5 Nonfatal Illness
Illnesses are often more difficult to link with work than injuries.
Illnesses related to occupational exposures (e.g., tuberculosis [TB], cancers, central
nervous system disorders, and asthma) appear no different when encountered in the absence
of occupational exposures. Work-related aspects of illness may go unrecognized for many
reasons, including long latency periods between the exposure and development of some
diseases and the failure of health care professionals to recognize or report work-related
illnesses or obtain information about a patient's work history.
The Bureau of Labor Statistics (BLS) records information about nonfatal occupational
illness in the Survey of Occupational Injuries and Illnesses (SOII) using data
from logs maintained by employers. The illnesses reported in SOII are those most easily
and directly related to workplace activity. Illnesses with workplace associations that
are not immediately obvious are vastly undercounted in SOII. Other illness surveillance
systems use different approaches to record and classify illnesses for targeting
prevention efforts. Data are presented here from SOII and other systems, including
the Sentinel Event Notification System for Occupational Risk (SENSOR), the Third National
Health and Nutrition Examination Survey (NHANES III), the Coal Workers'
X-Ray Surveillance Program (CWXSP), the Adult Blood Lead Epidemiology and Surveillance
Program (ABLES), the National Surveillance System for Hospital Health Care Workers (NaSH),
and various reporting systems for human immunodeficiency virus (HIV) and acquired immune
deficiency syndrome (AIDS), viral hepatitis, and TB. Details about each of the
surveillance systems and information contacts are presented in Appendix A.
Incidence of Occupational Illness in Private
Industry
New nonfatal occupational illness cases recorded in SOII totaled 429,800
in 1997-the third year of decline in reported illnesses after a high of more
than 500,000 cases in 1994 (
Figure 5-1). Disorders associated with repeated trauma
accounted for most of the decrease from 1994 to 1997. Sixty percent of nonfatal
occupational illnesses reported in 1997 occurred in manufacturing (Figure 5-2). The
overall incidence rate that year was 49.8 illnesses per 10,000 full-time workers, with the
highest rates reported by establishments with 1,000 or more workers (Figure 5-3). The
highest rate by industry division occurred in manufacturing (Figure 5-4).
To view, click on image
Figure 5-1. Incidence of nonfatal
occupational illness cases in private industry, 1976-1997. (Source: SOII
[1999].)
To view, click on image
Figure 5-2. Number and distribution of
nonfatal occupational illnesses in private industry by industry division, 1997.
(Source: SOII [1999].)
To view, click on image
Figure 5-3. Incidence rates of nonfatal
occupational illness in private industry by establishment employment size, 1997.
(Source: SOII [1999].)
To view, click on image
Figure 5-4. Incidence
rates of nonfatal occupational illness in private industry by industry division,
1997. (Source: SOII [1999].)
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Repeated Trauma Disorders
Repeated trauma disorders accounted for 64% (276,600 cases) of all
nonfatal occupational illness cases recorded in SOII in 1997. Included in this category
are carpal tunnel syndrome (CTS), tendinitis, and noise-induced hearing loss. Repeated
trauma disorders accounted for most of the increases in nonfatal occupational illnesses
recorded in SOII from 1976 through 1997 ( ure 5-1). Manufacturing accounted for 72% of
the cases in private industry in 1997 (Figure 5-5). Industries associated with the highest rates
of nonfatal occupational disorders involving repeated trauma were meat packing plants
(1,192 cases per 10,000 workers), motor vehicles and car bodies (741 cases per
10,000 workers), and poultry slaughtering and processing (523 cases per 10,000 workers).
To view, click on image
Figure 5-5. Number (thousands) and
distribution of repeated trauma disorders in private industry by industry
division, 1997. (Source: SOII [1999].)
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Carpal Tunnel Syndrome
Cases Recorded by SOII
CTS accounted for more than 29,000 nonfatal occupational illness cases
with days away from work recorded in SOII in 1997. Women accounted for 70% of these cases,
and more than half of all CTS cases required 25 or more days away from work. Most CTS
cases occurred in the manufacturing (42%) and service (21%) industries in 1997 ( Figure
5-6) among operators, fabricators, and laborers (39%) and technical, sales, and
administrative support personnel (30%) (Figure 5-7). The vast majority of SOII cases of
CTS (98%) were attributed to job tasks requiring repetitive motion.
To view, click on image
Figure 5-6. Number and distribution of CTS
cases with days away from work in private industry by industry division, 1997.
(Source: SOII [1999].)
To view, click on image
Figure 5-7. Number and distribution of CTS
cases with days away from work in private industry by occupational group, 1997.
(Source: SOII [1999].)
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Cases Identified by SENSOR
In collaboration with the National Institute for Occupational Safety and
Health (NIOSH), the California Department of Health Services conducts a SENSOR program for
CTS using first reports filed by physicians seeking reimbursement through the State
workers' compensation system. The CTS case definition for SENSOR includes (1) symptoms
such as pain, burning, or numbness in the hands or wrists, (2) objective evidence from a
physical examination or electrodiagnostic tests, and (3) a history of work involving one
of the known risk factors. Of the approximately 1,300 CTS cases identified by the
California SENSOR program in 1998, the industries with the most cases were services (30%),
manufacturing (17%), and wholesale trade (15%) ( Figure 5-8). Most cases occurred among
technical, sales, and administrative support personnel (44%) and managerial and
professional specialty personnel (14%) (Figure 5-9). Of the cases in which an activity or
exposure was associated with the injury, 49% reported using a computer (Figure 5-10).
To view, click on image
Figure 5-8. Number and distribution of CTS
cases in California by industry group, 1998. (Source: SENSOR [California
Department of Health Services 1999].)
To view, click on image
Figure 5-9. Number and distribution of CTS
cases in California by occupational group, 1998. (Source: SENSOR. [California
Department of Health Services 1999].)
To view, click on image
Figure 5-10. Number of CTS cases in
California by type of activity or exposure, 1998. (Source: SENSOR [California
Department of Health Services 1999].)
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Tendinitis
Nearly 18,000 tendinitis cases recorded in SOII in 1997 required days away
from work. Women accounted for more than 60% of those cases, and the upper extremities
were affected in more than 70% of cases. Most cases occurred in the manufacturing (45%)
and services (20%) industries (
Figure 5-11) among operators, fabricators, and laborers
(47%) and technical, sales, and administrative personnel (17%) (Figure 5-12). Worker motion or position was the event or exposure accounting for
73% of cases.
To view, click on image
Figure 5-11. Number and distribution of
tendinitis cases with days away from work in private industry by industry
division, 1997. (Source: SOII [1999].)
To view, click on image
Figure 5-12. Number and distribution of
tendinitis cases with days away from work in private industry by occupational
group, 1997. (Source: SOII [1999].)
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Noise-Induced Hearing Loss
A SENSOR program to protect workers from noise-induced hearing loss was
initiated in Michigan in 1992. The case definition for occupational noise-induced hearing
loss under the program requires audiometric findings consistent with noise-induced hearing
loss and a history of noise exposure at work sufficient to cause hearing loss. This case
definition includes (1) workers with standard threshold shifts reported by company hearing
conservation programs and (2) workers with a permanent noise-induced hearing loss
diagnosed by a clinician. From 1992 to 1998, there were 13,177 cases of noise-induced
hearing loss reported by companies, audiologists, otolaryngologists, the Bureau of
Workers' Compensation, and hospitals. Companies accounted for 85.2% of these cases (
Figure
5-13). The SENSOR program interviews workers identified with permanent hearing loss by
clinicians. In 1998, most of these cases were associated with manufacturing (Figure 5-14).
Within the manufacturing sector, 60% of cases were associated with transportation
manufacturing, which includes automobile manufacturing.
According to patient interviews, 25% to 76% of companies in major industry divisions
did not test hearing at the time the worker was exposed to noise ( Figure 5-15). Patients
with hearing loss reported by companies (more than 85% of the reports) tended to be
younger than patients whose hearing loss was reported by health professionals (Figure
5-16). Of the cases in which sex was listed, 89% were men.
To view, click on image
Figure 5-13. Number and distribution of
noise-induced hearing loss cases in Michigan by source of reports, 1992-1998.
Total number of cases was 13,177. (Source: SENSOR [Rosenman and Reilly
1999].)
To view, click on image
Figure 5-14. Number and distribution of
permanent hearing loss cases reported by clinicians by industry division, 1998.
(Source: SENSOR [Rosenman et al. 1999].)
To view, click on image
Figure 5-15. Percentage of companies within major industry divisions that did not test hearing at the time the worker was exposed to noise, as reported by patient interviews, 1992-1998. (Source: SENSOR [Rosenman et al. 1999].)
To view, click on image
Figure 5-16. Distributions of
noise-induced hearing loss cases by age range of patients and by company and
noncompany reports, 1998. Age was unknown for 31 workers reported by company
medical departments and 12 workers reported by noncompany hearing health
professionals. (Source: SENSOR [Rosenman et al. 1999].)
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Skin Diseases or Disorders
Skin diseases or disorders accounted for 13% (57,900) of all illness cases
reported in SOII in 1997. These disorders include allergic and irritant dermatitis, skin
cancer, and other conditions. Manufacturing accounted for 45% of the skin diseases or
disorders in private industry in 1997 (
Figure 5-17). The highest reported incidence rate
was in the canned and cured fish and seafoods industry (181 cases per 10,000 workers).
Other industries with the highest rates of occupational skin disease or disorder were meat
packing plants (104 cases per 10,000 workers), ball and roller bearings (92 cases per
10,000 workers), and leather tanning and finishing (86 cases per 10,000 workers).
Dermatitis, a subcategory of skin diseases and disorders, was associated with nearly 6,600
cases involving time away from work in 1997. A median number of 3 days away from work was
associated with dermatitis. Exposures to chemicals and chemical products accounted for 53%
of job-related dermatitis cases. The manufacturing and service industry divisions
accounted for the most dermatitis cases with days away from work (29% each)
(Figure 5-18). Occupational groups that experienced most dermatitis conditions were
operators, fabricators, and laborers (36%) and precision production, craft, and repair
personnel (18%) (Figure
5-19).
To view, click on image
Figure 5-17. Number (thousands) and
distribution of skin disease or disorder cases in private industry by industry
division, 1997. (Source: SOII [1999].)
To view, click on image
Figure 5-18. Number and distribution of
dermatitis cases with days away from work in private industry by industry
division, 1997. (Source: SOII [1999].)
To view, click on image
Figure 5-19. Number and distribution of
dermatitis cases with days away from work in private industry by occupational
group, 1997. (Source: SOII [1999].)
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Respiratory Disorders
Dust Diseases of the Lungs
Dust diseases of the lungs accounted for less than 1% (2,900) of the
nonfatal occupational illness cases recorded in SOII in 1997. These diseases include
silicosis, asbestosis, and coal workers' pneumoconiosis (CWP). The most cases of
occupational dust diseases of the lungs occurred in the manufacturing (33%) and service
(27%) industries in 1997 (
Figure 5-20). The highest dust disease incidence rates occurred
in aluminum sheet, plate, and foil manufacturing (33 per 10,000 workers), anthracite
mining (30 per 10,000 workers), and ship building and repairing (12 per 10,000 workers).
To view, click on image
Figure 5-20. Distribution of occupational
cases of dust diseases of the lungs in private industry, by industry division,
1997. Total number of cases was 2,900. (Source: SOII [1999].)
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Coal Workers' Pneumoconiosis
The prevalence and severity of CWP are examined in Coal Workers' X-Ray
Surveillance Program (CWXSP). CWP is defined as having X-ray evidence of lung
abnormalities (grade 1/0 or higher) using the International Labour Organization (ILO)
Guidelines for the use of ILO International Classification of Radiographs of
Pneumoconioses [ILO 1980]. Among workers with 25 or more years of underground tenure,
the prevalence of CWP category 1/0 or greater decreased from more than 28% during
1970-1973 to less than 10% during 1992-1995 (
Figure 5-21). In the same tenure group, the
prevalence of the more severe CWP category 2/1 or greater decreased from more than 10%
during 1970-1973 to less than 2% during 1992-1995 (Figure 5-22). Decreases in prevalence
are also apparent in groups with less tenure in underground mining (Figures 5-21 and 5-22).
To view, click on image
Figure 5-21. Prevalence of examined miners
with CWP category 1/0 or greater by tenure in mining, 1970-1995. (Source: CWXSP
[1999].)
To view, click on image
Figure 5-22. Prevalence of examined miners
with CWP category 2/1 or greater by tenure in mining, 1970-1995. (Source: CWXSP
[1999].)
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Silicosis
Silicosis is a chronic inflammatory condition of the lung caused by the
inhalation of silica particles; this condition is almost universally caused by
occupational exposures. Prevalence of silicosis can be examined through the SENSOR
program. For SENSOR purposes, silicosis cases require a history of occupational exposure
to airborne silica dust and one or both of the following: (1) a chest radiograph (or other
imaging technique) interpreted as consistent with silicosis and (2) pathologic findings
characteristic of silicosis.
From 1993 to 1995, seven States participated in the SENSOR silicosis
program. Together these States identified 604 cases of silicosis, mostly through hospital
reports (64%), reports by health care professionals (11%), and death certificates (9%)
(
Figure 5-23). The cases originated mostly in manufacturing industries (75%), construction
(9%), and mining (7%) (Figure 5-24). Operators, fabricators, and laborers
represented the majority of cases (61%) (Figure 5-25).
Among silicosis patients who were interviewed, most had chronic disease
with onset of symptoms 10 or more years after exposure. Exposure to high airborne
concentrations of silica can cause disease within a few years, and acute silicosis (much
less common) may result in death within months of intense occupational exposure. Although
most of the interviewed workers had been occupationally exposed for more than 20 years, 8%
had fewer than 10 years of exposure.
To view, click on image
Figure 5-23. Number and distribution of
silicosis cases in all seven reporting States by source of report, 1993-1995.
(Source: SENSOR [NIOSH 1999].)
To view, click on image
Figure 5-24. Number and distribution of
silicosis cases in all seven reporting States by industry division, 1993-1995.
(Source: SENSOR [NIOSH 1999].)
To view, click on image
Figure 5-25. Number and distribution of
silicosis cases in all seven reporting States by major occupational category,
1993-1995. (Source: SENSOR [NIOSH 1999].)
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Respiratory Disorders Attributable to Toxic Agents
Respiratory disorders attributable to toxic agents in the work environment accounted
for 5% (20,300) of the illness cases recorded in SOII in 1997. These disorders include
allergic and irritant asthma, chronic bronchitis, and reactive airways dysfunction (an
asthma-like syndrome). The industry divisions reporting the most cases in 1997 were
manufacturing (37%) and services (34%) (
Figure 5-26). SOII reported the highest industry
incidence rates in leather tanning and finishing (77 per 10,000 workers), motorcycles,
bicycles, and parts (50 per 10,000 workers), ammunition, except for small arms not
elsewhere classified (n.e.c.) (36 per 10,000 workers), ship building and repairing (36 per
10,000 workers), and musical instruments (34 per 10,000 workers).
To view, click on image
Figure 5-26. Number (thousands) and
distribution of respiratory disorder cases attributed to toxic agents in private
industry by industry division, 1997. (Source: SOII [1999].)
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Asthma and Chronic Obstructive Pulmonary Disease
NHANES III
Workers' prevalence rates for asthma and chronic obstructive pulmonary
disease (COPD) (such as chronic bronchitis and emphysema) are recorded in NHANES III
(Figures 5-27 and 5-28). These conditions may be caused or exacerbated by workplace
exposures, but no particular attribution to workplace factors is made in NHANES III.
Variations in prevalence rates among workers in different industries (particularly among
nonsmokers) may suggest an occupational association in some cases.
To view, click on image
Figure 5-27. Estimated prevalence rates
(and 95% confidence intervals [CIs]) for asthma among workers who are
nonsmokers, by usual industry of workers' employment-U.S. residents aged 17 and
older, 1988-1994. (Source: NHANES III [1999].)
To view, click on image
Figure 5-28. Estimated prevalence rates
(and 95% CIs) for COPD among workers who are nonsmokers, by usual industry of
workers' employment-U.S. residents aged 17 and older, 1988-1994. (Source: NHANES
III [1999].)
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Under the SENSOR program, several State health departments have developed
surveillance systems for work-related asthma (including occupational asthma,
occupationally induced reactive airways dysfunction syndrome [RADS], and work-aggravated
asthma). Occupational asthma is now the most common disease reported in occupational
respiratory disease surveillance systems in several developed countries. However, most
cases either are not recognized as work-related or are not reported as such.
Population-based estimates suggest that about 20% of new-onset asthma in adults is
work-related.
Four States-New Jersey, Michigan, Massachusetts, and
California-had active SENSOR programs during the years for which data are
included in this report (1993-1995). California relies on the first reports filed by
physicians seeking reimbursement through the State workers' compensation system. The three
remaining States rely primarily on more active physician reporting. In all four States,
90% of the 1,101 occupational asthma cases were identified through physician reports
(Figure 5-29). Most cases occurred in manufacturing (42%) and services (31%) (Figure 5-30)
among operators, fabricators, and laborers (32%) and technical, sales, and administrative
support personnel (21%) (Figure 5-31). The categories of agents most frequently associated
with occupational asthma cases were all isocyanates (toluene diisocyanate, methylene
diisocyanate, and other diisocyanates) (9%), indoor environments (8%), and mineral and
inorganic dusts not otherwise specified (n.o.s.) (7%) (Figure 5-32).
To view, click on image
Figure 5-29. Number and distribution of
occupational asthma cases for all four reporting States by source of report,
1993-1995. (Source: SENSOR [NIOSH 1999].)
To view, click on image
Figure 5-30. Number and distribution of
occupational asthma cases for all four reporting States by industry division,
1993-1995. (Source: SENSOR [NIOSH 1999].)
To view, click on image
Figure 5-31. Number and distribution of
occupational asthma cases for all four reporting States by occupation,
1993-1995. (Source: SENSOR [NIOSH 1999].)
To view, click on image
Figure 5-32. Number and distribution of
occupational asthma cases for all four reporting States by most frequently
associated agents, 1993-1995. (Source: SENSOR [NIOSH 1999].)
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Poisoning and Toxicity
Poisoning
Poisoning represented 1% (5,100) of all nonfatal occupational illness
cases recorded in SOII in 1997. Poisoning cases include exposures to heavy metals
(including lead), toxic gases (such as carbon monoxide and hydrogen sulfide), organic
solvents, pesticides, and other substances (such as formaldehyde). Manufacturing accounted
for 55% of poisoning cases reported in private industry (
Figure 5-33). The highest
incidence rates occurred in the production of storage batteries (120 cases per 10,000
workers) and costume jewelry (78 cases per 10,000 workers), and in the secondary smelting
and refining of nonferrous metals (62 cases per 10,000 workers).
To view, click on image
Figure 5-33. Number (thousands) and
distribution of poisoning cases in private industry by major industry division,
1997. (Source: SOII [1999].)
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Lead Toxicity
ABLES monitors elevated blood lead levels (BLLs) in adults (persons aged
16 and older). Twenty-seven States participated in this program in 1998 by collecting BLLs
from local health departments, private health care professionals, and private and State
reporting laboratories (
Figure 5-34). During that year, a total of 10,501 adults in 25 of
those States were reported to have BLLs of 25 µg/dL or greater. Prevalence rates for
BLLs of 25 µg/dL or greater (based on all persons reported in a given year) do not reveal
an obvious trend for the period 1993 through 1998, nor do the incidence rates (based on
new cases reported in a given year) (Figure 5-35). However, prevalence and incidence rates
for BLLs of 50 µg/dL or greater in 10 ABLES States decreased from 1993 to 1998 (Figure
5-36).
To view, click on image
Figure 5-34. States (shaded) participating
in the ABLES program in 1998. (Source: ABLES [1999].)
To view, click on image
Figure 5-35. Prevalence and incidence rates
of adults aged 16 to 64 with BLLs greater than 25 µg/dL, 1993-1998. (Source: ABLES
[1999].)
To view, click on image
Figure 5-36. Prevalence and incidence
rates for BLLs equal to or greater than 50 µg/dL in adults aged 16 to 64 from 10
States (California, Connecticut, Iowa, Maryland, Massachusetts, New Jersey, New
York, Oregon, Texas, Utah), 1993-1998. (Source: ABLES [1999].)
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Pesticide and Insecticide Toxicity
Several surveillance systems track acute occupational illness and injury
related to pesticides. Two systems are national, and several additional systems cover
individual States. The Toxic Exposure Surveillance System (TESS) is maintained by the
American Association of Poison Control Centers. Between 1993 and 1996, about 81% of the
U.S. population was covered by a participating poison control center. During those years,
more than 6,300 pesticide poisonings that occurred in the workplace were documented in
TESS. Most of the poisonings were associated with insecticides (Figure 5-37). Among those
cases, 41% involved organophosphates, and 29% involved pyrethrins/pyrethroids.
SOII collects information about pesticide poisonings associated with lost
workdays. Between 1992 and 1996, the annual number of nonfatal occupational illnesses and
injuries related to pesticides ranged from 504 to 914 (Figure 5-38). Most of those
illnesses were associated with exposure to insecticides. Because SOII records only cases
that result in lost work time, illnesses may be more severe than those recorded by other
surveillance systems.
Thirty-one States have reporting requirements for pesticide-related
illness and injury, but only eight States conduct surveillance for this condition. In
California, Florida, New York, Oregon, and Texas, surveillance activities for acute
occupational illness and injury related to pesticides are conducted in a SENSOR program
supported in part by the U.S. Environmental Protection Agency (EPA). Besides tabulating
case reports, these systems perform in-depth investigations for case confirmation, conduct
screening of other workers at a patient's worksite, and develop targeted interventions.
Over a 5-year period (1992-1996), the annual number of cases in New York, Oregon, and
Texas ranged from 72 to 170 (Figure 5-39). Most cases involved exposures to insecticides.
In addition, 33% of the cases involved agricultural exposures, including pesticide mixing,
loading, and application.
Pesticide-related illness has been a reportable condition in California
since 1971. The California Department of Pesticide Regulation (CDPR) has responsibility
for collecting and evaluating these reports. Between 60% and 75% of cases are identified
from workers' compensation reports. Most of the remainder are reported by physicians. The
annual number of acute occupational illnesses and injuries related to pesticides in
California ranged from 656 to 979 (Figure 5-40). Insecticides were responsible for the
largest proportion of cases. Among insecticides, insecticide combinations and
organophosphates were most commonly responsible (Figure 5-41). More than half of the
reported cases occurred in agriculture (56%); services and public administration together
contributed 28% (Figure 5-42).
To view, click on image
Figure 5-37. Number of acute occupational
illnesses related to pesticides by pesticide category (excludes antimicrobials),
1993-1996. (Source: TESS [1998].)
To view, click on image
Figure 5-38. Number of occupational
pesticide-related illnesses with days away from work in private industry by
pesticide category, 1992-1996. (Source: SOII [1999].
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To view, click on image
Figure 5-39. Number
of occupational illnesses related to pesticides in New York, Oregon, and Texas
by pesticide category, 1992-1996. (Source: SENSOR [New York State Department of
Health 1999; Oregon Health Division 1999; PEST 1999].)
To view, click on image
Figure 5-40. Number of occupational
illnesses related to pesticides in California by pesticide category (excludes
antimicrobials and unknown agents), 1991-1996. (Source: CDPR
[1999].)
To view, click on image
Figure 5-41. Number of occupational
illnesses related to insecticides in California by insecticide category,
1991-1996. (Source: CDPR [1999].)
To view, click on image
Figure 5-42. Number and distribution of
occupational illnesses related to pesticides (excluding antimicrobials and
unknown agents) in California, by industry division, 1991-1996. (Source: CDPR
[1999].)
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Infections in Health Care Workers
The 10 million health care workers in the United States constitute
approximately 8% of the workforce. Health care workers can be exposed to a variety of
occupational hazards, including repeated trauma, toxins, and a broad range of infectious
agents. Surveillance data on infections in these workers are included in four Federal
health databases:
Between June 1995 and October 1999, 60 participating NaSH hospitals
reported 6,983 cases of exposure to blood or body fluids. Most of these cases occurred in
nurses (43%) and physicians (29%) (Figure 5-43). The largest number of exposures to blood
or body fluids occurred in inpatient (30%) and operating/procedure room settings (29%)
(Figure 5-44). The major route of exposure was percutaneous (puncture/cut injury) (Figure
5-45).
To view, click on image
Figure 5-43. Number and distribution of
reported health care worker exposures to blood or body fluids in 60
participating hospitals by occupational group, June 1995 to October 1999.
(Source: NaSH [1999].)
To view, click on image
Figure 5-44. Number and distribution of
reported health care worker exposures to blood or body fluids in 60
participating hospitals by work location, June 1995 to October 1999. (Source:
NaSH [1999].)
To view, click on image
Figure 5-45. Number of reported health
care worker exposures to blood or body fluids in 60 participating hospitals by
exposure type, June 1995 to October 1999. (Source: NaSH [1999].)
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Consequences of Bloodborne Exposures
Hepatitis B Virus
VHSP and the Sentinel Counties Study of Acute Viral Hepatitis indicate a
93% decline in hepatitis B viral infections in health care workers over a 10-year
period-from approximately 12,000 cases in 1985 to 800 cases in 1995 (Figure
5-46). Infections also declined among the general population during this time, but not as
dramatically. The greater decline among health care workers may be attributed to the
adoption of universal precautions against exposure to body fluids and vaccinations against
hepatitis B.
To view, click on image
Figure 5-46. Estimated number of hepatitis B
infections among U.S. health care workers, 1985-1995. (Source: VHSP
[1999]; NCID [1999].)
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Hepatitis C Virus
Hepatitis C virus infection is the most common chronic bloodborne
infection in the United States. Although the prevalence of hepatitis C virus infection in
health care workers is similar to that in the general population (1% to 2%), health care
workers have an increased occupational risk from needlestick injuries. The number of
health care workers who have acquired hepatitis C infections occupationally is not known.
But approximately 2% to 4% of acute infections in the United States occurred among health
care workers exposed to blood in the workplace. Most workers exposed to hepatitis C were
physicians or nurses (Figure 5-47).
To view, click on image
Figure 5-47. Number and distribution of
health care workers exposed to hepatitis C virus by occupational group, June
1995 to October 1999. (Source: NaSH [1999].)
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Human Immunodeficiency Virus
Fifty-five cases of documented and 136 cases of possible occupational HIV
transmission were recorded in HARS through June 1999. Among the documented cases of HIV
seroconversion following occupational exposure, 85% resulted from percutaneous exposure
and 93% involved exposure to blood or visibly bloody fluid. Most documented cases of
occupational HIV transmission occurred among nurses (42%) and laboratory workers (35%)
(Figure 5-48).
To view, click on image
Figure 5-48. Number
and distribution of health care worker cases with documented occupational
transmission of HIV by occupation through June 1999. (Source: HARS
[CDC
1999].)
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Tuberculosis (TB)
Health care workers have long been at risk of contracting TB. This risk
increased in the 1980s with the resurgence of TB in the United States and the subsequent
development of drug-resistant TB bacteria during the AIDS epidemic. From 1994 through
1998, there were 2,732 cases of TB in health care workers reported to the Centers for
Disease Control and Prevention (CDC) through staffTRAK-TB from the 50 States, the
District of Columbia, and Puerto Rico. Incidence rates in health care workers are shown in Figure 5-49 for each year from 1994 through 1998. These rates are not associated
specifically with occupational exposure because that information is not available. Cases
in health care workers constituted 3% of all TB cases.
To view, click on image
Figure 5-49. Incidence rates of TB in health
care workers, 1994-1998. (Source: staffTRAK-TB [1999].)
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Physical Agents
Disorders attributable to physical agents represented 4% (16,600) of all
nonfatal occupational illness cases recorded in SOII in 1997. Disorders attributable to
physical agents include heatstroke, sunstroke, heat exhaustion, and other effects of
environmental heat; freezing and frostbite; effects of ionizing radiation (isotopes,
X-rays, radium); and effects of nonionizing radiation (welding flash, ultraviolet rays,
microwaves, and sunburn). Illnesses from toxic exposures are excluded. Among industry
divisions, manufacturing accounted for 55% of the disorders attributable to physical
agents in private industry in 1997 ( Figure 5-50). Among individual industries, the highest
illness rates occurred in metal sanitary ware (294 cases per 10,000 workers), primary
aluminum (89 cases per 10,000 workers), ship building and repairing (79 cases per 10,000
workers), and plumbing and heating, except electric (73 cases per 10,000 workers).
To view, click on image
Figure 5-50. Number (thousands) and
distribution of disorders attributable to physical agents in private industry by
major industry division, 1997. (Source: SOII [1999].)
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Anxiety, Stress, and Neurotic Disorders
Nearly 5,300 cases of anxiety, stress, or neurotic disorders with time
away from work were recorded in SOII in 1997. These represent 1% of all reported nonfatal
occupational illness cases. Women accounted for more than 60% of all occupational anxiety,
stress, and neurotic disorder cases with time away from work. Half of all such disorder
cases required 23 or more days away from work, and more than 40% of workers with these
disorders required more than 31 days away from work. The industry divisions accounting for
most cases were services (35%), wholesale and retail trade (20%), and manufacturing (20%)
(Figure 5-51). The occupational groups most frequently experiencing these disorders were
technical, sales, and administrative personnel (47%) and operators, fabricators, and
laborers (18%) (Figure 5-52). The exposures most frequently associated with anxiety,
stress, or neurotic disorders were harmful substances (30%) and assaults or violent acts
(13%) (Figure 5-53).
To view, click on image
Figure 5-51. Number and distribution of
anxiety, stress, and neurotic disorder cases with days away from work in private
industry by industry division, 1997. (Source: SOII [1999].)
To view, click on image
Figure 5-52. Number and distribution of
anxiety, stress, and neurotic disorder cases with days away from work in private
industry, by occupational group, 1997. (Source: SOII [1999].)
To view, click on image
Figure 5-53. Number and distribution of
anxiety, stress, and neurotic disorder cases with days away from work in private
industry, by event or exposure, 1997. (Source: SOII [1999].)
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All Other Nonfatal Occupational Illnesses
All other nonfatal occupational illnesses represented 12% (50,400) of all
illness cases recorded in SOII in 1997. This category captures illnesses such as anthrax,
brucellosis, hepatitis B and C, HIV disease, malignant and benign tumors, food poisoning,
histoplasmosis, and coccidioidomycosis. The largest percentages of such cases in 1997
occurred in services (41%) and manufacturing (29%) (Figure 5-54). Industries reporting the
highest incidence rates were luggage (163 cases per 10,000 workers), secondary smelting
and refining of nonferrous materials (120 cases per 10,000 workers), prefabricated metal
buildings (66 cases per 10,000 workers), and iron and steel forgings (61 cases per 10,000
workers).
To view, click on image
Figure 5-54. Number (thousands) and
distribution of all other occupational illnesses in private industry by major
industry division, 1997. (Source: SOII [1999].)
