Health hazard evaluation report: HETA-2002-0253-2894, Blue Ribbon Packing, Indianapolis, Indiana.
In May 2002, the National Institute for Occupational Safety and Health (NIOSH) received a request from the Indiana Occupational Safety and Health Administration (IOSHA) to evaluate Blue Ribbon Packing, a tomato-packing plant in Indianapolis, Indiana. Employees handling tomatoes and other produce and assembling ink-coated cardboard trays were reported to have skin lesions. NIOSH investigators made two visits to the facility in August 2002. On the first visit, NIOSH investigators noted that the skin and gloves of employees assembling cardboard trays were coated with pigment from the cardboard, and that the gloves were torn at the fingertips. An ink-coated cardboard sheet from the plant, analyzed for 30 elements (metals) by inductively coupled plasma-atomic absorption, was found to contain sodium, magnesium, potassium, copper, and iron. Gas chromatography/mass spectrometry showed di(propyleneglycol) propyl ether to be the dominant organic compound in the cardboard ink. A bulk sample of dust from a bundle of unfolded cardboard, examined by polarized light microscopy, contained 85% fibrous material, mostly sub-angular to sub-rounded in shape. On the second visit, NIOSH investigators conducted confidential employee interviews and skin examinations. Forty (93%) of the forty-three eligible employees participated in the survey. Seventeen (42.5%) of the participating employees reported skin lesions. According to the NIOSH dermatologist's assessment, four (23.5%) of the participants reporting skin lesions had visible lesions that were possibly caused by work and another four (23.5%) had lesions that were possibly aggravated by work. Their lesions included folliculitis (inflammation of the hair follicles), erythema (redness of the skin), and papules or plaques (raised skin lesions) on the face, neck, upper chest or back, arms, or hand. Participants who had skin lesions that were not related to work had acne, milia, or warts. Five participants who did not have work-related skin lesions reported irritation, itching, discoloration, or rash that occurred during or shortly after work. Some of them were able to identify a specific produce (e.g., cilantro) as the cause of the symptom. Additionally, the confidential employee interviews revealed symptoms consistent with temporary hearing loss related to noise from the cardboard baler. NIOSH investigators recommended that the company evaluate this potential health hazard. The dust, pigments, and organic compounds from coated cardboard; acidic tomato juice and pulp; allergy-causing produce such as cilantro; and alcohols in the hand sanitizer that were found at the plant are potential health hazards that can affect the skin. Thirteen (32.5%) of the employees surveyed had skin symptoms or visible skin lesions that were possibly caused by or aggravated by these types of work exposures. Recommendations to prevent skin symptoms and lesions are provided in this report.