I have nothing to disclose The findings and conclusions in this - PDF document

3/8/18 Novel and Persistent Occupational Hazards: Are We Making Gains? Insights from NIOSH’s Health Hazard Evaluation Program I have nothing to disclose “ The findings and conclusions in this report are those of the Bruce P. Bernard, M.D., M.P.H. author(s) and do not necessarily represent the official position of Captain, USPHS the National Institute for Occupational Safety and Health, Centers Chief Medical Officer, Health Hazard Evalua>ons for Disease Control and Prevention.” Centers for Disease Control and Prevention National Institute for Occupational Safety and Health Outline : Insights from NIOSH’s Health Hazard Evaluation Program NIOSH’s Health Hazard Evaluation Program 1. The Health Hazard Evaluation (HHE) Program Refer to pages- HHEs: Persistent Occupational Hazards/ Novel 2. Occupational Hazards 3. Examples of HHEs Persistent hazards : A respiratory outbreak in the DR § Lead § Poultry & Musculoskeletal Disorders; Disinfectants § Novel Hazards : Diacetyl and Coffee § Opioids and Emergency Response Workers § Cannabis Growers § Electronic Waste § Robotics § 4. Are we making Gains? 1

3/8/18 The NIOSH HHE Program investigates ALL What is a NIOSH Health Hazard Evaluation? Hazards except “Safety”… Worksite medical / epidemiologic / industrial hygiene investigation in response to a Chemical and request; right of entry same as OSHA Dust Ergonomic Determine whether harmful exposures, Biological processes, or conditions exist OR cause injuries or illnesses Organizational Involves employees at every step (… along with managers…) Safety Physical At no cost to the employer, unions, employees, etc. (your tax dollars at work) HHE= Health Hazard Evaluation 177 HHE Requests in 2017 Who Can Request an HHE* at their worksite? by Industry Sector 3 current employees (can Services maintain confidentially) T Transport r a d e Manufacturing Union Healthcare Employer Other gov’t agencies HHEs reflect the trend in the U.S. From the NIOSH HHE Website: towards a Service Economy http://www.cdc.gov/niosh/hhe/request.html 2

3/8/18 What is the Final Product from the HHE * Program? A final report Are we making GAINS Plain language summary in terms of protec6ng and and recommendations Technical Appendices improving the health of workers, • Methods and improving the science? • Evaluation criteria • Discussion/References Must be posted for 30 days prominently at the worksite Also posted on the NIOSH HHE website https://www.cdc.gov/niosh/hhe/ * HHE= Health Hazard Evaluation Persistent Occupational Hazards An Unexpected Respiratory Illness in the Dominican Republic Chemical and Dust Mineral dusts: silica, coal, asbestos; metals; Management no*fied the HHE Program about § Ergonomic Biological solvents, gases, irritants, Repetitive & 17 temp workers c̄ unknown severe febrile Flu Virus, HIV, allergens, Carcinogens: diesel, Forceful work; illness; several were hospitalized Hepatitis, PAHs, dioxins Bending and Tuberculosis, molds, twisting, standing, Symptoms : headache, fever/chills, malaise, fungus, § Organizational vibration; patient campylobacter, Let’s look at a persistent cough, shortness of breath Stress, intimidation, sexism, handling E coli, salmonella job demands, work pace, job biological hazard in a novel location Ini*ally, Rx for leptospirosis (endemic), but no § control, shift work, child Safety Physical labor, job insecurity, work-life response to penicillin Confined space, imbalance Noise, UV light, artificial Severe Respiratory Illness In falls, violence, fatigue, UV (welding, phototherapy, § A physician (luckily) no*fied local health dept. motor vehicles, dye and paint drying), Tunnel Workers in the about illnesses and common work at a disasters and radon, solar radiation, Dominican Republic hydroelectric dam emergency response; heat, cold human error 3

3/8/18 An An Unexpected Respiratory Illness in the § The tunnel workers had been Unexpected Dominican Republic provided with knee-high rubber Respiratory boots, hard hat & headlamp, and § A 36 member crew; working in Illness in the shovels previously closed access tunnels Dominican at the hydroelectric dam § A few were given paper surgical Republic masks; only 3 used them § Shoveling black muck & dry “mud”, knee-deep, out of tunnels § Worked in oppressive heat; into wheelbarrows and reported difficulty breathing while depositing it outdoors wearing masks inside the tunnel § Tunnels, built for access and § They worked a full shift, 5 days a maintenance of the dam, had not week been cleaned in decades An Unexpected Respiratory Illness in the Results of Investigation, Histoplasmosis Tunnel Workers in the Dominican Republic in the Dominican Republic When examined, the § § 36 male workers; working median 24 tunnels had a large days (range 1-25 days) number of bats flying in § Median age: 32 yrs. (range: 18-62) and out… around the workers § O/36 immunocompromised § All removed large amounts of earth § We suspected containing bat guano from tunnels Histoplasmosis: although there had never been an § None wore respiratory protection outbreak in the DR DR= Dominican Republic 4

3/8/18 Results of inves-ga-on, Histoplasmosis Histoplasmosis Investigation in 36 Tunnel Workers in the DR in Dominican Republic § Diagnosis on bronchoscopy: histoplasmosis § Severe illnesses and death from exposure to § 30 (83%) met the case definition* for Histo large inocula of Histoplasma capsulatum Ø 28 (93%) hospitalized spores in an enclosed space Ø 9 (30%) required intensive care Ø 6 (20%) required intubation Ø 3 (10%) died § Lack of respiratory protection, delay in § Time from symptom onset to antifungal Rx was recognition and treatment ~ 6 days (range: 1-11 days) § No prior outbreaks of histoplasmosis in DR § 22 (65%) had lab evidence** of histoplasmosis *Fever and ≥2 symptoms consistent with histoplasmosis **Urine or serum for H. capsulatum anQgen using enzyme immunoassay What Did We Recommend for Histoplasmosis Investigation: Environmental recommendations the Clinics and the Dam Regarding the Outbreak? § Use wet methods to remove waste, minimize Ø Educate clinicians about histo risk dust Ø Improve lab capacity to dx fungal infections § Collect waste in 6ghtly-sealed, plas6c Ø For tunnel work: biohazard bags in 55-gallon drums; transport to § Hire experienced environmental remediation firm for waste disposal site future work § Do not decontaminate tunnels with § Devise a worker safety and health plan formaldehyde or other chemicals § Train workers on health risks, protective measures (rabies vaccination) § Cover waste pile with agricultural lime § Provide appropriate PPE (Tyvek coveralls, disposable and re-cover with addi6onal soil gloves, boots, PAPRs) and train on use 5

3/8/18 Persistent Occupational Hazards Histoplasmosis Outbreak among Tunnel Workers: Chemical and Dust Were We Making Gains? Mineral dusts: silica, coal, asbestos; metals; Ø Made small inroads regarding previously unrecognized Ergonomic Biological solvents, gases, irritants, Repetitive & occupational disease in a foreign country & defining global allergens, Carcinogens: diesel, Flu Virus, HIV, Forceful work; burden HepaKKs, PAHs, dioxins Bending and Tuberculosis, molds, twisting, standing, fungus, Ø Using the Hierarchy of Controls , prevented new cases Organizational vibration; patient campylobacter, Let’s look at Lead Exposure Stress, inKmidaKon, sexism, handling E coli, salmonella Ø Changed the way the larger CDC involved the NIOSH HHE job demands, work pace, job control, shiN work, child Program– now there is a new algorithm to ask an intro Safety Physical labor, job insecurity, work-life question “Are there workers involved?”… then CDC contacts Confined space, imbalance Noise, UV light, artificial NIOSH (never before has that worked… usually person- falls, violence, fatigue, UV (welding, phototherapy, dependent) motor vehicles, dye and paint drying), disasters and radon, solar radiation, § Led to our involvement in 12 more recent CDC emergency response; heat, cold human error Investigations (Epi-Aids) A Persistent Occupational Health Worker lead levels have been steadily decreasing…. Problem: Lead Exposure Na8onal Prevalence of Lead Toxicity 1984-2016 The NIOSH HHE Program has evaluated Lead BLLs≥ 5 ug/dl Exposure in workplaces 533 times in the last 30 years, of these 16 were in the last year. BLLs≥ 10 ug/dl Direct + indirect costs of ALL occupational BLLs≥ 25 ug/dl lead work in 2017: ~$392 million * Per 100,000 employed adults aged ≥16 years. BLL= blood lead level; ug/dl= micrograms per deciliter 6