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HHE Search Results
1060 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
(2001) Technical assistance to Missouri Department of Health, interim report. (Click to open report) Nine former workers from a microwave popcorn packaging plant were reported to have a severe lung disease, bronchiolitis obliterans, but no recognized causes of this rare condition were evident in the plant. At the request of the Missouri Department of Health, staff of the National Institute for Occupational Safety and Health have investigated exposures and health outcomes at the company. Industrial hygiene assessments divided the plant into four work areas based on anticipated exposure levels ... (Click to show more)Nine former workers from a microwave popcorn packaging plant were reported to have a severe lung disease, bronchiolitis obliterans, but no recognized causes of this rare condition were evident in the plant. At the request of the Missouri Department of Health, staff of the National Institute for Occupational Safety and Health have investigated exposures and health outcomes at the company. Industrial hygiene assessments divided the plant into four work areas based on anticipated exposure levels to dust and volatile organic chemicals from artificial butter flavorings. Respirable dust concentrations from salt dumping operations were about 10-fold higher in the area in which flavorings were mixed compared to the office and outdoor work areas. Diacetyl, the predominant ketone in the plant, was present in concentrations 17 times higher in the mixing area compared to the microwave packaging area, 100 times higher compared to the warehouse and polyethylene packaging area, and 1000 times higher compared to the office and outdoor areas. In late October 2000, 117 current workers (87%) participated in health questionnaire interviews, spirometry, diffusing capacity, and chest x-rays. Plant employees had 2.6 times the rates of chronic cough and shortness of breath compared to national data, adjusted for smoking and age group; younger employees who had never smoked had rates about five times higher than expected from national rates. Overall, plant employees had 3.3 times the rate of obstructive spirometry abnornalities compared to national adjusted rates; never smokers had 10.8 times the national expected rate. Worker reports of physician-diagnosed asthma and chronic bronchitis were about twice as frequent as expected from national data, with a 3.3-fold excess of chronic bronchitis in never smokers. Microwave popcorn production workers had statistically higher rates of regular trouble with breathing and unusual fatigue, compared with workers in two lower exposure groups. Strong exposure-response relationships existed between quartile of estimated cumulative exposures to diacetyl and respirable dust and frequency and degree of airway obstruction. The survey findings are best explained by work-related bronchiolitis obliterans in relation to exposures arising in the mixing room but widely disseminated through other areas of the plant We recommend extensive primary, secondary, and tertiary prevention efforts for all current and former workers.
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(2001) University of California, Berkeley, Berkeley, California. (Click to open report) At the request of the University of California, Berkeley, the National Institute for Occupational Safety and Health (NIOSH) conducted a study of lead-based paint (LBP) exposures during exterior renovation work on campus buildings. Workers' personal airborne lead (PbA) exposures were assessed for eight renovation tasks during a three-day demonstration project. Additionally we measured concomitant area PbA concentrations 6 feet (ft) from the work surfaces, lead in settled dust (PbS) at three dis... (Click to show more)At the request of the University of California, Berkeley, the National Institute for Occupational Safety and Health (NIOSH) conducted a study of lead-based paint (LBP) exposures during exterior renovation work on campus buildings. Workers' personal airborne lead (PbA) exposures were assessed for eight renovation tasks during a three-day demonstration project. Additionally we measured concomitant area PbA concentrations 6 feet (ft) from the work surfaces, lead in settled dust (PbS) at three distances (6, 10, and 20 ft) from work surfaces for five tasks, and determined if these measures were correlated with the workers' PbA exposures. Five workers performed assigned renovation tasks during limited work periods (average time 28 minutes [min]) on 22 painted exterior surface areas (wood windows, wood doors, and metal stairs). A total of 132 work periods were sampled; the work took from 2 to 12 work periods per designated work surface, depending on the area. Lead concentrations in paint chip samples (one per work surface) ranged from 0.23% to 34% lead (Pb) by weight (average 11.3%). Personal PbA exposures were highly variable; range, none detected to 660 micrograms per cubic meter ( g/m3), geometric mean (GM) = 22 g/m3, geometric standard deviation (GSD) 4.3. Personal PbA exposures were significantly associated with task, worker, and paint lead concentration (p <0.001). High-exposure tasks were dry manual sanding (GM = 49 g/m3), dry manual scraping (53 g/m3), power finish sanding (44 g/m3), and power finish sanding with bag (68 g/m3). Low-exposure tasks were power sanding with high-efficiency particulate air (HEPA) exhaust (GM = 6.9 g/m3), wet manual sanding (6.2 g/m3), wet manual scraping (16 g/m3), and flame burning (23 g/m3). The area PbA concentrations at 6 ft distance, which were also highly associated with task, were roughly an order of magnitude below the personal exposures, ranging from none detected to 37 g/m3, GM = 1.5 g/m3, GSD = 3.3. GMs for PbS samples were 3.2 milligrams per square meter (mg/m2) at 6 ft (n=69), 1.4 mg/m2 at 10 ft (n=67), and 0.66 mg/m2 at 20 ft (n=39). Overall PbS levels decreased significantly as distance increased (p <0.0001). At each distance PbS levels were significantly associated with task (p-values 0.024, 0.0015, and <0.0001, respectively). Flame burning was among the tasks associated with the highest area PbA and PbS levels, although personal exposures were relatively low. Surface paint lead concentrations were poorly correlated with the PbA exposures (R = 0.30). Personal and area PbA levels were significantly correlated (R = 0.49, p <0.0001). Both area and personal PbA concentrations were significantly correlated with PbS levels measured 6 ft and 10 ft from the work surfaces (R values 0.34 to 0.73). Area PbA levels were significantly correlated with the PbS levels at 20 ft as well (R = 0.67). Worker lead exposures for eight renovation tasks on building exteriors with LBP were highly variable. Based on workers' exposures, the eight renovation tasks evaluated fell into two exposure groups. Estimated average exposures during dry manual sanding, dry manual scraping, power finish sanding, and power finish sanding with bag would exceed the permissible exposure limit (PEL) within an 8-hr period. Estimated average exposures for power sanding with HEPA exhaust, flame burning, wet manual sanding, and wet scraping would be below the PEL. Although it resulted in relatively low worker exposures, flame burning was among the tasks associated with the higher lead levels in air and settled dust levels in nearby areas. The power finish sander with a cloth dust bag was not effective in controlling worker exposures; the random-orbital power sanding equipped with HEPA-filtered exhaust ventilation appeared to be highly effective. Recommendations are provided in this report to help prevent hazardous worker exposures to LBP during renovation of surfaces with LBP.
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(2001) Winnebago Industries Inc., Forest City, Iowa. (Click to open report) In April 2000, the National Institute for Occupational Safety and Health (NIOSH) received a request for a Health Hazard Evaluation (HHE) from employees at Winnebago Industries, Inc. in Forest City, Iowa. The HHE request expressed concerns regarding exposures to airborne wood dust during woodworking operations in the production of interior components of motor homes. In response to this request, a site visit was conducted September 12 - 14, 2000. During this site visit, two NIOSH industrial hygien... (Click to show more)In April 2000, the National Institute for Occupational Safety and Health (NIOSH) received a request for a Health Hazard Evaluation (HHE) from employees at Winnebago Industries, Inc. in Forest City, Iowa. The HHE request expressed concerns regarding exposures to airborne wood dust during woodworking operations in the production of interior components of motor homes. In response to this request, a site visit was conducted September 12 - 14, 2000. During this site visit, two NIOSH industrial hygienists and a NIOSH occupational physician conducted a walk-through survey of the sawmill building and discussed the issues with management and employees in the area. Full-shift, personal breathing zone (PBZ) air sampling was performed to measure the levels of exposure to wood dust generated during the normal operation of the facility's woodworking machines such as sanders, routers, saws, and planers. Discussions were held with management regarding the ventilation system plans, personal protective equipment program (PPE), and environmental monitoring programs. Personal interviews were held with employees regarding their medical history and present health concerns related to the potential wood dust exposures. The Occupational Safety and Health Administration (OSHA) has no specific permissible exposure limit (PEL) for wood dust and therefore regulates it as Particulates Not Otherwise Regulated (PNOR). The results for seventeen air samples showed that no exposures were above this limit of 15 milligrams/cubic meter (mg/m3) as an 8-hour time-weighted average (TWA). However, seven individuals' exposures were above the NIOSH recommended exposure limit (REL) for wood dust of 1 mg/m3 as a full-shift TWA. These exposures included one hand router in each of Departments 804 and 806. These results were 2.2 mg/m3 and 1.9 mg/m3, respectively. The other area in which results showed exposures over the REL was Department 811. The activities performed during these over-exposures were disc hand sanding (1.1 mg/m3 and 1.3 mg/m3), 'Time-Saver' pre-sanding (1.8 mg/m3), trimming (2.6 mg/m3), and the use of a swing saw (1.3 mg/m3). Interviews with employees showed that workers from Department 811 reported experiencing possible work-related respiratory health effects that were not reported by the general area employees. The most commonly reported symptoms included respiratory irritation, nasal congestion, cough, and shortness of breath; less commonly reported were dry nasal and throat mucous membranes, bloody nasal mucous, sore throat, burning of the eyes, and generalized fatigue. Employees in Department 811 were also more likely to report perceived elevated dust levels in the work area than employees in other departments. NIOSH investigators concluded that a potential health hazard exists at this Winnebago Industries Inc. facility. Results from PBZ sampling showed that a number of individuals working in Department 811 were exposed to wood dust concentrations above the NIOSH REL. Additionally, two individuals working with hand routers in ventilation booths were also exposed to levels of airborne wood dust above the REL. The data collected from our survey suggests that employee symptoms were consistent with the known effects of wood dust exposure and that respiratory health effects appear to be more commonly experienced by workers in Department 811. Recommendations are made in this report concerning further evaluation and control of exposures to wood dust in these areas.
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(2001) Wire Rope Corporation of America, Inc., Sedalia, Missouri. (Click to open report) In March 2000, the National Institute for Occupational Safety and Health (NIOSH) received a confidential request from a group of employees to conduct a health hazard evaluation (HHE) at the Wire Rope Corporation of America (WRCA) in Sedalia, Missouri. The HHE request stated that some employees experienced symptoms of nose bleeds, eye irritation, and unspecified respiratory symptoms that were believed to be related to exposures to metal dust and asphalt fume at work. Employees were also concerned... (Click to show more)In March 2000, the National Institute for Occupational Safety and Health (NIOSH) received a confidential request from a group of employees to conduct a health hazard evaluation (HHE) at the Wire Rope Corporation of America (WRCA) in Sedalia, Missouri. The HHE request stated that some employees experienced symptoms of nose bleeds, eye irritation, and unspecified respiratory symptoms that were believed to be related to exposures to metal dust and asphalt fume at work. Employees were also concerned about hazardous noise levels, poor lighting, and lack of exhaust ventilation to control air contaminants. A site visit on June 14-16, 2000, included a walk-through inspection of the facility's processes and medical interviews. On June 28-29, 2001, personal breathing-zone (PBZ) and area air samples were collected for metal dust and asphalt fume. To measure asphalt fume, air samples were collected and analyzed for the total particulate, the benzene-soluble particulate fraction, and polycyclic aromatic compounds (PACs). Noise exposures and lighting levels were also measured. Six full-shift PBZ air samples showed exposures to metal dust that were less than 1 percent of the most stringent occupational exposure limit available. Six short-term air samples collected for asphalt fume (measured as total particulate) showed that utility workers' exposures ranged up to 3.2 milligrams per cubic meter (mg/m3), below the NIOSH 15-minute ceiling limit of 5 mg/m3. Air sampling for the benzene-soluble particulate fraction of asphalt showed a strander operator's time-weighed average (TWA) exposure as high as 0.8 mg/m3, a concentration which exceeded the American Conference of Governmental Industrial Hygienists' (ACGIH) time-adjusted Threshold Limit Value (TLV) of 0.25 mg/m3 for a 12-hour TWA concentration. Two utility workers' exposures of 0.3 mg/m3 and 0.4 mg/m3 also exceeded the 12-hour adjusted ACGIH TLV for benzene-soluble particulate. Although no occupational exposure limits are currently available for PACs as a group, area air sampling showed the most abundant subclass of PACs were those believed to be associated with irritative effects. A total of 15 workers were interviewed, including all three of the utility workers present during our site visit. The workers had complaints of headache, upper respiratory irritation, increases of allergy symptoms, cough, and dry eyes. The symptoms generally improve when the employees leave the work site. Interviewed employees noted that the majority of symptoms and complaints have decreased in frequency and severity following elimination of the scrap cutting and some descaling processes. Workers reported that current symptoms are frequently related to exposure to asphalt fume from the large lube holding tanks. The vast majority of workers at the WRCA are exposed to excessive noise levels; some up to 9 ½ times the allowable dose for a 12-hour work shift. All employees surveyed have noise exposures that require them to be included in a hearing conservation program. Illumination levels range from 8 to 76 foot-candles, which are generally less than the American National Standard Institute (ANSI) recommended range of 50 to 100 foot-candles for machining processes at WRCA. Workers who handle liquid asphalt are overexposed to asphalt fume (measured as benzene-soluble particulate). The majority of WRCA workers are exposed to excessive noise levels, and most areas of the plant are poorly illuminated. Interviewed workers complained of headache, upper respiratory irritation, increases of allergy symptoms, cough, and dry eyes. However, these employees have noticed a decrease in the frequency and severity of these symptoms and complaints since scrap cutting and some descaling processes have stopped. Workers also reported that current symptoms are frequently related to exposure to asphalt fume from the large lube holding tanks. Recommendations are offered to reduce exposures to asphalt fume and hazardous noise levels, and to improve lighting at work stations.
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(2000) AFG Industries, Bridgeport, WV. (Click to open report) In July 1997, the National Institute for Occupational Safety and Health (NIOSH) received a request for a health hazard evaluation and technical assistance (HHE) from the United Steel Workers of America (USWA) to investigate possible respiratory problems at AFG Industries in Bridgeport, West Virginia. AFG Industries produces sheet glass from raw materials. The respiratory health concerns cited in the request included breathing problems and irritation including nose bleeds; and exposure concerns i... (Click to show more)In July 1997, the National Institute for Occupational Safety and Health (NIOSH) received a request for a health hazard evaluation and technical assistance (HHE) from the United Steel Workers of America (USWA) to investigate possible respiratory problems at AFG Industries in Bridgeport, West Virginia. AFG Industries produces sheet glass from raw materials. The respiratory health concerns cited in the request included breathing problems and irritation including nose bleeds; and exposure concerns included adipic acid, crystalline silica, asbestos, sulfur dioxide (SO2), and nuisance dusts. A walk-through survey was conducted on September 23, 1997. Two industrial hygiene surveys were conducted on May 18 and June 10, 1998. During these surveys, samples were collected for respirable dust and respirable crystalline silica, adipic acid, and SO2 Medical records were reviewed from 10 workers who complained of work-related respiratory illness. A self-administered questionnaire was mailed to all employees during August and September of 1998. Participants were asked about upper and lower respiratory symptoms, skin and eye symptoms, personal health history, work history, work activities, and tobacco use. Four personal and two area samples were collected for respirable dust and respirable crystalline silica; all samples were collected from the silo tower area (the hot end of the plant). The respirable dust samples ranged from 0.31 mg/m^3 to 4.86 mg/m^3. The personal crystalline silica concentrations ranged from 0.09 mg/m^3 to 0.35 mg/m^3. The workers assigned to the silo tower used respiratory protection by company policy. The disposable respirators used by workers had an assigned protection factor (APF) of 10 and, when used properly, would reduce exposures ten-fold. Thus, these crystalline silica exposures, if attenuated by proper respirator use, would be below the existing Occupational Safety and Health Administration (OSHA) Permissible Exposure Limits (PEL), the NIOSH Recommended Exposure Limit (REL), and The American Conference of Governmental Industrial Hygienists (ACGIH), Threshold Limit Exposure Values (TLVs). However, the results from crystalline silica sampling demonstrate the potential for overexposure among workers in the silo tower area if respirators are not used or used improperly. Fifteen total dust samples were collected for adipic acid in air including 14 personal samples and 1 area sample. Adipic acid was used in the cold end of the plant. The total dust concentrations from this area ranged from 0.25 mg/m^3 to a high of 1.68 mg/m^3. The total adipic acid concentrations ranged from 0.01 mg/m^3 to a high of 0.89 mg/m^3; the mean adipic acid concentration from the total dust samples was 0.10 mg/m^3 with a standard deviation (SD) of 0.22 mg/m^3. The adipic acid content of the airborne total dust samples ranged from 3% to 53% by weight; the mean percent by weight adipic acid concentration in airborne total dust was 13.8% with a SD of 12%. These concentrations were below the existing ACGIH TLV. Sulfur dioxide was not detected in any of the seven short term area samples taken. Plant management reported that asbestos materials had been removed form the plant and no friable asbestos insulation was observed during this survey. Of the 312 questionnaires mailed, 144 (46%) were returned; 138 had complete information and were used for the analysis. Results of self-reported respiratory symptoms showed cough in the morning by 42%, phlegm in the morning by 47%, chest tightness by 53%, and wheeze by 52%. Symptoms were also stratified by smoking status and job category; results indicated that lower respiratory symptoms increased among former smokers from the hot end. Overall, work-related health problems were reported in 47% of the workers. These conditions included upper respiratory symptoms by 60%, mucosal irritation by 26%, musculoskeletal by 18%, and hearing loss by 14%. Overall nasal bleeding was reported by 25% (35 of 138) of the workers. Stratification by job category indicated that 30% of cold end workers reported nasal bleeding, as did 23% of the hot end workers, 22% of the warehouse workers, and 7% of maintenance workers. The frequency of nose bleeding was reported 1 to 4 times a year in 74% of the cases. Overall skin irritation was reported in 43% (59 of 138) of the workers. Symptoms by job category indicated that 47% of cold end workers reported skin irritation, as did 69% of the hot end workers, 17% of the warehouse workers, and 36% of maintenance workers. Overall eye irritation was reported by 71% (98 of 138) of the workers. Symptoms by job category indicated that 75% of worker in the cold end reported eye irritation, 69% of hot end workers, 57% of the warehouse workers, and from 79% of maintenance workers. These findings suggest a high prevalance of mucosal irritation symptoms among plant workers in both cold end and hot end areas. Thirteen cases of alleged pneumoconiosis were identified in the OSHA 200 logs; this prompted a review of the medical records. Ten medical records were obtained. Of these, the average age was 42 years. The tenure in the glass industry was 21 years. Radiographic evaluations conducted by certified B Readers from a medical group contracted by the company as well as NIOSH's B Reader physician did not document any finding related with occupational pneumoconiosis. A review of AFG's OSHA 200 log from 1996 included 63 cases of musculoskeletal injuries, seven cases of alleged pneumoconiosis, three cases of hearing loss, and two eye related injuries. During the first nine months of 1997, 41 cases of musculoskeletal injuries, one case of eye injury, and one case of SO2 inhalation were reported.
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(2000) Claremont Flock Corporation, Claremont, NH. (Click to open report) The Claremont Flock Corporation produces flock, from tow and cotton scrap fabric, and bags the products in four plants in Massachusetts and New Hampshire. The management requested a health hazard evaluation (HHE) to get a better understanding of the respiratory hazards in the plants. At the time of the request, an extensive HHE at another company's flocking facility in Rhode Island (NIOSH 1998) had uncovered a cluster of cases of a new occupational lung disease (flock workers' lung) [Kern et al.... (Click to show more)The Claremont Flock Corporation produces flock, from tow and cotton scrap fabric, and bags the products in four plants in Massachusetts and New Hampshire. The management requested a health hazard evaluation (HHE) to get a better understanding of the respiratory hazards in the plants. At the time of the request, an extensive HHE at another company's flocking facility in Rhode Island (NIOSH 1998) had uncovered a cluster of cases of a new occupational lung disease (flock workers' lung) [Kern et al. 1998]. In addition, one worker at Claremont Flock had a diagnosis of the same illness. In November 1998, NIOSH conducted an investigation at the Claremont Flock plants consisting of a symptom and work history questionnaire and personal and area sampling, primarily for respirable dust (dust small enough to reach the deepest areas of the lungs) and fiber counts. About 81% of the workers participated in the survey. The results and conclusions of the survey are as follows: The same types of particles identified at the Rhode Island plant were also present in air samples collected at Spectro Coating. Even though the dust concentrations were lower compared to those in the Rhode Island plant, blow-down exposures at Spectro Coating were associated with respiratory symptoms in workers. Blow-down cleaning with compressed air and flock-loading resulted in the highest dust concentrations measured in this workplace. Blow-down exposures were associated with an excess of fever/aches and cough/phlegm. Decreasing exposures should lead to decreased symptoms and complaints. Gravimetric respirable dust measurement appears to be a suitable method for characterizing concentrations in this setting. Smoking alone and in interaction with the exposures from compressed air cleaning was associated with symptoms. Respirator use was sporadic, and many workers had not been fit-tested. The following are specific recommendations for this workplace: Reduce dust exposures with engineering controls. Until engineering controls are in place, limit the use of blow-downs and use personal respiratory protection to control dust exposures. Expend the annual medical examination to include a means for identifying workers with frequent fever, aches, cough, phlegm, wheezing, or other respiratory symptoms. Workers with any of these symptoms should receive a medical evaluation and an opportunity to reduce dust exposures by placement out of high exposure jobs. Periodically inform workers about work-related disease observed among flock workers and how to reduce or control their risk of disease. Implement a no-smoking policy at the plant (NIOSH 1991). If allowed at all, smoking at the plant should be restricted to designated, seperately-ventilated smoking areas. Workers should be encouraged to stop smoking altogether through an employer-sponsored smoking cessation program and education campaign.
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(2000) Delphi Automotive Systems - Flint East Operations, Flint, Michigan. (Click to open report) On January 3, 2000, the National Institute for Occupational Safety and Health (NIOSH) received a request for a Health Hazard Evaluation (HHE) from employees at Delphi Automotive Systems - Flint East Operations in Flint, Michigan. The HHE request expressed concerns about possible exposure to lead resulting from the use of wave solder machines during the production of circuit boards. In response to this request, a site visit was conducted on March 30 through April 1, 2000. During this site visit, ... (Click to show more)On January 3, 2000, the National Institute for Occupational Safety and Health (NIOSH) received a request for a Health Hazard Evaluation (HHE) from employees at Delphi Automotive Systems - Flint East Operations in Flint, Michigan. The HHE request expressed concerns about possible exposure to lead resulting from the use of wave solder machines during the production of circuit boards. In response to this request, a site visit was conducted on March 30 through April 1, 2000. During this site visit, two NIOSH industrial hygienists and a visiting researcher conducted a walk-through inspection of the area of concern and discussed the exposure issue with management and employees working in the area. Full-shift personal breathing zone (PBZ) and area air sampling was performed to measure the levels of potential exposure to lead and tin dust originating from the 60% tin / 40% lead solder used in the wave solder machines. Surface sampling was also conducted for lead dust on equipment surfaces, lunch room tables, floors, and hands of employees. Discussions were held with management regarding their written lead compliance program, personal protective equipment program, and their environmental monitoring and medical surveillance plans. Results from the PBZ sampling ranged between nondetectable and 4.0 micrograms per cubic meter (microg/m3 ) for lead and between nondetectable and 7.0 microg/m3 for tin. The PBZ results were all well below the Occupational Safety and Health Administration (OSHA) permissible exposure limits (PEL) of 50 microg lead/m3 and 2000 microg tin/m3 averaged over an 8-hour work shift. None of the area air samples had detectable amounts of lead or tin. Wipe sampling did detect the presence of accumulated lead on a variety of work surfaces. These included the floor near wave solder machines, some equipment surfaces, and ceiling air supply ventilation registers. Results for the wipe sampling ranged from nondetectable to 1700 microg lead/wipe sample (each sample was collected over a 100 square centimeter [cm2] area.) Despite the fact that employee exposure to airborne lead does not appear to be excessive in the work areas evaluated, the presence of accumulated lead on work surfaces indicates a potential for occupational exposure to lead. Management needs to stress regular and thorough housekeeping procedures in these areas and employees need to recognize the importance of personal hygiene practices in the prevention of ingestion of this accumulated lead. Recommendations regarding the site's written lead compliance program, lead sampling, and housekeeping issues are provided in this report.
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(2000) Exempla St. Joseph Hospital, Denver, Colorado (revised). (Click to open report) On January 23, 1998, the National Institute for Occupational Safety and Health (NIOSH) received a confidential employee request for a health hazard evaluation (HHE) at Exempla Health Care Facility/St. Joseph's Hospital in Denver, Colorado. The request stated that hospital employees experienced facial flushing, rhinitis, sneezing, itching and watery eyes, and fainting while at work. According to the request, the exposure thought to cause the employees' health problems was latex protein from powde... (Click to show more)On January 23, 1998, the National Institute for Occupational Safety and Health (NIOSH) received a confidential employee request for a health hazard evaluation (HHE) at Exempla Health Care Facility/St. Joseph's Hospital in Denver, Colorado. The request stated that hospital employees experienced facial flushing, rhinitis, sneezing, itching and watery eyes, and fainting while at work. According to the request, the exposure thought to cause the employees' health problems was latex protein from powdered natural rubber latex (NRL) gloves. The NIOSH investigation consisted of concurrent medical and industrial hygiene evaluations during the weeks of July 13-16, 1998, and August 3-6, 1998. Additional medical evaluations were completed November 9-13, 1998. The medical evaluation included a self-administered questionnaire and blood tests for total IgE and latex-specific IgE. The industrial hygiene evaluation consisted of air, surface, and bulk dust sampling to evaluate the presence of latex proteins within the hospital environment. The overall prevalence of latex sensitization (defined by the presence of latex-specific IgE) was 10.5% (56/531). There was no statistically significant difference in the prevalence of latex sensitization between employees who wear latex gloves (10.6% or 28/264) and those who do not wear latex gloves (10.6% or 27/255) (p=1.0). There was also no statistically significant difference in the prevalence of latex sensitization between employees who reported current latex glove use or having worn at least one pair of latex gloves per day at another job or in training (i.e., ever having occupational latex glove use), with a prevalence of 11.0%, and those who reported never having occupational latex glove use, with a prevalence of 8.9% (p=0.5). Reporting of work-related hand dermatitis was more common among those who currently wore latex gloves (23.4%) than among those who did not (4.9%) (p < 0.01), as were rhinoconjunctivitis (16.3% and 7.9%, respectively, p < 0.01) and hand urticaria (9.9% and 2.1%, respectively, p < 0.01). There was no significant difference by latex glove use in the reporting of work-related asthma or general urticaria. There was no statistically significant association between any of these symptom complexes and latex sensitization, although hand urticaria and hand dermatitis were more prevalent in those who were sensitized. Atopy (history of allergic rhinitis, asthma, or atopic dermatitis) was significantly associated with latex sensitization; 83.6% of those with latex sensitization were atopic, compared to 58.2% of those who were not sensitized (p<0.05). Twenty-seven percent of those with latex sensitization reported no Type I allergic symptoms, i.e., urticaria, rhinoconjunctivitis, or asthma, either at work or home, while sixty-three percent reported no work-related Type I symptoms. A total of 23 area air samples for NRL allergen were collected in clinical (16) and non-clinical (7) areas of the hospital. Five of the seven samples collected in the non-clinical areas had no detectable NRL protein. One sample, collected in inpatient admitting, had a concentration between the limit of detection (LOD) and the limit of quantitation (LOQ), that is, a trace concentration. One sample, collected in the medical records area, had a quantifiable concentration, 0.26 nanograms per cubic meter (ng/m3). Sixteen air samples were collected in clinical areas of the hospital. Nine of sixteen samples (from a variety of clinical areas) had NRL protein concentrations ranging from 0.41 to 3.33 (ng/m3). Four samples contained trace concentrations, and three samples had no detectable NRL protein. v Nineteen surface dust samples were collected from ceiling tiles and air handling unit (AHU) plenums. Ten samples were collected from clinical areas and nine from non-clinical areas. In the non-clinical areas, no NRL was detected in seven of the samples, one had a trace amount, and one sample from an AHU serving the inpatient admitting had 368 nanograms of NRL per 100 square centimeters (ng/100 cm2). In the clinical areas, 7 of 10 surface dust samples had no detectable NRL protein. One sample collected from the back of a ceiling tile in the labor and delivery (L&D) suite 242 had 118 ng/100 cm2, and two surface samples collected inside AHUs contained 1,022 and 3,952 ng/100 cm2. Two filter dust samples were collected from AHUs serving non-clinical areas of the hospital; neither had detectable NRL protein. Five samples of filter dust collected from AHUs serving clinical areas of the hospital had NRL protein concentrations ranging from 4,433 ng/gram of dust (ng/gm), from an AHU which serves the emergency department (ED), to 83,682 ng/gm, from an AHU which serves the labor and delivery areas. We found that levels of airborne, surface, and filter dust latex proteins were higher in the work areas of the employees who were not sensitized to latex than those who were sensitized, although these differences were not statistically significant. We found that neither current nor past occupational use of latex gloves was associated with latex sensitization in this study population. Latex glove use, however, was associated with reporting of work related rhinoconjunctivitis, hand urticaria, and hand dermatitis. Airborne natural rubber latex protein levels were very low, but there was a significant amount of latex protein on filters in the ventilation system. Exposure to filter dust could present risks to individuals who change AHU filters (e.g., maintenance workers), or to other workers if NRL proteins were to be released into the hospital environment. Recommendations include the use of nonlatex gloves for those who do not encounter infectious materials, and the use of low-protein, powder-free latex gloves for those who do encounter infectious materials; education for employees about latex allergy; and re-assessment of prevention strategies if a worker is diagnosed with latex allergy.
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(2000) Exempla St. Joseph's Hospital, Denver, Colorado. (Click to open report) A health hazard evaluation (HHE) was requested by management at the neonatal intensive care unit (NICU) at Exempla St. Joseph's Hospital in Denver, Colorado. The request concerned possible exposures to natural rubber latex (NRL) proteins. Employees reported rhinitis, sneezing, rash, watery eyes, and aggravation of allergic symptoms. A reservoir of dust was found within the NICU; exhaust from the central vacuum cleaning system was leaking into the ceiling plenum of an area adjacent to the NICU. T... (Click to show more)A health hazard evaluation (HHE) was requested by management at the neonatal intensive care unit (NICU) at Exempla St. Joseph's Hospital in Denver, Colorado. The request concerned possible exposures to natural rubber latex (NRL) proteins. Employees reported rhinitis, sneezing, rash, watery eyes, and aggravation of allergic symptoms. A reservoir of dust was found within the NICU; exhaust from the central vacuum cleaning system was leaking into the ceiling plenum of an area adjacent to the NICU. The system exhausted vacuumed carpet dust into the ceiling plenum, rather than to the outside, as designed. The use of pressure measurements and carbon dioxide tracer gas demonstrated that a potential pathway existed for the movement of airborne dusts from the affected plenum to the adjacent plenum over the NICU. Two air samples, six surface samples, and two bulk dust samples were collected. Concentrations of NRL ranged from below the limit of detection [<1 allergy units (AU) per milliliter of extracted sample] to 4.2 AUs. Eight of the ten samples were in a range considered to be trace concentrations. The two NRL air samples were reported at less than the limit of detection and 1.8 AU. No mechanical or maintenance deficiencies and no visible microbiological contamination were identified in the air handling unit serving the NICU. A water leak in the NICU was identified, and remediated by hospital personnel.
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(2000) Haverhill High School, Haverhill, Massachusetts. (Click to open report) On January 27, 1999, the National Institute for Occupational Safety and Health (NIOSH) received a confidential request from staff at Haverhill High School in Haverhill, Massachusetts, for an evaluation of exposures to crystalline silica and other compounds in ceramics. The request indicated that employees were concerned about developing emphysema, silicosis, and/or asthma due to exposure to ceramics materials. In addition, the request indicated that staff were concerned about exposures to vari... (Click to show more)On January 27, 1999, the National Institute for Occupational Safety and Health (NIOSH) received a confidential request from staff at Haverhill High School in Haverhill, Massachusetts, for an evaluation of exposures to crystalline silica and other compounds in ceramics. The request indicated that employees were concerned about developing emphysema, silicosis, and/or asthma due to exposure to ceramics materials. In addition, the request indicated that staff were concerned about exposures to various materials used in five art rooms, and the woodworking shop. On April 27, 1999, an initial site visit was conducted which included an opening conference, informal discussions with teachers, and a walk-through inspection of the art rooms and woodworking shop. During the walk-through, activities were identified in ceramics and woodworking classrooms which could result in exposure to crystalline silica, metals, and wood dust. On May 4, 1999, a second site visit was conducted where environmental monitoring was conducted for airborne crystalline silica in the ceramics classroom, and wood dust in the woodworking shop. Surface wipe sampling for metals was conducted in ceramics. Measured concentrations of respirable crystalline silica were below the NIOSH Recommended Exposure Limit (REL) during the monitoring period. Neither of the respirable area samples revealed detectable levels of crystalline silica. Total crystalline silica (quartz) concentrations of 0.070 milligrams per cubic meter (mg/m3) and 0.075 mg/m3 were quantified in bulk air samples collected at the wedging table and at the center of the classroom, respectively. A bulk sample of settled dust, collected from a shelf adjacent to the door leading to the corridor, contained 25% quartz. Cristobalite was not detected in any of the samples. Gravimetric analysis of air samples indicates that concentrations of all airborne particulates were below occupational exposure limits for particulates not otherwise regulated (PNOR). Surface wipe sampling for metals found the highest concentrations of metals in the storage closet where glazes are prepared from powdered materials. Local exhaust ventilation (LEV) is not provided at the wedging table or in the glaze preparation area. The highest concentration of wood dust (3.4 mg/m3 during a 50-minute period) was measured in the personal breathing zone (PBZ) sample collected on the woodworking instructor. A similar concentration (3.2 mg/m3 during a 78-minute period) was measured in the vicinity of two students who were using hand-held orbit sanders at a "homemade" downdraft table. The presence of crystalline silica in a settled dust sample indicates a need for LEV and appropriate housekeeping practices in the ceramics classroom. Air samples collected in the woodworking shop indicate that current LEV is not providing effective control of wood dust. Recommendations include substituting premixed glazes, installation of effective LEV systems in ceramics and woodworking classrooms, improved housekeeping practices in ceramics, and implementation of an effective Chemical Hazard Communication Program.
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