Nicole Edwards

Health effects of exposure to water-damaged New Orleans homes six months after Hurricanes Katrina and Rita.

OBJECTIVES We investigated the relation between respiratory symptoms and exposure to water-damaged homes and the effect of respirator use in posthurricane New Orleans, Louisiana. METHODS We randomly selected 600 residential sites and then interviewed 1 adult per site. We created an exposure variable, calculated upper respiratory symptom (URS) and lower respiratory symptom (LRS) scores, and defined exacerbation categories by the effect on symptoms of being inside water-damaged homes. We used multiple linear regression to model symptom scores (for all participants) and polytomous logistic regression to model exacerbation of symptoms when inside (for those participating in clean-up). RESULTS Of 553 participants (response rate = 92%), 372 (68%) had participated in clean-up; 233 (63%) of these used a respirator. Respiratory symptom scores increased linearly with exposure (P < .05 for trend). Disposable-respirator use was associated with lower odds of exacerbation of moderate or severe symptoms inside water-damaged homes for URS (odds ratio (OR) = .51; 95% confidence interval (CI) = 0.24, 1.09) and LRS (OR = 0.33; 95% CI = 0.13, 0.83). CONCLUSIONS Respiratory symptoms were positively associated with exposure to water-damaged homes, including exposure limited to being inside without participating in clean-up. Respirator use had a protective effect and should be considered when inside water-damaged homes regardless of activities undertaken.

Serial evaluations at an indium-tin oxide production facility.

BACKGROUND We evaluated the effectiveness of workplace changes to prevent indium lung disease, using 2002-2010 surveillance data collected by an indium-tin oxide production facility. METHODS We assessed pulmonary function using lower limits of normal. Blood indium concentration and personal air sampling data were used to estimate exposure. RESULTS Abnormalities were uncommon at hire. After hire, prevalence of spirometric restriction was 31% (n = 14/45), about fourfold higher than expected. Excessive decline in FEV1 was elevated at 29% (n = 12/41). Half (n = 21/42) had blood indium ≥5 µg/l. More recent hires had fewer abnormalities. There was a suggestion that abnormalities were more common among workers with blood indium ≥5 µg/l, but otherwise an exposure-response relationship was not evident. Peak dust concentrations were obscured by time averaging. CONCLUSIONS Evolving lung function abnormalities consistent with subclinical indium lung disease appeared common and merit systematic investigation. Traditional measures of exposure and response were not illustrative, suggesting fresh approaches will be needed. Workplace changes seemed to have had a positive though incomplete impact; novel preventive interventions are warranted.

Respirator Donning in Post- Hurricane New Orleans

Most participants did not properly don an N95 FF respirator

Respiratory symptoms and lung function abnormalities related to work at a flavouring manufacturing facility

Objectives To better understand respiratory symptoms and lung function in flavouring manufacturing workers. Methods We offered a questionnaire and lung function testing to the current workforce of a flavouring manufacturing facility that had transitioned away from diacetyl and towards substitutes in recent years. We examined symptoms, spirometric parameters and diffusing capacity measurements by exposure variables, including facility tenure and time spent daily in production areas. We used linear and logistic regression to develop final models adjusted for age and smoking status. Results A total of 367 (93%) current workers participated. Shortness of breath was twice as common in those with tenure ≥7 years (OR 2.0, 95% CI 1.1 to 3.6). Other chest symptoms were associated with time spent daily in production. Participants who spent ≥1 h daily in production areas had twice the odds of any spirometric abnormality (OR 2.3; 95% CI 1.1 to 5.3) and three times the odds of low diffusing capacity (OR 2.8; 95% CI 0.9 to 9.4) than other participants. Mean spirometric parameters were significantly lower in those with tenure ≥7 years and those who spent ≥1 h daily in production. Mean diffusing capacity parameters were significantly lower in those with tenure ≥7 years. Differences in symptoms and lung function could not be explained by age, smoking status or employment at another flavouring plant. Conclusions Symptoms and lung function findings were consistent with undiagnosed or subclinical obliterative bronchiolitis and associated with workplace exposures. Further efforts to lower exposures to flavouring chemicals, including diacetyl substitutes, are warranted.

Health problems and disinfectant product exposure among staff at a large multispecialty hospital

Background: Hospital staff expressed health concerns after a surface disinfectant product containing hydrogen peroxide, peracetic acid, and acetic acid was introduced. We sought to determine if this product posed a health hazard. Methods: An interviewer‐administered questionnaire on work and health characteristics was completed by 163 current staff. Symptoms that improved away from work were considered work‐related. Forty‐nine air samples were taken for hydrogen peroxide, peracetic acid, and acetic acid. Prevalence ratios (PRs) were calculated using Poisson regression, and standardized morbidity ratios (SMRs) were calculated using nationally representative data. Results: Product users reported higher prevalence of work‐related wheeze and watery eyes than nonusers (P < .05). Workers in the department with the highest air measurements had significantly higher prevalence of watery eyes (PR, 2.88; 95% confidence interval [CI], 1.18‐7.05) than those in departments with lower air measurements, and they also had a >3‐fold excess of current asthma (SMR, 3.47; 95% CI, 1.48‐8.13) compared with the U.S. population. Conclusions: This disinfectant product was associated with mucous membrane and respiratory health effects. Risks of mucous membrane irritation and asthma in health care workers should be considered in development of disinfection protocols to protect patients from hospital‐acquired infections. Identification of optimal protocols that reduce worker exposures while maintaining patient safety is needed.

Respirable indium exposures, plasma indium, and respiratory health among indium-tin oxide (ITO) workers.

BACKGROUND Workers manufacturing indium-tin oxide (ITO) are at risk of elevated indium concentration in blood and indium lung disease, but relationships between respirable indium exposures and biomarkers of exposure and disease are unknown. METHODS For 87 (93%) current ITO workers, we determined correlations between respirable and plasma indium and evaluated associations between exposures and health outcomes. RESULTS Current respirable indium exposure ranged from 0.4 to 108 μg/m(3) and cumulative respirable indium exposure from 0.4 to 923 μg-yr/m(3) . Plasma indium better correlated with cumulative (rs  = 0.77) than current exposure (rs  = 0.54) overall and with tenure ≥1.9 years. Higher cumulative respirable indium exposures were associated with more dyspnea, lower spirometric parameters, and higher serum biomarkers of lung disease (KL-6 and SP-D), with significant effects starting at 22 μg-yr/m(3) , reached by 46% of participants. CONCLUSIONS Plasma indium concentration reflected cumulative respirable indium exposure, which was associated with clinical, functional, and serum biomarkers of lung disease. Am. J. Ind. Med. 59:522-531, 2016. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Styrene‐associated health outcomes at a windblade manufacturing plant

BACKGROUND Health risks of using styrene to manufacture windblades for the green energy sector are unknown. METHODS Using data collected from 355 (73%) current windblade workers and regression analysis, we investigated associations between health outcomes and styrene exposure estimates derived from urinary styrene metabolites. RESULTS The median current styrene exposure was 53.6 mg/g creatinine (interquartile range: 19.5-94.4). Color blindness in men and women (standardized morbidity ratios 2.3 and 16.6, respectively) was not associated with exposure estimates, but was the type previously reported with styrene. Visual contrast sensitivity decreased and chest tightness increased (odds ratio 2.9) with increasing current exposure. Decreases in spirometric parameters and FeNO, and increases in the odds of wheeze and asthma-like symptoms (odds ratios 1.3 and 1.2, respectively) occurred with increasing cumulative exposure. CONCLUSIONS Despite styrene exposures below the recommended 400 mg/g creatinine, visual and respiratory effects indicate the need for additional preventative measures in this industry.

Comparing plasma, serum and whole blood indium concentrations from workers at an indium-tin oxide (ITO) production facility

Objective Occupational exposure to indium compounds including indium-tin oxide (ITO) can result in potentially fatal indium lung disease. We compared plasma, serum and whole blood indium concentrations (InP, InS and InB) from workers at a single ITO production facility to assess the comparability of these matrices used for biological monitoring of indium exposure. Method InP, InS and InB were measured using inductively coupled mass spectrometry from consenting workers at an ITO production facility with specimen collection occurring during June−July 2014. Matched pairs from workers were assessed to determine the matrix relationships using the Pearson correlation, paired t-tests, per cent difference, linear regression and κ statistics. Results Indium matrices were collected from 80 workers. Mean (SD) InP, InS and InB were 3.48 (3.84), 3.90 (4.15) and 4.66 (5.32) mcg/L, respectively. The InS−InP difference was 14%; InS was higher in all but two workers. InP and InS were highly correlated (r=>0.99). The InB−InS difference was 19%; InB was higher in 85% of workers. The InB−InP difference was 34%; InB was higher in 66% of workers. InB was highly correlated with both InP and InS (r=0.97 and 0.96, respectively). κ Statistics were 0.84, 0.83 and 0.82 for InP, InS and InB, respectively, for individuals with each matrix ≥1 mcg/L (p<0.01). Conclusions While all matrices were highly correlated, we encourage the use of InP and InS to reliably compare studies across different populations using different matrices. The higher per cent difference and increased variability of InB may limit its utility in comparisons with InP and InS in different populations.

Notes from the Field: Respiratory Symptoms and Skin Irritation Among Hospital Workers Using a New Disinfection Product - Pennsylvania, 2015.

In March 2014, a new disinfection product, consisting of hydrogen peroxide, peroxyacetic acid, and acetic acid, was introduced at a Pennsylvania hospital to aid in the control of health care-associated infections. The product is an Environmental Protection Agency-registered non-bleach sporicide advertised as a one-step cleaner, disinfectant, and deodorizer. According to the manufacturers safety data sheet, the product requires no personal protective equipment when it is diluted with water by an automated dispenser before use. On January 30, 2015, CDCs National Institute for Occupational Health (NIOSH) received a confidential employee request to conduct a health hazard evaluation at the hospital. The request cited concerns about exposure of hospital environmental services staff members to the product and reported symptoms among persons who had used the product that included eye and nasal problems, asthma-like symptoms, shortness of breath, skin problems, wheeze, chest tightness, and cough.