Health Hazard Evaluations (HHEs)

(2003) Somerset County assistance office, Somerset, Pennsylvania. (Click to open report)
The National Institute for Occupational Safety and Health (NIOSH) received a request for a health hazard evaluation from employees of the Somerset County Assistance Office (SCAO) in November 2000. The request included health complaints (sinus infections, breathing problems, bronchial infections, chronic fatigue, muscle aches, and irritation of throat, nose and eyes) and environmental concerns about water incursion and malfunction of ventilation. At the time of the request, there had been four ... (Click to show more) The National Institute for Occupational Safety and Health (NIOSH) received a request for a health hazard evaluation from employees of the Somerset County Assistance Office (SCAO) in November 2000. The request included health complaints (sinus infections, breathing problems, bronchial infections, chronic fatigue, muscle aches, and irritation of throat, nose and eyes) and environmental concerns about water incursion and malfunction of ventilation. At the time of the request, there had been four reported cases of hypersensitivity pneumonitis (HP) and eight reported cases of doctor-diagnosed asthma among a staff of 68 employees. In response to the request, NIOSH investigators conducted an initial walk-through survey in March 2001. The results of sample analyses and the screening questionnaire from the initial survey suggested possible biological contamination of the building and adverse respiratory effects. A second visit was planned and conducted from July 25 through August 15, 2001, to conduct environmental sampling, a heating, ventilating, and air conditioning (HVAC) inspection, medical testing, and a more extensive questionnaire survey. In December 2001, SCAO relocated their employees to a newly constructed building. The objectives of the second visit were to assess potential fungal contamination in the building and exposure levels of occupants, to characterize respiratory symptoms among occupants, to objectively test occupants' pulmonary function, and to examine the association of symptoms and medical test results with environmental exposure. For those aims, we conducted an interviewer-administered questionnaire survey, objective medical tests (spirometry and methacholines challenge tests, carbon monoxide diffusion capacity test, and exhaled nitric oxide measurements), and environmental measurements for microbial contaminants (culturable fungi, spore counts, endotoxin, ergosterol, and (1-->3)-ß-D-glucan), and evaluation of the HVAC system during the survey period. The participation rate was 93% for the screening questionnaire and 59% for the main questionnaire. There were 62 participants in the screening questionnaire survey and 15% reported asthma, 10% HP, and 36% any chest symptoms (wheeze, chest tightness, or shortness of breath in the past 4 weeks). Work-relatedness was reported by about 61% of the symptomatic people with one or more lower-respiratory symptoms (cough, wheeze, chest tightness, shortness of breath in the past 4 weeks). There were 40 participants in the main questionnaire survey and shortness of breath was reported by 52%, chest tightness by 40%, wheezing by 38%, and coughing for three consecutive months in the past 12 months by 25%. Up to 60% of the symptomatic people with the lower respiratory symptoms reported work-relatedness. Ninety-two percent of the participants in the main survey reported nasal symptoms and 90% reported sinus symptoms. In our study, we defined a case of probable work-related HP as a building occupant who reported one or more work-related (getting better away from work) lower respiratory symptoms (cough, wheeze, shortness of breath, and chest tightness) AND one or more systemic symptoms (fever/chills, flu-like/muscle achiness, weight loss of 10 pounds or more). From the questionnaire we identified 11 probable work-related HP cases. Note, however, that only 4 of these 11 symptomatic individuals were diagnosed as having HP by their physicians. We found two employees with borderline airways obstruction from our objective pulmonary function tests. One participant had mildly elevated exhaled nitric oxide. Three employees had low vital capacity with normal total lung capacity. No participants had test results indicating airways hyperresponsiveness or difficulties in gas transfer in the lungs. Our environmental investigation showed that the count of total airborne fungal spores (geometric mean=20,654 spores/m3) was about 60 times higher outdoors than indoors (geometric mean=348 spores/m3). A total of twenty fungal genera were identified in 180 indoor spore trap samples, and Cladosporium, basidiospores, and Epicoccum were the most frequently identified fungi indoors and outdoors. The level of total culturable airborne fungi (geometric mean=1,224 colony forming units (CFU)/m3) was about 10 times higher outdoors than indoors (geometric mean=123 CFU/m3). A total of 55 species of culturable fungi were identified in indoor air samples, and only 15 species were identified in outdoors samples. Both airborne spore counts and culturable fungi data showed different fungal composition between indoors and outdoors which implies that the SCAO indoor environment is likely to have had indoor sources of fungal contamination. However, we did not observe visible sources of fungal contamination within the occupied spaces at the time of investigation. Stachybotrys chartarum was found in 7 chair dust samples, but not in floor and air samples. In air, floor and chair dust samples, a total of 77 fungal species were identified, and air showed the most diverse range of fungal species. Our indoor monitoring data for relative humidity, temperature, carbon dioxide, and particles, along with bioaerosol measures, clearly showed variation of those parameters in association with human activity. Occupants were exposed to more bioaerosol and particles toward the end of the workweek. The levels of indoor carbon dioxide were lower than the recommended level (1,000 ppm, which is 700 ppm plus the outdoor level) from ASHRAE (the American Society of Heating, Refrigerating and Air-Conditioning Engineers)1; temperature during the survey period ranged from 70 to 80 degrees F and relative humidity ranged from 43 to 55%, both of which are within the recommended ranges for comfort and minimizing microbial growth (68-77oF and 30-60% relative humidity). Although our analyses were limited by a possible participation bias and by the small number of subjects participating in the study, we found a significant association of (1-->3)-ß-D-glucan level as a surrogate for fungal level in chair dust with usual cough using multivariate logistic regression analysis adjusting for age, gender, and atopic status. Airborne ergosterol, a surrogate measure for airborne fungi, was significantly associated with self-reported asthma after adjusting for gender. In our interim report on the NIOSH investigation of the HVAC system (see Appendix A), we recommended the remediation of roof leaks and problems with the HVAC system. Based on our HVAC evaluation and on the health evaluations described above, we make the following recommendations to SCAO, the previous building managers, and the SCAO employees. We recommend that the SCAO manager take the following actions: 1. Replace or clean the water-damaged furniture which may have been brought from the evaluated building to current SCAO offices. We recommend that employees take the following actions: 1. Consult a doctor for persistent or work-related lower respiratory symptoms such as wheeze, chest tightness, shortness of breath and/or cough or a combination of work-related lower respiratory symptoms and systemic symptoms (such as fever/chill, flu-like/muscle achiness, weight loss of 10 pounds or more). Objective medical tests can help your doctor diagnose the respiratory condition and its severity, and may help establish that it is work-related. We recommend that the manager of the evaluated building take the following actions to protect future tenants: 1. Fix or renovate areas with water incursion (roof, walls, and floor). Especially, repair the damaged roof to prevent condensed water from the air handling units (AHUs) from leaking through the roof. 2. Redirect the drainage from the AHU drain traps directly to the gutter, at least until the damaged roof is completely repaired. 3. Replace any water damaged building materials and water-stained carpet or ceiling tiles. 4. Inspect int... (Click to show less)
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(2003) The Concrete Revolution, Denver, Colorado. (Click to open report)
The National Institute for Occupational Safety and Health (NIOSH) received a management request from The Concrete Revolution in Denver, Colorado, to evaluate potential occupational exposure hazards in the manufacture of custom concrete counter tops. Five site visits were made to the plant between April and October 2002. Exposure assessments were conducted for noise, respirable crystalline silica, respirable dust (or particulates not otherwise regulated, respirable fraction), and asbestos fibers.... (Click to show more) The National Institute for Occupational Safety and Health (NIOSH) received a management request from The Concrete Revolution in Denver, Colorado, to evaluate potential occupational exposure hazards in the manufacture of custom concrete counter tops. Five site visits were made to the plant between April and October 2002. Exposure assessments were conducted for noise, respirable crystalline silica, respirable dust (or particulates not otherwise regulated, respirable fraction), and asbestos fibers. Full shift exposures to noise were less than the NIOSH recommended exposure level of 85 decibels on the A-weighted scale. Personal breathing zone (PBZ) exposures to respirable crystalline silica (as quartz and cristobalite) were below the limit of detection (LOD) for quartz in one sample and at trace concentrations [between the LOD and the limit of quantitation (LOQ)] for five other samples. Cristobalite was never detected above the LOD nor were airborne asbestos fibers. Certain elements (metals) were detected in samples of settled dusts from drying rooms 1 and 2 but were in very low concentrations. Quartz was also detected in settled dust samples in concentrations of 2.0 to 3.3%. Three area and six PBZ air samples collected for respirable dust ranged in concentration from 1.8 to 10 milligrams per cubic meter of air (mg/m3). One of these samples exceeded the OSHA Permissible Exposure Limit for respirable dust of 5 mg/m3. At the time of the NIOSH survey, management and employees at the Concrete revolution were refining work practices and considering modifications to exhaust ventilation in the drying rooms to reduce particulate exposures. Work practice, housekeeping, and ventilation recommendations are provided on pages 6-7 of this report. Occupational exposure to noise, respirable crystalline silica, asbestos and metals were all below established occupational health criteria at the time of this survey. One of nine samples for respirable dust exceeded the Occupational Safety and Health Administration (OSHA) criterion of 5 milligrams per cubic meter of air as an 8-hour time-weighted average. Recommendations are provided to modify work practices and consider ventilation changes to better control dusts while patching and finishing custom concrete counter tops. (Click to show less)
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(2002) 26 Federal Plaza, New York, New York. (Click to open report)
On November 7, 2001, the National Institute for Occupational Safety and Health (NIOSH) received a request for a health hazard evaluation (HHE) from Department of Health and Human Services (DHHS) representatives regarding indoor environmental quality (IEQ) problems at the Federal Office Building, 26 Federal Plaza, New York City (NYC), New York. This building is located approximately 5 blocks northeast of the World Trade Center (WTC) disaster site. DHHS employees in the building expressed conce... (Click to show more) On November 7, 2001, the National Institute for Occupational Safety and Health (NIOSH) received a request for a health hazard evaluation (HHE) from Department of Health and Human Services (DHHS) representatives regarding indoor environmental quality (IEQ) problems at the Federal Office Building, 26 Federal Plaza, New York City (NYC), New York. This building is located approximately 5 blocks northeast of the World Trade Center (WTC) disaster site. DHHS employees in the building expressed concerns regarding potential exposures and health effects related to the attacks on, and subsequent collapse of, the WTC. Because of the immense impact the WTC attack had on the lives of NYC residents and workers, as well as the concerns of many employees about ongoing security issues, NIOSH investigators included an assessment of mental health symptoms in the HHE. On November 12-15, 2001, NIOSH investigators conducted a site visit at the Federal Office Building to perform an environmental survey and meet with employees. A second site visit for a questionnaire survey was performed on December 4-5, 2001, and a similar questionnaire survey among a comparison group of DHHS employees in Dallas, Texas, was performed on December 12, 2001. Area air samples in the Federal Office Building were collected to measure concentrations of elements, asbestos, volatile organic compounds (VOCs), total dust, polynuclear aromatic hydrocarbons (PAHs), and polychlorinated biphenyls (PCBs). Bulk samples of settled material were collected at the 44th floor air intake and analyzed for elements and asbestos. Qualitative wipe samples of dust on surfaces were collected in various work areas and analyzed for elements. Carbon monoxide was monitored at various locations, including areas where employees had noted potential health problems, the 44th floor air intake, and near the basement loading dock. Additionally, on approximately every 5th floor, carbon dioxide (CO2), small particle counts, temperature, and relative humidity measurements were collected. One of the bulk samples of settled material indicated the presence of chrysotile asbestos (in the range of 1 - <3 percent). No asbestos fibers were found in the air. Many of the air samples collected inside the building indicated that concentrations of contaminants were below the limit of detection (LOD) for the method used. The concentrations of volatile organic compounds we found in our sampling were similar to concentrations we have found in other offices (outside NYC and unrelated to the WTC disaster) evaluated by NIOSH. One hundred ninety-one (68 percent of the 279 available) NYC Federal Office Building employees completed the questionnaire; 155 (47 percent of the available 328) Dallas DHHS employees completed the questionnaire. A variety of constitutional symptoms, most related to headache, eye, nose, and throat irritation, and irritation of the respiratory tract, were reported more frequently among the workers in NYC compared to those in Dallas. The most commonly reported symptoms among workers in NYC were eye and nose/throat irritation - both were reported by more than 60 percent of participants, compared to 12 (prevalence ratio [PR] 5.0, 95 percent confidence interval [95 percent CI] 3.2 - 7.7) and 21 percent (PR 3.1, 95 percent CI 2.3 - 4.3) (respectively) in Dallas. Measures of medical care for these constitutional symptoms did not differ between the workers in NYC and Dallas. Workers in NYC were more likely than those in Dallas to experience both depressive (prevalence ratio [PR] 3.4, 95 percent confidence interval [CI] [1.9 - 5.9]) and post traumatic stress disorder (PTSD) (PR 5.7, 95 percent CI [2.5 - 13.1]) symptoms. The prevalence of symptoms varied by agency within DHHS. Because our HHE was performed more than two months after the WTC disaster, we are unable to document occupational exposures of Federal Office Building employees closer to the time of the WTC disaster. No exploration of an association between exposure to potential air contaminants present at the time of our HHE and reported symptoms was possible because measured concentrations of air contaminants were too low. We observed that constitutional symptoms (such as headache, eye, nose, and throat irritation, and symptoms affecting the respiratory tract) were more prevalent among NYC Federal Office Building employees than the employees in Dallas. Symptoms associated with depression and stress were also more commonly reported among workers in NYC; the prevalence of both constitutional and mental health symptoms varied by agency within DHHS. Our survey revealed no occupational exposures to substances at concentrations which would explain the reported symptoms; however, we are unable to assess potential occupational exposures of Federal Office Building employees in the time immediately after the WTC disaster. Although our data suggest that an increase in social support might be associated with fewer reported symptoms of depression and stress, an evaluation of all factors which may be related to the reported symptoms was not performed in this HHE. Recommendations are provided in the report to assist DHHS management in addressing these findings. (Click to show less)
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(2002) Lead Safe Services, Inc., Neenah, Wisconsin. (Click to open report)
At the request of a state-licensed contractor, the National Institute for Occupational Safety and Health (NIOSH) conducted a study of residential lead hazard reduction work. Workers' task-specific and full-shift personal airborne lead (PbA) exposures were measured on three consecutive days during exterior work at two single-family homes in Oshkosh, Wisconsin. Tasks assessed were cleaning, demolition, dry scraping, component removal, set-up, and wet scraping. Additionally, we measured surface pai... (Click to show more) At the request of a state-licensed contractor, the National Institute for Occupational Safety and Health (NIOSH) conducted a study of residential lead hazard reduction work. Workers' task-specific and full-shift personal airborne lead (PbA) exposures were measured on three consecutive days during exterior work at two single-family homes in Oshkosh, Wisconsin. Tasks assessed were cleaning, demolition, dry scraping, component removal, set-up, and wet scraping. Additionally, we measured surface paint lead concentrations and, for dry scraping and a mix of other tasks, concomitant lead concentrations in settled dust (PbS) at 10, 15, and 25 feet (ft) (3.1, 4.6, and 7.6 meters [m]) from work surfaces. Mean exterior paint lead concentrations at the two houses were high: 22 percent (%) and 37% Pb by weight. The 79 task-specific worker PbA exposures measured were highly variable; range 1.4-2240 micrograms per cubic meter (microg/m3), geometric mean (GM) = 71 microg/m3, geometric standard deviation (GSD) = 4.6. Within-task variability of PbA exposures was high (GSDs = 1.9-5.4). PbA exposures were significantly associated with task, worker, and house variables (p <0.0001). High-exposure tasks were cleaning (GM = 108 microg/m3), dry demolition (77 mcirog/m3), dry scraping (136 micorg/m3), and wet scraping (90 microg/m3); the means did not differ significantly in paired comparisons. The low-exposure task was set-up (GM = 12 microg/m3); the GM for removal also appeared to be low (30 microg/m3 ) but is uncertain due to small sample size (n = 3). Nearly all (14/15) of the full-shift PbA exposures collected for workers performing scraping and a mix of other tasks were above the permissible exposure limit (PEL) (GM = 100 microg/m3, range: 39-526 microg/m3). Results for five full-shift area PbA samples collected to measure potential bystander exposures on work days were relatively low, ranging from 0.83 to 6.1 microg/m3. Seventeen PbS samples collected at 10 ft (3.05 m), sixteen samples at 15 ft (4.57 m), and twelve samples at 25 ft (7.62 m) had respective GMs of 1716, 458 and 65 milligrams per square meter (mg/m 2). PbS levels were significantly associated with distance from the work surface, p <0.0005. PbS levels were not significantly associated with the two task categories (dry scraping and a mix of other tasks). Almost all of the full-shift PbA exposures for workers performing exterior scraping and a mix of other tasks were greater than the PEL. Task-specific PbA exposures were highly variable both within and between tasks. High-exposure tasks were cleaning, demolition, dry scraping, and wet scraping, with mean exposures exceeding the PEL. Mean exposures for set-up and component removal were below the PEL. The respirators used were adequate to protect workers from the exposures measured. Recommendations are provided in this report to assist the contractor in controlling worker exposures to hazardous levels of lead-based paint. (Click to show less)
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(2002) Nassau Community College, Garden City, New York. (Click to open report)
Nassau Community College (NCC), located in Garden City, New York, is the largest two-year community college in the State of New York, employing over 1,200 full time faculty and staff in 40 different buildings on a 225 acre campus. On February 29, 2000, the National Institute for Occupational Safety and Health (NIOSH) received a formal request to conduct a health hazard evaluation (HHE) at the Nassau Community College. The request, submitted by the Nassau Community College Federation of Teachers ... (Click to show more) Nassau Community College (NCC), located in Garden City, New York, is the largest two-year community college in the State of New York, employing over 1,200 full time faculty and staff in 40 different buildings on a 225 acre campus. On February 29, 2000, the National Institute for Occupational Safety and Health (NIOSH) received a formal request to conduct a health hazard evaluation (HHE) at the Nassau Community College. The request, submitted by the Nassau Community College Federation of Teachers (NCCFT), was concerned with indoor air quality-related health effects, including asthma, chronic sinusitis, hypersensitivity pneumonitis, respiratory infections, and dermatitis, within eight specified buildings on campus. On March 16, 2000, a second request was submitted from the President of NCCFT and the President of NCC amending the initial request to include all existing structures on campus. This request followed 20 years of reports and environmental investigations at the college of water incursions, relative humidity problems, mold growth, and ventilation problems, as well as reported respiratory symptoms. Most of these survey reports focused on environmental conditions within the academic buildings built in the late 1970s. On October 23-27 and December 4-8, 2000, NIOSH conducted an environmental assessment of buildings cited in the request using an 'Environmental Assessment Check Sheet' for visual assessment of water stains., visible mold, mold odor, and standing water or moisture in 724 offices and laboratories in 13 buildings. The 13 buildings included seven buildings, built in 1978, with a history of water damage and six others built either prior to, or after, 1978. On November 20,2000, NIOSH investigators mailed out health questionnaires on respiratory symptoms, supplemented with questions concerning demographic information, work history information, cigarette/cigar/pipe smoking habits, physician-diagnosed asthma, and use of latex gloves and sensitivity information, to all faculty and staff within 30 departments on campus. This was followed by attempts to increase participation and to assess respondent bias. The objectives of the investigation were: 1. to estimate the prevalence of reported respiratory symptoms, work-related symptoms, and post-hire onset of symptoms and to determine whether building-related excesses exist; 2. to assess the indoor environmental factors relating to potential fungal contamination in the campus buildings; 3. to examine the possible associations between reported work-related respiratory symptoms and environmental factors; and 4. to examine symptom rates among the Nursing Department faculty and staff, especially in relation to their move from Cluster F in February 2000. Findings from the environmental assessment showed clear differences between groups of buildings across the campus. Rooms within the Cluster buildings and the Library exhibited distinctly more evidence of water stains, visible mold, mold odor, and current moisture than any of the other buildings studied. The one new building examined, built in 1992, had the lowest scores for water-damage associated factors, while the older buildings, built in 1929, had levels which fell between those for the 1970s buildings and the new building. Of the 393 participants in the questionnaire survey (71 % participation), 328 were faculty and 65 were staff. Most were white and never smokers, average age 50 years, with about half being male. Overall, about one third of the participants reported symptoms of wheezing, chest tightness, shortness of breath, or attacks of coughing. About half reported anyone of these symptoms. Upper respiratory symptoms, such as nasal and sinus symptoms and throat irritation, and itchy or burning eyes were reported by half to two-thirds of the participants overall. Most of the reported symptoms had onset after starting work at NCC, and about half of those who reported symptoms noted them to be work-related (either less severe or required less medication away from work). Overall, 17% of the participants reported physician-diagnosed asthma, with about half of those noting it to be post-hire onset or exacerbated by work. The prevalence of diagnosed asthma reported by those aged 35-65 years among faculty and staff respondents was 18%, compared to 10% reported overall by New York state residents of that age range. Symptom prevalences by building group showed marked differences. Employees in the 1970s buildings (those with a history of water damage) reported substantially higher prevalences of both lower and upper respiratory symptoms that were post-hire and work-related. The prevalence of any chest symptoms post-hire was 44% for the, 1970s buildings versus 14% for the older buildings (p-value < 0.05) and 21 % for the new building (p-value < 0.05). Worked-related prevalences were 34, 3 and 19%, respectively (statistical significance for 1970s compared to older buildings, p-Value < 0.05). Post-hire upper respiratory symptoms were not greatly different across buildings, at 72,69 and 56%, respectively (statistical significance for 1970s compared to newer building, p-value < 0.05). However, the prevalence of work-related upper respiratory symptoms was higher in the 1970s buildings: 56% compared to 31 % for the older buildings (p-value < 0.05) and 35% for the newer building (p-value < 0.05). To explore the relationship between environmental factors in the rooms and reported symptoms and health complaints, we developed an exposure index based on reported time spent in the rooms and the assessments of stains, mold presence and odor, and moisture. Using statistical models that adjusted for employee status (faculty or staff), gender, age, cigarette smoking history, reported allergies, reported use of latex gloves, and the year of hire, we found clear evidence that symptom reporting was related to factors reflecting water damage and its sequelae. Significantly increased odds of having wheeze, chest tightness, shortness of breath, at least one chest symptom, and nasal and sinus symptoms were all related to recorded presence of visible mold (p-values < 0.05). Water stain also was associated with nasal and sinus symptoms and throat irritation (p-value < 0.05). Mold odor was associated with throat irritation and any upper respiratory symptoms or eye irritation (p-value < 0.05). Although elevated odds ratios were frequently found for moisture presence, none were statistically significant. For participating faculty and staff within the Nursing Department (N=26), 54% reported lower respiratory symptoms and 73% reported upper respiratory symptoms or eye irritation while they were working in Cluster F. After the Nursing Department moved out of Cluster F in the early months of the year 2000, 36% of those who reported having chest symptoms prior to the move reported that their symptoms or breathing problems had either lessened or disappeared after they moved. This improvement, however, was not reflected in the reporting of upper respiratory symptoms. Overall, the results show high prevalences of lower and upper respiratory symptoms among employees of Nassau Community College, including an excess of asthma compared to state rates. Much of the reported prevalence was likely work-related, either in terms of post-hire onset or exacerbation at work, and was confirmed by evidence from medical records of affected individuals. There were obvious differences in the environmental factors across buildings. Reduction in lower respiratory symptoms was observed among a small subset who moved from, the affected buildings. Finally, there was clear evidence of association of health conditions with environmental factors, including higher symptom prevalences in water-damaged buildings and in association with exposure indices based on factors related to water damage and mold growth. Together, these provide convincing evidence that building-related disease has occurred at Nassau Community... (Click to show less)
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