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Bullard-Sherwood Research to Practice (r2p) Award Winners and Honorable Mentions: Backgound, 2008
Title: Prevention of Flavoring-Related Bronchiolitis Obliterans
Authors: Kreiss K, Kanwal RS, Kullman G, Taylor McKernan L, Dunn KH, Hubbs A, Streicher R, Okun A, Anderson S, Fedan J, Ahlers HW
- plus 77 additional contributors: Sahakian N, Bailey RL, Piacitelli C, Boylstein RJ, Fedan KB, Tift B, Couch J, Goldsmith W, Frazer D, Weissman D, Pendergrass S, Reed L, Sublet V, Castranova V, Porter D, Battelli LA, Schwegler-Berry D, Mercer RR, Kashon M, Wells JR, Fedorowicz A, Wagner GR, Butterworth LF, Meade BJ, Munson AE, Dowdy J, Echt A, Garcia A, Hodson L, Grote A, Brown K, Neumeister C, Schleiff P, Burkhart J, Castellan R, Coffey C, Cress D, Cox-Ganser JM, Day G, Edwards N, Englehart S, Freeland D, Game SR, Hnizdo E, Hoover M, Gaughan D, Jefferson TB, Tennant M, Petsko RA, Hayes E, Beaty M, Bledsoe T, Friend S, Newcomer D, Mehta A, Keller J, Lawrence R, Martin S, Petsonk EL, Rooney T, Spainhour D, Taylor J, Wang ML, White SK, Wolfe C, Akpinar-Elci M, Elci OC, Enright P, Gomaa A, Dunn KL, Harton A, Hilsbos K, Jones W, Bonnett B, Yereb D, Stemple K, Reynolds JS, Tucker SP
Source: Division of Respiratory Disease Studies; Division of Surveillance, Hazard Evaluations, and Field Studies; Division of Applied Research and Technology; Health Effects Laboratory Division; Education and Information Division; National Personal Protective Technology Laboratory
Background: Exposure to food flavoring chemicals, such as diacetyl in butter flavoring, causes an untreatable lung disease known as clinical bronchiolitis obliterans that results in severe shortness of breath on exertion. This emerging occupational disease was identified as an industry-wide risk in the microwave popcorn manufacturing industry between 2000 and 2004, and in the flavor manufacturing industry between 2004 and 2007. More recently, attention has focused on food production workers as a result of the excess numbers of obstructive lung disease found in three studies. It is estimated that more than 3.5 million workers are potentially exposed to food flavoring chemicals and therefore, are at risk of acquiring bronchiolitis obliterans.
Relevance: In 2007, the multi-faceted approach used by NIOSH motivated many public and private entities to strive for the prevention of this emerging occupational disease. In California alone 21 flavor manufacturers began medical screening programs which spurred the California Department of Public Health to provide guidance to health care providers regarding spirometry quality and appropriate clinical response to abnormalities on screening. CalOSHA visited all flavoring manufacturers in California, conducted exposure assessments to compliment the medical screening results, disseminated engineering guidance developed by NIOSH, and held several advisory committee meetings to inform the development of a regulation for diacetyl in the flavoring industry. These activities in turn stimulated prevention action on the part of several associations and labor unions including the Grocery Manufacturers Association, the Flavoring and Extract Manufacturers Association, the Teamsters, the United Food and Commercial Workers, and Worksafe. The California model was then disseminated to all state epidemiologists and led to the passing of H.R. 2693 which instructed the Occupational Safety and Health Administration (OSHA) to establish a temporary standard within 90 days and a permissible exposure limit within two years.
In the private industry, ConAgra, one of the five major microwave popcorn manufacturers, presented findings of their 4-plant study of pulmonary functions, symptoms, and exposures affecting all of their workers. These findings confirmed the hazards of mixing jobs. ConAgra also developed control technologies in novel ventilation configurations that it has shared with other companies in the industry.
The NIOSH efforts to prevent workplace injury and illness in this industry have motivated a commitment on the part of many stakeholders that should prevent the onset of future cases of bronchiolitis obliterans. Collectively, the many partnerships and collaborations established as a part of this prevention effort has allowed the scientific groundwork to be developed, experience to be gained, and the momentum of voluntary compliance from the industry obtained.
More information about flavorings-related lung disease can be found at www.cdc.gov/niosh/topics/flavorings.
Title: Health Effects of Occupational Cycling
Authors: Schrader SM, Breitenstein MJ, Lowe BD
Source: Division of Applied Research and Technology
Background: The Law Enforcement Bicycle Association estimates that there are currently over 50,000 bicycling police officers (officers) across the country. Police on bike programs are highly visible to the public and have been shown to be effective in reducing crime. For these reasons, more communities are adding bicycle patrol units to their police departments. Research studies have found that long periods of bicycle riding with a traditional saddle seat is associated with urogenital paresthesia (numbness) and sexual dysfunction. The average officer spends more than 25 hours per week riding and the number of officers who report experiencing periodic numbness has been seen as high as 94%.
Relevance: The NIOSH research effort on bicycle police officers began in 2000 in response to a Health Hazard Evaluation in which officers were complaining of numbness and impotence. Since that time, the research effort has increased and has verified the problem in men, identified a similar problem in women, and implemented an effective intervention to reduce occupational injury and illness to officers. The results of this research are having a demonstrable impact on 50,000 officers as well as an indirect impact on estimated five million recreational cyclists in the United States.
Published NIOSH studies have demonstrated the existence of health problems among bicycle police officers using the traditional "nosed" bicycle saddles, and have shown that the "no-nose" saddle is a viable option to reduce or eliminate the problem.
In 2007, NIOSH completed an intervention study that assessed officers in five major metropolitan areas for reproductive health function during use of the traditional nosed saddle (pre-intervention) and then again after six months of using the no-nose saddle (post-intervention). Results found that the majority of men who experienced numbness while using the nosed saddle had the problem resolved post-intervention. In addition, several indicators of sexual function improved significantly after using the no-nose saddle for a period of six months. Several significant action items have occurred as a result of this research and intervention activity. Items include continued use of no-nose saddles among officers who participated in the study; major police departments purchased no-nose saddles for their officers; the International Police Mountain Bike Association (IPMBA) invited NIOSH to participate in its annual meeting and published study findings in the second edition of Public Safety Cycling and its member newsletter; and numerous news media and cycling organizations have reported on the results, have occurred as a result of this research and intervention activity.
More information about bicycle saddles and reproductive health can be found at www.cdc.gov/niosh/topics/bike.
Title: Mitigating an Ignition Hazard in Oxygen Resuscitator Regulators
Authors: Merinar T, Washenitz, F
Source: Division of Safety Research
Background: Oxygen resuscitators are common equipment used by emergency responders and health care providers to administer medical oxygen to patients. In 1998, the International Association of Fire Fighters (IAFF) requested that NIOSH investigate a series of incidents involving fire fighters who received serious injuries when portable oxygen resuscitators spontaneously ignited and burned. Subsequently, the Food and Drug Administration (FDA) reportedly received more than 50 reports of adverse events since 1996; although the events occurred infrequently, the severity was significant.
Relevance: As a result of this request, NIOSH conducted investigations of several incidents and sought the assistance of public and private partners at the FDA, Wendull Hull & Associates (a forensics laboratory), and the National Aeronautics and Space Administration (NASA). Through these collaborative efforts, it was quickly determined that the ignitions were associated with the use of aluminum in the device which controlled the flow of oxygen from the resuscitator. It was also determined that most of the incidents involved the same model oxygen regulator. NIOSH worked with the manufacturer who voluntarily took steps to address the hazard. Two-hundred-thousand units were recalled from the field, a retrofit kit was made available, and the product design was improved. NIOSH and the FDA publicized the hazard in a public health advisory document and reported the findings in peer-reviewed journals. In addition, the hazard and appropriate safety measures were broadly distributed to emergency responders and others in the health care industry.
On February 27, 2007, the FDA published a proposed rule in the Federal Register Notice that would require oxygen regulators to conform to a new test method established by the American Society for Testing and Materials or show safety equivalency prior to being placed on the market. The FDA has estimated that the proposed rule would generate annual benefits between $41,000 and $1.2 million by reducing injury events and associated costs. NIOSH provided comments on the proposed rule and is in favor of adoption as a means to improve the safety of emergency responders and health care providers who handle oxygen resuscitators as a regular part of their work duties.
Title: Permeation Calculator: Computer Software for Automated and Standardized Analysis of Chemical Protective Clothing Permeation Data
Authors: Gao P, Weise T, Tomasovic B
Source: National Personal Protective Technology Laboratory
Background: When engineering controls are not feasible for reducing exposure of a given substance to an acceptable level, the use of chemical protective clothing (CPC) such as full ensembles, gloves, and footwear, is the primary method of personal skin protection in the workplace. It is estimated that approximately 15 million workers in the United States (U.S.) rely on CPC for protection. A report from SBI (Specialists in Business Information) forecasts the U.S. Personal Protective Equipment market will reach $7.2 billion by 2012. The "body, clothing, and other" category has led the industry in recent years adding more than $1 billion to the market since 2002.
Relevance: Permeation testing is the only means available to determine the chemical resistance of CPC and ensure its level of protection with respect to breakthrough time as an indicator of "shelf-life." Therefore, an accurate determination of chemical resistance is extremely important in occupational safety and health. Unfortunately, current data analysis methods for permeation testing involve a number of equations and experimental factors. Experimenter bias and possible calculation errors are critical issues when determining permeation parameters. For example, two NIOSH staff performed hand calculations of breakthrough detection times using seven permeation data files. Results showed a relative difference up to 29.9%, which would raise uncertainty about whether a certain piece of CPC could safely be used for five hours or only 3.5 hours before breakthrough occurred.
NIOSH researchers, along with several stakeholders, expressed the need for a more accurate testing method. In response, NIOSH developed a computer program (Microsoft Windows compatible) that is capable of automating and standardizing permeation testing data analysis for CPC. The program imports the data collected during a permeation test, reduces the time it takes to calculate relevant permeation parameters from several hours to only a few seconds, allows all of the permeation parameters related to ASTM F739 and ISO 6529 standards to be calculated, reduces the need for labor intensive and often unreliable hand calculations, and prevents experimenter bias ensuring identical permeation parameters are obtained from a given permeation testing data file. The American Society for Testing and Materials (ASTM) developed a new standard that is currently being balloted. The expected long-term outcome of this program is the reduction of occupational dermal exposure to hazardous chemicals through the safe use of CPC.
For more information about the permeation calculator or to download a free copy, please visit NIOSH at www.cdc.gov/niosh/npptl/PermeationCalculator/permeationcalc.html
Title: Preventing Winch Entanglement Injuries on Commercial Fishing Vessels
Authors: Lincoln J, McKibbin R, Woodward C, Lucas D, Bevan J
Source: Alaska Regional Office, Spokane Research Laboratory
Background: In 2006, 51 commercial fishermen were killed on the job resulting in an occupational fatality rate of 142 deaths per 100,000 workers; the highest rate for any U.S. occupation and 36 times higher than the national workplace average. In Alaska, most fatalities in the fishing industry occur from the loss of a fishing vessel. Injury epidemiologists have shown that 67% of severe non-fatal injuries occur on-deck during the deployment and retrieval of fishing gear. Severe, non-fatal injuries are defined as those that require hospitalization including lacerations, broken bones, and head injuries. Between 1991 and 2002, NIOSH found that 798 fishermen were hospitalized for severe non-fatal injuries; an equivalent of 410 injuries per 100,000 full-time workers per year. Of these, 23% were a result of becoming entangled in or struck by lines or gear, or becoming trapped in a winch, pulley, or other piece of deck equipment.
Relevance: Many deck machines lack adequate safety features and therefore, serious injury may occur; entanglement in particular. Experts have recommended that vessel machinery be redesigned or retrofitted with safety features to prevent these types of injuries from occurring. NIOSH epidemiologists met with several fishermen across Alaska to discuss injuries resulting from deck machinery. Fishermen identified one particular safety hazard posed by the capstan-type winch aboard many purse-seine vessels; there are approximately 3000 of these vessels in operation in Alaska and along the west coast.
This winch is powerful, has up to 1000 foot-pounds of torque, and is usually mounted in the center of the deck near the wheelhouse. Fishermen who lose their balance or are inattentive can become entangled in the purse-line as the line winds around the drum. Severe injuries to the hand, arm, torso, and head can occur or may even lead to death because the controls to stop drum rotation are often located out of reach and no entanglement protection is present.
Through the collaborative efforts of NIOSH epidemiologists and engineers, fishing vessel owners, purse-seine fishermen, and winch manufacturers, an engineering design solution was developed. This emergency stop, referred to as the "e-stop," incorporated a robust, low-profile, momentary contact button mounted on the top port-side winch horn. When pushed, the button switches a safety-relay that de-energizes the solenoid of an electro-hydraulic valve. This valve closes the flow of hydraulic oil to and from the winch motor and locks the capstan drum in place. This current design lends itself to the development of more advanced systems, allows buttons to be placed in other locations of the vessel, and may be applied to other types of deck machinery.
NIOSH sought the assistance of fishing vessel owner/operators in its design and installation, and tested the device during the 2005, 2006, and 2007 Southeast Alaska salmon seasons. The e-stop has received an overwhelming positive response from fishermen who have tested it, with many owner/operators requesting information on how to obtain this device for their vessels. In November of 2007, NIOSH entered into a Proprietary Licensing Agreement with a marine company in Seattle, Washington to develop the e-stop for commercial use.
Title: Development of a Hand Wipe Removal Method for Toxic Metals
Authors: Esswein EJ, Boeniger MF, Ashley KE
Source: Office of the Director, Denver Regional Office, Division of Applied Research and Technology
Background: Controlling lead exposure is a national health priority. Poisoning from lead is one of the oldest known public and occupational health hazards, and it is currently reported that 95% of lead poisoning in the U.S. results from occupational exposure. The National Health and Nutrition Examination Survey (1988-1991) estimated that approximately 700,000 adults in the U.S. had blood lead levels greater than or equal to 25 micrograms per deciliter. The U.S. public health objective for 2010 is reduction in prevalence of blood lead levels greater than 25 micrograms per deciliter in employed adults to a level of zero. This is an extremely ambitious goal that is unlikely to occur without additional public health tools, techniques, and knowledge.
Relevance: A wide variety of workers are at increased risk for lead poisoning including construction trades, painters and abrasive blasters, welders, laborers, machinists and auto-body shop repairmen, and those in lead-acid battery plants. Numerous NIOSH field studies and recent laboratory research have demonstrated that washing with soap and water is an ineffective means of removing lead and other toxic metals from the skin. However, workers and the public are forced to wash their skin with soap and water because more effective methods have not been available.
NIOSH recently developed a novel and highly effective method of removing lead and other toxic metals from the skin and other surfaces. The technology includes a three-dimensionally textured absorbent wipe onto which proportions of cationic surfactant and a weak acid are applied. Published research has shown that this particular method does not damage the skin. The technology was developed as a follow-on to a previous NIOSH intervention that detects minute concentrations of lead on the skin and workplace surfaces, and was intended to "close the loop" on detection and decontamination of lead and other toxic metals. It is packaged into single-unit wipes for clinical use and in canisters for industrial or commercial use.
In 2007, the technology was successfully licensed to a vertically-integrated U.S. company that will offer it to the healthcare market for removing lead contamination from the skin prior to collecting blood samples to measure blood lead levels, and to the industrial market for removing lead contamination from skin and workplace surfaces. Other non-industrial sectors and their uses are currently being evaluated, such as use in the removal of gunshot residue from the skin of firearm users.
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