Donald P. Schill

Cleaning products and work-related asthma.

To describe the characteristics of individuals with work-related asthma associated with exposure to cleaning products, data from the California-, Massachusetts-, Michigan-, and New Jersey state-based surveillance systems of work-related asthma were used to identify cases of asthma associated with exposure to cleaning products at work. From 1993 to 1997, 236 (12%) of the 1915 confirmed cases of work-related asthma identified by the four states were associated with exposure to cleaning products. Eighty percent of the reports were of new-onset asthma and 20% were work-aggravated asthma. Among the new-onset cases, 22% were consistent with reactive airways dysfunction syndrome. Individuals identified were generally women (75%), white non-Hispanic (68%), and 45 years or older (64%). Their most likely exposure had been in medical settings (39%), schools (13%), or hotels (6%), and they were most likely to work as janitor/cleaners (22%), nurse/nurses’ aides (20%), or clerical staff (13%). However, cases were reported with exposure to cleaning products across a wide range of job titles. Cleaning products contain a diverse group of chemicals that are used in a wide range of industries and occupations as well as in the home. Their potential to cause or aggravate asthma has recently been recognized. Further work to characterize the specific agents and the circumstances of their use associated with asthma is needed. Additional research to investigate the frequency of adverse respiratory effects among regular users, such as housekeeping staff, is also needed. In the interim, we recommend attention to adequate ventilation, improved warning labels and Material Safety Data Sheets, and workplace training and education.

A descriptive study of work aggravated asthma

Background and Aims: Work related asthma (WRA) is one of the most frequently reported occupational lung diseases in a number of industrialised countries. A better understanding of work aggravated asthma (WAA), as well as work related new onset asthma (NOA), is needed to aid in prevention efforts. Methods: WAA and NOA in the United States were compared using cases reported to the National Institute for Occupational Safety and Health (NIOSH) from four state Sentinel Event Notification Systems for Occupational Risks (SENSOR) surveillance programmes for 1993–95. Results: A total of 210 WAA cases and 891 NOA cases were reported. WAA cases reported mineral and inorganic dusts as the most common exposure agent, as opposed to NOA cases, in which diisocyanates were reported most frequently. A similar percentage of WAA and NOA cases still experienced breathing problems at the time of the interview or had visited a hospital or emergency room for work related breathing problems. NOA cases were twice as likely to have applied for workers’ compensation compared with WAA cases. However, among those who had applied for worker compensation, approximately three-fourths of both WAA and NOA cases had received awards. The services and manufacturing industrial categories together accounted for the majority of both WAA (62%) and NOA (75%) cases. The risk of WAA, measured by average annual rate, was clearly the highest in the public administration (14.2 cases/105) industrial category, while the risk of NOA was increased in both the manufacturing (3.2 cases/105) and public administration (2.9 cases/105) categories. Conclusions: WAA cases reported many of the same adverse consequences as NOA cases. Certain industries were identified as potential targets for prevention efforts based on either the number of cases or the risk of WAA and NOA.

Work-related reactive airways dysfunction syndrome cases from surveillance in selected US states.

Learning ObjectivesDistinguish between reactive airways dysfunction syndrome (RADS) and other cases of work-related asthma (WRA) associated with a known asthma-inducing agent.Contrast the clinical features, severity, and course of RADS with those of other WRA related to an identified asthma inducer.Identify differences in outcome and disposition between RADS and other WRA. The objective was to elaborate the descriptive epidemiology of work-related cases of reactive airways dysfunction syndrome (RADS). Cases of work-related asthma (WRA) were identified in four states in the United States during 1993–1995 as part of the Sentinel Event Notification Systems for Occupational Risks (SENSOR). Information gathered by follow-back interview was used to describe 123 work-related RADS cases and to compare them to 301 other WRA cases whose onset of disease was associated with a known asthma inducer. RADS represented 14% of all new-onset WRA cases identified by the state SENSOR surveillance systems. RADS cases had significant adverse medical and occupational outcomes identified by follow-back interview. In particular, 89% still had breathing problems, 78% had ever sought emergency care and 39% had ever been hospitalized for work-related breathing problems, 54% had applied for worker compensation benefits, and 41% had left the company where they experienced onset of asthma. These values equaled or exceeded the comparable figures for those WRA cases whose onset was attributed to a known inducer. Work-related RADS represents a minority of all WRA cases, but the adverse impact of this condition appears to equal that of other WRA cases.

Highway Repair: A New Silicosis Threat

OBJECTIVES We describe an emerging public health concern regarding silicosis in the fast-growing highway repair industry. METHODS We examined highway construction trends, silicosis surveillance case data, and environmental exposure data to evaluate the risk of silicosis among highway repair workers. We reviewed silicosis case data from the construction industry in 3 states that have silicosis registries, and we conducted environmental monitoring for silica at highway repair work sites. RESULTS Our findings indicate that a large population of highway workers is at risk of developing silicosis from exposure to crystalline silica. CONCLUSIONS Exposure control methods, medical screenings, protective health standards, and safety-related contract language are necessary for preventing future occupational disease problems among highway repair workers.

Responding to a Bioterrorist Attack: Environmental Investigation of Anthrax in New Jersey

A bioterrorism attack using the United States postal system to deliver a hazardous biological agent to specific targets created multiple environmental and occupational exposure risks along the path of the anthrax-containing letters. On October 18, 2001, a suspected case of cutaneous anthrax was confirmed in a postal worker from the Trenton Processing and Distribution Center where at least four suspect letters were postmarked. Over the next three weeks, a team of investigators collected samples at 57 workplaces in New Jersey as part of a comprehensive environmental investigation to assess anthrax contamination as a result of this bioterrorist attack. A total of 1369 samples were collected with positive sample results found in two mail processing and distribution centers, six municipal post offices, and one private company. This large-scale epidemiological and public health investigation conducted by state and federal agencies included environmental evaluations utilizing general industrial hygiene principles. Issues of sampling strategy, methods, agency cooperation and communication, and site assessment coordination are discussed.

Control of Respirable Dust and Crystalline Silica from Breaking Concrete with a Jackhammer

The Engineering and Physical Hazards Branch (EPHB) of the National Institute for Occupational Safety and Health (NIOSH) has been given the lead within NIOSH to study and develop engineering controls and assess their impact on reducing occupational illness. The objective of each of these studies has been to evaluate and document control techniques and to determine their effectiveness in reducing potential health hazards in a specific industry or for a specific process. The goal of the project reported in this article was to quantify the exposure reduction that could be achieved through the use of a water-spray attachment and two different tool-mounted local exhaust ventilation shrouds during concrete pavement breaking with jackhammers. In this case, the water-spray attachment consisted of a spray nozzle (of the type used with oil-burning furnaces) and associated hoses and fittings. Water was supplied by a pressurized tank mounted on the air-compressor trailer. The local exhaust ventilation (LEV) included an off-the-shelf shroud typically used with hand-held rock drills and a custom-made shroud. The same dust collector (one sold for use with the rockdrill hood) was used for both LEV attachments.

Preliminary Study of Propyl Bromide Exposure among New Jersey Dry Cleaners as a Result of a Pending Ban on Perchloroethylene

Abstract Many states are considering, and some states have actively pursued, banning the use of perchloroethylene (PERC) in dry cleaning establishments. Proposed legislation has led many dry cleaners to consider the use of products that contain greater than 90% n-propyl bromide (n-PB; also called 1-bromopropane or 1-BP). Very little information is known about toxicity and exposure to n-PB. Some n-PB-containing products are marketed as nonhazardous and “green” or “organic.” This has resulted in some users perceiving the solvent as nontoxic and has resulted in at least one significant poisoning incident in New Jersey. In addition, many dry cleaning operators may not realize that the machine components and settings must be changed when converting from PERC to n-PB containing products. Not performing these modifications may result in overheating and significant leaks in the dry cleaning equipment. A preliminary investigation was conducted of the potential exposures to n-PB and isopropyl bromide (iso-PB; also called 2-bromopropane or 2-BP) among dry cleaners in New Jersey who have converted their machines from PERC to these new solvent products. Personal breathing zone and area samples were collected using the National Institute for Occupational Safety and Health Sampling and Analytical Method 1025, with a slight modification to gas chromatography conditions to facilitate better separation of n-PB from iso-PB. During the preliminary investigation, exposures to n-PB among some workers in two of three shops were measured that were greater than the American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit value (TLV) for n-PB. The highest exposure measured among a dry cleaning machine operator was 54 parts per million (ppm) as an 8-hr time-weighted average, which is more than 5 times the ACGIH TLV of 10 ppm. The preliminary investigation also found that the work tasks most likely to result in the highest short-term exposures included the introduction of solvent to the machine, maintenance of the machine, unloading and handling of recently cleaned clothes, and interrupting the wash cycle of the machine. In addition, this assessment suggested that leaks may have contributed to exposure and may have resulted from normal machine wear over time, ineffective maintenance, and from the incompatibility of n-PB with gasket materials.