Health Hazard Evaluations (HHEs)

(2013) Health hazard evaluation report: evaluation of respiratory concerns at a cream cheese manufacturing facility. (Click to open report)
In April 2011, the National Institute for Occupational Safety and Health received a confidential employees' request for a health hazard evaluation at a cream cheese manufacturing plant. The employees submitted the request because of respiratory concerns related to exposures during the manufacturing and packaging processes. We visited the plant on two occasions. On our initial site visit, we toured the plant, talked with employees, and collected bulk samples of flavorings and cardboard debris. We... (Click to show more) In April 2011, the National Institute for Occupational Safety and Health received a confidential employees' request for a health hazard evaluation at a cream cheese manufacturing plant. The employees submitted the request because of respiratory concerns related to exposures during the manufacturing and packaging processes. We visited the plant on two occasions. On our initial site visit, we toured the plant, talked with employees, and collected bulk samples of flavorings and cardboard debris. We analyzed the headspace air over each bulk sample we collected during our initial visit and identified the ketone chemical compounds diacetyl, 2,3-pentanedione, and acetoin in the headspace of a liquid dairy flavoring. We identified diacetyl and 2,3-pentanedione in the headspace of a liquid strawberry flavoring and liquid smoke flavoring. We found small amounts of diacetyl in the headspace of a powder cheesecake flavoring, a powder cheese flavoring, a liquid blueberry flavoring, and a liquid kosher strawberry flavoring. We also found a small amount of diacetyl in the headspace of a strawberry puree. On our follow-up industrial hygiene survey visit, we performed area and personal air sampling alongside the production and packaging of various cream cheese products. We identified diacetyl in air samples at levels above the NIOSH proposed recommended exposure limit in several areas (free ingredients room, free cook room, cook room, 703 fill room) and jobs (703 fill operator, free cook, condiment cook, soft cook). We identified 2,3-pentanedione and 2,3-hexanedione in air samples in the free ingredients room during clean-in-place and clean-out-of-place operations. We have provided recommendations to decrease exposures to flavoring chemicals, cardboard dust, and cleaning chemicals. We recommended additional sampling for diacetyl and 2,3-pentanedione during cleaning operations and after the additional of local exhaust systems. We also recommended that employees see a healthcare provider if they develop or have developed persistent or worsening respiratory or other symptoms. (Click to show less)
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(2013) Health hazard evaluation report: evaluation of safety climate, health concerns, and pharmaceutical dust exposures at a mail order pharmacy. (Click to open report)
The Health Hazard Evaluation (HHE) Program received a request from a mail order pharmacy. Employees were concerned about possible health effects from exposures to hazardous drugs and pharmaceutical dust, and communication and other workplace safety climate issues. Roughly 175 employees worked at the pharmacy; the majority of whom were contractors performing most production functions (e.g., filling, labeling, packaging, and housekeeping). On average, the mail order pharmacy filled approximately 7... (Click to show more) The Health Hazard Evaluation (HHE) Program received a request from a mail order pharmacy. Employees were concerned about possible health effects from exposures to hazardous drugs and pharmaceutical dust, and communication and other workplace safety climate issues. Roughly 175 employees worked at the pharmacy; the majority of whom were contractors performing most production functions (e.g., filling, labeling, packaging, and housekeeping). On average, the mail order pharmacy filled approximately 74,000 prescriptions per day using automated and manual distribution systems. HHE Program investigators evaluated the pharmacy in August 2012. We surveyed employees and talked with them about job stress, work-related health concerns, and perceptions of the job and social factors at work. We sampled air and work surfaces for lactose (inactive ingredient in pharmaceuticals) and active pharmaceutical ingredients. Overall, employees had a positive perception of safety climate. However, contractor employees were not comfortable taking time off work when ill and they reported more eye, nose, throat, and skin irritation and cough associated with work than company employees. Some employees were concerned about repetitive tasks and prolonged standing. No employees reported changes in their health consistent with exposures to hazardous drugs. However, air sampling results indicated that employees who clean or repair automatic dispensing machine cells, refill automatic dispensing machine canisters, clean manually-fed automated counters with canned air, and hand-fill hazardous drug prescriptions may be exposed to airborne dust from uncoated tablets. Inhalation exposures to active pharmaceutical ingredients were mostly below manufacturers' occupational exposure limits (if a limit was available). However, an employee who cleaned and repaired Baker machine cells was exposed to airborne Lisinopril, an antihypertension medication, above the exposure limit. Some employees were exposed to multiple active pharmaceutical ingredients, the effects of which are not well understood. The surface sampling results and our observations also indicate the potential for personal clothing contamination with active pharmaceutical ingredients and the potential for take home exposure. Employees were provided vinyl gloves but no other protective clothing. Employees demonstrated good housekeeping and hand-washing practices. To address areas of concern identified in the survey and employee interviews, HHE Program investigators recommended the employer (1) create a health and safety committee, (2) stop the punitive "point system" for discouraging absences, and (3) provide seats at workstations. To address the potential for exposures to pharmaceutical dust, HHE Program investigators recommended the employer (1) substitute uncoated tablets with coated tablets when that option is available, (2) create a list of pharmaceuticals that are dusty and use this information to determine how to handle these pharmaceuticals, (3) use local exhaust ventilation hoods that are ducted outdoors for filling hazardous drug prescriptions and other tasks that could create pharmaceutical dust, (4) require employees to wear nitrile gloves as these are better suited than vinyl gloves for pharmaceutical dust and the isopropyl alcohol used to clean surfaces and equipment, and (5) provide safety glasses and long-sleeve protective clothing to employees who hand fill hazardous drug prescriptions or create pharmaceutical dust. (Click to show less)
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(2013) Health hazard evaluation report: evaluation of zoonotic disease and exposures in persons working with marine mammals. (Click to open report)
The HHE Program evaluated potential exposure of employees and volunteers to zoonotic diseases at a marine mammal rescue and rehabilitation center. Zoonotic diseases are those that can be transmitted from animals to humans. Investigators with the HHE Program observed work practices and personal protective equipment use and found that some practices may lead to a higher risk of exposure to zoonotic diseases. Employees and volunteers were given a survey and blood tests to look for evidence of past ... (Click to show more) The HHE Program evaluated potential exposure of employees and volunteers to zoonotic diseases at a marine mammal rescue and rehabilitation center. Zoonotic diseases are those that can be transmitted from animals to humans. Investigators with the HHE Program observed work practices and personal protective equipment use and found that some practices may lead to a higher risk of exposure to zoonotic diseases. Employees and volunteers were given a survey and blood tests to look for evidence of past infection. Among the 213 participants, little evidence was found of past infection with the organisms that cause leptospirosis, brucellosis, or Q fever. Air, surface, and bulk dust samples were collected for C. burnetti, the bacterium that causes Q fever; all but one of 130 samples was negative. A ventilation assessment showed that the biological safety cabinet in the laboratory did not have enough airflow so investigators recommended that the employer have this cabinet certified yearly and ensure that it meets minimum flow requirements. Investigators also found that when the harbor seal area ventilation system was turned on air flowed from the intensive care unit to other areas of the building. Investigators recommended that harbor seal pups not be housed in the intensive care unit if they are suspected of having Q fever. Instead they should be housed outside and isolated from other harbor seal pups. Investigators recommended that the carpet in the triage building be removed and replaced with a nonporous surface. Investigators noted that some employees and volunteers were not wearing the correct personal protective equipment and recommended that the employer provide initial training and refresher training for all employees and volunteers on hand washing, proper personal protective equipment use, and the risk of infection. Employees were encouraged to (1) wash their hands after exposure to animals or animal areas even if they were wearing gloves, (2) not wear personal protective equipment in areas where people eat or drink, (3) report signs of possible zoonotic infection to their supervisor, and (4) to tell their healthcare provider about their duties and exposures to marine mammals. The employer was encouraged to post signs about hand washing. (Click to show less)
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(2013) Health hazard evaluation report: followback evaluation of lead and noise exposures at an indoor firing range. (Click to open report)
The Health Hazard Evaluation (HHE) Program received a request to re-evaluate an indoor firing range for lead and noise exposure during firearms qualifications. In the initial evaluation in 2009, we measured airborne lead exposures among instructors, shooters, and technicians above occupational exposure limits. HHE investigators recommended the employer redesign the ventilation system to reduce lead exposures at the range and were later informed that changes had been made. HHE investigators retur... (Click to show more) The Health Hazard Evaluation (HHE) Program received a request to re-evaluate an indoor firing range for lead and noise exposure during firearms qualifications. In the initial evaluation in 2009, we measured airborne lead exposures among instructors, shooters, and technicians above occupational exposure limits. HHE investigators recommended the employer redesign the ventilation system to reduce lead exposures at the range and were later informed that changes had been made. HHE investigators returned in 2012 to reassess lead and noise exposure and to evaluate the redesigned range ventilation system. We collected air samples, surface vacuum, and surface wipe samples for lead throughout the complex and measured airflow in the firing range. Surface wipes were also used to qualitatively evaluate the presence of lead on skin, clothing, and shoes. Low levels of lead in the air were found in the firing range and firearms cleaning area. High levels of lead were detected in the air while the hazardous materials technician vacuumed behind the bullet trap. Instructors' and shooters' exposure to airborne lead was below occupational exposure limits. Surface wipe and vacuum samples detected lead throughout the complex. Most of the wipe samples collected on the hands, shoes, and pants of the instructors, shooters, and the hazardous material technician were above the limit of visual identification. Measured airflow along the firing line met NIOSH recommendations. HHE investigators recommended that the employer remove all carpets and rugs, clean the floors with an explosion-proof vacuum cleaner, and improve general housekeeping practices throughout the facility. The employer was encouraged to provide instructors and technicians with annual training and educational materials regarding lead and noise exposure. Investigators recommended the employer provide lockers for employees to change from their personal clothing into work clothing. Employees were encouraged to wear dual hearing protection; to shower prior to leaving the facility each day; and to not eat, drink, chew gum or use tobacco in the firearms cleaning area and firing range. All were encouraged to wear shoe covers while in the range and use lead removal wipes to wash their hands and faces before eating, drinking, or contact with others. (Click to show less)
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(2012) Legionnaires' disease at an automobile and scrap metal shredding facility, New York. (Click to open report)
On May 11, 2011, the National Institute for Occupational Safety and Health (NIOSH) received a request from the management of an automobile and scrap metal shredding facility regarding cases of Legionnaires' disease that had been identified among their workers. The request listed concerns about dusts, mists, and vapors generated during the process of shredding automobiles and scrap metal. The health concerns were Legionnaires' disease and respiratory disease. During telephone discussions with the... (Click to show more) On May 11, 2011, the National Institute for Occupational Safety and Health (NIOSH) received a request from the management of an automobile and scrap metal shredding facility regarding cases of Legionnaires' disease that had been identified among their workers. The request listed concerns about dusts, mists, and vapors generated during the process of shredding automobiles and scrap metal. The health concerns were Legionnaires' disease and respiratory disease. During telephone discussions with the New York State Department of Health (NYSDH), NIOSH learned that four employees from the shredding facility had been diagnosed with Legionnaires' disease: one in 2009, two in 2010, and one in May 2011. All performed shoveling and/or picking activities; the latter involves manually removing copper and other material passing on a moving conveyor. In December 2010, NYSDH identified Legionella bacteria on a swab sample taken from a conveyor belt that exited the shredder and from water dripping from that same belt. An additional water sample obtained in May 2011 from the same conveyor belt also contained Legionella. Prior to our initial site visit, NIOSH investigators contacted management and recommended that any employee with respiratory, flu-like, or gastrointestinal symptoms (e.g., fever, chills, cough, shortness of breath, muscle aches, nausea, vomiting, diarrhea) be removed from his or her job and seek evaluation for Legionnaires' disease from a healthcare provider. We also recommended that employees who work near any aerosols or mists wear fit-tested N-95 respirators. On June 1-2, 2011, NIOSH investigators visited the facility. We spoke briefly with all available facility employees about Legionnaires' disease and any symptoms they may have or have had; none reported current symptoms consistent with Legionnaires' disease. We observed large quantities of standing water throughout the facility grounds. We also observed workers standing and shoveling in or around the water; vehicles driving through puddles of water; and front-end loaders picking up and setting down materials in and around standing water. We observed no employees wearing respirators. We collected air, water, and swab samples at multiple locations around the facility to be tested for Legionella bacteria. We also collected area air samples to be analyzed for metals, volatile organic compounds (VOCs) and dust. Legionella was identified in water dripping from the exterior of the shredder onto the exit conveyor belt that contained the shredded material and in multiple puddles of water. Metals detected in the air samples were below applicable NIOSH recommended exposure limits (RELs) and the Occupational Safety and Health Administration (OSHA) permissible exposure limits (PELs), where standards existed. Toluene, ethyl benzene and xylene isomers, and some alkyl benzenes were the major VOCs identified. The dust samples were below the OSHA particulates not otherwise regulated standard of 5 milligrams per cubic meter (mg/m3) for respirable particles. At the end of the walk-through visit, we again recommended implementing a formal respiratory protection program that would require employees working around or near aerosols or mists to wear fit-tested N-95 respirators. We also discussed the possibility of Legionella in the standing water which could be aerosolized during shoveling activities and while driving or walking through the puddled water. We reiterated that symptomatic employees should be removed from their jobs until they are evaluated for Legionnaires' disease by a healthcare provider. We recommended that the groundwater drainage system be improved to eliminate the pools of water and that shoveling activities be avoided as much as possible during shredding operations because of the potential for generating aerosols. We recommended the shredder, conveyor systems, and any mobile equipment be cleaned and sanitized. Following our initial site visit, a fifth employee was diagnosed with Legionnaires' disease in June 2011. He had recently been hired at the facility, worked in the picking shed, and had not worn a respirator. On September 23, 2011, we revisited the facility to conduct a follow-up assessment. Facility grounds had been cleared of a build-up of dirt, improving drainage and revealing a previously blocked drain. A new shredder had been installed which required only half the previous water flow. The plant manager reported that the picking room had been cleaned and sanitized but not the rest of the facility. Some puddles of water still existed, and Legionella was detected in water samples taken from multiple puddles. Legionella was not detected in swab samples taken from the conveyor system. We observed workers wearing N-95 respirators; none had been fit-tested, and some were wearing their respirators incorrectly. In each of these cases, we showed the worker how to wear the respirator. We also hung posters in the break room and mechanical room that showed how to put on and take off an N-95 respirator. We recommended that workers wearing respirators be fit-tested. We also recommended that the ground drainage be improved to remove the remaining standing water, and that the rest of the facility be cleaned and sanitized. (Click to show less)
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