Scott E. Brueck

Use of historical data and a novel metric in the evaluation of the effectiveness of hearing conservation program components

Objectives To evaluate the effectiveness of hearing conservation programs (HCP) and their specific components in reducing noise-induced hearing loss (NIHL). Methods This retrospective cohort study was conducted at one food-processing plant and two automotive plants. Audiometric and work-history databases were combined with historical noise monitoring data to develop a time-dependent exposure matrix for each plant. Historical changes in production and HCP implementation were collected from company records, employee interviews and focus groups. These data were used to develop time-dependent quality assessments for various HCP components. 5478 male (30 427 observations) and 1005 female (5816 observations) subjects were included in the analysis. Results Analyses were conducted separately for males and females. Females tended to have less NIHL at given exposure levels than males. Duration of noise exposure stratified by intensity (dBA) was a better predictor of NIHL than the standard equivalent continuous noise level (Leq) based upon a 3-dBA exchange. Within this cohort, efficient dBA strata for males were <95 versus ≥95, and for females <90 versus ≥90. The reported enforced use of hearing protection devices (HPDs) significantly reduced NIHL. The data did not have sufficient within-plant variation to determine the effectiveness of noise monitoring or worker training. An association between increased audiometric testing and NIHL was believed to be an artifact of increased participation in screening. Conclusions Historical audiometric data combined with noise monitoring data can be used to better understand the effectiveness of HCPs. Regular collection and maintenance of quality data should be encouraged and used to monitor the effectiveness of these interventions.

Agreement between Task-Based Estimates of the Full-Shift Noise Exposure and the Full-Shift Noise Dosimetry

Noise assessments have been conducted using full-shift dosimetry and short-term task-based measurements. Advantages of the task-based method include the opportunity to directly identify high-noise exposure tasks and to target control measures, as well as obtain estimates of task-based full-shift exposures; however, there is little empirical evidence comparing the two methods. National Institute for Occupational Safety and Health assessed noise exposures at three industrial facilities using dosimetry and task-based methods with the objective of comparing the two strategies and assessing the degree of agreement and causes of disagreement. Eight indices of task-based full-shift exposures were created from task-based sampling using three methods to assess time-at-task (direct observation by industrial hygienist, end-of-shift worker estimates and supervisor estimates) and three methods to assign noise levels to tasks [direct measurement, arithmetic mean (AM) and geometric mean (GM)]. We assessed aspects of agreement (precision, bias and absolute agreement) using Bland-Altman plots and concordance correlation coefficient (CCC). Overall, the task-based methods worked fairly well, with mean biases less than +/-2.8 dBA and precision ranges of 3.3-4.4 dBA. By all measures, task-based full-shift estimates based on supervisor assessment of time-at-task agreed most poorly with the dosimetry data. The task-based full-shift estimates based on worker estimates of time-at-task generally agreed as well as those based on direct observation. For task noise level, task-based full-shift estimates based on directly measured task agreed the best with dosimetry data, while agreement for task-based indices based on task AM or GM was variable. Overall, the task-based full-shift estimates based on direct observation task and direct measured task noise level achieved the best agreement with the dosimetry data (CCC 0.84) with 95% of their differences being within 7.4 dBA and 56% of the differences <3 dBA. For this index, a high degree of accuracy was observed (accuracy coefficient = 0.96) with major cause of disagreement arising from a lack of precision (precision coefficient = 0.88). When the measurements were classified by job characteristics, significant improvements in the degree of agreement were observed in the low job mobility, low job complexity and low job variability categories. Our data suggest that a high degree of absolute agreement can be achieved between the task-based and dosimetry-based estimates of full-shift exposures. The task-based approach that uses worker reports combined with task AM or GM levels is similar to the more time-intensive direct observation method to estimate full-shift exposures.

Epidemiologic Investigation of Immune-Mediated Polyradiculoneuropathy among Abattoir Workers Exposed to Porcine Brain

Background In October 2007, a cluster of patients experiencing a novel polyradiculoneuropathy was identified at a pork abattoir (Plant A). Patients worked in the primary carcass processing area (warm room); the majority processed severed heads (head-table). An investigation was initiated to determine risk factors for illness. Methods and Results Symptoms of the reported patients were unlike previously described occupational associated illnesses. A case-control study was conducted at Plant A. A case was defined as evidence of symptoms of peripheral neuropathy and compatible electrodiagnostic testing in a pork abattoir worker. Two control groups were used - randomly selected non-ill warm-room workers (n = 49), and all non-ill head-table workers (n = 56). Consenting cases and controls were interviewed and blood and throat swabs were collected. The 26 largest U.S. pork abattoirs were surveyed to identify additional cases. Fifteen cases were identified at Plant A; illness onsets occurred during May 2004–November 2007. Median age was 32 years (range, 21–55 years). Cases were more likely than warm-room controls to have ever worked at the head-table (adjusted odds ratio [AOR], 6.6; 95% confidence interval [CI], 1.6–26.7), removed brains or removed muscle from the backs of heads (AOR, 10.3; 95% CI, 1.5–68.5), and worked within 0–10 feet of the brain removal operation (AOR, 9.9; 95% CI, 1.2–80.0). Associations remained when comparing head-table cases and head-table controls. Workers removed brains by using compressed air that liquefied brain and generated aerosolized droplets, exposing themselves and nearby workers. Eight additional cases were identified in the only two other abattoirs using this technique. The three abattoirs that used this technique have stopped brain removal, and no new cases have been reported after 24 months of follow up. Cases compared to controls had higher median interferon-gamma (IFNγ) levels (21.7 pg/ml; vs 14.8 pg/ml, P<0.001). Discussion This novel polyradiculoneuropathy was associated with removing porcine brains with compressed air. An autoimmune mechanism is supported by higher levels of IFNγ in cases than in controls consistent with other immune mediated illnesses occurring in association with neural tissue exposure. Abattoirs should not use compressed air to remove brains and should avoid procedures that aerosolize CNS tissue. This outbreak highlights the potential for respiratory or mucosal exposure to cause an immune-mediated illness in an occupational setting.

Influenza-like illness and presenteeism among school employees.

We determined the prevalence of influenza-like illness (ILI) among employees of a suburban Ohio school district. In a survey of 412 of 841 employees (49%), 120 (29%) reported ILI symptoms during the school year, and 92 (77%) reported working while ill. Age ≥50 years and asthma were significantly associated with reporting of ILI symptoms. Encouraging school employees to receive the seasonal influenza vaccine and to stay home when ill should be part of a comprehensive influenza prevention strategy.

Evaluation of 2009 pandemic influenza A (H1N1) exposures and illness among physicians in training

BACKGROUND A cluster of influenza-like illness (ILI) among physicians in training during the 2009 influenza A (H1N1) pandemic (pH1N1) led to a health hazard evaluation. METHODS We conducted a cross-sectional study to examine exposures, infection control practices, ILI prevalence, and transmission among physicians in training at 4 affiliated hospitals during the pandemic. We administered an electronic survey and met with physicians in training and hospital personnel. RESULTS Of the 88 responding physicians, 85% reported exposure to pH1N1. Exposures occurred at work from patients or coworkers and outside of work from coworkers, household members, or the community. Thirteen cases of ILI were reported in May-June 2009; 10 respondents reported working while ill (duration, 1-4 days). Between 13% and 88% of respondents knew which personal protective equipment (PPE) was recommended when caring for influenza patients at the 4 hospitals. The most common reasons for not using PPE were not knowing that a patient had pH1N1 or ILI and not having PPE readily available. CONCLUSIONS Physicians in training have gaps in their knowledge of and adherence to recommended PPE and compliance with work restrictions. Our findings underscore the importance of installing isolation precaution signage, making PPE readily available near patients with influenza, and facilitating work restrictions for ill health care personnel.

Influenza Vaccination Coverage Among School Employees: Assessing Knowledge, Attitudes, and Behaviors

BACKGROUND Influenza can spread among students, teachers, and staff in school settings. Vaccination is the most effective method to prevent influenza. We determined 2012-2013 influenza vaccination coverage among school employees, assessed knowledge and attitudes regarding the vaccine, and determined factors associated with vaccine receipt. METHODS We surveyed 412 (49%) of 841 employees at 1 suburban Ohio school district in March 2013. The Web-based survey assessed personal and work characteristics, vaccine receipt, and knowledge and attitudes regarding the vaccine. RESULTS Overall, 238 (58%) respondents reported getting the 2012-2013 influenza vaccine. The most common reason for getting the vaccine was to protect oneself or ones family (87%). Beliefs that the vaccine was not needed (32%) or that it was not effective (21%) were the most common reasons for not getting it. Factors independently associated with vaccine receipt were having positive attitudes toward the vaccine, feeling external pressure to get it, and feeling personal control over whether to get it. CONCLUSIONS Influenza vaccine coverage among school employees should be improved. Messages encouraging school employees to get the vaccine should address misconceptions about the vaccine. Employers should use methods to maximize employee vaccination as part of a comprehensive influenza prevention program.

Noise Exposure Reconstruction and Evaluation of Exposure Trends in Two Large Automotive Plants

This study used a task-based approach to reconstruct employee noise exposures at two large automotive manufacturing plants for the period 1970-1989, utilizing historic noise measurement data, work history records, documented changes in plant operations, focus group discussions, structured interviews with long-tenure employees, and task-based job profiles. Task-based job noise exposure profiles were developed in the 1990s when the plants conducted task-based noise monitoring. Under the assumption that tasks and time-at-task profile within jobs did not change over time, these profiles were applied to historic jobs. By linking historic noise exposure measurements to job tasks, this approach allowed task-based reconstructed noise exposure profiles to capture variability of daily noise exposures. Reconstructed noise exposures, along with task-based noise exposure measurements collected at each plant during the 1990s, were analyzed to examine time trends in workplace noise levels and worker noise exposure. Our analysis of noise exposure trends revealed that noise levels for many jobs declined by ≥3 dBA from 1970 to 1998 as operational and equipment changes occurred in the plants and some noise control measures were implemented, but for some jobs, noise levels increased in the mid- to late 1990s, most likely because of an increase in production at that time. Overall, the percentage of workers exposed to noise levels >90 dBA decreased from 95% in 1970 to 54% in 1998 at one of the plants and decreased from 36% in 1970 to ~5% in 1999 at the other plant. These reductions indicate a degree of success for the hearing conservation program. However, the actual number of employees with noise exposure >90 dBA increased because of a substantial increase in the number of production employees, particularly in jobs with high noise levels, which shows a hearing conservation program challenge that companies face during periods of increased production. Future analysis of hearing levels in these plant populations will help determine whether noise level reduction translates into decreased hearing loss at these plants.

Assessment of environmental and surgical mask contamination at a student health center — 2012–2013 influenza season

Abstract Increased understanding of influenza transmission is critical for pandemic planning and selecting appropriate controls for healthcare personnel safety and health. The goals of this pilot study were to assess environmental contamination in different areas and at two time periods in the influenza season and to determine the feasibility of using surgical mask contamination to evaluate potential exposure to influenza virus. Bioaerosol samples were collected over 12 days (two 6-day sessions) at 12 locations within a student health center using portable two-stage bioaerosol samplers operating 8 hr each day. Surface samples were collected each morning and afternoon from common high-contact non-porous hard surfaces from rooms and locations where bioaerosol samplers were located. Surgical masks worn by participants while in contact with patients with influenza-like illness were collected. A questionnaire administered to each of the 12 participants at the end of each workday and another at the end of each workweek assessed influenza-like illness symptoms, estimated the number of influenza-like illness patient contacts, hand hygiene, and surgical mask usage. All samples were analyzed using qPCR. Over the 12 days of the study, three of the 127 (2.4%) bioaerosol samples, 2 of 483 (0.41%) surface samples, and 0 of 54 surgical masks were positive for influenza virus. For the duration of contact that occurred with an influenza patient on any of the 12 days, nurse practitioners and physicians reported contacts with influenza-like illness patients >60 min, medical assistants reported 15–44 min, and administrative staff reported <30 min. Given the limited number of bioaerosol and surface samples positive for influenza virus in the bioaerosol and surface samples, the absence of influenza virus on the surgical masks provides inconclusive evidence for the potential to use surgical masks to assess exposure to influenza viruses. Further studies are needed to determine feasibility of this approach in assessing healthcare personnel exposures. Information learned in this study can inform future field studies on influenza transmission.

Investigating a persistent odor at an aircraft seat manufacturer

ABSTRACT An aircraft seat manufacturing company requested a NIOSH health hazard evaluation to help identify a strong odor that had persisted throughout the facility for over a year. Employees reported experiencing health effects thought to be related to the odor. We collected and analyzed area air samples for volatile organic compounds, endotoxin, bacterial and fungal metagenome, and metalworking fluid aerosol. Bulk metalworking fluid samples were analyzed for endotoxin, bacterial and fungal metagenome, and viable bacteria and fungus. We also evaluated the building ventilation systems and water diversion systems. Employees underwent confidential medical interviews about work practices, medical history, and health concerns. Based on our analyses, the odor was likely 2-methoxy-3,5-dimethylpyrazine. This pyrazine was found in air samples across the facility and originated from bacteria in the metalworking fluid. We did not identify bacteria known to produce the compound but bacteria from the same Proteobacteria order were found as well as bacteria from orders known to produce other pyrazines. Chemical and biological contaminants and odors could have contributed to health symptoms reported by employees, but it is likely that the symptoms were caused by several factors. We provided several recommendations to eliminate the odor including washing and disinfecting the metalworking machines and metalworking fluid recycling equipment, discarding all used metalworking fluid, instituting a metalworking fluid maintenance program at the site, and physically isolating the metalworking department from other departments.

Healthcare personnel exposure in an emergency department during influenza season

Introduction Healthcare personnel are at high risk for exposure to influenza by direct and indirect contact, droplets and aerosols, and by aerosol generating procedures. Information on air and surface influenza contamination is needed to assist in developing guidance for proper prevention and control strategies. To understand the vulnerabilities of healthcare personnel, we measured influenza in the breathing zone of healthcare personnel, in air and on surfaces within a healthcare setting, and on filtering facepiece respirators worn by healthcare personnel when conducting patient care. Methods Thirty participants were recruited from an adult emergency department during the 2015 influenza season. Participants wore personal bioaerosol samplers for six hours of their work shift, submitted used filtering facepiece respirators and medical masks and completed questionnaires to assess frequency and types of interactions with potentially infected patients. Room air samples were collected using bioaerosol samplers, and surface swabs were collected from high-contact surfaces within the adult emergency department. Personal and room bioaerosol samples, surface swabs, and filtering facepiece respirators were analyzed for influenza A by polymerase chain reaction. Results Influenza was identified in 42% (53/125) of personal bioaerosol samples, 43% (28/ 96) of room bioaerosol samples, 76% (23/30) of pooled surface samples, and 25% (3/12) of the filtering facepiece respirators analyzed. Influenza copy numbers were greater in personal bioaerosol samples (17 to 631 copies) compared to room bioaerosol samples (16 to 323 copies). Regression analysis suggested that the amount of influenza in personal samples was approximately 2.3 times the amount in room samples (Wald χ2 = 16.21, p<0.001). Conclusions Healthcare personnel may encounter increased concentrations of influenza virus when in close proximity to patients. Occupations that require contact with patients are at an increased risk for influenza exposure, which may occur throughout the influenza season. Filtering facepiece respirators may become contaminated with influenza when used during patient care.