire responses, (3) provide firefighters with long hoods that are unlikely to come untucked, (4) provide as much natural ventilation as possible to burned structures before starting investigations, (5) take off gear before entering a rehab area; remove SCBA and hood last, (6) store gear on the outside of the apparatus when riding back to the station, and (7) wash hands immediately and shower as soon as possible after a fire response. <a href="https://www.cdc.gov/niosh/hhe/reports/pdfs/2010-0156-3196.pdf"target="_blank">The full 83 page report is also available.</a> (Click to show less)
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