Health hazard evaluation report: HETA-2005-0329-2995, Swannanoa Valley Youth Development Center, Swannanoa, North Carolina.
The National Institute for Occupational Safety and Health (NIOSH) received a confidential request from employees at the North Carolina Department of Juvenile Justice and Delinquency Prevention's (DJJDP) Swannanoa Valley Youth Development Center (SVYDC) in Swannanoa, North Carolina, to conduct an investigation of tuberculosis (TB) control, indoor air quality (IAQ), and asbestos management at that facility. Employees expressed concerns about possible TB exposure after hearing that at least one of the facility's students was being treated with TB medication and that one employee recently had a positive tuberculin skin test (TST) result when tested by a private physician. They questioned the change in policy that occurred in 2000, whereby annual skin testing for employees was replaced with testing at hire only. In addition, employees expressed concerns about indoor air quality, including exposure to mold. They reported asthma and other respiratory symptoms. Finally, employees expressed concerns about possible exposure to asbestos. They reported broken floor tiles that they believed contained asbestos as well as construction debris containing asbestos that had been buried on the campus grounds. The NIOSH response consisted of several phone interviews with the requesters and management to gather information, phone interviews with members of the state health department, a two-day site visit by NIOSH staff, review of the state's tuberculosis control policy manual, and review of the facility's operations and management plan. During the site visit, a NIOSH industrial hygienist conducted a walkthrough of the facility's buildings, evaluated building ventilation systems, and interviewed both SVYDC and DJJDP safety officers. A NIOSH medical officer reviewed the facility's TB control program (including skin testing protocols and results for students and employees), inquired about its respiratory protection program, and interviewed the facility and state health department health care personnel responsible for infection control. A TB control nurse consultant from the state health department participated in the site visit, including the review of the facility's TB control program. The TB control program includes one-step TST at baseline (pre-admission) and every two years for students; and one-step TST at hire for employees. Employees do not receive information on TB as part of their safety training and do not participate in a respiratory protection program for TB. Review of student TST results for the past three years revealed five newly positive results in students who had negative baseline results. According to the facility and state health department health care personnel, there have not been any cases of infectious TB among the students for at least the past three years. Mold growth in some of the student shower areas was observed. Some of the ventilation ducts had substantial dust build-up. Concentrations of carbon dioxide were found to be elevated in the clinic area when it was occupied by multiple people. Materials identified in the facility's Asbestos Management Plan as containing asbestos were noted to be intact with the exception of several broken floor tiles in one area. NIOSH staff conducted a two-day site visit to the Swannanoa Valley Youth Development Center in Swannanoa, North Carolina to address employee concerns about exposure to TB, indoor air quality, exposure to asbestos, and health effects that employees were experiencing. Students are skin-tested for TB every two years. While some students have had tuberculin skin test conversions, there have been no documented cases of infectious TB among students. Employees are skin-tested at hire only. One employee who had a positive test in 2005 when tested by a private physician may have had a workplace exposure. Further investigation is recommended and annual employee testing should be initiated. A respiratory protection program for TB was not in place for employees and should be established. A small amount of mold growth was noted in the student showers and there was evidence of roof leaks in the cafeteria. Real-time measurements indicated that carbon dioxide levels in the clinic area were elevated when it was occupied by multiple people, indicating that fresh air supply was inadequate. Floor tiles in the Greenwood Cottage A-wing had been identified in the Asbestos Management Plan as containing asbestos. Several of these tiles were found to be broken and should be replaced.