Health hazard evaluation report: HETA-2000-0255-2868, Benefis Healthcare, Great Falls, Montana.
Benefis Healthcare in Great Falls Montana provides tertiary healthcare services for the 200,000 people of North-central Montana. In April 2000 the National Institute for Occupational Safety and Health (NIOSH) received a health hazard evaluation request from the management of Benefis Healthcare to investigate respiratory health and indoor air quality at the healthcare facility. We posed the following questions: Does the prevalence of lower respiratory symptoms, upper respiratory symptoms, and asthma differ between the East and West Campus hospitals and the floors within the hospitals? Do the levels of biological agents and characterization of particles differ between the sample sites at the hospitals? Is there an association between prevalence of lower and upper respiratory health outcomes and environmental assessment for signs of water incursion, levels of biological agents, and particles? What is the prevalence of latex sensitivity and latex glove use in hospital employees? Are there areas that are acting as reservoirs of latex allergens? In May and August 2000 NIOSH conducted an investigation at the East and West Campus hospital buildings of Benefis Healthcare. NIOSH administered a health questionnaire and measured levels of various exposures in the air, chair dust and floor dust (culturable fungi, spore counts, ergosterol, endotoxin, dust mite allergen, cockroach allergen, extracellular polysaccharides, ß1-3 glucans, culturable bacteria, cat allergen, latex allergen, mouse urinary protein, particle counts, volatile organic compounds, temperature, relative humidity, and carbon dioxide). Approximately 60% of the workers participated in the survey and 70% in the areas we sampled. The results and conclusions of the investigation are as follows: We documented that building-related respiratory problems were occurring among employees in the Benefis East and West Campus hospitals. The diagnosed asthma prevalence was 17.1% compared to 11.4% for the state of Montana. Medical records of the sentinel asthma cases from the 8th floor of the East Campus hospital documented both the occurrence of asthma with methacholine challenge and a work-related pattern with the use of serial peak flow spirometry. The sentinel cases were not latex asthma since their latex-specific IgE tests were negative. We found higher levels of mold on the 6th, 7th and 8th floors of the East Campus. Our direct measures of environmental contamination and our subjective assessment also showed positive associations with health outcomes. Physician-diagnosed latex allergy was reported by 3.2% of participants, with no differences between the two campuses. The reported use of powdered latex gloves was 6% and 8% in the East and West Campus hospitals, respectively. The reported use of powder-free latex gloves was 17% in both hospitals. The reported use of non-latex gloves was 51% and 34% in the East and West Campus hospitals, respectively. Twenty-seven percent and 42% of the East and West Campus hospitals, respectively, reported no glove use. Departments with the highest reported use of powder-free latex gloves were Surgery East (52%), Home Care (50%), Housekeeping (43%), Surgery West (38%) and Transitional Care Unit (36%). Latex allergen was not detected in the air. The highest ventilation duct latex allergen reservoirs were found in 4 West Campus hospital departments. The following are specific recommendations for this workplace: Disseminate the findings of this report so that employees with respiratory conditions can consult their physicians or the employee health department regarding any need for relocation or environmental intervention at work or at home. Prognosis for work-related asthma is improved by early recognition and exposure cessation. Conduct medical surveillance for the early detection of work-related respiratory problems, both for appropriate clinical management and to show whether remediations have been effective in preventing new cases. Promptly remediate water incursions and replace all wetted material that can not be dried out in 24 hours. Doing so reduces the potential for microbial amplification. Use containment measures during renovations that keep exposures to construction dusts and the reservoirs of mold and latex that we identified to a minimum. Institute housekeeping practices that keep dust accumulation at a minimum. Repair eroded and damaged casing liners in ventilation systems on the West Campus. HVAC personnel and infection control officers should review air flow maps (Appendix G) to insure that the airflows observed are in compliance with American Institute of Architects (AIA) and American Society of Heating, Refrigerating and Air-conditioning Engineers (ASHRAE) guidelines for airflows required. Provide both service and health-care workers with powder-free latex and/or non-latex gloves where appropriate. Clean areas contaminated with latex dust. NIOSH documented that building-related respiratory problems were occurring among employees in the Benefis East and West Campus hospitals. Our direct measures of environmental contamination and our subjective assessment also showed positive associations with health outcomes. Prognosis for work-related asthma is improved by early recognition and exposure cessation. We recommend that medical surveillance is conducted for the early detection of work-related respiratory problems, both for appropriate clinical management and to show whether remediations have been effective in preventing new cases. Prompt remediation of water incursions and replacement of all wetted material that can not be dried out in 24 hours should be carried out. Containment measures should be used during renovations to keep exposures to construction dusts and the reservoirs of mold and latex that we identified to a minimum. Housekeeping practices that keep dust accumulation at a minimum should be set in place.