Health Hazard Evaluations (HHEs)

(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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(2001) Group Health Associates, Cincinnati, Ohio. (Click to open report)
The National Institute for Occupational Safety and Health (NIOSH) conducted a health hazard evaluation at the Group Health Associates' Western Hills facility in Cincinnati, Ohio. The request listed several instances of water incursion. Reported health problems among employees included headaches, nasal congestion, chronic coughing, three diagnosed cases of chlamydia pneumonia, and an increase in the number of nonspecific illnesses. NIOSH investigators conducted an initial site visit to the of... (Click to show more) The National Institute for Occupational Safety and Health (NIOSH) conducted a health hazard evaluation at the Group Health Associates' Western Hills facility in Cincinnati, Ohio. The request listed several instances of water incursion. Reported health problems among employees included headaches, nasal congestion, chronic coughing, three diagnosed cases of chlamydia pneumonia, and an increase in the number of nonspecific illnesses. NIOSH investigators conducted an initial site visit to the office on August 23 and 24, 2000, and a follow-up visit to look at moisture issues on December 14, 2000. The August site visit included a limited ventilation system assessment, measurement of indoor environmental quality indicators (carbon dioxide [CO2], temperature, and relative humidity), moisture measurements, and limited microbial sampling. The environmental evaluation identified problems with temperature and humidity regulation and air delivery. Temperatures ranging from 69 F to 73 F, and relative humidities ranging from 48% to 70% were recorded on the day of sampling. Elevated CO2 concentrations (up to 1540 parts per million) were recorded in the examination rooms, waiting areas, and the Medical Records Department, indicating insufficient ventilation. The ventilation systems' thermostats were located in the perimeter offices where solar load affected the office conditions. Excessive moisture was detected in interior and exterior walls which could be due to water incursion from overflowing toilets and poor humidity control in the building. The visual assessment did not reveal widespread microbial contamination. A sticky tape sample collected beside one of the toilet areas indicated fungal growth. The outside air damper for the original building heating, ventilating, and air-conditioning unit was closed, and there was no provision of outside air to the basement. The major water-incursion issues had been addressed before the initial NIOSH site visit. NIOSH investigators recommend that problems with the regulation of temperature, humidity, and air delivery within the Group Health Associates' Western Hills facility be corrected. It is unclear if these issues were the cause of the reported health symptoms, many of which were non-specific, however, improving the indoor environmental quality should minimize work-related health complaints. The cases of Chlamydia pneumonia are likely caused by person-to-person transmission from respiratory secretions. The occurrence of these cases reinforces the need to practice good personal hygiene in the workplace. (Click to show less)
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(2000) Equifax Payment Services, St. Petersburg, Florida. (Click to open report)
On August 7, 2002, the National Institute for Occupational Safety and Health (NIOSH) received a confidential employee request for a health hazard evaluation (HHE) at the Equifax company in St. Petersburg, Florida. The request asked NIOSH to determine if workplace exposures are related to health problems that some employees at this facility have reported. The primary health complaint indicated on the request was hair loss. Specific work areas of concern identified in the request were offices in t... (Click to show more) On August 7, 2002, the National Institute for Occupational Safety and Health (NIOSH) received a confidential employee request for a health hazard evaluation (HHE) at the Equifax company in St. Petersburg, Florida. The request asked NIOSH to determine if workplace exposures are related to health problems that some employees at this facility have reported. The primary health complaint indicated on the request was hair loss. Specific work areas of concern identified in the request were offices in the Southeast section of the building. On September 12-13, 2002, NIOSH researchers conducted a site visit at the Equifax facility. The objectives of this site visit were to determine if there were unusual occurrences of hair loss or other health problems among employees and evaluate plausible exposure pathways for environmental substances that could cause hair loss or other health problems. During the site visit, a walkthrough of the facility was conducted, and reports from previous evaluations that assessed employee health complaints and measured environmental contaminants at Equifax were reviewed. The air handling units (AHUs) supporting the southeast portion of the building were inspected, and surface samples wee collected for metals analysis. Information regarding the past use of radioactive materials at the building prior to occupancy by Equifax was reviewed, and a survey to assess ionizing radiation was conducted. Confidential medical interviews with 28 Equifax employees were conducted. Following the site visit, two Equifax employees and one former employee who were unavailable during the site visit were interviewed by telephone. NIOSH representatives also reviewed information compiled by the requestor concerning employees diagnosed with cancer. The building walkthrough and review of previous environmental evaluations did not identify any obvious pollutant sources that could contribute to the reported health complaints or poor indoor environmental quality (IEQ). The AHUs inspected were operational, clean (filters, coils, accessible portions of the AHUs), and appeared well-maintained and in good condition. the outdoor air intakes were well spaced and were not located in close proximity to building exhaust vents. Surface samples collected from the ventilation systems supporting the southeast portion of the building and the cafeteria did not identify any thallium, a metal associated with hair loss. All radiation measurements were within general background levels (<15 microRoentgens per hour) and no evidence of contamination was found in any of the surface measurements. Several types of hair loss have occurred among some Equifax employees. eleven individuals with a history of current moderate to severe diffuse thinning over the scalp were interviewed; these 11 individuals worked in 8 different areas of the building. five persons with confirmed or suspected alopecia areata of varying severity, were identified. three of the five persons worked in one primary area and developed initial hair loss over approximately 1.5 year period. regarding cancer, there was no unusual distribution of similar cancers or exposure to cancer causing agents found at this facility. No evidence was found that the hair loss/thinning reported by Equifax employees is related to an occupational exposures(s) at Equifax. The occurrences of cancer among Equifax employees reported to NIOSH representatives are unlikely to be related to occupational exposures at the Equifax facility. No occupational exposure to ionizing radiation was identified. Recommendations to address employee health concerns are provided; the importance of continued efforts towards achieving effective communication with employees is stressed. (Click to show less)
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(2000) Immigration and Naturalization Service, Salt Lake City, Utah. (Click to open report)
The National Institute for Occupational Safety and Health (NIOSH) received a request from an authorized representative of employees at the Salt Lake City, Utah, office of the Immigration and Naturalization Service (INS) concerning communication problems in the work area. The office configuration made the information officers raise their voices to be heard and understood by the public. One INS employee had been seen by a physician and told that the office conditions led to this person's voice los... (Click to show more) The National Institute for Occupational Safety and Health (NIOSH) received a request from an authorized representative of employees at the Salt Lake City, Utah, office of the Immigration and Naturalization Service (INS) concerning communication problems in the work area. The office configuration made the information officers raise their voices to be heard and understood by the public. One INS employee had been seen by a physician and told that the office conditions led to this person's voice loss. Other employees felt there was an increased illness rate related to poor ventilation in the building. NIOSH representatives visited the INS office on September 29, 1999, to conduct a health hazard evaluation (HHE). During the evaluation, the area of concern was investigated by measuring the area noise levels and the ventilation parameters as well as interviewing employees who worked in this location. The noise levels in the public reception area were found to be incompatible with good communication guidelines. The INS information officers were not being heard clearly by the public. Poor acoustic conditions in the public area and a plexiglass barrier between the officers and public contributed to the poor communication environment. The indoor environmental quality measurements made by NIOSH investigators revealed that the heating, ventilating, and air conditioning (HVAC) system was not supplying proper amounts of outdoor air to the waiting area and that temperature and relative humidity levels were outside of recommended ranges for indoor office environments. (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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