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HHE Search Results
1057 HHE reports were found based on your search terms. Reports are listed in order of year published with the most recently published reports listed first.
Year Published and Title
(2006) Buildings in the Vicinity of the World Trade Center, New York City, New York. (Click to open report) On January 1, 2002, the National Institute for Occupational Safety and Health (NIOSH) received three health hazard evaluation (HHE) requests from employee representatives at four different work sites: Stuyvesant High School, the Borough of Manhattan Community College (BMCC), 120 Broadway and 40 Rector Street (housing four city agencies), near the World Trade Center (WTC) site. This report summarizes four separate NIOSH investigations, which document the extent of physical and psychological sympt... (Click to show more)On January 1, 2002, the National Institute for Occupational Safety and Health (NIOSH) received three health hazard evaluation (HHE) requests from employee representatives at four different work sites: Stuyvesant High School, the Borough of Manhattan Community College (BMCC), 120 Broadway and 40 Rector Street (housing four city agencies), near the World Trade Center (WTC) site. This report summarizes four separate NIOSH investigations, which document the extent of physical and psychological symptoms among workers at these sites in the months following the September 11, 2001 disaster at the WTC. Each of these reports compared physical and mental health symptoms among employees at these buildings with the same symptoms among employees at comparable New York City work sites distant from the WTC. NIOSH personnel conducted a questionnaire survey of employees at Stuyvesant High School and a comparison high school, La Guardia High School, in late January 2002. The survey occurred at BMCC and a comparison college, York Community College, in mid-March 2002; at 40 Rector Street in early April 2002, and at 120 Broadway (state attorney general's office) in early June 2002. The LeFrak Building, was surveyed in early April 2002 and was the comparison building for 40 Rector Street and 120 Broadway. We used a self-administered questionnaire to ask about physical and mental health symptoms that occurred since September 11 and symptoms still present at the time of the survey. In addition, we used the questionnaire to ask participants about experiences on September 11, about medical diagnoses since then, and about social support. Participation rates were 82%-83% at both high schools and at the 40 Rector Street building, 76% at the comparison office building, about 55%-60% at BMCC, about 45%-50% at the comparison college, and 37% at the 120 Broadway building. In all four studies, the prevalence of physical symptoms, including upper and lower respiratory symptoms, tended to be higher at the work sites near the WTC site than at the comparison work sites. The prevalence of persistent symptoms (upper and lower respiratory symptoms) also tended to be higher. Depressive symptoms and post traumatic stress disorder (PTSD) symptoms were prevalent at Stuyvesant and BMCC, but not at the two office buildings. Likewise, PTSD diagnosed since September 11 was more prevalent at Stuyvesant and BMCC than at their comparison sites, and a similar, though not statistically significant, prevalence ratio was found at the 40 Rector Street building. Newly diagnosed depression was not statistically more prevalent at any of the individual sites than at the comparison sites. All the surveys were limited by the lack of quantitative information about employees' exposures to dust and smoke from the collapsing buildings and fires on September 11 and our inability to infer medical diagnoses solely on the basis of a symptom survey. Since our interim letters were issued, published reports from several studies have described short- and medium-term physical health effects among rescue workers, office workers, and residents from the surrounding community. These studies have provided information suggesting that exposure to the dust cloud and the chemical/physical properties of the dust from the collapse of the buildings on September 11 as well as exposures to combustion products from the burning materials have contributed to the respiratory problems. Continued longitudinal follow-up of those exposed will be necessary to determine whether the changes in spirometry documented up to 5 years post-disaster will lead to chronic problems or whether the initial decline in respiratory function will be followed by recovery, as has been seen in other irritant-exposed groups. Reports of psychological problems have also been well documented since our interim letters were issued. On-going interventions addressing these reactions may help prevent the development of long-lasting psychological sequelae. NIOSH investigators determined that an occupational health hazard due to exposures surrounding the collapse of the World Trade Center existed among the working groups studied. A substantial burden of symptoms of depression and PTSD, as well as physical symptoms of eye irritation and upper airway irritation were present among those surveyed. Recommendations for medical evaluation of symptomatic persons, facilitating access to medical heath services, fostering social support, and training were given.
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(2006) Claremont Flock Corporation, Leominster, Massachusetts. (Click to open report) In 1997, a case of flock workers' lung occurred at Claremont Flock Corporation. The National Institute for Occupational Safety and Health (NIOSH) conducted a health hazard evaluation (HHE) in 1998 at several of Claremont Flock's plants and found that cleaning with compressed air and bagging flock were associated with worker-reported symptoms. The HHE report provided environmental and medical recommendations to the company to prevent flock-related disease in their plants. In March 2004, based on ... (Click to show more)In 1997, a case of flock workers' lung occurred at Claremont Flock Corporation. The National Institute for Occupational Safety and Health (NIOSH) conducted a health hazard evaluation (HHE) in 1998 at several of Claremont Flock's plants and found that cleaning with compressed air and bagging flock were associated with worker-reported symptoms. The HHE report provided environmental and medical recommendations to the company to prevent flock-related disease in their plants. In March 2004, based on a case report consistent with flock workers' lung at Claremont Flock's only remaining plant, the Massachusetts Department of Public Health Occupational Health Surveillance Program requested technical assistance to determine if there had been improvement in the environmental conditions and to update the health status of the workforce. NIOSH conducted environmental and medical surveys at this plant in January 2005 to characterize exposures and symptoms of flock-exposed workers and internal comparison groups. The environmental survey consisted of personal time-integrated gravimetric sampling for respirable dust concentration and sampling with aerosol photometers to obtain real-time continuous relative levels of dust (approximately respirable) during some plant activities. Videotaping was done to record events that might be associated with any observed peaks in real-time readings. We invited all 80 employees to take part in the medical survey. Trained NIOSH interviewers administered computer-based questionnaires that focused on respiratory and systemic symptoms, physician diagnosis of respiratory illnesses, smoking, work history, respirator use, and whether fit-testing had been conducted. Time-integrated respirable dust sampling results showed that the bagger/cutters and the dryer operators had the highest geometric mean 8-hour time-weighted exposures of 0.13 and 0.80 mg/m3, respectively. For most groups of workers, the exposures were found to be largely unchanged since our previous investigation in 1998, but for these 2 groups of workers the exposures were found to have increased. This happened despite the engineering control changes made in the plant since 1998. Real-time personal sampling results indicated that cleaning operations, such as blowing with compressed air, sweeping, and shovelling of flock, were associated with increases in dust levels around the workers. Manipulation of bags of flock both inside and outside of designated "respirator-required" zones at bagging stations was also associated with elevated levels of dust. A total of 74 employees (participation rate = 92.5%) participated in the medical survey. The majority of employees were male (92%), white (58%), and non-smokers (76%). The mean tenure of Claremont Flock workers was 8 years, and only 16% of workers had either changed jobs or started working at Claremont Flock within the last 6 months. A total of 22 participants (30%) reported cleaning with compressed air for at least one hour per week, and 23 participants (31%) reported working with cotton in the last 12 months. Except for bagging cotton, there was an increase in the percentage of employees who wear respirators during their activities, when we compared the 2005 and 1998 surveys. The percentage of fit-tested workers also increased in the 2005 survey compared to the 1998 survey. The most frequently reported symptoms were wheeze apart from colds, throat irritation, and sinus problems. The prevalences of throat irritation, usual and chronic cough, shortness of breath while walking up a slight hill, and wheeze apart from colds were lower among never smokers compared to current or former smokers. When we took into account only symptoms with onset after employment at Claremont Flock, chronic phlegm and shortness of breath were the most frequently reported symptoms. "Wheeze apart from cold" and "pneumonia in the last year" were statistically significantly elevated when we compared symptom prevalences of participating workers to expected prevalences based on national data. In general, dryers and baggers/cutters, workers who cleaned for one hour or more per week using compressed air, and employees with high cumulative exposure to flock-associated dust (> 0.425 mgyear/m3) had higher prevalences of symptoms than other workers. In multivariate models, cleaning equipment with compressed air was significantly associated with throat irritation. High cumulative exposures were significantly associated with the development of sinus irritation. A comparison of 1998 symptom prevalences for a subgroup that participated in both the 1998 and 2005 surveys indicated that those who continued working had lower symptom prevalences than those who had left after 1998. This is a form of "healthy-worker effect", whereby health effects of a workplace exposure are underestimated by looking at current workers. We conclude that working with flock and cleaning with compressed air are associated with health effects at this plant. We recommend that the company prevent flock-associated dust exposures: by providing engineering controls and improving work practices for the bagging process including not only the filling of bags at the bagging stations but also the subsequent manipulation of the bags for weighing, sewing, and palletizing; by determining and controlling the source of elevated dust levels during production in the dryer rooms and repositioning the dryer room bagging station local exhaust ventilation hoods to the tops of the bags being filled with flock; by providing new cleaning methods that will eliminate the elevated dust levels associated with compressed-air blow-downs, sweeping, and shovelling of flock; by verifying effectiveness of controls with regular air sampling; and by expanding respiratory protection requirements, until the controls can be implemented, to all bagging and flock-cleaning processes, including manual unplugging of accumulators (enclosed baghouses), and to the entire production operation in the dryer rooms. In terms of medical recommendations, we suggest that the company continue to offer a smoking cessation program and to enforce the no-smoking policy already in place; include in the current respirator program a means of identifying workers with respiratory symptoms such as shortness of breath, wheezing, or phlegm production, and a means of detecting declines in lung function; and provide information about flock workers' lung to employees and health consultants responsible for the respirator program. We also recommend that employees wear respirators when required; handle bags of flock with care to prevent airborne flock; seek medical evaluation for respiratory symptoms, such as shortness of breath, wheezing, or phlegm production and inform health care providers of flock exposures; and inform management of respiratory symptoms and associated flock exposures. The Claremont Flock plant in Leominster, Massachusetts was first evaluated by NIOSH in 1998 as part of its initial investigation of the risk of occupational lung disease from exposure to flock-associated dust. In 2004, after learning that a worker at this plant had been recently identified as having medical findings consistent with flock workers' lung, the Massachusetts Department of Public Health Occupational Health Surveillance Program requested NIOSH technical assistance to determine if there had been improvement in environmental conditions at the plant and to obtain updated information on the health status of the workforce. NIOSH conducted a medical and environmental survey at this plant in January 2005. Despite engineering control changes implemented after 1998, respirable dust levels were found to be unchanged or increased. Upper respiratory symptoms were associated with cleaning equipment with compressed air, and with high cumulative exposure to flock-associated dust. To minimize the risk to workers, management should improve work practices and increase mandatory use of respirator...
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(2006) DaimlerChrysler Jefferson North Assembly Plant, Detroit, Michigan. (Click to open report) On November 15, 2005, the National Institute for Occupational Safety and Health (NIOSH) received a request for a Health Hazard Evaluation from workers at DaimlerChrysler's Jefferson North Assembly Plant (JNAP) in Detroit, Michigan. The request stated that workers were experiencing respiratory problems (asthma, chronic bronchitis, chronic obstructive pulmonary disease (COPD)) and deaths in the setting of inadequate control of welding-related exposures. Several workers reported that they were awar... (Click to show more)On November 15, 2005, the National Institute for Occupational Safety and Health (NIOSH) received a request for a Health Hazard Evaluation from workers at DaimlerChrysler's Jefferson North Assembly Plant (JNAP) in Detroit, Michigan. The request stated that workers were experiencing respiratory problems (asthma, chronic bronchitis, chronic obstructive pulmonary disease (COPD)) and deaths in the setting of inadequate control of welding-related exposures. Several workers reported that they were aware of coworkers who had developed respiratory disease (COPD, cancer) after they started working at the plant and had died at relatively young ages (mid 40s to early 60s). A young worker with preexisting asthma had died of asthma in October 2005 several hours after getting off work. Findings indicating that asthma was the cause of death were noted on the autopsy report. Most of the welding at JNAP is resistance (spot) welding performed by robots. Some of the welding areas have plastic sheeting and exhaust fans (process ventilation) to decrease contamination of the plant air. Some repair welding is performed by workers utilizing gas metal arc welding (also known as metal inert gas (MIG) welding) and flux-cored arc welding. Among the concerns reported by workers was the potential for increased welding-related exposures when less outside air is brought into the plant by the ventilation system during cold weather. Workers reported that repair welding was often performed with no local exhaust ventilation. Workers were also concerned about the potential for health effects from exposures to chemicals resulting from welding on metal parts that have had adhesives applied in the production process. Some workers on the fluid-fill deck reported recurrent problems with asthma, bronchitis, and sinusitis that they felt were related to exposures to engine fluids (radiator, brake, power steering) and airconditioning refrigerant. NIOSH staff visited JNAP from February 8-10, 2006 to obtain additional information regarding potential worker exposures and health effects. NIOSH staff performed a walkthrough of the entire facility and performed qualitative and semiquantitative air sampling for particulate and volatile organic compounds (VOCs) at several locations. The highest particle counts were for particles less than one micrometer in diameter. Some of the VOCs detected in the plant air were also detected in the headspace of adhesive bulk samples. NIOSH staff reviewed air sampling data and material safety data sheets provided by the company, and two reports prepared by the Michigan Occupational Safety and Health Administration (MIOSHA) which detailed the findings of their evaluations of welding-related exposures at JNAP in October 2005 and January 2006. None of the air sampling results exceeded existing MIOSHA permissible exposure limits or NIOSH recommended exposure limits. The potential for eye, skin, or respiratory tract irritation from exposures to adhesives and other substances used in the plant was documented in material safety data sheets. Twenty one employees discussed their health concerns with NIOSH staff. Four of these employees permitted review of their medical records. Information on the 31 year-old employee, who died after completing his work shift, was obtained from an autopsy report, his next of kin, and coworkers. Seven employees in the body shop reported symptoms consistent with new-onset asthma or exacerbation of pre-existing asthma (including the 31 year-old employee who died after completing his work shift). Three of these seven employees had medical evaluation results (including the above-mentioned autopsy report) that were consistent with new-onset asthma or exacerbation of pre-existing asthma. Four employees reported asthma and/or recurrent bronchitis while working on the fluid-fill deck. One of these four employees provided medical records which showed reversible airways obstruction consistent with asthma on lung function tests. JNAP employees can be exposed to many agents with potential to induce or aggravate respiratory illness. Some employees may be affected by the combined effects of exposure to several irritants in the form of dusts, fumes, and gases. This will be more likely when ventilation is decreased due to mechanical breakdowns or in an attempt to decrease heating costs during winter months. Regulatory compliance with exposure limits does not ensure that all workers are protected. The potential for exposures in automotive assembly plants to cause occupational respiratory problems has not yet been adequately assessed. Symptoms and illnesses in employees suggest that additional medical monitoring and control of exposures at JNAP should be implemented and detailed studies to assess occupational health risk conducted. JNAP management should implement the recommendations provided in this report to minimize the potential risk to employees from welding-related and other exposure sources in the plant.
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(2006) Diversified Roofing Inc., Phoenix, Arizona. (Click to open report) On March 31, 2003, the National Institute for Occupational Safety and Health (NIOSH) received a request for a health hazard evaluation (HHE) from the United Union of Roofers, Waterproofers, and Allied Workers Local 135 at Diversified Roofing Inc. in Phoenix, Arizona. The request stated that employees were exposed to hazardous levels of dust, particularly crystalline silica, while cutting cement tiles. A concern was also raised about the lack of training and use of personal protective equipment. ... (Click to show more)On March 31, 2003, the National Institute for Occupational Safety and Health (NIOSH) received a request for a health hazard evaluation (HHE) from the United Union of Roofers, Waterproofers, and Allied Workers Local 135 at Diversified Roofing Inc. in Phoenix, Arizona. The request stated that employees were exposed to hazardous levels of dust, particularly crystalline silica, while cutting cement tiles. A concern was also raised about the lack of training and use of personal protective equipment. An initial site visit was conducted on April 29-30, 2003. This visit included observations of the tile cutting process, collection of bulk samples of tile dust, and spot measurements of dust, noise, and carbon monoxide (CO) levels. A second site visit was conducted on June 16-18, 2003. Respirable and total dust, respirable silica, noise, and CO were monitored on employees performing roof installation. All employees who were monitored were asked questions on general health symptoms, work practices, and use of personal protective equipment. Eight full-shift personal noise samples, eight full-shift personal breathing zone (PBZ) air samples for CO, sixteen full-shift PBZ air samples for respirable dust and silica, and nineteen full-shift PBZ air samples for total dust were collected over the 2 days. The noise exposure results showed that all of the employees' exposures were over the NIOSH Recommended Exposure Limit (REL), 63% (5 of 8) exceeded the Occupational Safety and Health Administration (OSHA) Action Level, and 38% (3 of 8) were over the OSHA Permissible Exposure Limit (PEL) for noise. The CO exposure results showed that all of the employees' exposures were below the REL time-weighted average; one employee's exposure exceeded the NIOSH ceiling level. The respirable silica (quartz) exposure results showed that 88% (14 of 16) of the employees' levels exceeded the NIOSH REL and American Conference of Governmental Industrial Hygienists threshold limit value, and 75% (12 of 16) exceeded the OSHA PEL for respirable silica. The total dust exposures ranged from 0.68 milligrams per cubic meter (mg/m3) to 13 mg/m3. The respirable dust exposures ranged from 0.23 mg/m3 to 2.3 mg/m3. During the initial site visit informal employee interviews revealed that the duration of employment ranged from a few weeks to 7 years. Most of the employees reported wearing hard hats and eye protection regularly; respirators and hearing protection were infrequently worn. None of the employees reported that they knew the hazards of silica overexposure even though some employees reported respiratory symptoms consistent with silica overexposures, such as difficulty breathing and/or cough. A follow-up visit was conducted February 22-24, 2005, to perform the medical screening component of the HHE. Employees were invited to participate if they had at least 5 years experience as a roofer. Duration of dry cutting was used as a marker for duration of respirable silica exposure. The medical screening included a questionnaire, lung function test (i.e., spirometry), and a chest x-ray. NIOSH personnel read the questionnaire aloud to participants in their primary language. Spirometry results were reviewed by a NIOSH pulmonologist. The chest x-rays were interpreted by NIOSH certified B-readers according to the standards set forth by the International Labor Organization for grading work-related lung disease chest x-rays. Most roofers who participated in the medical screening had normal lung function. Of those with abnormal lung function, none had moderate or severe impairments. After controlling for the effects of smoking, it was found that lung function decreased with increasing years of dry cutting cement tiles. No chest x-rays showed findings consistent with silicosis. Previous air sampling confirmed that all employees on the roof when tile cutting was occurring could be overexposed to respirable silica, placing them at risk for silicosis. It is vital to institute OSHA-mandated employee protection programs to protect workers from further exposure to respirable silica. Employee monitoring for silicosis should also be started as per the recommendations set forth in OSHA's Special Emphasis Project for Silicosis. NIOSH investigators determined that an occupational health hazard due to exposures to respirable silica and noise existed for workers at Diversified Roofing Inc. Recommendations for controlling workplace exposures include reducing or eliminating exposures by implementing engineering controls and enforcing the use of personal protective equipment under the OSHA respirator program guidelines. Employees need education regarding the potential health hazards of respirable silica exposure, and an employee monitoring program as per the OSHA Special Emphasis Program on silica should be implemented. Additional recommendations are included at the end of this report.
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(2006) Dixie Cultured Marble, Birmingham, Alabama. (Click to open report) In May 2001, NIOSH received a confidential employee request for a Health Hazard Evaluation at Dixie Cultured Marble (DCM) in Birmingham, Alabama. Employees were concerned with exposures to PVC glue, fiberglass, acetone, organic peroxide, and unsaturated polyester resins in the production of cultured marble vanities, bath tubs, and shower walls and floors. Employees reported symptoms that included itchy skin, breathing problems, and headaches. In response to employee concerns, NIOSH investigators... (Click to show more)In May 2001, NIOSH received a confidential employee request for a Health Hazard Evaluation at Dixie Cultured Marble (DCM) in Birmingham, Alabama. Employees were concerned with exposures to PVC glue, fiberglass, acetone, organic peroxide, and unsaturated polyester resins in the production of cultured marble vanities, bath tubs, and shower walls and floors. Employees reported symptoms that included itchy skin, breathing problems, and headaches. In response to employee concerns, NIOSH investigators conducted an initial site visit on December 9-10, 2004 and a follow-up site visit on June 21-22, 2005. During the initial site visit, NIOSH investigators collected general area (GA) and personal breathing zone (PBZ) air samples for volatile organic compounds, collected tape samples from consenting employees' arms and a bulk sample of cultured marble dust to be analyzed for fiberglass and identified areas within the facility where they perceived elevated noise levels. They also interviewed DCM employees to gather information on demographics, health problems (work-related and non-work related), work practices, and workplace personal hygiene. During the follow-up site visit, PBZ air samples were collected for total and respirable particulate, styrene, alpha-methyl styrene, and methyl methacrylate. Noise dosimeters were placed on selected workers. Respirable particulate, alpha-methyl styrene, and methyl methacrylate air sample concentrations were all below relevant evaluation criteria. The product grinder's total particulate exposure exceeded the Occupational Safety and Health Administration (OSHA) and American Conference of Governmental Industrial Hygienists (ACGIH), 8-hr time-weighted average (TWA) exposure limits. Styrene concentrations for two employees casting cultured marble exceeded the ACGIH 8-hr TWA of 20 parts per million (ppm). Noise monitoring data indicated that the daily noise doses of the product grinder and a product buffer exceeded the OSHA permissible exposure limit, and 10 of 11 evaluated employees exceeded the NIOSH-recommended daily allowable noise dose. Twelve of 15 employees were interviewed. Four of 12 employees reported respiratory problems and skin irritation. Based on personal air sampling, noise monitoring, and employee interviews, NIOSH investigators conclude that a health hazard exists from exposure to total particulate, styrene, and noise. Recommendations to minimize exposures include improving existing ventilation systems, creating respiratory and hearing loss prevention programs, using improved hearing protection devices, and ensuring consistent use of respiratory protection.
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(2006) Dixie Regional Medical Center, Saint George, Utah. (Click to open report) The National Institute for Occupational Safety and Health (NIOSH) received a confidential Health Hazard Evaluation (HHE) request on August 23, 2005 from Intermountain Health Care (IHC) employees working at Dixie Regional Medical Center (DRMC) in Saint George, Utah. The request reported concerns about inadequate maintenance practices and poor indoor air quality (IAQ), including excess water and mold growth in heating and air conditioning units and in a crawlspace under one of the buildings. Emplo... (Click to show more)The National Institute for Occupational Safety and Health (NIOSH) received a confidential Health Hazard Evaluation (HHE) request on August 23, 2005 from Intermountain Health Care (IHC) employees working at Dixie Regional Medical Center (DRMC) in Saint George, Utah. The request reported concerns about inadequate maintenance practices and poor indoor air quality (IAQ), including excess water and mold growth in heating and air conditioning units and in a crawlspace under one of the buildings. Employee health problems included lung, immune system, and skin ailments. The HHE was originally closed with a letter to the requesters on September 1, 2005. Due to continued occupational health concerns of the requesters, the HHE reopened in January 2006. NIOSH staff visited DRMC on January 30-31, 2006. DRMC is comprised of two separate facilities, River Road Campus and 400 East Campus. The HHE requesters reported concerns at both. At the River Road Campus, there was concern about potential mold exposures related to a water leak in the crawlspace under the building. Requesters reported that leaking high-pressure ventilation ductwork running through the crawlspace created positive pressure causing air to flow from the crawlspace into the hospital. At the 400 East Campus, requesters were concerned about uncontrolled renovations that might have allowed contaminants to enter patient care areas and employee workspaces. Additionally, there were numerous concerns with the 400 East heating, ventilating, and air conditioning (HVAC) systems resulting in possible dust and mold exposures. Poor maintenance practices resulting in dirty/moldy ductwork and filters, improper or missing filters, and standing water in the air handling units (AHUs) were also reported. NIOSH found both campuses to be generally clean and well-maintained. The crawlspace area at River Road was dry with no visible mold present. Any mold growth that had occurred during the water leak had been remediated. A borate-based fungicide had been applied to the support columns and some areas of the soil floor. To help rapidly detect any future water leaks (or incursion from the outside) in the crawlspace, DRMC installed a modular-zone water-detection system complete with seven moisture sensing cables. Additionally, proper air vents and small fans had been installed in the crawlspace to help keep the area dry. The HVAC systems at River Road were clean and functioning properly, with correct filter configurations installed in each. Multiple structural changes and renovations at the 400 East campus had resulted in 13 different AHUs of various age from various manufacturers. Each unit had filters installed in the correct configuration during the NIOSH visit, and no filters appeared excessively dirty or damaged. Many of the 400 East AHUs were installed without allowing the height needed for proper condensate drainage. There was rust from standing water resulting from the overflow of drain pans. The facilities manager stated that standing water is typical during the rainy season of late summer and early fall when high outdoor humidity overwhelms the ability of the AHUs to remove moisture from the incoming air. The facilities manager also stated that during these periods, excess condensation from cooling coils can cause the filters to become saturated with water that might facilitate mold growth. However, during NIOSH's visit in January, no mold growth or wetted filters were found. Suspected mold growth was found in the rooftop mechanical room housing AHU 4th West. We conducted a video examination of the interior ventilation ductwork on the third floor of the 400 East building. The air supply duct was clean and free from any visible dirt deposits. The return ductwork had visible accumulations of lint attributed to the high volume of linens that are used by the hospital. Aside from the lint, there was no excess dirt or evidence of mold growth seen during the duct examination. NIOSH conducted a site visit at the River Road and 400 East Campuses of Dixie Regional Medical Center in Saint George, Utah to address employee concerns about water incursion and inadequate maintenance that might be adversely impacting the indoor air quality at their workplace. NIOSH found evidence of previous water incursion in the River Road crawlspace and in some air handling units at the 400 East Campus. Water-monitoring equipment had been installed in the crawlspace to detect future leaks. Modifications were planned for air handlers known to retain water during the wet season. Management had implemented policies and procedures to ensure better monitoring of areas prone to water incursion and identified a contact person for employee concerns.
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(2006) Gilster-Mary Lee Corporation, Jasper, Missouri. (Click to open report) In August 2000, the Missouri Department of Health and Senior Services requested technical assistance from the National Institute for Occupational Safety and Health (NIOSH) in an investigation of severe obstructive lung disease (bronchiolitis obliterans) in former workers of the Gilster-Mary Lee popcorn plant in Jasper, Missouri. Affected workers had worked in the room where butter flavoring was mixed into heated soybean oil (mixing room) and in the adjacent microwave popcorn packaging-area. A NI... (Click to show more)In August 2000, the Missouri Department of Health and Senior Services requested technical assistance from the National Institute for Occupational Safety and Health (NIOSH) in an investigation of severe obstructive lung disease (bronchiolitis obliterans) in former workers of the Gilster-Mary Lee popcorn plant in Jasper, Missouri. Affected workers had worked in the room where butter flavoring was mixed into heated soybean oil (mixing room) and in the adjacent microwave popcorn packaging-area. A NIOSH medical and environmental survey at the plant in November 2000 showed that plant employees had 3.3 times the rate of obstruction on NIOSH spirometry tests compared to national rates; the prevalence of obstruction in never-smokers was 10.8 times the national rate. Nineteen of 21 workers with obstruction had fixed obstruction (unresponsive to bronchodilators), and most chest x-rays and diffusing capacity tests were normal. These findings are consistent with constrictive bronchiolitis obliterans. Five of six quality control (QC) workers who repeatedly popped bags of product in microwave ovens (approximately 100 bags per worker per work shift) in a poorly ventilated room were found to have obstruction on spirometry. A strong exposure-response relationship was demonstrated between quartiles of estimated cumulative exposure to diacetyl (a volatile butter flavoring chemical contaminating the air in the plant) and the frequency of airways obstruction on spirometry tests. NIOSH investigators provided air purifying respirators that filtered both vapors and particulates for mixers and assisted with employee training in respiratory protection. In January 2001, NIOSH investigators conducted a detailed engineering control assessment and provided exposure control recommendations. NIOSH performed seven additional cross-sectional medical and environmental surveys from April 2001 through August 2003 to determine if controls were effective in reducing exposures and protecting workers. Follow-up Environmental Findings: As a result of the implementation of exposure controls from January 2001 through May 2003, average diacetyl air concentrations declined two orders of magnitude in the mixing room (from 38 ppm to 0.46 ppm) and the QC laboratory (from 0.54 to 0.002 ppm), and three orders of magnitude in the packaging area (from 1.69 ppm to 0.002 ppm for machine operators). Follow-up Medical Survey Findings: A total of 373 current workers participated in one or more NIOSH surveys. Participation by current workers at each survey ranged from 71% to 91%. One hundred eighty six of the 373 total participants participated in more than one survey (50%). However, participation in more than one survey was much greater for workers hired prior to the first NIOSH survey (Cohort-1; 100 of 146 participants, 68%) than for workers hired after the first NIOSH survey (Cohort-2; 86 of 227 participants, 38%). From the first to last survey, there was a statistically significant decline in the prevalence of eye, nose, and throat irritation in Cohort-1 participants but no significant changes in the prevalences of other symptoms or spirometry abnormalities, or in mean percent predicted FEV1. Cohort-2 participants had lower prevalences of symptoms and spirometry abnormalities, and a higher mean percent predicted FEV1, compared to Cohort-1 participants at their first survey. There were no statistically significant changes in these outcomes over time for Cohort-2 participants. Of the 88 Cohort-1 participants who participated in three or more NIOSH medical surveys, 19 (22%) had FEV1 declines of greater than 300 ml and/or 10% from their first to their last spirometry test, compared to 3 of 41 (7%) Cohort-2 participants who participated in three or more surveys. Four of nine participants who worked as mixers after the 1st NIOSH survey had FEV1 declines of greater than 300 ml and/or 10% of baseline, including one mixer who declined more than 1300 ml in nine months while working as a mixer. The total FEV1 decline in this mixer was 2800 ml over 2.75 years, which included a 1500 ml decline over two years after stopping work as a mixer. The NIOSH investigation at the Gilster-Mary Lee microwave popcorn plant in Jasper, Missouri, determined that inhalation exposure to butter flavoring chemicals is a risk for occupational lung disease. With the exposure controls implemented to date, workers in the microwave popcorn packaging area should now be at minimal risk as long as isolation of the mixing room and mezzanine is maintained and all ventilation systems are operational. The exposure controls implemented in the QC laboratory have likely minimized the risk to workers in this area as well. However, QC laboratory workers should have regularly scheduled spirometry to assure that their lung function remains stable. Mixers are still at potential risk from open handling of butter flavorings and from tank emissions. Use of appropriate respiratory protection by mixers and other workers who enter the mixing room and mezzanine area is a short-term solution to this problem. Re-engineering the oil and butter flavoring mixing process to a closed system (so that mixers do not have to handle open containers of flavoring and no longer have to open tanks that contain heated oil and/or butter flavoring) is recommended to eliminate this risk. Until a closed process is implemented, all workers who enter the mixing room or mezzanine should use appropriate respiratory protection when in those locations and should have regularly scheduled spirometry to identify early declines in lung function that may be due to exposures to butter flavoring chemicals.
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(2006) Hallmark Cards, Inc., Lawrence, Kansas. (Click to open report) NIOSH has found evidence of interstitial lung disease among workers exposed to nylon flock (flock workers' lung) in various plants in the past. In November 2003, based on health complaints among several workers, employees from Hallmark Cards, Inc. requested a health hazard evaluation (HHE) to get a better understanding of the potential respiratory hazards associated with the use of rayon flock at this card-producing plant. In order to characterize exposures, symptoms, and lung function of flock-... (Click to show more)NIOSH has found evidence of interstitial lung disease among workers exposed to nylon flock (flock workers' lung) in various plants in the past. In November 2003, based on health complaints among several workers, employees from Hallmark Cards, Inc. requested a health hazard evaluation (HHE) to get a better understanding of the potential respiratory hazards associated with the use of rayon flock at this card-producing plant. In order to characterize exposures, symptoms, and lung function of flock-exposed workers and appropriate internal comparison groups, NIOSH conducted environmental and medical surveys at this plant. The environmental survey consisted of time-integrated sampling, including air samples for gravimetric concentration of respirable dust with side-by-side air samples for fiber concentration. We conducted real-time sampling with aerosol photometers to obtain real-time continuous relative levels of dust (approximately respirable) during some plant activities together with video taping, to record events that might be associated with any observed peaks in real-time readings. For the cross-sectional medical survey, we invited 284 employees, divided into three groups according to their potential exposure, as follows: Group A, workers exposed to flock and paper dust; Group B, workers exposed to paper dust only; and Group C, workers from the ribbon production areas (without significant flock or paper dust exposure). Trained NIOSH interviewers administered computer-based questionnaires that focused on respiratory symptoms, systemic symptoms, physician diagnosis of respiratory illnesses, smoking, work history, respirator use, and whether fit-testing had been conducted. Each participant, unless medically contraindicated, was offered spirometry testing, carbon monoxide diffusing capacity (DLCO) testing, and either a bronchodilator test or a methacholine challenge test (MCT). The 8-hour time-weighted average airborne respirable dust and fiber concentrations were largely below or near the minimum detectable concentrations of 0.03 milligrams per cubic meter of air (mg/m3) and 0.01 fibers per cubic centimeter (fibers/cc), respectively. Peak exposures to airborne particulate occurred during cleaning with compressed air and vacuuming with a compressed-air vacuum. Production-related sources of airborne particulate included the open top of a flock line cyclone, flock module card feed and discharge points, and small foil compressed-air card separators. A total of 239 employees (participation rate = 84%) participated in the medical survey. The employees were predominantly female (54%), white (80%), and never-smokers (55%). Nearly one-half of the employees had worked over 20 years at the Hallmark plant. A total of 146 participants (61%) reported working at least one hour per week in an area where flock-coated cards are processed. A total of 47 participants (20%) reported cleaning with compressed air for at least one hour per week. Overall, 41 workers (17%) reported wearing air-purifying respirators at the plant. Use of respirators while cleaning equipment with compressed air was reported by 26 participants; none of the 26 reported that they had been fit-tested. Use of respirators at other times besides cleaning was reported by 31 workers, only one of whom reported having been fit-tested. Nasal irritation, sinus problems, and eye irritation were the most frequently recorded symptoms. In general, flock workers had higher prevalences of symptoms arising during employment at Hallmark than non-flock workers with paper dust exposures and ribbon workers. Workers who cleaned for one hour or more per week using compressed air generally had higher symptom prevalences than other workers. Working in areas where flock-coated cards are processed and cleaning equipment with compressed air were both significantly associated with the development of nasal symptoms after hire at Hallmark. Cleaning with compressed air was also significantly associated with the development of chronic cough. Spirometry tests showed that male flock workers were significantly more likely than male nonflock workers to have results indicating restrictive lung disease (low forced vital capacity), in which the lungs cannot expand normally. Also, employees who worked a higher number of years in areas where flock-coated cards are processed were more likely to have test findings of decreased volume in the air sacs (decreased alveolar volume) and decreased ability of the lung to transfer gases (low carbon monoxide diffusion capacity). This pattern of changes is not diagnostic by itself, but can indicate scarring and stiffness of the lung tissue which is found in interstitial lung disease (ILD), including "flock workers' lung". We conclude that working with flock and cleaning with compressed air were associated with health effects in workers at this plant. We recommend that the company take steps to prevent flock-associated dust exposures: by controlling the airborne particulate generated in compressed air cleaning and vacuuming, in the separation of cards at small foil machines processing flocked cards, and at card feed and discharge points at flock lines; by reducing the need to reach into modules; by capturing the opentop cyclone discharge, and by requiring that employees use vacuuming rather than compressed air to remove dust from their clothes. Since safe levels of flock-associated dust are unknown, we recommend that a written respiratory protection program be developed that requires NIOSH certified respirators for compressed air cleaning and fit testing of all respirator users. We recommend informing employees about work-related disease observed among flock workers and providing informational materials to them to share during any physician consultation about concerns or actual health problems. NIOSH investigators determined that a health hazard exists from occupational exposure to flock-associated dust at this plant. This risk is evidenced by upper and lower respiratory symptoms, such as nasal irritation and cough, and objective measurements of lung function suggesting a restrictive pattern, compatible with subclinical interstitial lung disease. These health outcomes are associated with work in areas where flock-coated cards are processed and equipment is cleaned with compressed air.
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(2006) International Marine Terminal, Portland, Maine. (Click to open report) On February 14, 2005, the National Institute for Occupational Safety and Health (NIOSH) received a management request for a health hazard evaluation (HHE) at the offices of Scotia Prince Cruises (SPC) in the International Marine Terminal (IMT) in Portland, Maine. Employees of Scotia Prince Cruises were concerned their respiratory and neurologic symptoms might be related to mold exposure in the IMT building. An indoor environmental quality (IEQ) evaluation by a SPC consultant during the summer of... (Click to show more)On February 14, 2005, the National Institute for Occupational Safety and Health (NIOSH) received a management request for a health hazard evaluation (HHE) at the offices of Scotia Prince Cruises (SPC) in the International Marine Terminal (IMT) in Portland, Maine. Employees of Scotia Prince Cruises were concerned their respiratory and neurologic symptoms might be related to mold exposure in the IMT building. An indoor environmental quality (IEQ) evaluation by a SPC consultant during the summer of 2004 revealed extensive fungal contamination of the SPC portion of the IMT, and employees were relocated in August 2004 to temporary offices. On February 16, 2005, the U.S. Customs and Border Protection (CBP) agency, which is also housed in the IMT building, submitted a separate HHE request based on their concern about exposure to mold and water intrusion. On March 9-11, 2005, NIOSH investigators made an initial site visit of the IMT. This visit included the collection of air, dust, and bulk samples for fungal analyses, and environmental measurements of humidity, temperature, and carbon dioxide. Information concerning the ventilation systems was collected. Confidential interviews were conducted with the SPC and CBP employees. On March 29-30, 2005, NIOSH returned to the IMT to conduct further environmental testing and to complete the confidential interviews of the CBP employees. Blood was collected from the CBP employees for measurement of Stachylysin, a possible marker of exposure to Stachybotrys chartarum. In addition, NIOSH performed an environmental assessment of the U.S. Customs House, another CBP site in Portland with no known history of fungal (mold) contamination in order to compare findings between employees exposed to mold and those not exposed to mold. Confidential interviews and blood collection for Stachylysin were performed with the employees of the U.S. Customs House. Blood from some SPC employees that had been previously collected and stored by physicians in Maine and Maryland between September and November 2004, was obtained by NIOSH for Stachylysin analysis because it was closer in time to when the employees occupied the building in August 2004. The SPC section of the IMT had signs of ongoing water intrusion, pigeon roosting, and visible mold growth in wall cavities. Active fungal growth was noted in areas of the second floor by surface (tape) sampling. The CBP section of the IMT had similar signs of water intrusion and pigeon roosting. Overall, in both portions of the IMT building, low levels of airborne fungi were noted. Most airborne fungi were of the Basidiospore genus, common in water-damaged buildings. Settled dust samples revealed many types of fungi, including Penicillium chrysogenum. Microscopic analysis of tape samples and culturable air samples showed that Stachybotrys chartarum spores and numerous other fungi were present. The walk-through survey of the U.S. Customs House revealed no evidence of water intrusion. Fungal ranking at the U.S. Customs House was found to be similar between indoor and outdoor samples and fungal levels overall were lower indoors than outdoors, providing further evidence that there was no fungal contamination problem in the building. Among the SPC employees, the most commonly reported work-related symptoms were memory problems, irritability, and cough. The CBP-IMT workers reported work-related symptoms of sinus problems, fatigue, concentration problems, and irritability most frequently. SPC employees had statistically significantly greater rates of work-related cough, wheeze, irritated eyes, headaches, concentration and memory problems, irritability, chest tightness, shortness of breath, fever/sweats, body aches, sinus problems, fatigue, sore or dry throat, sneezing, dizziness, confusion, depression, and changes in sleep than Customs House employees. The CBP IMT group had higher rates of work-related cough, shortness of breath, body aches, sinus problems, fatigue, irritated/watery eyes, headaches, nosebleeds, sore or dry throat, sneezing, concentration problems, confusion, memory problems, irritability, and depression than Customs House employees but these differences were not statistically significant. Serum Stachylysin concentrations exhibited poor reproducibility, with same sample mean coefficient of variation of 35.8%. Only one blood sample (from an SPC employee) was considered positive (greater than or equal to 41.4 nanogram per milliliter [ng/ml]) for Stachylysin. Overall, neither the presence of Stachylysin nor its concentrations correlated with our assessment of fungal exposure. NIOSH investigators documented ongoing water incursion and subsequent fungal contamination in the IMT building. Employees in the IMT had symptoms consistent with fungal exposure. Therefore, a health hazard did exist at the IMT building. The serum Stachylysin test showed poor reproducibility when used in the field. Recommendations concerning remediation and the establishment of an IEQ management program are included in this report.
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(2006) New Orleans Fire Department, New Orleans, Louisiana. (Click to open report) In October 2005, the National Institute for Occupational Safety and Health (NIOSH) received a request for a health hazard evaluation (HHE) from the New Orleans Fire Department (NOFD) and the International Association of Fire Fighters Local 632 (IAFF). This HHE request concerned health hazards from exposure to the floodwater and sediment and the mental health of fire fighters following the NOFD's response to Hurricanes Katrina and Rita. Reported health problems included respiratory, throat, and s... (Click to show more)In October 2005, the National Institute for Occupational Safety and Health (NIOSH) received a request for a health hazard evaluation (HHE) from the New Orleans Fire Department (NOFD) and the International Association of Fire Fighters Local 632 (IAFF). This HHE request concerned health hazards from exposure to the floodwater and sediment and the mental health of fire fighters following the NOFD's response to Hurricanes Katrina and Rita. Reported health problems included respiratory, throat, and sinus irritation; and symptoms suggestive of depression and anxiety. NIOSH representatives conducted a survey to evaluate health concerns among fire fighters; 525 NOFD personnel participated in the survey. This self-administered questionnaire contained questions about demographics, job characteristics, lifestyle, work duties and location, hurricane-related activities, and symptoms that occurred during and after the hurricanes. The Center for Epidemiologic Study-Depression scale (CES-D) was used to assess symptoms associated with depression, and the Veterans Administration posttraumatic stress disorder (PTSD) checklist was used to define posttraumatic stress symptoms among participants. Of the 525 fire fighters who completed the questionnaire (77% participation), 201 (38%) reported one or more new-onset respiratory symptoms, such as sinus congestion (145 [28%]), throat irritation (92 [17%]) and cough (124 [24%]). Skin rash was reported by 258 (49%) of respondents, 414 (79%) reported skin contact with floodwater, 165 (32%) reported they had contact with floodwater on multiple days, 133 of 493 respondents (27%) had major depressive symptoms, and 114 of 518 (22%) showed posttraumatic stress disorder (PTSD) symptoms. In multivariate analyses adjusting for age, gender, and smoking, fire fighters who had floodwater contact with skin and either eyes or nose/mouth (224, 44%) had increased risk of new-onset upper respiratory symptoms (prevalence ratio [PR]=1.9; 95% confidence interval [CI], 1.1-3.1) and skin rash (PR=2.1; 95% CI, 1.4-3.2) compared to those not exposed to the floodwater. Depressive symptoms were associated with new-onset lower respiratory symptoms (PR=1.8; 95% CI, 1.2-3.0), skin rash (PR=1.7; 95% CI, 1.2-2.6) and low supervisor support (PR=1.6; 95% CI, 1.1-2.3). Fire fighters housed with their family were less likely to report depressive symptoms (PR=0.7; 95% CI, 0.5-1.0) compared to those not living with their family. Higher prevalence of PTSD symptoms were reported from fire fighters involved in one or more gunshot incidents (PR=2.4; 95% CI, 1.6-3.7), guard duty (PR=1.8; 95% CI, 1.2-2.7), and body retrieval (PR=1.7; 95% CI, 1.1-2.6). The results of the questionnaire survey showed that fire fighters who reported floodwater contact with their skin and nose/mouth or eyes for longer than a few hours at the time of the hurricanes reported significantly more upper respiratory symptoms than those who reported no contact with the floodwater. Fire fighters with respiratory symptoms and skin rash also reported more depressive symptoms than those without respiratory symptoms and skin rash. Fire fighters involved in gun shot incidents and body retrieval in response to the hurricanes were more likely to report PTSD symptoms. Clinical follow-up of affected fire fighters for physical and psychological conditions should be implemented. This report, along with the environmental survey conducted at the Jackson Barracks temporary staging area (Appendix A) should be construed as the final report. The environmental evaluation looked at fire fighter activities during simulated apparatus runs, and included air sampling to evaluate fire fighter exposures to dust. For the fire fighters working out of the Jackson Barracks temporary staging area, airborne exposures to respirable particulates and silica, total particulates, and elements (metals and minerals) were below all applicable exposure criteria. NIOSH investigators determined that a work-related hazard existed among New Orleans fire fighters due to Hurricane Katrina-related exposures. We found that physical and mental health symptoms were associated with work-related exposures. This report includes recommendations pertaining to these findings.
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