John Decker

Exposure of casino employees to environmental tobacco smoke.

Environmental and medical evaluations were performed to evaluate occupational exposure to environmental tobacco smoke (ETS) among casino employees. Air concentrations of both nicotine and respirable dust were similar to those published in the literature for other non-industrial indoor environments. The geometric mean serum cotinine level of the 27 participants who provided serum samples was 1.34 nanograms per milliliter (ng/mL) (pre-shift) and 1.85 ng/mL (post-shift). Both measurements greatly exceeded the geometric mean value of 0.65 ng/mL for participants in the Third National Health and Nutrition Examination Survey (NHANES III) who reported exposure to ETS at work. This evaluation demonstrates that a sample of employees working in a casino gaming area were exposed to ETS at levels greater than those observed in a representative sample of the US population, and that the serum and urine cotinine of these employees increased during the workshift.

Health care worker exposure to aerosolized ribavirin: biological and air monitoring.

Aerosolized ribavirin is administered frequently to treat severe respiratory syncytial virus infections. The drugs potential reproductive effects in occupationally exposed workers remains a concern among health care workers. In this evaluation, we measured urinary ribavirin concentrations in occupationally exposed health care workers. Ribavirin was detected in 16 of 26 (62%) post-work-shift urine samples that had been provided by nurses, and in five of 22 (23%) post-work-shift urine samples that had been provided by respiratory therapists (range, < 0.01 to 0.22 mumol/L). We also measured airborne ribavirin concentrations in the personal breathing zones of nurses. Ventilators and other administration units that were enclosed by an aerosol containment tent produced significantly lower airborne ribavirin exposures than administration units without a containment tent did (range, < 2.5 to 78 micrograms/m3). On the basis of this and other evaluations of airborne ribavirin concentrations, we recommend using aerosol containment systems with all types of ribavirin administration units except mechanical ventilators.

Protecting workers in large-scale emergency responses: NIOSH Experience in the Deepwater Horizon response.

O n April 20, 2010, the Deepwater Horizon (DWH) semisubmersible Mobile Offshore Drilling Unit, located 45 miles southeast off the Louisiana coast, suffered a massive explosion and subsequent fire that ultimately led to the sinking of the Unit. Eleven workers lost their lives as a result of the explosion and fire, and seventeen other workers were injured. Oil from a subsea blowout began flowing into the Gulf of Mexico soon after the explosion, and continued to flow until the well was finally capped on July 15, 2010. Since that day in April, tens of thousands of workers have engaged in the onand offshore containment and cleanup activities as part of the DWH response. These workers were deployed by a wide array of response organizations from various federal, state, and local agencies, as well as private businesses and contractors and volunteer organizations. The workers were geographically spread throughout the Gulf of Mexico region in Louisiana, Mississippi, Alabama, and Florida, and were engaged in a range of potentially hazardous activities. Such circumstances presented significant challenges to those who had responsibility for protecting the workers’ health and safety. As part of the response effort, National Institute for Occupational Safety and Health (NIOSH) supported the Unified Area Command (UAC)a by leading several initiatives. These activities included the rostering of workers, conducting health hazard evaluations, providing technical guidance and communication/educational materials, conducting health surveillance activities, and performing toxicity testing on samples of the oil dispersant and the crude oil itself. This article describes these activities and illustrates how the DWH response experience has greatly added to the knowledge previously gained from other large-scale disaster responses, including the World Trade Center terrorist attack and Hurricane Katrina.

Protecting Poultry Workers from Exposure to Avian Influenza Viruses

Emerging zoonotic diseases are of increasing regional and global importance. Preventing occupational exposure to zoonotic diseases protects workers as well as their families, communities, and the public health. Workers can be protected from zoonotic diseases most effectively by preventing and controlling diseases in animals, reducing workplace exposures, and educating workers. Certain avian influenza viruses are potential zoonotic disease agents that may be transmitted from infected birds to humans. Poultry workers are at risk of becoming infected with these viruses if they are exposed to infected birds or virus-contaminated materials or environments. Critical components of worker protection include educating employers and training poultry workers about occupational exposure to avian influenza viruses. Other recommendations for protecting poultry workers include the use of good hygiene and work practices, personal protective clothing and equipment, vaccination for seasonal influenza viruses, antiviral medication, and medical surveillance. Current recommendations for protecting poultry workers from exposure to avian influenza viruses are summarized in this article.

Recommendations for Biomonitoring of Emergency Responders: Focus on Occupational Health Investigations and Occupational Health Research

The disaster environment frequently presents rapidly evolving and unpredictable hazardous exposures to emergency responders. Improved estimates of exposure and effect from biomonitoring can be used to assess exposure-response relationships, potential health consequences, and effectiveness of control measures. Disaster settings, however, pose significant challenges for biomonitoring. A decision process for determining when to conduct biomonitoring during and following disasters was developed. Separate but overlapping decision processes were developed for biomonitoring performed as part of occupational health investigations that directly benefit emergency responders in the short term and for biomonitoring intended to support research studies. Two categories of factors critical to the decision process for biomonitoring were identified: Is biomonitoring appropriate for the intended purpose and is biomonitoring feasible under the circumstances of the emergency response? Factors within these categories include information needs, relevance, interpretability, ethics, methodology, and logistics. Biomonitoring of emergency responders can be a valuable tool for exposure and risk assessment. Information needs, relevance, and interpretability will largely determine if biomonitoring is appropriate; logistical factors will largely determine if biomonitoring is feasible. The decision process should be formalized and may benefit from advance planning.

A novel source of carbon monoxide poisoning: explosives used in construction

We describe an incident of carbon monoxide (CO) poisoning caused by CO migrating through soil after nearby detonation of explosive charges. Employees worked in a newly installed, unconnected manhole without incident and finished shortly before underground explosives were detonated 50 feet south of the manhole to break up rock and soil. A worker entering the manhole 45 minutes after the explosion collapsed within minutes, as did two coworkers who rescued him. One worker died, and all had elevated levels of carboxyhemoglobin. Air samples collected from the manhole 2 days after the incident showed 1,910 ppm CO; in laboratory detonations, sample explosive yielded 27 L CO per kilogram detonated. We believe the CO in this incident was released from the nearby explosion and migrated through soil and fractured rock into the manhole. The blasting and construction industries should be made aware of this previously unrecognized route of CO exposure. Additionally, confined-space procedures and training are needed to prevent future accidents.