Elizabeth Marshall

Identification of factors that disrupt negative air pressurization of respiratory isolation rooms.

OBJECTIVES To investigate the airflow characteristics of respiratory isolation rooms (IRs) and to evaluate the use of visible smoke as a monitoring tool. METHODS Industrial hygienists from the New York State Department of Health evaluated 140 designated IRs in 38 facilities within New York State during 1992 to 1998. The rooms were located in the following settings: hospitals (59%), correctional facilities (40%), and nursing homes (1%). Each room was tested with visible smoke for directional airflow into the patient room (ie, negative air pressure relative to adjacent areas). Information was obtained on each facilitys policies and procedures for maintaining and monitoring the operation of the IRs. RESULTS Inappropriate outward airflow was observed in 38% of the IRs tested. Multiple factors were associated with outward airflow direction, including ventilation systems not balanced (54% of failed rooms), shared anterooms (14%), turbulent airflow patterns (11%), and automated control system inaccuracies (10%). Of the 140 tested rooms, 38 (27%) had either electrical or mechanical devices to monitor air pressurization continuously. The direction of airflow at the door to 50% (19/38) of these rooms was the opposite of that indicated by the continuous monitors at the time of our evaluations. The inability of continuous monitors to indicate the direction of airflow was associated with instrument limitations (74%) and malfunction of the devices (26%). In one facility, daily smoke testing by infection control staff was responsible for identifying the malfunction of a state-of-the-art computerized ventilation monitoring and control system in a room housing a patient infectious with drug-resistant tuberculosis. CONCLUSION A substantial percentage of IRs did not meet the negative air pressure criterion. These failures were associated with a variety of characteristics in the design and operation of the IRs. Our findings indicate that a balanced ventilation system does not guarantee inward airflow direction. Devices that continuously monitor and, in some cases, control the pressurization of IRs had poor reliability. This study demonstrates the utility of using visible smoke for testing directional airflow of IRs, whether or not continuous monitors are used. Institutional tuberculosis control pro grams should include provisions for appropriate monitoring and maintenance of IR systems on a frequent basis, including the use of visible smoke.

Effects of maternal work activity during pregnancy on infant malformations

This article examines the association between two birth defects, neural tube defects and oral cleft defects, and maternal physical work demands during the periconceptional period. A case-control study was conducted by comparing exposure characteristics of mothers of malformed infants, as ascertained from the New York State Congenital Malformations Registry (n = 520), with mothers of non-malformed infants (n = 1154). Case groups were further subdivided on whether infants had additional defects. Occupational exposure information was collected from a self-administered questionnaire, and demographic variables from vital records. The results showed no general differences between cases and controls in most variables. However, those infants with cleft defects plus additional defects tended to have a marginally increased risk (odds ratio = 1.76; 95% confidence interval, 1.02-3.21) in relation to maternal jobs requiring standing (> or = 75% of time). We suggest that exposure assessment be improved and defects subdivided for future studies.

A multi-modality assessment of peripheral nerve function in organophosphate-pesticide applicators

Health effects from chronic, low-level exposure to organophosphate pesticides have not been studied extensively and are not well-established. This report follows up a study in New York State in which a cohort of 90 male pesticide applicators were found to have increased vibration sensitivity thresholds, compared with a matched sample drawn from the general population. This investigation examined the nature and extent of peripheral nerve abnormalities in a small subgroup of the original cohort. Of the nine subjects studied, four had clinical evidence of peripheral neuropathic dysfunction, and one who was normal physiologically showed electrophysiological abnormalities. The remaining four showed no clinical, electrophysiologic, or quantitative signs or other abnormalities. This study adds to the growing evidence that organophosphates are toxic to the peripheral nervous system at levels of exposure that do not induce acute or subacute symptomatology.

Negative-Pressure monitoring of tuberculosis isolation rooms within New York State hospitals.

A previously published study recommended the daily use of visible smoke to test for negative air pressure in isolation rooms occupied by potentially infectious tuberculosis cases. Continuous monitoring devices were found to have poor reliability. Findings from our survey of engineering controls in acute-care hospitals within New York State support this recommendation.

Are Workplace Psychosocial Factors Associated With Work-Related Injury in the US Workforce?: National Health Interview Survey, 2010

Introduction: Psychosocial hazards in the workplace may adversely impact occupational and general health, including injury risk. Methods: Among 16,417 adult workers in the 2010 National Health Interview Survey Occupational Health Supplement, weighted prevalence estimates were calculated for work-related injuries (WRI) and any injuries. The association between injury and psychosocial occupational hazards (job insecurity, work–family imbalance, hostile work environment) was assessed adjusting for sociodemographic and occupational factors. Results: WRI prevalence was 0.65% (n = 99); any injury prevalence was 2.46% (n = 427). In multivariable models job insecurity, work–family imbalance, and hostile work environment were each positively associated with WRI prevalence (odds ratio [OR]: 1.60, 95% CI: 0.97–2.65; OR: 1.69, 95% CI 0.96–2.89; and 2.01, 95% CI 0.94–4.33, respectively). Conclusions: Stressful working conditions may contribute to injuries. There is need for ongoing surveillance of occupational psychosocial risk factors and further study of their relationship with injury.