Outcomes for a Heat Illness Prevention Program in Outdoor Workers: A 9-Year Overview.

OBJECTIVE: To describe the outcomes effect of removing the medical surveillance component from a heat illness prevention program (HIPP) for outdoor workers from a Central Texas municipality. METHODS: Heat-related illness (HRI) frequency and workers' compensation (WC) cost were assessed retrospectively in a cohort of 329 workers from 2011-2019. During 2011-2017, the HIPP included training, acclimatization, and medical surveillance. In 2018-2019, a modified (mHIPP) was implemented that included training and acclimatization, but without medical surveillance. RESULTS: The HRI rate during HIPP averaged 19.5 per 1000 workers during the first 4 years, dropped to 1.01 per 1,000 workers over the next 3 years, (2015-2017), and increased during mHIPP, to 7.6 per 1,000 workers. DISCUSSION: Although the case increase during the mHIPP was small, medical surveillance may be an important component in lowering workforce HRI.

An outbreak of work-related asthma and silicosis at a US countertop manufacturing and fabrication facility.

BACKGROUND: Outbreaks of severe silicosis have affected workers who fabricate artificial stone countertops. Work-related asthma (WRA) has not been a prominent feature of those prior outbreaks. METHODS: This report describes an outbreak of WRA and silicosis at a facility that manufactures and fabricates chemical-resistant countertops comprised of sand, epoxy resin, and phthalic anhydride (PA), a known respiratory sensitizer. The multi-disciplinary investigation included clinical examinations of workers, an industrial hygiene survey with qualitative and quantitative exposure assessments, and a cross-sectional questionnaire. RESULTS: Engineering controls and personal protective equipment were inadequate. Some workers were exposed to PA or silica above permissible exposure limits established by the Occupational Safety and Health Administration (OSHA). Clinical and epidemiologic investigations identified 16 workers with confirmed or suspected WRA. Two years later, after OSHA began to enforce its new silica standards, 12 workers received medical surveillance for silicosis. Of these 12 workers, four (33.3%) were diagnosed with silicosis based on abnormal chest computed tomography examinations. CONCLUSIONS: Artificial stone countertop workers can develop asthma or silicosis. Risk of asthma may be highest in workers exposed to asthmagens such as PA and epoxy resins while manufacturing the artificial stone material.

Prevention of Occupational Heat-Related Illnesses.

High ambient temperatures and strenuous physical activity put workers at risk for a variety of heat-related illnesses and injuries. Through primary prevention, secondary prevention, and treatment, OEM health providers can protect workers from the adverse effects of heat. This statement by the American College of Occupational and Environmental Medicine provides guidance for OEM providers who serve workers and employers in industries where heat exposure occurs.

Proposed Mitigation and Adaptation Strategies Related to Climate Change: Guidance for OEM Professionals.

Climate change is an urgent challenge amplified by socioeconomic factors that demands thoughtful public health responses from OEM professionals. This guidance statement from the American College of Occupational and Environmental Medicine focuses on the different strategies that these health professionals can implement to protect workers from health impacts associated with climate change hazards, foster workplace resilience in the face of rapidly changing environments, and take the necessary steps to mitigate the effects of global climate change.

Heat Safety in the Workplace: Modified Delphi Consensus to Establish Strategies and Resources to Protect the US Workers.

The purpose of this consensus document was to develop feasible, evidence-based occupational heat safety recommendations to protect the US workers that experience heat stress. Heat safety recommendations were created to protect worker health and to avoid productivity losses associated with occupational heat stress. Recommendations were tailored to be utilized by safety managers, industrial hygienists, and the employers who bear responsibility for implementing heat safety plans. An interdisciplinary roundtable comprised of 51 experts was assembled to create a narrative review summarizing current data and gaps in knowledge within eight heat safety topics: (a) heat hygiene, (b) hydration, (c) heat acclimatization, (d) environmental monitoring, (e) physiological monitoring, (f) body cooling, (g) textiles and personal protective gear, and (h) emergency action plan implementation. The consensus-based recommendations for each topic were created using the Delphi method and evaluated based on scientific evidence, feasibility, and clarity. The current document presents 40 occupational heat safety recommendations across all eight topics. Establishing these recommendations will help organizations and employers create effective heat safety plans for their workplaces, address factors that limit the implementation of heat safety best-practices and protect worker health and productivity.

Severe Silicosis in Engineered Stone Fabrication Workers - California, Colorado, Texas, and Washington, 2017-2019.

Silicosis is an incurable occupational lung disease caused by inhaling particles of respirable crystalline silica. These particles trigger inflammation and fibrosis in the lungs, leading to progressive, irreversible, and potentially disabling disease. Silica exposure is also associated with increased risk for lung infection (notably, tuberculosis), lung cancer, emphysema, autoimmune diseases, and kidney disease (1). Because quartz, a type of crystalline silica, is commonly found in stone, workers who cut, polish, or grind stone materials can be exposed to silica dust. Recently, silicosis outbreaks have been reported in several countries among workers who cut and finish stone slabs for countertops, a process known as stone fabrication (2-5). Most worked with engineered stone, a manufactured, quartz-based composite material that can contain >90% crystalline silica (6). This report describes 18 cases of silicosis, including the first two fatalities reported in the United States, among workers in the stone fabrication industry in California, Colorado, Texas, and Washington. Several patients had severe progressive disease, and some had associated autoimmune diseases and latent tuberculosis infection. Cases were identified through independent investigations in each state and confirmed based on computed tomography (CT) scan of the chest or lung biopsy findings. Silica dust exposure reduction and effective regulatory enforcement, along with enhanced workplace medical and public health surveillance, are urgently needed to address the emerging public health threat of silicosis in the stone fabrication industry.

Outcomes of a Heat Stress Awareness Program on Heat-Related Illness in Municipal Outdoor Workers.

INTRODUCTION: Heat stress is an occupational hazard. Exposed workers may suffer heat-related illness, disease exacerbation, increased injuries, and reduced productivity. Response strategies include mitigation policies and preparedness. METHODS: Frequency of heat-related illness and workers' compensation costs before and after implementation of a voluntary Heat Stress Awareness Program were evaluated retrospectively in outdoor workers from 2009 to 2017. The program consisted of training, acclimatization, and medical monitoring as outlined in NIOSH's Criteria for a Recommended Standard: Occupational Exposure to Heat and Hot Environments. RESULTS: Of the 604 workers assessed, those with two or more risk factors reported a heat-related illness at greater frequency, which decreased after program implementation. Median workers' compensation costs decreased by 50%. DISCUSSION: Heat-related illness prevention programs can be effective in reducing the frequency and severity of these occupational injuries as well as associated costs.

Characterisation of occupational blood and body fluid exposures beyond the Needlestick Safety and Prevention Act.

OBJECTIVE: To describe the use of mandated safety engineered sharps devices (SESDs) and personal protective equipment in healthcare workers (HCWs) with occupational body fluid exposures (BFE) since the Needlestick Safety and Prevention Act. METHODS: Two questionnaires were administered, over 3 years, to HCWs who reported sharps or splash BFEs. Descriptive statistics and chi-square analysis were used. RESULTS: Of the 498 questionnaires completed, nurses completed 262 (53%), house staff 155 (32 %), technicians 63 (13%) and phlebotomists 11 (2%). Four (1%) completers reported 'other' and three (1%) reported unknown. Sharps injuries accounted for 349 (70%) of the BFEs. SESDs were utilised 43% (128/299) of the time with a 54% (70/130) activation rate. Phlebotomists (80%; 8/10) and nurses (59%; 79/267) used SESDs more than doctors (27%; 31/86) and technicians (26%; 10/39) (P <0.0001). Fifty-four percent (185/207) of HCWs reported having had training on SESD use; nurses (64%; 98/154) and phlebotomists (70%; 7/8) significantly more so than house staff (44%; 59/133) and technicians (44%; 21/48) (P <0.05). Most splash BFEs were to the eyes 73% (91/149). Five percent (4/79) of HCWs used protective eyewear. CONCLUSIONS: Systematic regular training, appropriate protocols and iteratively providing the safest SESDs based on HCW experience and technological advances will further reduce the physical and emotional toll of BFEs.