PHYSICAL AND BIOLOGICAL HAZARDS OF THE WORKPLACE

PHYSICAL AND BIOLOGICAL HAZARDS OF THE WORKPLACE

Third Edition

Edited by

GREGG M. STAvE, MD, JD, MPHConsultant, Occupational Medicine and Corporate Health, Chapel Hill, North Carolina and Assistant Consulting Professor, Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina

PETER H. WALD, MD, MPHEnterprise Medical Director, USAA, San Antonio, Texas and Adjunct Professor of Public Health, San Antonio Regional Campus, University of Texas School of Public Health, Houston, Texas

Copyright © 2017 by John Wiley & Sons, Inc. All rights reserved

Published by John Wiley & Sons, Inc., Hoboken, New JerseyPublished simultaneously in Canada

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Library of Congress Cataloging‐in‐Publication Data:

Names: Stave, Gregg M., editor. | Wald, Peter H., 1955– editor.Title: Physical and biological hazards of the workplace / edited by Gregg M. Stave, Peter H. Wald.Description: Third edition. | Hoboken, NJ : John Wiley & Sons Inc., [2017] | Includes bibliographical references and index.Identifiers: LCCN 2016019942 | ISBN 9781118928608 (hardback) | ISBN 9781119276524 (Adobe PDF) | ISBN 9781119276517 (epub)Subjects: LCSH: Medicine, Industrial. | Industrial hygiene. | Occupational diseases. | BISAC: TECHNOLOGY & ENGINEERING /

Industrial Health & Safety.Classification: LCC RC963 .P48 2017 | DDC 616.9/803–dc23 LC record available at https://lccn.loc.gov/2016019942

Printed in the United States of America

Set in 10/12pt Times by SPi Global, Pondicherry, India

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The authors and the publishers have exerted every effort to ensure that treatment recommendations including drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to treatment, drug therapy, and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug.

To our wives—Chris and Isabel

And to our children—Elise, Sam, and Ben

vii

About the editors xiii

List of Contributors xv

foreword to the first edition xix

PrefACe xxi

ACGih PoLiCy stAtement xxiii

ACGih stAtement of Position xxv

PART I PHYSICAL HAZARDS 1

1 introduction to Physical hazards 3Peter H. Wald

I Worker–Material Interfaces 13

2 ergonomics and upper extremity musculoskeletal disorders 13Thomas R. Hales

3 manual materials handling 33Robert B. Dick, Stephen D. Hudock, Ming‐Lun Lu, Thomas R. Waters, and Vern Putz-Anderson

4 occupational Vibration exposure 53David G. Wilder and Donald E. Wasserman

5 mechanical energy 73James Kubalik

II The Physical Work Environment 87

6 hot environments 87David W. DeGroot and Laura A. Pacha

CONTENTS

Contents

viii

7 Cold environments 101David W. DeGroot and Laura A. Pacha

8 high‐pressure environments 111Tony L. Alleman and Joseph R. Serio

9 Low‐pressure and high‐Altitude environments 131Worthe S. Holt

10 shift work 139Allene J. Scott

III Energy and Electromagnetic Radiation 177

11 ionizing radiation 177James P. Seward

12 ultraviolet radiation 197James A. Hathaway and David H. Sliney

13 Visible Light and infrared radiation 203James A. Hathaway and David H. Sliney

14 Laser radiation 209David H. Sliney and James A. Hathaway

15 microwave, radiofrequency, and extremely Low‐frequency energy 215Richard Cohen and Peter H. Wald

16 noise 223Robert A. Dobie

17 electrical Power and electrical injuries 231Jeffrey R. Jones

PART II BIOLOGICAL HAZARDS 241

18 General Principles of microbiology and infectious disease 243Woodhall Stopford

19 Clinical recognition of occupational exposure and health Consequences 249Gary N. Greenberg and Gregg M. Stave

20 Prevention of illness from biological hazards 261Gregg M. Stave

21 Viruses 275Manijeh BerenjiArboviruses (yellow fever, dengue fever, Chikungunya, Zika fever, Japanese encephalitis, st Louis encephalitis, west nile encephalitis, eastern equine encephalitis, western equine encephalitis, La Crosse encephalitis, Colorado tick fever) 275Arenaviruses 282Coronavirus 283Cytomegalovirus (CmV) 287filoviruses (ebola and marburg Viruses) 288hantaviruses 294hepatitis A Virus (hAV) 296hepatitis b Virus (hbV) 299hepatitis C Virus (hCV) 304

Contents

ix

herpes b Virus 306herpes simplex Virus (hsV) 308human immunodeficiency Virus (hiV‐1) 310human t‐Cell Lymphotrophic Virus 316influenza Virus 317measles Virus 320mumps Virus 322norovirus (formerly norwalk Virus) and other enteric Viruses 324Parvovirus b19 325rabies Virus 327respiratory syncytial Virus (rsV) 333rubella Virus 334simian retroviruses 336Vaccinia 338Varicella Zoster Virus (VZV) 342

22 bacteria 347Christopher J. Martin, Aletheia S. Donahue, and John D. MeyerAcinetobacter species 347bacillus species 348borrelia species 352brucella species 356Campylobacter species 359Clostridium botulinum (including C. Argentinense, C. baratii, and C. butyricum) 361Clostridium difficile 363Clostridium Perfringens (also C. septicum, C. novi) 364Clostridium tetani 366Corynebacterium species 368erysipelothrix rhusiopathiae 370escherichia Coli 371francisella tularensis (including f. novocida) 373haemophilus ducreyi 376haemophilus influenza 377helicobacter Pylori 378Legionella species (Legionella Pneumophila, Legionella Longbeachae) 379Leptospira interrogans 381Listeria monocytogenes 383mycoplasma Pneumoniae 384neisseria Gonorrhoeae 386neisseria meningitidis 387Pasteurella multocida 389Pseudomonas and burkholderia species 390rat‐bite fever: streptobacillus moniliformis and spirillum minor 392relapsing fever: borrelia species (other than b. burgdorferi) 393salmonella species 394shigella species 397staphylococcus species 399streptococcus species 401treponema Pallidum 403Vibrio Cholerae 404Vibrio species other than V. Cholerae (V. Parahemolyticus, V. Vulnificus) 405yersinia Pestis 407yersinia Pseudotuberculosis and enterocolitica 409

Contents

x

23 mycobacteria 411Gregg M. Stavemycobacterium tuberculosis (m. tb.) 411mycobacteria other than mycobacterium tuberculosis 420

24 fungi 425Craig S. Glazer and Cecile S. RoseAlternaria species 425Aspergillus species 427basidiomycetes (including merulius Lacrymans, Lycoperdon, and mushrooms) 430blastomyces dermatitidis 432Candida species 434Cladosporium species 435Coccidioides immitis 436Cryptococcus neoformans and Cryptococcus Gattii 439Cryptostroma Corticale 440fonsecaea and other Agents of Chromomycosis 441histoplasma Capsulatum 442madurella species and other Agents of mycetoma 445Paracoccidioides brasiliensis 446Penicillium species 447sporothrix schenckii 449stachybotrys Chartarum 450trichophyton and other dermatophytes 452Zygomycetes 453

25 Anaplasma, Chlamydophila, Coxiella, ehrlichia, and rickettsia 457Dennis J. DarceyAnaplasma 457Chlamydophila Psittaci 459Coxiella burnetii 461ehrlichia species 463rickettsia rickettsii 466

26 Parasites 471William N. YangCryptosporidium Parvum 471Cyclosporiasis 474Cutaneous, mucocutaneous, and Visceral Leishmaniasis 478nanophyetus 485Pfiesteria Piscicida 486Plasmodium species 487toxoplasma Gondii 493

27 envenomations 501James A. PalmierArthropod envenomations 501Latrodectus species 503Loxosceles species 504scorpionida (scorpions) 505marine envenomations 506Coelenterate: Anthozoa 507Coelenterate: hydrozoa 508Coelenterata: scyphozoa 509dasyatis (stingray) 509

Contents

xi

echinodermata 510mollusca 511Porifera 512scorpaenidae 512snake envenomations 513Crotalidae 514elapidae 516hydrophidae 517

28 Allergens 519David C. Carettoenzymes 519farm Animals 521Grain dust 522insects 524Laboratory Animals 526mites 529Plants 531shellfish and other marine invertebrates 533wheat flour and egg 534

29 Latex 537Carol A. Epling

30 malignant Cells 543Aubrey K. Miller

31 recombinant organisms 547Jessica Herzstein and Gregg M. Stave

32 Prions: Creutzfeldt–jakob disease (CJd) and related transmissible spongiform encephalopathies (tses) 553Dennis J. Darcey

33 endotoxins 557Robert Jacobs

34 wood dust 563Harold R. Imbus and Gregg M. Stave

index 569

xiii

Gregg M. Stave, MD, JD, MPH, FACP, FACOEM, FACPM, is a consultant in occupational medicine and corporate health and Assistant Consulting Professor in the Division of Occupational and Environmental Medicine at Duke University Medical Center. Previously, he worked as a cor-porate medical director for Glaxo.

Dr. Stave received his undergraduate education at the Massachusetts Institute of Technology before attending the dual‐degree MD/JD program at Duke University. He received his MPH degree in epidemiology from the University of North Carolina, Chapel Hill. Dr. Stave is board certified in internal medicine and preventive medicine (occu-pational medicine).

A Fellow of the American College of Physicians, American College of Occupational and Environmental Medicine, and the American College of Preventive Medicine, Dr. Stave is also a member of the Bar in North Carolina and the District of Columbia. He lives in Chapel Hill, North Carolina, with his wife and daughter.

Peter H. Wald, MD, MPH, FACP, FACOEM, FACMT, is the Enterprise Medical Director at USAA in San Antonio, Texas, and Adjunct Professor of Public Health, San Antonio Regional Campus, University of Texas School of Public Health, Houston, Texas.

Dr. Wald received his undergraduate education at Harvard before attending Tufts Medical School. He also holds an M.P.H. degree from the University of California, Berkeley. Dr. Wald is board certified in internal medicine, occupa-tional medicine, and medical toxicology. Before joining USAA, he was a principal at WorkCare and the Corporate Medical Director for ARCO. Prior to that, he worked in the medical departments at Mobil Oil and the Lawrence Livermore National Laboratory.

Dr. Wald is a Fellow of the American College of Physicians, the American College of Occupational and Environmental Medicine, and the American College of Medical Toxicology. He lives in San Antonio with his wife.

About the editors

xv

List of Contributors

tony L. Alleman, Md, MPh, Medical Director, Occupational Medicine Clinics of South Louisiana, Lafayette, Louisiana

Manijeh berenji, Md, MPh, Assistant Clinical Professor, Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina

david C. Caretto Md, MPh, Occupational and Environmental Medicine Physician, Mercy Medical Group, Sacramento, California

richard Cohen, Md, MPh, Clinical Professor, Division of Occupational and Environmental Medicine, University of California School of Medicine, San Francisco, California

dennis J. darcey, Md, MPh, MsPh, Division Chief and Assistant Clinical Professor, Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina

david W. deGroot, Phd, Research Physiologist, Epidemiology and Disease Surveillance Portfolio, Army Public Health Center (Provisional), Aberdeen Proving Ground, Maryland

robert b. dick, Phd, Captain, U.S. Public Health Service (retired), Visiting Scientist, National Institute for Occupational Safety and Health, Cincinnati, Ohio

robert A. dobie, Md, Clinical Professor, Department of Otolaryngology  –  Head and Neck Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas

Aletheia s. donahue, Md, Resident, Selikoff Centers for Occupational Medicine Icahn‐Mount Sinai School of Medicine, New York, New York

Carol A. epling, Md, MsPh, Assistant Professor, Division of Occupational and Environmental Medicine; and Director, Duke University Employee Occupational Health and Wellness, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina

Craig s. Glazer, Md, MsPh, Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine University of Texas Southwestern, Dallas, Texas

Gary n. Greenberg, Md, MPh, Medical Director, Urban Ministries of Wake County, Raleigh, North Carolina; Adjunct Associate Professor, Department of Public Health Leadership, University of North Carolina School of Public Health, Chapel Hill, North Carolina

thomas r. hales, Md, MPh, National Institute for Occupational Safety and Health (retired), Cincinnati, Ohio

James A. hathaway, Md, MPh, Occupational Medical Consultant, Solvay USA Inc., Princeton, New Jersey

LIST OF CONTRIBUTORS

xvi

Jessica herzstein, Md, MPh, Former Global Medical Director, Air Products, Adjunct Faculty, Milken Institute School of Public Health, George Washington University

Worthe s. holt Jr., Md, MMM, Vice President, Office of the Chief Medical Officer, Humana, Inc., Louisville, Kentucky

stephen d. hudock, Phd, CsP, Manager, Musculoskeletal Health Cross‐Sector and Lead Research Safety Engineer, Human Factors and Ergonomics Research Team, National Institute for Occupational Safety and Health, Cincinnati, Ohio

harold r. imbus, Md, Mscd., Health and Hygiene, Inc. (retired), Greensboro, North Carolina

robert r. Jacobs, Phd, Professor, Environmental and Occupational Health Sciences, Director Masters in Public Health Program, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky

Jeffrey r. Jones, MPh, Ms, Cih, Supervisor of Environmental Compliance and Safety, Environmental Programs and Planning, Port of Oakland (retired), Oakland, California

James Kubalik, Ms, CsP, Manager Occupational Health, Safety, and Risk Management, B. Braun, Inc., Irvine, California

Ming‐Lun Lu, Phd, Research Ergonomist, National Institute for Occupational Safety and Health, Cincinnati, Ohio

Christopher J. Martin, Md, Msc, Professor of Medicine and Emergency Medicine and Director, Institute for Occupational and Environmental, Health Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia

John d. Meyer, Md, MPh, Assistant Professor, Selikoff Centers for Occupational Medicine, Icahn-Mount Sinai School of Medicine, New York, NY

Aubrey K. Miller, Md, MPh, Senior Medical Advisor, National Institute of Environmental Health Sciences, Bethesda, Maryland

Laura A. Pacha, Md, MPh, Director, Epidemiology and Disease Surveillance Portfolio, Army Public Health Center (Provisional), Aberdeen Proving Ground, Maryland

James A. Palmier, Md, MPh, MbA, Vice President and Medical Director, ExamOne/Quest Diagnostics, Lenexa, Kansas

Vern Putz-Anderson, Phd, Research Psychologist, National Institute for Occupational Safety and Health, Cincinnati, Ohio

Cecile s. rose, Md, MPh, Professor of Medicine, Division of Environmental and Occupational Health Sciences, National Jewish Health Division of Pulmonary Medicine and Critical Care Sciences, University of Colorado, Denver, Colorado

Allene J. scott, Md, MPh, Mt (AsCP), Medical Consultant, UNUM Life Insurance Company of America, Portland, Maine.

Joseph r. serio, Md, Staff Physician, Occupational Medicine Clinics of South Louisiana, Lafayette, Louisiana

James P. seward, Md, MPP, MMM, Clinical Professor of Medicine, University of California, San Francisco, California; and Clinical Professor of Public Health, University of California, Berkeley, California

david h. sliney, Phd, Associate, Department of Environmental Health Sciences, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland; Program Manager (retired), Laser/Optical Radiation Program, US Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Grounds, Maryland

Gregg M. stave, Md, Jd, MPh, Consultant, Occupational Medicine and Corporate Health, Chapel Hill, North Carolina; and Assistant Consulting Professor, Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina

Woodhall stopford, Md, MsPh, Assistant Clinical Professor, Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina

Peter h. Wald, Md, MPh, Enterprise Medical Director, USAA, San Antonio, Texas; and Adjunct Professor of Public Health, San Antonio Regional Campus, University of Texas School of Public Health, Houston, Texas

LIST OF CONTRIBUTORS

xvii

donald e. Wasserman, Msee, MbA, Human Vibration Consultant, Frederick, Maryland

thomas r. Waters†, Phd, Chief, Human Factors and Ergonomics Research Section, National Institute for Occupational Safety and Health, Cincinnati, Ohio

david G. Wilder, Phd, Pe, CPe, Jolt/Vibration/Seating Lab, Director, Iowa Spine Research Center; Researcher,

Center for Computer Aided Design; Professor, Biomedical Engineering Department, College of Engineering; Professor, Occupational and Environmental Health Department, College of Public Health; Orthopedic Surgery Department, College of Medicine, The University of Iowa, Iowa City, Iowa

William n. Yang, Md, MPh, Occupational Medicine Physician (retired), The Emory Clinic, Atlanta, Georgia

†Deceased October 29, 2014.

xix

foreWord to the first edition

It has been 15 years since the original publication of Chemical Hazards of the Workplace. That work was con-ceived as a handbook—which would serve as an authorita-tive guide to current concepts and practices aimed at protecting workers from chemical hazards. Over the inter-vening years, Chemical Hazards of the Workplace has been updated twice, but there has been a need for a similar work on the prevention and management of hazardous exposures from physical and biological agents.

I am happy to report that this void has now been filled expertly in the present volume prepared by Drs. Peter Wald and Gregg Stave. This exciting companion piece to Chemical Hazards of the Workplace is an important contribution to the practice of occupational and environmental health. It is

arranged to function both as an introduction to and a review of physical and biological hazards. It provides practical information not previously available in a single source on emerging, reemerging, and classical hazards due to these agents. Topics range from electromagnetic fields, ionizing radiation, and ergonomics, to occupational exposures to tuberculosis, HIV, and hantavirus. The reader will find help-ful current information on a broad array of hazardous agents with a selection of timely literature citations for follow‐up review.

All health professionals involved in protecting worker health will find this work a valuable addition to their basic reference library.

James P. Hughes, M.D.

xxi

Fifteen years have passed since the second edition of this book appeared. During this time, physical and biological hazards have been increasingly recognized as important hazards of the workplace. We have seen new research along with revisions of government standards and guidelines for physical agents such as manual materials handling, shift work and high‐pressure environments, and biological agents including tuberculosis and tick‐borne diseases. In addition, we have seen the emergence or spread of biological hazards, including Ebola and Zika virus.

The reception of the first two editions has been very grati-fying to us. Many of our colleagues have written to us with suggestions for new topics and agents. We have tried to pre-serve the unique style and format of the original edition, while updating and expanding existing content, and adding new agents that we felt have become important over the intervening years. We are deeply indebted to our contribu-tors. Many of them have returned to update their original chapters, and many colleagues are new contributors to the third edition.

The primary focus of the book continues to be as a practical “how to” reference containing basic information about the physical and biological hazards for occupational health and safety professionals from an occupational health perspective. We are pleased that readers have told us that this is the book that they pull off the shelf when they need a quick introduction or refresher to a topic in physical and biological hazards, just before they go to talk to employees or patients. This is not meant to be a definitive reference book, but rather a first refer-ence that provides a practical overview for the primary health practitioner. It is also intended to be useful for health profes-sionals who have no formal occupational medicine training.

Our goal continues to be to bring you an introduction to the fascinating world of physical and biological hazards. We hope that the third edition will continue to assist all health professionals who are responsible for protecting the health and safety of workers.

Gregg M. Stave, MD, JD, MPH, FACP, FACOEM, FACPMPeter H. Wald, MD, MPH, FACP, FACOEM, FACMT

Preface

xxiii

ACGIH PolICy StAtement

1330 Kemper Meadow Drive • Cincinnati, OH 45240-4148, USAPhone: 513-742-2020 • Fax: 513-742-3355E-Mail: mail@acgih.org • http://www.acgih.org

POLICY STATEMENT ON THE USES OF TLVs® AND BEIs®

The Threshold Limit Values (TLVs®) and Biological Exposure Indices (BEIs®) are developed asguidelines to assist in the control of health hazards. These recommendations or guidelines areintended for use in the practice of industrial hygiene, to be interpreted and applied only by aperson trained in this discipline. They are not developed for use as legal standards and ACGIH®

does not advocate their use as such. However, it is recognized that in certain circumstancesindividuals or organizations may wish to make use of these recommendations or guidelines as asupplement to their occupational safety and health program. ACGIH® will not oppose their usein this manner, if the use of TLVs® and BEIs® in these instances will contribute to the overallimprovement in worker protection. However, the user must recognize the constraints andlimitations subject to their proper use and bear the responsibility for such use.

The Introductions to the TLV®/BEI® Book and the TLV®/BEI® Documentation provide thephilosophical and practical bases for the uses and limitations of the TLVs® and BEIs®. To extendthose uses of the TLVs® and BEIs® to include other applications, such as use without thejudgment of an industrial hygienist, application to a different population, development of newexposure/recovery time models, or new effect endpoints, stretches the reliability and evenviability of the database for the TLV® or BEI® as evidenced by the individual Documentation.

It is not appropriate for individuals or organizations to impose on the TLVs® or the BEIs® theirconcepts of what the TLVs® or BEIs® should be or how they should be applied or to transferregulatory standards requirements to the TLVs® or BEIs®.

Special Note to User

The values listed in this book are intended for use in the practice of industrial hygiene asguidelines or recommendations to assist in the control of potential workplace health hazardsand for no other use. These values are not fine lines between safe and dangerousconcentrations and should not be used by anyone untrained in the discipline of industrialhygiene. It is imperative that the user of this book read the Introduction to each sectionand be familiar with the Documentation of the TLVs® and BEIs® before applying therecommendations contained herein. ACGIH® disclaims liability with respect to the use of theTLVs® and BEIs®.

Defining the Science of Occupational and Environmental Health®

®

___________ Approved by the ACGIH® Board of Directors on March 1, 1988.

xxv

ACGIH StAtement of PoSItIon

1330 Kemper Meadow Drive • Cincinnati, OH 45240-4148, USAPhone: 513-742-2020 • Fax: 513-742-3355E-Mail: mail@acgih.org • http://www.acgih.org

ACGIH® Statement of Position Regarding the TLVs® and BEIs®

Defining the Science of Occupational and Environmental Health®

®

The American Conference of Governmental Industrial Hygienists (ACGIH®) is a private not-for-profit,nongovernmental corporation whose members are industrial hygienists or other occupational health andsafety professionals dedicated to promoting health and safety within the workplace. ACGIH® is a scientificassociation. ACGIH® is not a standards setting body. As a scientific organization, it has establishedcommittees that review the existing published, peer-reviewed scientific literature. ACGIH® publishesguidelines known as Threshold Limit Values (TLVs®) and Biological Exposure Indices (BEIs®) for use byindustrial hygienists in making decisions regarding safe levels of exposure to various chemical andphysical agents found in the workplace. In using these guidelines, industrial hygienists are cautioned thatthe TLVs® and BEIs® are only one of multiple factors to be considered in evaluating specific workplacesituations and conditions.

Each year ACGIH® publishes its TLVs® and BEIs® in a book. In the introduction to the book, ACGIH®

states that the TLVs® and BEIs® are guidelines to be used by professionals trained in the practice of industrial hygiene. The TLVs® and BEIs® are not designed to be used as standards. Nevertheless,ACGIH® is aware that in certain instances the TLVs® and the BEIs® are used as standards by national,state, or local governments.

Governmental bodies establish public health standards based on statutory and legal frameworks thatinclude definitions and criteria concerning the approach to be used in assessing and managing risk. Inmost instances, governmental bodies that set workplace health and safety standards are required toevaluate health effects, economic and technical feasibility, and the availability of acceptable methods todetermine compliance.

ACGIH® TLVs® and BEIs® are not consensus standards. Voluntary consensus standards are developed oradopted by voluntary consensus standards bodies. The consensus standards process involvescanvassing the opinions, views and positions of all interested parties and then developing a consensusposition that is acceptable to these parties. While the process used to develop a TLV® or BEI® includespublic notice and requests for all available and relevant scientific data, the TLV® or BEI® does notrepresent a consensus position that addresses all issues raised by all interested parties (e.g., issues oftechnical or economic feasibility). The TLVs® and BEIs® represent a scientific opinion based on a review ofexisting peer-reviewed scientific literature by committees of experts in public health and related sciences.

ACGIH® TLVs® and BEIs® are health-based values. ACGIH® TLVs® and BEIs® are established bycommittees that review existing published and peer-reviewed literature in various scientific disciplines(e.g., industrial hygiene, toxicology, occupational medicine, and epidemiology). Based on the availableinformation, ACGIH® formulates a conclusion on the level of exposure that the typical worker canexperience without adverse health effects. The TLVs® and BEIs® represent conditions under whichACGIH® believes that nearly all workers may be repeatedly exposed without adverse health effects. Theyare not fine lines between safe and dangerous exposures, nor are they a relative index of toxicology. TheTLVs® and BEIs® are not quantitative estimates of risk at different exposure levels or by different routesof exposure.

ACGIH StAtement of PoSItIon

xxvi

• ACGIH® is a not-for-profit scientific association.

• ACGIH® proposes guidelines known as TLVs® and BEIs® for use by industrial hygienists inmaking decisions regarding safe levels of exposure to various hazards found in the workplace.

• ACGIH® is not a standards setting body.

• Regulatory bodies should view TLVs® and BEIs® as an expression of scientific opinion.

• TLVs® and BEIs® are not consensus standards.

• ACGIH® TLVs® and BEIs® are based solely on health factors; there is no consideration given toeconomic or technical feasibility. Regulatory agencies should not assume that it is economically ortechnically feasible to meet established TLVs® or BEIs®.

• ACGIH® believes that TLVs® and BEIs® should NOT be adopted as standards without an analysisof other factors necessary to make appropriate risk management decisions.

• TLVs® and BEIs® can provide valuable input into the risk characterization process. Regulatoryagencies dealing with hazards addressed by a TLV® or BEI® should review the full writtenDocumentation for the numerical TLV® or BEI®.

ACGIH® is publishing this Statement in order to assist ACGIH® members, government regulators, and industry groups in understanding thebasis and limitations of the TLVs® and BEIs® when used in a regulatory context. This Statement was adopted by the ACGIH® Board ofDirectors on March 1, 2002.

Since ACGIH® TLVs® and BEIs® are based solely on health factors, there is no consideration given toeconomic or technical feasibility. Regulatory agencies should not assume that it is economically ortechnically feasible for an industry or employer to meet TLVs® or BEIs®. Similarly, although there areusually valid methods to measure workplace exposures at TLVs® and BEIs®, there can be instanceswhere such reliable test methods have not yet been validated. Obviously, such a situation can createmajor enforcement difficulties if a TLV® or BEI® was adopted as a standard.

ACGIH® does not believe that TLVs® and BEIs® should be adopted as standards without full compliancewith applicable regulatory procedures including an analysis of other factors necessary to make appropriaterisk management decisions. However, ACGIH® does believe that regulatory bodies should consider TLVs®

or BEIs® as valuable input into the risk characterization process (hazard identification, dose-responserelationships, and exposure assessment). Regulatory bodies should view TLVs® and BEIs® as anexpression of scientific opinion.

ACGIH® is proud of the scientists and the many members who volunteer their time to work on the TLV®

and BEI® Committees. These experts develop written Documentation that include an expression of scientific opinion and a description of the basis, rationale, and limitations of the conclusions reached byACGIH®. The Documentation provides a comprehensive list and analysis of all the major published peer-reviewed studies that ACGIH® relied upon in formulating its scientific opinion. Regulatory agencies dealingwith hazards addressed by a TLV® or BEI® should obtain a copy of the full written Documentation for the TLV® or BEI®. Any use of a TLV® or BEI® in a regulatory context should include a careful evaluation of theinformation in the written Documentation and consideration of all other factors as required by the statuteswhich govern the regulatory process of the governmental body involved.

Part I

PHYSICAL HAZARDS