OCCUCON 2022 Abstracts

The proceedings contain 40 papers. The topics discussed include: respiratory hypersensitivity profiling among farmers with pesticide exposure: field- based, cross-sectional study;requirements of prescription safety eye wear;Covid-19 and comorbidities: deleterious impact on infected patients;knowledge regarding heat stress and practice of personal protective equipment use among healthcare workers during the Covid 19 pandemic;arrhythmia burden in Covid-19 patients from industrial workforce evaluated by remote patient monitoring technology;a qualitative perspective of construction site migrant workers' plight during covid-19 lockdown in Bhavnagar (Western India);elimination of volatile organic compound VOCs exposure at chemical testing laboratory: through effective OHIH assessment;and perceived morbidity, its risks and catastrophic health expenditure among construction workers: a cross sectional observation from Ahmedabad.

A Persistent Nightmare: A Case of Recurrent Brachial Artery Thrombosis

Background Brachial artery thrombosis can be seen with thromboembolism, hypercoagulability, and arterial thoracic outlet syndrome. Case A 33-year-old healthy female construction worker presented with right hand discoloration and pain. She suffered a COVID-19 infection 8 weeks prior with hand symptoms developing shortly thereafter. She could no longer work due to the pain. Duplex ultrasound and CTA of the right upper extremity (Figure) demonstrated localized thrombosis of the right brachial artery. The workup yielded no aortic or intracardiac thrombus, and cardiac event monitor showed no atrial arrhythmia. She underwent thrombectomy with brachial artery stenting and was found, during surgery, to have distal ulnar artery occlusion. Two days post-op, she had recurrent pain and was found to have brachial artery recurrent thrombosis. She underwent urgent brachial-brachial bypass. Arm pain continued despite graft patency, so ulnarpalmar bypass was performed. Decision-making Hypercoagulability workup, including antiphospholipid antibody, protein C, protein S, homocysteine, and Lp(a), was negative. Neither central thrombus on TEE nor evidence of thoracic outlet syndrome was found. As a diagnosis of exclusion, brachial artery thrombosis was ascribed to COVID infection. Despite rivaroxaban, the patient developed gangrene (Panel C) requiring partial digit amputation. Conclusion We present a case of COVID-19-induced recurrent brachial artery thrombosis despite surgical intervention. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Factors Affecting Preventive Behaviors for Safety and Health at Work during the COVID-19 Pandemic among Thai Construction Workers.

Occupational health and safety risks are of major concerns in construction industry. The COVID-19 outbreak provides an additional risk that could drastically affect the safety risks and health of construction workers. Understanding the factors that affect the health and safety of construction workers is significant in reducing risky behaviors and enhancing worker preventive behaviors. Via integrating the Protection Motivation Theory (PMT) and the extended Theory of Planned Behavior (TPB), this study investigates the factors that affect preventive behaviors among construction workers during the COVID-19 pandemic in Bangkok, Thailand. A total of 610 Thai construction workers participated in an online questionnaire survey, which consisted of nine factors with 43 questions. Structure equation modeling (SEM) was adopted to analyze the causal relationships among the latent variable. The SEM results indicated that organizational support and knowledge about COVID-19 had significant (p < 0.0001) direct influences on perceived vulnerability and perceived severity. In addition, perceived vulnerability and perceived severity had significant direct influences on perceived behavioral control. Perceived severity had significant (p < 0.0001) direct influence on attitude towards behavior. Moreover, perceived behavioral control and attitude towards behavior had significant (p < 0.0001) direct influence on intention to follow the preventive measure. Furthermore, the intention to follow the preventive measure had significant (p < 0.0001) direct influences on the COVID-19 preventive behavior. Of note, organizational support and knowledge about COVID-19 had significant (p < 0.0001) indirect influence on COVID-19 preventive behavior. The findings of this study may assist project managers/supervisors and authorities in the construction industry in understanding the challenge during COVID-19 and possible similar epidemics in the future. In addition, conducting effective strategies would improve construction industry safety and promote preventive behaviors among construction workers.

HYPERSENSITIVITY PNEUMONITIS PRESENTING AS SEVERE CYSTIC LUNG DISEASE FOLLOWING COVID-19 INFECTION

SESSION TITLE: Dirty Jobs: Occupational Lung Diseases SESSION TYPE: Case Reports PRESENTED ON: 10/18/2022 11:15 am - 12:15 pm INTRODUCTION: Hypersensitivity Pneumonitis (HP) is a group of immunologically mediated lung diseases. It develops in susceptible individuals with exposure to provoking antigens along with influence from genetic and environmental factors. There remains no standardized approach for assessing the various forms of HP and the diverse nature of the disease makes it difficult and often underdiagnosed. Cystic disease is not uncommon in HP, but the advanced cystic disease seen in our young patient was unique and likely compounded by her pregnancy as well as a previous illness with COVID-19. CASE PRESENTATION: A 26-year-old female construction worker at 12 weeks gestation, with a past medical history of polysubstance abuse and previous COVID-19 infection ten months prior, presented with progressively worsening dyspnea of 9 months. She was admitted with acute hypoxic respiratory failure due to recurrent right pneumothorax requiring multiple thoracenteses and eventually chest tube placement. CT Chest demonstrated severe cystic interstitial fibrosis with emphysematous changes. Initial lung biopsy showed interstitial fibrosis as a possible sequela of COVID-19. Due to her pregnancy and medical complications, she was transferred to a transplant center where she continued to have recurrent pneumothoraces requiring video-assisted thoracoscopic surgery. Autoimmune workup, HP panel, and extended myositis panel were negative. However, a repeat lung biopsy pointed to subacute HP. Despite steroid and immunosuppressant initiation, her hospital course was complicated by cardiac arrest and brain death. She went on to become an organ donor. DISCUSSION: Diffuse cystic lung diseases are characterized by parenchymal destruction of the airway walls leading to expansion of the distal airspaces forming multi-lobular cysts. A broad differential diagnosis for this exists including infection, Langerhans histiocytosis, lymphangioleiomyomatosis, interstitial pneumonia, and HP. The first step to evaluate HP is a detailed history of potential exposures. Our patient worked in construction and was exposed to commonly demonstrated antigens used in paint, plastic, and wood manufacture. Pregnancy appears to trigger symptoms in some patients, seen in prior case reports. Our patient's symptoms began after her COVID infection. Though not clearly studied, some studies have proposed that dysregulation of COVID - 19 immune response triggers interstitial fibrosis as a long-term sequela. Early diagnosis and treatment with steroids are vital to the treatment and prevention of complications such as recurrent pneumothorax. CONCLUSIONS: Covid-19 is an emerging risk factor for the propagation of various immune-mediated diseases. Progression of disease may occur even after the infection has been cured and limited data is available regarding its relation. Early recognition and treatment can be effective life-saving measures in these patients. Reference #1: Baldi BG, Carvalho CRR, Dias OM, Marchiori E, Hochhegger B. Diffuse cystic lung diseases: differential diagnosis. J Bras Pneumol. 2017;43(2):140-149. Reference #2: Densem C, Niven R, Barber P, Bishop P. Development of cryptogenic fibrosing alveolitis during pregnancy. J R Soc Med. 1998;91(11):591-593. Reference #3: Ambardar SR, Hightower SL, Huprikar NA, Chung KK, Singhal A, Collen JF. Post-COVID-19 Pulmonary Fibrosis: Novel Sequelae of the Current Pandemic. J Clin Med. 2021;10(11):2452. Published 2021 Jun 1 DISCLOSURES: No relevant relationships by Anastasia Brit No relevant relationships by Steven Colby No relevant relationships by Patrick Koo No relevant relationships by Vishruth Vyata No relevant relationships by Harika Yadav

SIGNIFICANT CK ELEVATION IN HEAT-EXPOSURE ADULT RHABDOMYOLYSIS WITH CONCURRENT ASYMPTOMATIC SARS-COV2 INFECTION

CASE: A 59 years old male with past medical history of type 2 diabetes presented in August of 2020 after 2 weeks of leg cramps, nausea, and dark urine that followed several weeks of poor fluid intake during his job as a construction worker. Patient reported that he had a similar episode in 2011, and was diagnosed with rhabdomyolysis with a CK value of 3442. Physical examination revealed a blood pressure of 138/79 mmHg, a pulse of 99 beats/min, respiratory rate of 16 breaths/min, temperature of 36.9 °C, and oxygen saturation of 96% on room air. He was alert and oriented, able to ambulate with pain, and no other significant cardiovascular, pulmonary, neurologic, and gastrointestinal findings. Notable elevation of plasma creatinine of 10.23 mg/dL, BUN of 90mg/dL, sodium of 123 mmol/L, potassium of 5.4 mmol/L, bicarbonate of 15 mmol/L, CRP of 115.4, D-dimer of 4305, Ferritin of 7927, Serum myoglobin of 5320 mcg/L, and total CK of 365148 U/L were noted. Nasopharyngeal swab at presentation was positive for Sars-CoV-2. Patient's urine drug/toxicology screen were negative. The patient was placed on intermittent hemodialysis, and IV fluids were administered. Given his unusually high CK level and COVID-19 positive status, viral myositis associated with COVID-19 was initially suspected. Muscle biopsy showed necrotizing myositis, and ANA titer and myositis specific antibodies were negative. Patient's sole complaint continued to be bilateral lower extremity spasm that gradually improved. The patient was discharged 13 days later with improving kidney functions and total CK of 1683. Patient did not follow up until January of 2021 when he presented to our emergency department for a gunshot wound. His kidney function was back to his baseline at the time. IMPACT/DISCUSSION: Multiple reports in the past 2 years have noted some relationship between rhabdomyolysis and SARS-CoV2 infection, including cases of rhabdomyolysis as a presenting and late complication of severe and mild COVID-19 pneumonia (Valente-Acosta et al, Min et al, and Suwanwongse et a). This case shows both an non- respiratory COVID-19 patient presenting with rhabdomyolysis as well as extremely high presenting CK of 365148 in a non-exercise associated adult rhabdomyolysis. While there are studies that suggests SARS-CoV2 can cause a direct viral injury on muscles, patient's muscle biopsy showing necrotizing myositis rather than direct viral injury suggests that this is not the likely mechanism that aggravated the disease. Rather, given that patient had significantly elevated d-dimer, ferritin, and CRP at presentation, the mechanism may be due to the significant inflammatory responses seen in COVID-19 patients. CONCLUSION: COVID-19 infection, regardless of severity, can significantly exacerbate rhabdomyolysis. Proper inpatient management in such cases can lead to no lasting musculoskeletal or renal complications despite severity. The relationship between COVID-19 infection and severe rhabdomyolysis may be based on the inflammatory responses.

The effect of economical phenomenon on informal construction workers earnings within Covid-19 pandemic: A mixed method analysis.

The informal sector is an alternative to getting a job without special conditions such as education level or job skills. These informal workers are often found in the construction sector. Informal construction workers have no social protection and are economically marginalized, making their economy worse during the Covid-19 pandemic. This study investigates informal construction workers' economic phenomenon, from big cities in Java Island, Indonesia, when facing difficult situations due to the pandemic of Covid-19 with the mixed method. First, the quantitative method gathered the questionnaire from 225 informal workers in the construction sector who experienced a drastic reduction in their regular income, even weekly or monthly. They take advantage of savings and increase debt to cover the reduced income. Then, the qualitative method was conducted to investigate the informal construction worker's economical phenomenon with in-depth interviews with five foremen and five construction field managers. During the pandemic, government programs to provide income support for informal workers have contributed less to informal sector workers. Thus, the results of this research can be used by the government or other parties to help provide better social protection to informal sector workers from a more significant economic recession due to the pandemic.

Preventing Tuberculosis (TB) in health workers and silica-exposed occupations

The COVID-19 pandemic has reminded us of the importance of workplace exposures and transmission in the control of airborne infectious diseases. The importance of workplace transmission of Tuberculosis (TB) has been well documented for decades, yet these past lessons have largely gone unheeded for health workers and silica-exposed occupations which are some of the highest risk subpopulations. It is estimated that health care workers who represent 3% of the global population made up 14% of reported COVID-19 and the same front-line workers are at three times greater risk for active TB compared to the general population. Despite these known risks, multiple studies have demonstrated that few health workers are provided with training or protections. Workplace TB prevention measures overlap with measures known to reduce the spread of COVID-19 and include improved ventilation, UV germicidal irradiation, personal protective equipment and training. These dual pandemics present an opportunity to refocus investment in Infection Prevention Control (IPC) measures in healthcare settings. Silica dust exposures and silicosis are known to significantly increase the risk of active TB among miners, construction workers and other exposed occupations. Reducing silica dust exposures has been shown to reduce TB incidence in high-risk workers. Recent studies have demonstrated that informal sector miners experience much higher rates of TB infection than large-scale miners. However, low-cost dust controls have been shown to reduce respirable silica dust by 80% which can have a large impact in reducing TB and silicosis. Workplace interventions to reduce TB in healthcare setting and among silica-exposed workers are cost effective and are considerably less expensive than treatment. The International Commission on Occupational Health (ICOH) has been taking an active role in working to increase recognition of workplace interventions to reduce TB transmission. Starting in 2017 the organization spear-headed efforts at the United Nations (UN) to gain recognition for workplace interventions in the General Assembly TB declaration (2018) and has since engaged with UN agencies, the World Bank and other global TB funding organizations. There is a considerable need to expand primary prevention in the workplace as part of the global TB response.

Pilot testing two take-home exposure prevention educational sessions with construction workers and their families

Introduction 'Take-home exposures' occur when workers accidentally bring home contaminants from work. In construction, job responsibilities may expose workers to lead and other metals, which extend to their household members via the take-home pathway. It is crucial that construction workers are aware of the take-home pathway and learn about exposure prevention strategies. Objectives This work is part of the RECLEAN Pilot Study, which aims to reduce lead in the homes of construction workers through educational and environmental interventions. Methods We developed and evaluated a suite of educational materials to train construction workers and their families on strategies to prevent take-home lead exposure. Each of the two sessions targets a specific audience, with one tailored to construction workers and the other to workers' family or household members. The sessions were originally developed to take place in person but given the COVID-19 pandemic we adapted them for online delivery as well. Results Like traditional occupational health and safety trainings, the construction worker sessions present workers with best practices to prevent take-home lead and open discussion for how such practices may fit into their own routine after work. Alternatively, the family session is designed to engage household members in discussion through a process derived from motivational interviewing. The materials for both sessions include an introduction, behavior scoring sheet, behavior wheel, and action plan. Facilitators and participants discuss strategies to prevent take-home lead, identify barriers participants (and their coworkers or families) experience when trying to change their behaviors, and ultimately prioritize a prevention goal. Conclusion The materials for both educational sessions were developed based on current literature on take-home lead and behavioral theories and in partnership with lead and construction experts from multiple organizations. Using feedback from participants, project stakeholders, and session facilitators, we evaluate the feasibility and efficacy of these educational interventions.