Health Hazard Evaluations (HHEs)

(1999) Allgrind Plastics, Inc., West Portal, New Jersey. (Click to open report)
In January 1998, the State of New Jersey, Department of Health and Senior Services (NJDHSS), requested technical assistance from the National Institute for Occupational Safety and Health (NIOSH) in investigating a possible health hazard at the Allgrind Plastics, Inc., milling facility in West Portal, New Jersey. Allgrind Plastics is primarily engaged in size reduction of various plastics using attrition mills, knife mills, and hammer mills. In general, the company does many small jobs and thus o... (Click to show more) In January 1998, the State of New Jersey, Department of Health and Senior Services (NJDHSS), requested technical assistance from the National Institute for Occupational Safety and Health (NIOSH) in investigating a possible health hazard at the Allgrind Plastics, Inc., milling facility in West Portal, New Jersey. Allgrind Plastics is primarily engaged in size reduction of various plastics using attrition mills, knife mills, and hammer mills. In general, the company does many small jobs and thus over time has processed many types of plastics. Within the last few years, the company has also been processing organic materials, primarily shark cartilage, into fine powders for use as natural remedies for various diseases. The request was prompted by the death of a 38-year-old employee of an acute asthma attack while at work on April 19, 1997. Prior to his death, the employee had attributed acute asthmatic symptoms to shark cartilage dust on a number of occasions. On May 26-28, 1998, an industrial hygienist and two medical officers from NIOSH, and an industrial hygienist from the NJDHSS, visited Allgrind Plastics. They conducted a walk-through evaluation of the plant, met with all current workers, and reviewed pertinent company records. Subsequent to the visit, former employees were contacted by telephone and questioned regarding work-related symptoms. Also, bulk samples collected at the worksite underwent laboratory analysis. In addition to the site visit noted above, personnel from the NJDHSS conducted a prior site visit on November 14, 1997, and conducted industrial hygiene evaluations, with air sampling of selected processes, on March 12 and April 22, 1998. Personal samples in the shark grinding areas measured 44.7 and 26.4 milligrams per cubic meter of air (mg/m 3 ) total dust and 5.14 and 0.92 mg/m 3 respirable dust on March 12, 1998. During the sampling on April 22, 1998, the personal samples measured 12.3 mg/m 3 total dust and 1.97 mg/m 3 respirable dust, and concentrations of 2.94 mg/m 3 total dust and 0.34 mg/m 3 respirable dust were measured on samplers worn by an operator milling plastic. Area samples for total dust did not exceed 0.43 mg/m 3 , and area respirable dust samples remained below 0.24 mg/m 3 during both days of sampling by NJDHSS. Endotoxin concentrations of bulk samples of shark cartilage did not exceed 1.6 endotoxin units per milligram (EU/mg). It was found that unique exposures exist at Allgrind Plastics due to the production of dusts from materials not normally inhaled. Air monitoring showed that certain processes generated significant airborne concentrations of these dusts. Limited medical experience exists to predict the health effects of many of these dusts after inhalation. However, medical findings noted during the May 1998 site visit were consistent with a significant burden of work-associated respiratory symptoms in current and former workers, many of them irritative in nature. In addition, three workers were identified as being likely to have developed true occupational asthma after working at Allgrind Plastics for a period of months to years. An additional worker was identified with urticaria and angioedema induced by a material in the workplace (ethylene diamine acid phosphate). These findings strongly suggest that a sensitizing substance or substances are present in the workplace and capable of inducing disease. Two materials were identified as particular problems by workers. Shark cartilage dust was the material most frequently identified as troublesome by current and former workers. Ethylene diamine acid phosphate was the second most frequently cited material. Dusts of both appear to be irritating. Ethylene diamine is a well documented sensitizer and has been reported to cause asthma. Shark cartilage has not previously been reported to cause immunologic sensitization but in theory it could. Although dusts generated from both of these materials are regulated under a "particulates, not otherwise classified or regulated (PNOC/R)" standard, this standard is likely not fully protective against the effects of poorly studied but potentially more injurious dusts such as those encountered here. Various industrial hygiene measures are recommended to control dust exposures, not only to the respiratory tract but also to face, eyes, and skin. In addition, worker education, environmental monitoring, and medical surveillance measures are recommended for prevention of disease, as well as for early identification and prevention of disease progression. NIOSH investigators conclude that dusts produced by industrial processes at Allgrind Plastics are a significant health hazard. Many workers have symptoms when exposed to these dusts. Several workers have developed asthma while working at the plant. Two materials, shark cartilage dust and ethylene diamine acid phosphate dust, appear to pose a significant health hazard. The "Recommendations" section of this report provides suggestions for ways to decrease problems caused by these dusts. These include ways to decrease exposure, worker education, ways to detect early illness, and what to do if a worker gets sick. (Click to show less)
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(1999) Central Maui Composting Facility Maui, Hawaii. (Click to open report)
On March 28, 1995, the National Institute for Occupational Safety and Health (NIOSH) received a management request for a health hazard evaluation from the Maui County Council, Maui, Hawaii. The Council asked NIOSH to evaluate their composting operation since they recently began receiving complaints of poor working conditions from former employees, as well as complaints from neighboring business (Kahului Airport) about odors emitting from the composting site. There was no indication that any curr... (Click to show more) On March 28, 1995, the National Institute for Occupational Safety and Health (NIOSH) received a management request for a health hazard evaluation from the Maui County Council, Maui, Hawaii. The Council asked NIOSH to evaluate their composting operation since they recently began receiving complaints of poor working conditions from former employees, as well as complaints from neighboring business (Kahului Airport) about odors emitting from the composting site. There was no indication that any current employees have or had any health problems associated with the compost operation. This request was also prompted by the NIOSH Alert pertaining to Organic Dust Toxic Syndrome (ODTS). On May 11, 1995, NIOSH investigators conducted an initial site visit to the composting facility. During that site visit, the composting operation was toured, and area air samples were collected for total dusts, bacteria, fungi, and endotoxin. Bulk samples were collected of the various compost products for microbiological analysis. The purpose for collecting theses samples was to determine the microbial activity of the compost. The contractor operating the site was in the process of ending his contract with the County, so very little work was being accomplished at that time. On September 11-13, 1995, a return visit was made to the composting facility to conduct a comprehensive industrial hygiene survey. During that survey, the old contractor was still in the process of leaving and the new contractor preparing to take over operations. During that transition, the old contractor was loading and removing product, while the new contractor was focusing on reducing the stock-pile of accumulated green waste and sewage sludge by mixing one static windrow of compost. A final survey was conducted during June 24-26, 1996. During that survey, the composting site was fully operational under the new management. Many positive changes to the site were obvious, including the reduced stock pile of sewage sludge and green waste, a new office trailer, and most importantly, new front-end loaders equipped with air conditioned enclosed cabs. Other equipment used consisted of a compost mixing truck, a screener, and a new chipper/grinder. Water was also now available from the nearby quarry to spray on the compost and the roads to keep dust down. Total dust concentrations from the samples collected upwind ranged from 0.2 to 21.5 mg/m3, with the highest level measured on the outside of the loader working the greens. Other samples of note were the total and respirable samples collected inside and outside of the cab of a front end loader loading in the greens area. Total dust concentrations inside the cab were 0.69 mg/m3, while concentrations measured outside were 21.5 mg/m3. Respirable dust concentrations inside and outside the cab were 0.3 ands 0.72 mg/m3, respectively with the highest level measured on the access road to the landfill. Bacteria concentrations ranged from none detected (ND) to 8.0 x 107 colony forming units per cubic meter of air (CFU/m3), with the highest levels also measured on the loader at the greens. The primary bacteria identified was Bacillus. Thermophilic bacteria was only detected on the sample collected near the workshop. Fungi concentrations ranged from ND to 2.8 x 106 CFU/m3, with the highest levels measured near chipper/grinder. The primary fungi identified from the samples were Aspergillus and Penicillium. Endotoxin concentrations ranged from none detected (ND) to 3.0 x 105 endotoxin units per cubic meter of air (EU/m3), with the highest concentration measured near the greens chipper/grinder. To reduce this potential hazard it is important to reduce worker exposures by means of either engineering controls (e.g., enclosed cabs), respiratory protection, or a combination of engineering controls and respiratory protection. Samples collected showed that the enclosed cabs, when used properly such as keeping the windows closed, can reduce worker exposures. However, these controls are relatively ineffective if the cab windows are opened during compost handling operations. Also, these results show that individuals in the general area of the composting pads or those not operating enclosed equipment, should either wear respiratory protection or stay upwind during turning operations. The results from this health hazard evaluation has shown that the enclosed machinery cabs on the equipment can reduce exposures. Also, these results show that individuals in the general area of the chipper/grinder should wear respiratory protection during operation. Acceptable levels of airborne microorganisms have not been established. Lack of standardized exposure assessment techniques, inability to measure non-viable organisms, and inter-individual variability in response have confounded efforts to set such standards. Just as individuals vary in their resistance to disease, a few individuals may be particularly sensitive to some of the organisms in compost. (Click to show less)
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(1999) Delphi Chassis Systems, Dayton, Ohio. (Click to open report)
On June 6, 1997, the National Institute for Occupational Safety and Health(NIOSH) received a request for a health hazard evaluation (HHE) from employee and management representatives of Delphi Chassis Systems in Dayton, Ohio. The request stated that employees in departments 2, 12, 37, and 40 of this automotive brake parts manufacturing facility were experiencing a high frequency of upper respiratory irritation and colds. A prior HHE request (HETA 96-0199) involving the same concerns had been rec... (Click to show more) On June 6, 1997, the National Institute for Occupational Safety and Health(NIOSH) received a request for a health hazard evaluation (HHE) from employee and management representatives of Delphi Chassis Systems in Dayton, Ohio. The request stated that employees in departments 2, 12, 37, and 40 of this automotive brake parts manufacturing facility were experiencing a high frequency of upper respiratory irritation and colds. A prior HHE request (HETA 96-0199) involving the same concerns had been received on June 10, 1996. In response to that first request, an initial walk-through survey was conducted on August 30, 1996, at which time several brake pads were collected for analysis. That HHE was postponed by management and union representatives due to ongoing contract negotiations. (Click to show less)
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(1999) Gwinnett Medical Center, Lawrenceville, Georgia. (Click to open report)
On February 1, 1999, the National Institute for Occupational Safety and Health (NIOSH) received a management request for a health hazard evaluation (HHE) at the Gwinnett Medical Center (GMC) in Lawrenceville, Georgia. The request asked NIOSH to determine if workplace exposures are related to health problems reportedly experienced by some GMC employees working in the In Patient Surgery (IPS) and Day Surgery (DS) departments at this hospital. Health problems described in the request included derma... (Click to show more) On February 1, 1999, the National Institute for Occupational Safety and Health (NIOSH) received a management request for a health hazard evaluation (HHE) at the Gwinnett Medical Center (GMC) in Lawrenceville, Georgia. The request asked NIOSH to determine if workplace exposures are related to health problems reportedly experienced by some GMC employees working in the In Patient Surgery (IPS) and Day Surgery (DS) departments at this hospital. Health problems described in the request included dermatitis, burning and itching eyes, respiratory irritation, headache, and cough. Potential exposures included construction dust and debris, volatile contaminants from new carpet and paint, disinfectants, common cleaning chemicals, and waste anesthetic gases. On March 1, 1999, NIOSH investigators conducted an initial site visit at GMC. The purpose of this site visit was to review the current status of the health complaints with GMC personnel, inspect the IPS and DS departments and observe work practices, and assess the ventilation system supporting these two areas. A follow-up site visit was conducted on April 20-21, 1999. During this follow up site visit, eight area air samples for natural rubber latex (NRL) allergen were collected in the IPS and DS departments. Bulk and surface samples for NRL allergen analysis were obtained from ceiling plenums (ventilation return air pathways) in both departments. Because of concerns regarding latex allergy, GMC had previously implemented a powder-free latex glove policy and cleaned both the DS and IPS departments. In response to cases of clinically confirmed latex allergy in the DS department, the ventilation duct work was also cleaned. No workers in the IPS department were found to be latex-allergic and the ventilation duct work in this area was not cleaned. NRL monitoring was conducted to compare the two areas. At the time of the NIOSH site visits, the health concerns in the DS department were associated with poor indoor environmental quality (IEQ), and monitoring for standard IEQ parameters (temperature, relative humidity [%RH], and carbon dioxide [CO2]) was conducted in this area. No NRL allergen was detected on any of the air samples collected from the IPS or DS departments. However, NRL allergen was not detected on two quality control sample filters spiked with known concentrations of NRL. Therefore, a meaningful comparison of airborne NRL allergen between the DS and IPS cannot be made from these results. Regulatory standards for acceptable levels of NRL allergen in air have not been established. The bulk and surface dust samples indicated the presence, at various concentrations, of NRL allergen in the return air (RA) plenums from the IPS and DS departments. NRL allergen in bulk samples from the RA plenum in IPS ranged from 21,070 nanograms per gram sample (ng/gm) to 52,800 ng/gm. The two samples from the RA plenum in DS contained 21,067 ng/gm and 39,301 ng/gm of NRL allergen. Regulatory criteria for NRL allergen in surface or dust samples has not been established, although guidelines have been suggested (Mayo Clinic) for bulk dustsamples. The suggested recommendations for bulk dust are: Low, < 10,000 ng/gm; Low-Moderate, 10,000-100,000 ng/gm; High, >100,000 ng/gm. Although only limited samples were collected, there did not appear to be any appreciable difference in NRL concentrations in dust between the DS and IPS departments. The temperature, RH, and CO2 monitoring found all measured parameters to be within acceptable ranges. Inspection of the air handling units (AHUs) providing ventilation to the IPS and DS departments found the units to be clean and well maintained. The units are equipped with efficient filtration that should effectively prevent most dust particles from entering the supply side of the air handlers. As such, dispersion of latex containing particles from supply ducts into occupied areas is unlikely. However, because a reservoir of NRL was identified in the plenum spaces, episodic dispersion of latex-containing particles is a possibility, and actions should be implemented (e.g., proper work practices, particularly during maintenance activities) to control the potential release of NRL-containing dust into occupied areas. Humidification of supply air to the operating rooms is accomplished by direct injection of boiler steam, and there is the potential for introducing boiler water treatment chemicals into the system, and subsequently into the work environment. (Click to show less)
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(1999) LDS Hospital/Intermountain Health Care, Salt Lake City, Utah. (Click to open report)
On November 18, 1998, the National Institute for Occupational Safety and Health (NIOSH) received a request for a health hazard evaluation (HHE) from the Occupational Health Nurse at the Latter Day Saints/Intermountain Health Care hospital in Salt Lake City, Utah. The HHE request stated that several nurses and nurses' aides working in the bone marrow transplant unit (BMT) had experienced allergic symptoms. These included two reports of anaphylaxis and several reports of less severe symptoms, such... (Click to show more) On November 18, 1998, the National Institute for Occupational Safety and Health (NIOSH) received a request for a health hazard evaluation (HHE) from the Occupational Health Nurse at the Latter Day Saints/Intermountain Health Care hospital in Salt Lake City, Utah. The HHE request stated that several nurses and nurses' aides working in the bone marrow transplant unit (BMT) had experienced allergic symptoms. These included two reports of anaphylaxis and several reports of less severe symptoms, such as shortness of breath, rashes, and itching. The health effects reported by the health care workers were thought to be associated with an activity specific to the BMT: the infusing of patients with a solution containing stem cells and dimethyl sulfoxide (DMSO). The NIOSH investigation consisted of concurrent medical and industrial hygiene evaluations on December 7, 1998, and an additional medical evaluation on February 18-19, 1999. The medical evaluation included a questionnaire, private interviews with employees, and review of medical records. The industrial hygiene evaluation consisted of air, surface, and bulk dust sampling to evaluate the presence of DMSO and latex proteins in the BMT. None of the volatile chemicals known to be present in the stem cell infusion solutions, including DMSO, were detected in the air during the administration of stem cells into a patient. Natural rubber latex was not detected in air samples. A medical records review revealed rashes and respiratory symptoms to be the most commonly reported symptoms among affected employees. Since no direct dermal contact with DMSO occurs, and no chemicals could be measured in the breathing zone of the staff nurse or in the ambient environment of the room where the infusion occurred, it is unlikely that skin and respiratory symptoms are caused by exposures from the administration of stem cells. Medical questionnaires (from 64 workers) revealed that 22% of employees reported some type of chest symptom and 50% reported skin symptoms including rashes (47%) and hives (13%). Hay fever was reported by 59% of the employees and 22% reported a physician diagnosis of asthma. Pre-existing atopy and asthma in the employees who worked in the BMT could explain the upper respiratory symptoms reported by staff in the BMT. Skin symptoms (especially hand rash) are common in the nursing profession due to frequent washing and drying of the hands and the use of gloves as a part of universal precautions. (Click to show less)
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