Evaluation of Dermatitis Among Sanders in a Furniture Manufacturing Plant
Loren Tapp
Nancy Burton
Health Hazard Evaluation (HHE) Program investigators evaluated sanding department exposures and rashes among employees at a furniture manufacturing company in North Carolina. The employer became concerned after two sanders had severe skin reactions at work and were unable to continue work in the area. In November 2011, HHE investigators toured the facility, observed work processes and practices, and reviewed the company’s material safety data sheets for the epoxies and other chemicals used in the sanding department. They assessed ventilation in the work area using smoke tubes to observe air flow patterns, collected personal air samples for volatile organic compounds (VOCs), surface wipe samples for bisphenol A and diglycidyl ether of bisphenol A (DGEBA) (epoxy components), and surface samples for metals and minerals. They interviewed 18 employees confidentially and reviewed employee medical records and OSHA 300 Logs. The sanders’ downdraft tables were ineffective in controlling dust while employees sanded large frames. Compressed air was used to clean off the chairs, which increased the airborne dust levels in the sanding department. The wipe samples of work surfaces in the sanding department found low levels of DGEBA, indicating that employees had potential for skin contact with this epoxy resin component. They found low levels of metals and minerals in surface wipe samples and low concentrations of airborne VOCs. Eight of the 18 interviewed employees, all sanders or prior sanders, reported current or recent skin rash that began within 2 years of our site visit and that they associated with work. Five employees had visible skin rash. A few employees reported upper respiratory symptoms and one employee reported asthma symptoms. Employees reported using a much larger amount of epoxy than they did 2 years prior to our visit because they began plugging furniture screw holes with epoxy instead of wood plugs. Employees reported using their fingers to mix the epoxies because of their thick consistency. The company began requiring employees to wear gloves while working with epoxy about a month prior to the site visit. Medical record review of four employees revealed that one employee had been diagnosed with work-related allergic contact dermatitis after skin patch testing showed an allergic skin reaction to bisphenol A; the other three were diagnosed with contact dermatitis. Skin contact with epoxy resin may cause allergic contact dermatitis and occupational asthma. The increased use of epoxy 18 months before the site visit, insufficient dust control during sanding, and lack of skin protection likely played a role in the development of dermatitis among sanders. HHE investigators recommended the employer reduce epoxy resin exposures by using a dispensing gun to apply the epoxies, adding local exhaust ventilation to the hand-held sanders to control dust, and educating employees on the hazards of epoxy exposure and the need for work practices to prevent skin exposures to epoxy resins, including appropriate glove use. They encouraged employees to report work-related skin rashes and respiratory symptoms as early as possible and those with persistent symptoms were advised to be evaluated by an occupational medicine physician. A full report is available at http://www.cdc.gov/niosh/hhe/reports/pdfs/2011-0180-3193.pdf.
Followback Evaluation of Lead and Noise Exposures at an Indoor Firing Range
Jessica Ramsey
R. Todd Niemeier
Elena Page
Lilia Chen
JungHo Choi
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. A full report is available at http://www.cdc.gov/niosh/hhe/reports/pdfs/2012-0065-3195.pdf.
Evaluation of Job Stress and Work-related Health Concerns at a Telephone Call Center
Douglas Wiegand
The Health Hazard Evaluation (HHE) Program received a confidential request from employees at a telephone call center. The employees were concerned about psychosocial factors at work and the impact of job stress on their health. Approximately 50 call center employees at this facility receive 2,000–5,000 calls per day and assist callers with U.S. citizenship and immigration services and benefit-related matters. HHE Program investigators visited the telephone call center in January 2013. We surveyed employees about job stress, psychosocial factors at work, job satisfaction, work-related health concerns, and symptoms of depression and anxiety. We also held a meeting with all employees to address questions and discuss mental health and suicide prevention. We received 38 of the 43 surveys we distributed. All employees reported a job stress score between 5 and 10; 46% rated their job stress at the highest level of 10. Employees reported that workload and the demanding nature of the job contributed to stress. Job satisfaction was low; most employees believed they did not receive the respect they deserved, their salary was inadequate, and promotion prospects were poor. Employees reported work-related health concerns that included headaches/migraines, musculoskeletal strain, and health effects (e.g., allergy and cold symptoms) they attributed to poor indoor environmental quality. Among survey respondents, 45% reported moderate to severe symptoms of depression and 39% reported moderate to severe symptoms of anxiety. To address stress and mental health symptoms, HHE Program investigators recommended the employer (1) engage employees in discussion about whether workload could be better managed and how, (2) if feasible, hire more employees to reduce the number of calls employees must answer, (3) encourage employees to debrief with their supervisor or a coworker immediately after a call with an unfriendly customer, and (4) program the phone system to give a 6-second rest period between calls. They also recommended that employees get emergency help immediately if they have thoughts about harming themselves or someone else, and seek counseling from a qualified professional if they feel anxious, angry, depressed, or have other mental health disorders that are interfering with their social, occupational, or other important areas of functioning. To address ergonomic and environmental issues, HHE Program investigators recommended the call center (1) have a certified ergonomist set up the workstations for each employee or hold a training session to teach employees how to properly set up their own station, (2) maintain and clean the heating, ventilation, and air-conditioning units regularly, and (3) follow a cleaning schedule for the entire facility. A full report is available at http://www.cdc.gov/niosh/hhe/reports/pdfs/2012-0211-3197.pdf.
Evaluation of Dermal Exposure to Polycyclic Aromatic Hydrocarbons in Fire Fighters
Kenneth Fent
Judith Eisenberg
Doug Evans
Deborah Sammons
Shirley Robertson
Cindy Striley
John Snawder
Charles Mueller
Vance Kochenderfer
Joachim Pleil
Matthew Stiegel
Gavin Horn
The Health Hazard Evaluation Program carried out a study at a fire service training facility to assess exposures to airborne polycyclic aromatic hydrocarbons (PAHs) and other aromatic hydrocarbons. The purpose was to learn whether these substances pass through the skin of firefighters wearing full ensembles. Some PAHs and other aromatic hydrocarbons are known or suspected of causing cancer. The study consisted of two rounds (1 year apart). In each round, five firefighters fought a controlled structure burn once a day for 3 days. Firefighters wore new or freshly laundered turnout gear each day and wore self-contained breathing apparatus (SCBA). The burns took place in a timber-framed structure or a metal container; interior walls were covered with drywall. The rooms were set up with typical family room furniture. The burns lasted an average of 22 minutes. Firefighters’ activities included an average of 11 minutes watching the fire build, 3.5 minutes knocking down the fire, and 7.5 minutes doing overhaul. We collected air, breath, urine, and wipe samples of the skin (forearms, hands, neck, face, and scrotum) throughout the day. We analyzed the samples for PAHs and aromatic hydrocarbons in the air, PAHs on firefighters’ skin before and after firefighting, and PAHs and aromatic hydrocarbons in firefighters’ blood and urine before and after firefighting. The air samples showed that all the burns released PAHs into the air. The PAH levels were the same or higher than levels reported in other firefighting studies. The levels of PAHs in air during five burns were higher than the occupational exposure limit. The air levels decreased after knockdown but remained above the occupational exposure limit during overhaul. Firefighters do not always wear SCBA during overhaul. The biological monitoring showed that (1) the PAH levels on fire fighters’ necks (least protected body area) were higher right after the burns than before (PAHs were not found on other areas of fire fighters’ skin), (2) levels of PAHs excreted in urine 3 hours after firefighting were higher than those excreted just before or just after firefighting, and (3) benzene was the main aromatic hydrocarbon measured in fire fighters’ breath at levels that were higher just after firefighting than just before (we detected no benzene in urine after firefighting). HHE investigators determined that the levels of PAHs and benzene in firefighters’ bodies were similar to levels in occupational groups with low exposures to these compounds. PAHs and benzene likely entered their bodies through their skin because most fire fighters wore properly working SCBA. The following recommendations were provided: (1) maintain and routinely test SCBA to ensure proper function, (2) require firefighters to wear full protective ensembles, including SCBA, during knockdown and overhaul for all fire responses, (3) provide firefighters with long hoods that are unlikely to come untucked, (4) provide as much natural ventilation as possible to burned structures before starting investigations, (5) take off gear before entering a rehab area; remove SCBA and hood last, (6) store gear on the outside of the apparatus when riding back to the station, and (7) wash hands immediately and shower as soon as possible after a fire response. A full report is available at http://www.cdc.gov/niosh/hhe/reports/pdfs/2010-0156-3196.pdf.
Evaluation of Safety Climate, Health Concerns, and Pharmaceutical Dust Exposures at a Mail Order Pharmacy
Kenneth Fent
Loren Tapp
Douglas Wiegand
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. A full report is available at http://www.cdc.gov/niosh/hhe/reports/pdfs/2012-0044-3199.pdf.
Evaluation of Radiofrequency Radiation Exposures at an Atomic Time Radio Station
Karl Feldmann
Kenneth Fent
The Health Hazard Evaluation Program received a request from a federal research institution. Health and safety managers were concerned about potential employee exposures to radiofrequency (RF) radiation at the institute’s atomic time radio station. The radio station broadcasts time announcements, standard time intervals, standard frequencies, geophysical alerts, marine storm warnings, and global positioning system status reports. The station radiated 5 kilowatts on a 2.5-MHz antenna array and 10 kilowatts on 5-, 10-, and 15-megahertz (MHz) antenna arrays. Each frequency was broadcast from a separate transmitter. Additionally, a weather station was on top of a 45-foot tower. Four employees spent most of their time working in the radio station building. Although employees spent little time in the antenna field, they could be exposed to electric and magnetic fields when cleaning, repairing, and painting antennas; maintaining the weather station; or mowing the antenna field. NIOSH investigators assessed RF exposures by collecting measurements around the antennas as well as areas on the inside, outside, and on the roof of the radio station building in January 2012. Electric and magnetic field strengths were below action levels and exposure limits on the roof, in the office, and in the transmission room of the radio station building as well as in the cab of the pickup while mowing the antenna field near transmitting antennas. Electric and magnetic field strength measurements exceeded action levels and exposure limits in certain areas of the antenna field. Electric and magnetic field strengths measured near the 5-, 10-, and 15-MHz antennas exceeded exposure limits and magnetic field strengths exceeded exposure limits about halfway up the weather station tower and near unpowered 10- and 15-megahertz antennas. During activities involving primary or backup antennas that were powered off, or when servicing the weather station, employees could be overexposed to magnetic fields induced from nearby transmitting antennas. NIOSH investigators recommended the research institution (1) start a comprehensive RF safety program and assign a safety officer to develop and oversee the program, (2) install caution signs to identify areas where exposure limits could be exceeded, (3) reduce power to a primary antenna before working on the standby antenna of the same frequency or vice versa, (4) reduce power to the 5-megahertz antenna before servicing the weather station, and (5) train employees on the potential hazards associated with RF exposure. A full report is available at http://www.cdc.gov/niosh/hhe/reports/pdfs/2011-0097-3200.pdf.