Anila Bello

Pollution prevention--occupational safety and health in hospitals: alternatives and interventions.

An integrated pollution prevention (P2) and occupational safety and health (OSH) worksite intervention and alternatives assessment strategy was developed in hospitals. It was called the Pollution Prevention-Occupational Safety and Health (P2OSH) assessment for the “Sustainable Hospitals Project.” Methods included (a) developing a participatory intervention model for introducing more environmentally sound, healthy, and safe materials and work practices for specific hospital procedures; (b) developing an integrated P2OSH survey to evaluate environmental and occupational impacts of the intervention; and (c) conducting and evaluating interventions by applying the P2OSH assessment pre- and post-intervention. Eleven interventions were performed in six hospitals: an aliphatic fixative replaced xylene in three histology laboratories; a mercury reduction plan was implemented in three clinical laboratories; digital imaging replaced wet chemical film processing in three radiology departments; a less toxic aldehyde replaced formaldehyde in one hospital histopathology laboratory; and conventional mopping was replaced by microfiber mopping in one hospital. Occupational and environmental health and safety impacts were observed for all interventions. The alternatives generally were beneficial, although each had limitations that resulted in process and task changes with potentially negative P2 and/or OSH impacts. When these were identified in the pilot phase they could be addressed before full-scale implementation. The P2OSH method shifts the focus of occupational and environmental hygiene from hazard control to substitution. Because few ideal alternatives exist, the emphasis is on a continuous process to identify, implement, and evaluate alternatives, rather than on a particular alternative. Occupational and environmental health and safety professionals have an important role as agents in hospital organizational change and in the search for healthier and safer alternatives. Through these activities they can become involved in the design/redesign of products, materials, and processes, thus expanding their traditional role.

Determinants of Exposure to 2-Butoxyethanol from Cleaning Tasks: A Quasi-experimental Study

BACKGROUND The quantitative assessment of airborne cleaning exposures requires numerous measurement methods, which are costly and difficult to apply in the workplace. Exposure determinants can be used to predict exposures but have yet to be investigated for cleaning activities. We identified determinants of exposure to 2-butoxyethanol (2-BE), a known respiratory irritant and suspected human carcinogen, commonly found in cleaning products. In addition, we investigated whether 2-BE exposures can be predicted from exposure determinants and total volatile organic compounds (TVOCs) measured with direct reading methods, which are easier to apply in field investigations. METHODS Exposure determinants were studied in a quasi-experimental study design. Cleaning tasks were performed similarly as in the workplace, but potential factors that can impact exposures were controlled. Simultaneously for each task, we measured concentrations of (1) 2-BE according to the National Institute for Occupational Health and Safety 1430 method and (2) TVOC with photoionization detectors (PIDs). Simple and multiple linear regression analyses were performed to identify 2-BE exposure determinants and to develop exposure prediction models. RESULTS Significant determinants from univariate analyses consisted of product type, tasks performed, room volume, and ventilation. The best-fit multivariable model was the one comprised of product type, tasks performed, 2-BE product concentration, room volume, and ventilation (R(2) = 77%). We found a strong correlation between the 2-BE and the TVOC concentrations recorded by the PID instruments. A multivariable model with TVOC explained a significant portion of the 2-BE concentrations (R(2) = 72%) when product type and room ventilation were included in the model. CONCLUSIONS Our results suggest that quantitative exposure assessment for an epidemiologic investigation of cleaning health effects may be feasible even without performing integrated sampling and analytic measurements.

Studying home health care nurses and aides: Research design and challenges

Home health care (HHC) is growing rapidly and yet health and safety conditions of HHC clinicians are poorly understood. Study of this workforce presents unique challenges because it is decentralised, often part-time and mobile. As part of a larger project on sharps injuries and blood exposures in HHC, this paper addresses the challenges of recruiting a large cohort of HHC nurses and aides and describes novel cross-sectional survey methodology. Recruitment was conducted with cooperation from eight HHC agencies and two labour unions. Intensive personal contacts and a financial incentive (

Facilitators and Barriers to Using Treadmill Workstations Under Real Working Conditions: A Qualitative Study in Female Office Workers

25) were employed. Some groups of HHC clinicians could be contacted only by mail, while others were contacted during a promotional “mini-fair” at their agency. A total of 1772, 18-page health and safety surveys were distributed and 1225 usable surveys were collected. This 69% overall response rate is better than that in many recent health surveys. Survey returns were highest (67—91%) where promotional events were held. The mailing-only strategy generated lower response rates (53—55%), despite the same financial incentive. Despite the challenges of reaching out to the decentralised HHC workforce, adequate response to a detailed health survey is possible, using appropriate techniques and with the close cooperation of employers and labour unions.

Exposure to organophosphate flame retardants in spray polyurethane foam applicators: Role of dermal exposure

Purpose. Characterize barriers and facilitators to use treadmill workstations in real work sites. Design. For 6 months, workers tried a sit-stand-walk treadmill workstation at will with expert ergonomic support. Qualitative data were collected monthly. Setting. Administrative and academic departments at a higher education institution in Massachusetts, United States. Participants. Five female administrative office workers. Method. One monthly group interview and one personal interview per participant during 6 months. Emerging topics from previous interviews were used in successive data gatherings. Transcribed data were manually coded according to the predefined topics of usability, comfort, safety, and productivity. Results. The setup of the work station, communication difficulties while walking (disrespectful, noisy), and peer pressure to maximize use were the main usability barriers. There was no event of falls. Trips were minimized. About comfort, subjects reported it hard to get used to prolonged standing position during the first month. Treadmill speed affected productivity mostly while drawing and working in spreadsheets. Lack of job autonomy was revealed as a generic barrier. Conclusion. In this female group, treadmill workstations had serious design problems for workers with not enough control of their jobs. The early identification and removal of barriers likely needs to be considered when offering these workstations to workers with low job autonomy.

Testing of Disposable Protective Garments Against Isocyanate Permeation From Spray Polyurethane Foam Insulation

BACKGROUND Spray polyurethane foam (SPF) is a highly effective thermal insulation material that has seen considerable market growth in the past decade. Organophosphate flame retardants (PFRs) are added to SPF formulations to meet fire code requirements. A common flame retardant used in SPF formulations is tris 1-chloro 2-propyl phosphate (TCIPP), a suspected endocrine disruptor. Exposure monitoring efforts during SPF applications have focused primarily on the isocyanate component, a potent respiratory and dermal sensitizer. However, to our knowledge, there is no monitoring data for TCIPP. OBJECTIVE To characterize occupational exposures to TCIPP and other flame retardants during SPF insulation. METHODS Workers at four SPF insulation sites and one foam removal site (total n = 14) were recruited as part of this pilot study. Personal inhalation exposure to TCIPP was monitored with a CIP-10MI inhalable sampler and potential dermal exposure was assessed through the use of a glove dosimeter. Biomarkers of TCIPP and three other PFRs were measured in urine collected from workers pre-and post-shift. Linear mixed effect models were used to analyze associations of urinary biomarkers with inhalation and dermal exposures and paired t-tests were used to examine the difference on the means of urinary biomarkers pre-and post-shift. Chemical analysis of all species was performed with liquid chromatography-electrospray ionization tandem mass spectrometry. RESULTS Geometric mean (GM) concentrations of TCIPP in personal air monitors and glove dosimeters collected from SPF applicators, 294.7 μg/m3 and 18.8 mg/pair respectively. Overall, GM concentrations of the two TCIPP urinary biomarkers BCIPP and BCIPHIPP and (6.2 and 88.8 μg/mL) were 26-35 times higher than reported in the general population. Post-shift levels of TCIPP biomarkers were higher than pre-shift even though workers at insulation sites wore supplied air respirators, gloves and coveralls. The urinary biomarkers for the other PFRs were not elevated post shift. Concentrations of TCIPP on glove dosimeters were positively associated with post-shift urinary TCIPP biomarkers (p < 0.05) whereas concentrations in personal air samples were not. CONCLUSIONS High levels of urinary biomarkers for TCIPP among SPF applicators, including post-shift, points to absorption of TCIPP during the work shift, in spite of the use of best industry exposure control practices. Dermal exposure appears to be an important, if not the primary exposure pathway for TCIPP, although inhalation or incidental ingestion of foam particles post-SPF application cannot be ruled out in this pilot study.

The Use of Noise Dampening Mats to Reduce Heavy-Equipment Noise Exposures in Construction

Background Diisocyanates (isocyanates), including methylene diphenyl diisocyanate (MDI), are the primary reactive components of spray polyurethane foam (SPF) insulation. They are potent immune sensitizers and a leading cause of occupational asthma. Skin exposure to isocyanates may lead to both irritant and allergic contact dermatitis and possibly contribute to systemic sensitization. More than sufficient evidence exists to justify the use of protective garments to minimize skin contact with aerosolized and raw isocyanate containing materials during SPF applications. Studies evaluating the permeation of protective garments following exposure to SPF insulation do not currently exist. Objectives To conduct permeation testing under controlled conditions to assess the effectiveness of common protective gloves and coveralls during SPF applications using realistic SPF product formulations. Methods Five common disposable garment materials [disposable latex gloves (0.07 mm thickness), nitrile gloves (0.07 mm), vinyl gloves (0.07 mm), polypropylene coveralls (0.13 mm) and Tyvek coveralls (0.13 mm)] were selected for testing. These materials were cut into small pieces and assembled into a permeation test cell system and coated with a two-part slow-rise spray polyurethane foam insulation. Glass fiber filters (GFF) pretreated with 1-(9-anthracenylmethyl)piperazine) (MAP) were used underneath the garment to collect permeating isocyanates. GFF filters were collected at predetermined test intervals between 0.75 and 20.00 min and subsequently analyzed using liquid chromatography-tandem mass spectrometry. For each garment material, we assessed (i) the cumulative concentration of total isocyanate, including phenyl isocyanate and three MDI isomers, that effectively permeated the material over the test time; (ii) estimated breakthrough detection time, average permeation rate, and standardized breakthrough time; from which (iii) recommendations were developed for the use of similar protective garments following contamination by two-component spray polyurethane foam systems and the limitations of such protective garments were identified. Results Each type of protective garment material demonstrated an average permeation rate well below the ASTM method F-739 standardized breakthrough rate threshold of 100.0 ng/cm2 min-1. Disposable latex gloves displayed the greatest total isocyanate permeation rate (4.11 ng/cm2 min-1), followed by the vinyl and nitrile gloves, respectively. The Tyvek coverall demonstrated a greater average rate of isocyanate permeation than the polypropylene coveralls. Typical isocyanate loading was in the range of 900 to 15,000 ng MDI/cm2. Conclusion Permeation test data collected during this study indicated that each type of protective garment evaluated, provided a considerable level of protection (i.e. 10-110-fold reduction from the level of direct exposure) against the isocyanate component of the SPF insulation mixture. Nitrile gloves and polypropylene coveralls demonstrated the lowest rate of permeation and the lowest cumulative permeation of total isocyanate for each garment type.

0235 Barriers and Facilitators of Supplying a Treadmill Workstation to Office Workers: usability, safety, comfort, and productivity. A qualitative study0235 Barriers and Facilitators of Supplying a Treadmill Workstation to Office Workers: usability, safety, comfort, and productivity. A qualitative study

The performance of sound barriers was evaluated to determine their technical effectiveness and practicality in reducing noise exposures to operating engineers in construction. Commercially purchased sound dampening mats (SDMats) were installed inside three heavy-equipment engine compartments. Sound pressure levels (SPLs) were measured before and after installing the SDMats while the equipment was on idle and full-throttle settings where it normally operates. SPLs inside the heavy-equipment operator cabs were significantly reduced by 5.6–7.6 dBA on the full-throttle setting following installation of the SDMats (p < 0.01). The evaluated engineering control intervention was simple to install, affordable, and substantially reduced the engine noise reaching the heavy-equipment operator, potentially reducing reliance on hearing-protection devices to protect construction workers from noise exposures.

Characterization of occupational exposures to cleaning products used for common cleaning tasks-a pilot study of hospital cleaners

Objectives Characterise usability, safety, comfort, and impact on productivity of treadmill workstations in real worksites. Method Office workers volunteered to try out for six months a treadmill workstation consisting of a height adjustable electric desk, a walking treadmill, and their own sitting device (chair or “sitting ball”). They were instructed to set up and use the workstation at will. Monthly individual and group meetings were performed to gather qualitative data. Results USABILITY: Difficult set up of the workstation, which demanded use of wireless mouse and keyboards and generated creative arrangements. Unanimous love for the adjustable electric desk. Difficult to talk to people while walking (disrespectful, “On the treadmill we are taller” - affect hierarchies). SAFETY: There was no event of either trips or falls. COMFORT: An important difficulty was during the first weeks to get used to longer time in standing position. In average it took two weeks for discomfort symptoms in foot and knees to recede. PRODUCTIVITY: faster speed implies faster impact on productivity. 7–.8 mph was the most used and comfortable speed. Walking on the treadmill was not compatible with drawing or working with spreadsheets. Conclusions Treadmill workstation did not meet workers’ expectations but the electric adjustable desk exceeded those expectations. Guiding and external motivation to increase use would be accepted and expected. DESIGN RECOMMENDATIONS: Reduce maximum speed. Even 2.0 mph is too much. Additional design study needed to improve global workstation setup without decreasing flexibility and adaptation of the station.