Evaluation of 2009 pandemic influenza A (H1N1) exposures and illness among physicians in training.

BACKGROUND: A cluster of influenza-like illness (ILI) among physicians in training during the 2009 influenza A (H1N1) pandemic (pH1N1) led to a health hazard evaluation. METHODS: We conducted a cross-sectional study to examine exposures, infection control practices, ILI prevalence, and transmission among physicians in training at 4 affiliated hospitals during the pandemic. We administered an electronic survey and met with physicians in training and hospital personnel. RESULTS: Of the 88 responding physicians, 85% reported exposure to pH1N1. Exposures occurred at work from patients or coworkers and outside of work from coworkers, household members, or the community. Thirteen cases of ILI were reported in May-June 2009; 10 respondents reported working while ill (duration, 1-4 days). Between 13% and 88% of respondents knew which personal protective equipment (PPE) was recommended when caring for influenza patients at the 4 hospitals. The most common reasons for not using PPE were not knowing that a patient had pH1N1 or ILI and not having PPE readily available. CONCLUSIONS: Physicians in training have gaps in their knowledge of and adherence to recommended PPE and compliance with work restrictions. Our findings underscore the importance of installing isolation precaution signage, making PPE readily available near patients with influenza, and facilitating work restrictions for ill health care personnel.

Exposure to flour dust and sensitization among bakery employees.

BACKGROUND: The National Institute for Occupational Safety and Health conducted a study to determine prevalences of sensitization to bakery-associated antigens (BAAs) and work-related respiratory symptoms at a large commercial bakery. METHODS: The following measurements were carried out: personal breathing zone (PBZ) and general area (GA) monitoring for inhalable flour dust, α-amylase and wheat, a questionnaire, and blood tests for IgE specific to flour dust, wheat, α-amylase, and common aeroallergens. RESULTS: Of 186 bakery employees present during our site visit, 161 completed the questionnaire and 96 allowed their blood to be drawn. The geometric mean PBZ and GA inhalable flour dust concentrations for the lower-exposure group was 0.235 mg/m(3), and for the higher-exposure group was 3.01 mg/m(3). Employees in the higher-exposure group had significantly higher prevalences of work-related wheezing, runny nose, stuffy nose, and frequent sneezing than the lower-exposure group. The prevalence of IgE specific to wheat was significantly higher among employees who ever had a job in the higher-exposure group or in production at another bakery at both the ≥ 0.10 kU/L and the ≥ 0.35 kU/L cutoffs, and to flour dust and α-amylase at the ≥ 0.10 kU/L cutoff, compared to the lower-exposure group. CONCLUSIONS: Despite knowledge of the risks of exposure to flour being available for centuries, U.S. employees are still at risk of sensitization and respiratory symptoms from exposure to high levels of BAA.

Eye and respiratory symptoms in poultry processing workers exposed to chlorine by-products.

BACKGROUND: CDC/NIOSH responded to a request to investigate complaints of eye and respiratory irritation among workers in a poultry processing facility's evisceration department. METHODS: Investigators administered symptom questionnaires and sampled for chlorine and chloramines. Spirometry was performed on workers before and after their work shift. RESULTS: Symptoms were significantly more prevalent in evisceration workers than in dark meat workers (a control group). Air concentrations of chloramine compounds (i.e., trichloramine and 'soluble chlorine') were significantly higher in the evisceration area than the dark meat area. Exposure levels were significantly higher for employees reporting various symptoms compared to employees not reporting those symptoms. Mean trichloramine exposure concentrations were significantly higher in workers with significant cross-shift declines in lung function; air concentrations of 'soluble chlorine' were higher as well, however, not significantly so. CONCLUSIONS: Results of this evaluation suggest a health hazard may exist from exposure to chloramines.

Evaluation of the NIOSH MWF total particulate matter: thoracic particulate matter conversion factor in a machining environment.

Worker exposures to metalworking fluids were characterized at a plant that produced air compressors. Full-shift, side-by-side air samples (n = 147) were collected and analyzed for total particulate matter, extractable total particulate matter, thoracic particulate matter, and extractable thoracic particulate matter. The thoracic particulate matter geometric mean of 0.32 m/m (3)was below the National Institute for Occupational Safety and Health (NIOSH) recommended exposure limit (REL) of 0.4 mg/m (3). The total particulate matter geometric mean of 0.52 mg/m (3), however, was above 0.5 mg/m (3), the total particulate matter concentration offered as a surrogate REL in the NIOSHCriteria for a Recommended Standard for Occupational Exposure to Metalworking Fluids.[1]Of the 83 total particulate matter results that were at or above smash 0.5 mg/m (3), only 50 (60%) of the corresponding thoracic particulate matter results were at or above 0.4 mg/m (3). These data indicated a conversion factor of 1.65 between thoracic particulate matter and total particulate matter concentrations and 1.40 between thoracic extractable particulate matter and total extractable concentrations. These factors were significantly different from the 1.25 used to compare total particulate matter with thoracic particulate matter concentrations in the NIOSHCriteria Document[1](p < 0.01) and call into question the validity of a universal conversion factor. The authors conclude that thoracic particulate matter exposure assessment should be done directly. In terms of protecting the worker, however, the 1.25 conversion factor appeared to be conservative since each time a total particulate matter result was below 0.5 mg/m (3), its paired thoracic particulate matter measurement was below 0.4 mg/m (3).