Health Hazard Evaluations (HHEs)

(2003) Fayette County Courthouse, Uniontown, Pennsylvania. (Click to open report)
In July 2002, the National Institute for Occupational Safety and Health (NIOSH) received a request for a health hazard evaluation (HHE) from employees at the Fayette County Courthouse in Uniontown, Pennsylvania. Employees had reported a variety of health concerns: headaches, nausea, tiredness, nasal and sinus symptoms, vomiting, burning eyes, sore throats, breathing problems, coughing, ear infections, and dizziness. The employees reported strong and unpleasant odors from the carpeting, old pa... (Click to show more) In July 2002, the National Institute for Occupational Safety and Health (NIOSH) received a request for a health hazard evaluation (HHE) from employees at the Fayette County Courthouse in Uniontown, Pennsylvania. Employees had reported a variety of health concerns: headaches, nausea, tiredness, nasal and sinus symptoms, vomiting, burning eyes, sore throats, breathing problems, coughing, ear infections, and dizziness. The employees reported strong and unpleasant odors from the carpeting, old papers, and dirty ceiling tiles; poor air quality; lack of airflow; stale water; mold, fungus, and mildew; asbestos; excessive dust; and dampness. All of the concerns involved the basement and first floors of both the original courthouse and annex buildings. On August 28, 2002, NIOSH investigators completed a preliminary site walkthrough evaluation. Medical interviews and an environmental investigation were conducted in October of 2002. The environmental investigation revealed a number of locations in the courthouse that may have had mold growth due to water incursion or leakage. The ventilation systems in most of the basement and first floors were inadequate (i.e., air changes and the amount of fresh air entering the offices did not meet the American Society of Heating, Refrigerating, and Air-Conditioning Engineers [ASHRAE] minimum requirements). Temperature, relative humidity, carbon dioxide and carbon monoxide levels were largely within recommendations in all monitored areas. The levels for volatile organic compounds were generally below established exposure limits. The ventilation systems should be upgraded to meet ASHRAE recommendations. Water leaks should be repaired and damaged ceiling tiles and walls should be replaced with care to ensure that any generated dust does not enter occupied sections of the building. Interviewed office workers reported respiratory symptoms consistent with asthma with onset after the date of hire. Environmental assessment demonstrated insufficient ventilation, mold growth, and water incursion in the building. (Click to show less)
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(2003) Letter to Nebraska Popcorn, Clearwater, Nebraska. (Click to open report)
While our lung function tests of workers at your plant did not reveal obstruction, the abnormality most associated with butter flavoring exposure, this should not be interpreted to mean that there is little, or no risk from flavoring exposure in your plant. As I discussed in my previous letter, while most of your microwave production workers had lung function that was in the normal range, it is possible that some had higher levels of function in the past. The respiratory symptoms reported by som... (Click to show more) While our lung function tests of workers at your plant did not reveal obstruction, the abnormality most associated with butter flavoring exposure, this should not be interpreted to mean that there is little, or no risk from flavoring exposure in your plant. As I discussed in my previous letter, while most of your microwave production workers had lung function that was in the normal range, it is possible that some had higher levels of function in the past. The respiratory symptoms reported by some of them may mean that their lung function could become abnormal in the future. In addition, since not all workers are equally susceptible to the effects of a chemical exposure, it is possible that the small number of workers we tested at your plant did not include workers that were sensitive to the air concentrations of flavoring chemicals that were present during our evaluation. Future new employees could be at risk, and changes in your production process, level of production, or the flavorings that you use could increase risk for current workers if exposures to flavorings chemicals increase as a result. (Click to show less)
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(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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