Bullard-Sherwood Research-to-Practice (r2p) Award Winners and Honorable Mentions: Backgound, 2012
Title: NIOSH Alert: Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings
Authors: Connor T, McDiarmid M, MacKenzie B, Mead K, DeBord DG, Hammond D, Schnorr T, Power L, Polovich M, Burroughs GE, Reed L
Source: Division of Applied Research and Technology (DART)
Background: Modern society is fortunate to have powerful treatments available for a wide range of medical conditions. However, some useful medications can also have serious side effects. When using these drugs for medical treatment, doctors carefully control the dose and monitor the patient to minimize harmful consequences. But the doctors, nurses, pharmacists, and other healthcare workers who handle these medications are also being exposed and may also demonstrate adverse health effects. When these drugs are prepared and administered, there are workplace best practices that can minimize potentially harmful exposure, but healthcare workers need to know which drugs pose a hazard in order to effectively implement and use these practices. After recognizing the growing evidence of shortfalls in the then-current work practices and control technologies applied in oncology work settings, NIOSH convened a workgroup in 2000 to address the inadequate protections and on-going oncology worker exposure to hazardous, anti-cancer drugs.
Relevance: As part of the established workgroup, NIOSH experts led the development of a comprehensive re-thinking of the total approach to the safe handling of highly hazardous drugs as described in the "NIOSH Alert: Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health care Settings" in 2004. Critical to the workgroup's success was the richness of its membership; comprised of government agencies having jurisdiction, professional organizations of oncology workers, principal unions in healthcare, manufacturers of oncology drugs and various safety equipment and technologies, and the Joint Commission on Accreditation of Health Care Organizations which is the principal accreditation body in healthcare. This careful, inclusive stakeholder process permitted the production of a new, comprehensive and harmonized approach to safe handling of hazardous drugs which was endorsed by all the stakeholders involved in drug handling.
In the years since the Alert's publication, several legislative and non-legislative impacts have occurred to improve the safety and health of healthcare workers including: a) the participating stakeholder organizations, which publish professional guidance of their own, have adopted by reference elements of the NIOSH Alert, thus, further endorsing and promoting the Alert as the recognized standard of professional safe handling practice; b) the State of Washington adopted a bill in April 2011 that directs the state to enforce safe-handling rules based on guidelines established by the 2004 NIOSH Alert, which the state adopted in its entirety into the legislation. Senate Bill 5594 is the first of its kind and could serve as a model for other states in their efforts to protect the approximately 8 million workers potentially exposed to hazardous drugs; c) leaders from NIOSH, OSHA, and the Joint Commission sent a combined letter to healthcare facilities throughout the U.S. reinforcing the need to follow Alert’s guidance, as well as make institutions aware of the 2010 update to the NIOSH Hazardous Drug List; d) new performance standards for personal protective equipment have been adopted; and e) new classifications of protective engineering controls and associated terminology have been developed. For example, engineering design guidance and equipment selection recommendations from the Alert were adopted into the 2011 edition of a prominent engineering design manual.
More information about hazardous drugs and other chemicals can be found at:
Title: The SENSOR-Pesticides Program
Authors: Calvert G, Alarcon W, Hudson N, Lackovic M, Mitchell Y, Prado J, Mehler L, Diebolt-Brown B, Waltz J, Schwartz A, O’Malley M, Mulay P, Walker R, Evans E, Higgins S, Kass D, Beckman J, Moraga-McHaley S, Roisman R, Kasner E, Wall D.
Source: Division of Surveillance, Hazard Evaluations and Field Studies (DSHEFS)
Background: Among the estimated two million agricultural workers in the U.S., physicians diagnose 10,000 to 20,000 pesticide poisonings each year. In 1987, NIOSH established the Sentinel Event Notification System for Occupational Risks - Pesticides Program (SENSOR-Pesticides) to reduce the number of injuries and illnesses associated with occupational pesticide exposure. The Program is a U.S. state-based surveillance effort that monitors pesticide-related illness and injury in 11 states. Under this Program, NIOSH provides technical support and funding to state health departments to build and maintain surveillance capacity and to bolster pesticide-related illness and injury surveillance. The U.S. Environmental Protection Agency (EPA) also provides funding support for the Program. The SENSOR-supported surveillance systems tabulate the number of acute occupational pesticide poisonings, allowing for the timely identification of outbreaks. The Program also helps develop preventive interventions and maintains a national database that compiles information from participating states.
Relevance: About 1.1 billion pounds of pesticides are used annually in the U.S. and over 20,000 pesticide products are marketed. Furthermore, farmworkers have a 10-fold higher risk of acute pesticide poisoning compared to workers in other industries. Therefore, the need for comprehensive surveillance programs is imperative because surveillance serves as an early warning system; in the case of the SENSOR-Pesticides program, it captures and helps identify harmful effects not detected by manufacturer pre-market testing of pesticide products. Since the establishment of this program, numerous impacts have resulted. Recent examples include: a) SENSOR-Pesticides findings were cited in a United Farmworkers report titled "Inventory of farmworker issues and protections in the United States" that was published in March 2011, b) several media, advocacy organizations, State regulators, researchers, and university extension services began citing published SENSOR-Pesticides findings to describe the magnitude of acute pesticide poisoning among farmworkers and address the public health implications, c) an illegal pesticide product from China available for purchase on the internet became unavailable after two SENSOR-Pesticides partners informed the EPA of its availability and the EPA took action by warning 4 internet sites to cease processing orders immediately; all sites cooperated, and d) Health Canada, the Canadian agency that regulates pesticides, issued its first-ever advisory about buying pesticides online after being notified about the above-stated incident by SENSOR-Pesticides partners; EPA identified 550 Canadians who had bought the banned pesticide.
Additionally, EPA announced that it will release for public comment this year draft regulations to enhance farmworker protections. EPA is a vital partner to this program given that they are the Federal agency responsible for regulating pesticides. The SENSOR-Pesticides program is considered the principal source of surveillance data in the U.S., and perhaps the world, on the acute poisoning effects associated with pesticide exposure. Ongoing collaboration between NIOSH, EPA, the National Center for Environmental Health (NCEH), state and city health departments, and the California Department of Pesticide Regulation, among others, will help to ensure that the SENSOR-Pesticides program continues to make new important impacts long into the future.
More information about the SENSOR-Pesticides program can be found at:
Title: Reducing Fatalities Due to Falls Overboard
Authors: Lucas D, Lincoln JM, Teske T, Anderson P, Somervell P, Burton J, Woodley C, Medlicott C
Source: Alaska Pacific Regional Office (APRO)
Background: Commercial fishing is a high-risk industry with most fatalities resulting from vessels sinking or capsizing. However, 30% of fatalities in the US fishing industry result from falls overboard. During 2000-2009, 155 fishermen drowned after falling overboard. None of them were wearing a personal flotation device (PFD). Although the drowning risk is high, most fishing industry workers do not wear PFDs while on the deck of the vessel. There are currently no mandates by regulatory agencies for these workers to wear PFDs; however, wearing a PFD greatly increases the probability of survival.
Relevance: The NIOSH Commercial Fishing Safety Research Team conducted a project titled, "Reducing Fatalities Due to Falls Overboard." In response to a discussion that included a controversial recommendation by the Commercial Fishing Industry Advisory Committee to the U.S. Coast Guard (USCG) mandating the use of PFDs for crewmen working on deck, NIOSH conducted a field study to determine which type of commercially available PFD resulted in the highest satisfaction score among fishermen. About 200 fishermen evaluated PFDs during their fishing seasons for comfort and wearablity during deck work. The multifaceted project included both field work and the development of training materials, including a DVD developed in cooperation with the Alaska Marine Safety Education Association (AMSEA) and Alaska Sea Grant. Additionally, many impacts have resulted from the evaluation project and related communication products, and have been expressed by vessel owners, fishing organizations and the National Transportation Safety Board (NTSB) alike.
Examples of impacts include: a) the adoption of mandatory PFD-use policies/practices while on deck by individual boat owners as well as fishing boat associations, b) implementation rebate programs for fishing organization members who purchase PFDs for their crews, c) use of NIOSH research by the NTSB to develop recommendations for improving commercial fishing safety; NTSB recommendations included the mandatory use of flotation aids for workers while on deck, d) requests by industry and manufacturers from across the country for hundreds of copies of the DVD titled, "Man Overboard Prevention and Recovery;" manufacturers have used the DVD and the PFD study findings to promote use and modify PFD designs, and e) anecdotally, more fishermen are wearing PFDs and have expressed interest in doing other PFD studies in the Gulf of Mexico and in New England to identify PFDs and "Overboard Alarms" that are suitable to work in while participating in fisheries in these locations.
The project involved partnerships from its inception with fishermen, vessel owners, fishing organizations, training organizations, PFD manufacturers, the NTSB, and the USCG. For example, the PFD evaluation was developed from a suggestion of a fisherman; the fishermen who participated in the PFD evaluation responded very positively providing dozens of suggestions on how to improve the PFDs they wore; fishermen, AMSEA, and Alaska Sea Grant were involved in the making of the DVD; vessel owners allowed access their crew members; AMSEA, Alaska Sea Grant, were partners in the production of the NIOSH DVD; the USCG provided personnel to help with the field study, they have been very helpful in disseminating he PFD evaluation results and the DVD to fishermen during their Safety Exams and through their website, and they continue to be a NIOSH partner in promoting PFD use. Partnerships have been instrumental to the success and impact of this project.
More information about commercial fishing can be found at:
Title: Development, Evaluation, and Implementation of Engineering Controls to Protect Workers from Potential Anthrax Exposure from Sorting Machines at USPS Processing and Distribution Facilities
Authors: Hammond D, Lo L, Garcia A, Marlow D, Farwick D, Farwick D, Hirst D, Echt A, Kratzer J, Shulman S, Feng HA, Kovein R, Lewis T, Clark B, Campbell D, Blythe E, Topmiller J, Gressel M, Hall R, Earnest GS
Source: Division of Applied Research and Technology (DART)
Background: In 2008, the U.S. Postal Service (USPS)—the 2nd largest civilian employer in the United States—began a multi-year project to update and replace its entire fleet of 20-year old legacy mail sorting equipment. The new systems addressed machine obsolescence, providing improved functionality and energy cost savings for all 300 postal processing and distribution centers. The USPS asked NIOSH to assist in the development and evaluation of the new machine design, including testing of the local exhaust ventilation (LEV) and biohazard detection systems (BDS), to ensure postal workers and the general public would continue to be protected from potential biological agents in the mail. In April 2009, the NIOSH team conducted a multi-week tracer gas test at a California postal facility to assess the level of worker protection provided by the upgraded equipment.
While this tracer gas evaluation was being conducted, USPS raised the issue of performing an aerosol tracer test on the updated Advanced Facer Canceller Systems (AFCS). BDS performance is dependent on particles being expelled from the mail, and the failure of the updated equipment to expel particles at a sufficient quantity would limit its detection sensitivity. Up to that point, aerosol tracer tests had never been conducted on any type of mail handling equipment. In response to this inquiry, NIOSH developed a test method to simulate the expulsion of biological aerosols from powder filled envelopes to further assess control effectiveness of the new mail sorting system.
Relevance: The engineering controls evaluated during this project have been installed on mail sorting machines in about 300 postal processing and distribution centers across the country. The USPS has estimated that the controls, tested by NIOSH engineers, prevent the potential for anthrax exposure for approximately 574,000 postal workers and approximately 300 million Americans who receive letter mail. The USPS contractor designing and building the new mail sorting system incorporated several NIOSH design recommendations into the equipment to improve exhaust hood capture and control. The final production machine was tested by NIOSH engineers and results showed that the design was up to 25% more effective at controlling contaminants than the legacy equipment.
Furthermore, results from the aerosol tracer tests showed the updated mail sorting system was at least 40% more effective at capturing released particles than the legacy equipment, providing improved protection for both USPS employees and the public. This study is the only documented testing using dry powder to simultaneously evaluate particle expulsion from letters and the capture efficiency of control equipment for mail processing equipment. Meeting an aggressive schedule, NIOSH effectively aided the USPS and its contractor in staying on schedule with their required SAFETY Act review. As a result of this important occupational and public health research, the USPS and their contractors continue to rely on NIOSH engineers for expert guidance on protecting postal workers and the general public from potential exposures to biological agents.
More information about engineering controls can be found at:
Title: Developing a Real Time Diesel Particulate Monitor
Authors: Noll J, Mischler S, Janisko S, Hummer J
Source: Office of Mine Safety and Health Research (OMSHR)
Background: Exposure to diesel exhaust particles and gases has been linked to negative health effects such as cancer, cardiovascular disease, cardiopulmonary disease, and asthma. Since underground miners work alongside diesel equipment in a confined environment, they are correspondingly exposed to the highest levels of diesel exhaust when compared to any other occupational group. As a result, the mining division of NIOSH established a goal to reduce respiratory diseases in miners by reducing health hazards in the workplace associated with diesel emissions, and the Mine Safety and Health Administration (MSHA) promulgated a rule to limit exposures of metal/nonmetal underground miners to diesel particulate matter (DPM). As part of the MSHA rule, the exposure to DPM is determined by collecting particle samples for an entire shift and analyzing the filter via NIOSH method 5040.
NIOSH method 5040 is a sound method; however, it can take weeks to obtain results. The results indicate an overexposure has occurred and does not provide the ability to prevent an overexposure or even detect its source. Consequently, a need for portable, on-site, and real-time measurement of diesel concentration levels was both voiced by industry (mines and the National Mining Association) and recognized by NIOSH researchers. In response, NIOSH pursued a project to develop a portable sensing technology and to design an instrument that could be worn by a miner while accurately measuring elemental carbon exposure levels in real-time. Elemental carbon was chosen because it is a major portion of DPM, is not prone to interferences, and is one of the surrogates used by MSHA for compliance sampling. A measurement technology was developed and, shortly after, a working prototype was produced. Finally, in conjunction with a partnership with industry and stakeholders, a commercial version was made available to the mining community.
Relevance: This newly available technology is already having impact nationally and internationally. As of December 2011, over 40 commercial units have been deployed within the U.S. metal and non-metal mining industry, which is composed of around 200 mines total. Furthermore, several instruments have been deployed in Canadian and Australian mines, and one consulting company is utilizing the device to survey DPM concentrations in mines throughout Australia as well as is introducing the Australian mining industry to this novel measurement technique. In addition, there are several documented case studies that describe specifically how the instrument is being used to combat DPM exposures in underground mines and highlight the diversity of methods by which the industry is deploying the technology. In one of these cases, a mine was able to trace the cause of unacceptable concentrations of DPM in an area to a poorly located “vent bag” and take immediate action to improve the ventilation in that section of the mine. In another case, a mine was able to detect that the enclosed cab on one diesel vehicle was not adequately filtering the air and allowing high concentrations of DPM inside of the cab where the miner was working. The vehicle was promptly inspected by the machine maintenance group at that mine, where the problem was pinpointed and repaired.
The real and potential impacts of real-time exposure monitoring are significant. Real-time measurement provides workers with timely information to allow administrative and engineering controls to be deployed immediately, and to identify the major factors contributing to the overexposures. Specifically, real-time measurement of diesel particles may significantly reduce the cost and labors associated with assessing DPM exposures; hence, promoting more frequent analysis of occupational conditions, allowing for more control over the problem than was previously available to the industry, and substantially reducing DPM exposures of miners.
More information about diesel particulate monitoring and other mining-related topics can be found at:
Title: Commercially-available Drill Bit Isolator Noise Control for Miners
Authors: Azman A, Alcorn L, Yantek D
Source: Office of Mine Safety and Health Research (OMSHR)
Background: Mining has the highest prevalence of hazardous noise exposure of any major industry sector and is second only to the railroad industry in prevalence of workers reporting hearing difficulty. To reduce noise exposures and the risk of noise-induced hearing loss, NIOSH is working with industry partners to develop and commercialize effective noise controls. The drill bit isolator for roof bolting machines is a recent product of this development approach. It was developed specifically to address the problem of high noise exposures for operators of roof bolting machines in underground coal mines. NIOSH noise surveys found that operators of these machines are exposed to sound pressure levels ranging from 86 to 112 dB(A) which resulted in 81% of the operators suffering daily noise exposures that exceeded the Mine Safety and Health Administration (MSHA) Permissible Exposure Limit. Subsequent NIOSH field studies found that the most hazardous exposures occurred when the operator was drilling holes into the mine roof prior to inserting a roof bolt into the hole. NIOSH laboratory studies isolated the dominant noise source, showing that the noise occurred due to vibrations transmitted from the drill bit and then radiated from the drill steel itself.
The drill bit isolator is a device that was developed to interrupt the vibration path and prevent the energy from being radiated as noise. It consists of two tubes, one inserted inside the other, with a layer of rubber in between. The overall diameter of the isolator is the same as a drill steel, so it can be simply inserted in place of a segment of drill steel with no change in how drilling is performed. Bringing the device from initial concept to a commercially-available and field-validated product was made possible specifically through the collaboration with two manufacturing companies (Company A and Company B). The NIOSH partnership with these manufacturers, along with willing participation by the mining industry, has resulted in a successful noise control intervention that effectively reduces the risk of noise-induced hearing loss.
Relevance: In collaboration with the research team's mining company partners, it has been demonstrated through a series of field studies that exposure to hazardous noise was significantly reduced for miners who use the drill bit isolator. The final evaluations were completed at three different mines in the U.S. that varied in conditions and mining technology. The device reduced the noise reaching the machine operator by 3-5 dB(A). When normalized by the number of holes drilled by the machine operator, the isolator reduced the dose per hole by 25 to 51% across the test sites. Based on the evidence gathered from these field trials, the manufacturing partners decided to engage in fabricating a commercial version of the drill bit isolator. Company A introduced the device at national tradeshows in June and September 2011. Additionally, both companies A and B are working with NIOSH to develop and test a variant of the device to be used with smaller 1" drill bits. MSHA has recognized the effectiveness of the device by including it in a list of promising noise controls in their Program Information Bulletin (PIB) No. P08-12, "Technologically Achievable, Administratively Achievable, and Promising Noise Controls (30 C.F.R. Part 62)." Furthermore, MSHA intends to elevate its status to " Administratively and Technologically Achievable" in a future edition of the PIB now that the isolator has completed additional field tests and is commercially availability. As with most successful technology transfer efforts, manufacturing partners were crucial to the impact of the drill bit isolator given their position and influence within the mining industry. Company A is a major manufacturer of drill bits and related components used for mine roof bolting; Company B is a supplier to several mining equipment manufacturers and has a significant development capability. These partners were involved from the earliest stages of development to provide expertise that would ultimately lead to a device that could be manufactured and distributed to industry users. Their product development expertise complemented the NIOSH team's noise control development and evaluation expertise to ensure impact of the device.
More information about noise exposure among miners and other noise-related topics can be found at:
- National Institute for Occupational Safety and Health (NIOSH)
- Centers for Disease Control and Prevention
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