Health Hazards

John Newquist

Draft 1 8 2016

August 2013• Franklin, NC • One person has died and 16 others

were hospitalized from exposure to high levels of carbon monoxide in a packing facility

• "We monitored the (carbon monoxide) levels once we got there, and the highest reading we got was 1,000 parts per million."

Worst Job?

Introduction

• Top Ten Health Issues found by OSHA• Problem correlated to Overexposures• Effect Measure• Best Practices

• Sampling Data 2004-2010, Region V, all industries

Clean Air Paradox

• Quality of Air• 78.1% Nitrogen• 20.9% Oxygen• 0.9% Argon• 0.03% Carbon

Dioxide

Units Seem Small

1 % = 10,000 ppmPEL = Permissible

Exposure Limits (OSHA)

5 Mg/M3 is very small2 f/cc = 2,000,000f/M3

Health Effects

• Irritation• Asphyxiation• Organ Specific Effects• Mutagen• Teratogen• Acute/Chronic• Reversible vs.

Nonreversible

Factors

• Genetics• Age• Health status• Route of entry• Frequency and

duration of exposure

Exposure Limits

• Animal Studies• Epidemiological

studies• Industrial Experience• STEL – 15 minutes• Ceiling – never

exceeded• Threshold Limit Value

Sampling

• Qualified person• Appropriate

instrument• Duration of sampling• Pre and post

calibration

Hierarchy of Controls

• Engineering• Administrative• Personal Protective

Equipment• Training

Past Health Hazards• 400 BC Hippocrates

describes lead poisoning in mines

• 1473 Ellenbog – Mercury Poisoning

• 1700 Dr. Ramazzini published the first edition of his most famous book, the De Morbis Artificum Diatriba (Diseases of Workers)

“I can hire one-half the working class to kill the other half.” Jay Gould

Alice Hamilton• In 1908, Hamilton was

appointed to the newly formed Occupational Diseases Commission of Illinois, the first such investigative body in the United States

• Lead in dishes, added to gasoline and paints

• Silica in granite cutting, • Benzene in solvents• Carbon-monoxide gassing in

the steel mills• Pneumonia and rheumatism in

the stockyards

Phossy Jaw

• Alice Hamilton discovered matchstick workers risked the dreaded "phossy jaw, which comes from breathing the fumes of white or yellow phosphorus

Mad as a Hatter

• Alice Hamilton found that Mercury poisoning in the felt hat industry caused uncontrollable jerking of arms and legs and mental illness

Problem #1 Noise• BLS

• 125,000+ workers w permanent, hearing loss since 2004

• In 2008 alone, 22,000 hearing loss cases were reported

#1 Noise• Hearing Protection worn

20%*• Several processes

involving hammering, cutting, blasting will cause overexposure

• Set up an effective hearing conservation program

REMEMBER!• The aforementioned

applies to overexposures above 90 dBA TWA (Time-Weighted-Average)

“Effective hearing conservation program?”

Monitoring

Engineering, work practice, and administrative controls

Hearing protectors with an adequate noise reduction rating

Employee training and education in hazards and protection measures

Baselines and annual audiometry

Audiograms• Conduct a baseline analysis on

all equipment (New too!)• Employees can request personal

noise monitoring at any time at VPP sites

• 60 employees were tested in IL. • It cost $29.00 per person plus

some labor cost (VPP)• Insurance carrier will charge

$35.00 per person. (VPP site)

#2 Lead

• Requires compliance with 1910.1025• Overexposure can occur in less than 5 minutes

when torch cutting or painting

Lead effects

• Chronic overexposure - severe damage to the blood-forming, nervous, urinary, and reproductive systems

• High levels will require medical removal • Bridge Painting/Removal continues to be

ones of the consistent lead issues in construction

#3 Silica

• Cutting, hammering, drilling, blasting can create high silica levels

• Use wet methods and wear respirators

• One of the oldest occupational diseases

Silica

• 150-200 deaths a year (2009)

• 1150-1200 deaths a year (1968)

• Yet….one company had 3 silicosis and 10x+ severe respiratory diseases

Gauley Bridge in 1920’s had workers die in months.

#4 Copper Fumes - Welding• Copper is inhalation

hazard affecting respiratory system

• Mild steel (red iron) and carbon steel contain manganese

• Manganese may cause Parkinson's disease

What do you see?

#5 Total Dust

• All the things not regulated.

• Good, bad, or indifferent?

• Air blowing!

#6 Iron Oxide -Welding• Metal fume fever • Direct Draw or forced

ventilation should be used

• Personal Protective Equipment should be used

• Bystanders should be protected as well

#7 Carbon Monoxide

• Generators are most common problem of CO

• Heaters out of tune are another cause

• CO TWA is 50 ppm• Others set levels 25

ppm

#8 Hex Chrome

• Stainless steel contains nickel and chromium

• Plating, grinding, welding are problems

• Some cements

# 9 Cadmium• Overexposure to

cutting cadmium bolts, coated poles

• Torch cutting should never be used

• Use hydraulic bolt cutters

• Comply with 1926.1127 Cadmium bolts are often

found in sprinkler pipe use.

#10 Methylene Chloride• Paint stripping• Parts cleaners• Cancer causing

Asbestos

• Common Fireproofing material used pre- 1980s

• Found in pipe insulation, ceiling tiles, and floor tiles

• Must comply with 1926.1101 or 1910.1001

June 2014• The asbestos lawsuit that

saw a $1 million award • Richard Rost has

Mesothelioma• Defendants included Ford

Motor Company (Ford), General Electric, Westinghouse and Ingersoll-Rand.

• However, the latter three defendants settled with the plaintiffs out of court, before the trial had an opportunity to begin.

Overall, nearly 3,000 people are diagnosed with mesothelioma each year in the United States, which represents 0.02 percent of all U.S. cancer cases.

Heat Stress• Train the workforce • Perform the heaviest work in the

coolest part of the day• Slowly build up tolerance to the

heat and the work activity (usually takes up to two weeks)

• Drink plenty of cool water (one cup every 15-20 minutes)

• Wear light, loose-fitting, breathable (cotton) clothing

• Take frequent short breaks in cool or shaded areas

• Provide fans

SUNBURN

Dealing with Heat Stress

Heat stress can be more than a minor inconvenience for those who work in extremely warm conditions. Knowing how to prevent, identify and treat its symptoms can literally save lives.

Symptoms• Red, painful skin (first degree burns)• Blistering and/or peeling (second degree burns)

Treatment• Skin lotions• Topical anesthetics

Prevention• Limit sun exposure on bare skin

HEAT RASH & CRAMPSSymptoms• Red rash and itching• Hot, moist skin• Normal to slightly high body temperature

Treatment• Ointment

Prevention• Keep skin dry and clean• Loosen clothing• Drink lightly salted liquids (.1% saline)• Seek medical aid if cramps persist

Dealing with Heat Stress

HEAT EXHAUSTION

First Aid Treatment• Loosen or remove clothing and boots• Cool the victim as fast as possible• Call 911 if victim becomes faint or is unconscious

Symptoms• Heavy sweating• Intense thirst from dehydration• Fatigue, weakness or loss of coordination• Tingling in hands and feet or headache

Dealing with Heat Stress

HEAT STROKEEarly Symptoms• High body temperature• Hot, red or flushed, dry skin• Headache or dizziness• Confusion or delirium

Advanced Symptoms• Seizure or convulsions• Loss of consciousness• No detectable pulse

Call 911 at the first sign of the above symptoms!

Dealing with Heat Stress

HEAT STROKETreatment• Lower the victim’s body temperature as fast as possible• Don’t give liquids to unconscious victims

Other tips for controlling heat stress• Allow your body to become acclimatized to your surroundings• Follow scheduled work/rest cycles to avoid overexertion• Drink 5-7 ounces of cool water every 15 minutes• Consume a light, cool lunch instead of hot,

heavy meals

Dealing with Heat Stress

Dehydration

Confined Spaces

• Manholes, pits, vaults, tanks, are common confined spaces

• Ensure atmosphere is safe by testing and ventilating

Worker in a sludge pit exposed to lead, arsenic, and cadmium

Paint Solvents

• Ventilation is required or overexposure can result

• Fire Hazard • Electrical must be

Class I if within 20 feet during open spraying with flammable paints

Tank painting. What could go wrong?

Waterproofing

• Volatile compounds are heavier than air and toxic.

• Death• Hazards similar to a

confined space

Diesel Fuel Exhaust• blue smoke (mainly oil and

unburnt fuel) • black smoke (soot, oil and

unburnt fuel); • white smoke (water droplets

and unburnt fuel)• Diesel Fuel Exhaust is

reasonably anticipated to be a human carcinogen per IARC

What else is toxic in this ????

Back Strains

• Many workers out in with bad backs

• Due to lifting and twisting constantly

• Heavy loads should have assistance via machines or another person

West Nile

• Use DEET or lemon eucalyptus based sprays for protection

• Clothing can be treated with Permethrin

• Wear light color clothing and reduce exposed skin

Mold• Stachybotrys chartarum (also

known as Stachybotrys atra)• Aspergillus sp.• Penicillium sp.• Fusarium sp.• Trichoderma sp.• Memnoniella sp.• Cladosporum sp.• Alternaria sp.

First Aid

First aid training

Good Samaritan Collateral duty* Designated responder

Not covered by BBP Standard

BBP standard applies

* if First-Aid response is an expected part of the job

BBP standard applies

Universal Precautions

Treat as if known to be infectious

All human blood

Certain human body fluids

All human body fluids if they can’t be distinguished

Regulated Waste Handling

• When moving containers:» Close immediately

» If leaking, place in secondary container

» If reusable, clean in a manner that will not expose employees.

Exposure Incident

Contact with blood or OPIM via:

• Cuts, puncture, needle sticks

• Mucous membrane

• Eye

• Non-intact skin

Post Exposure Evaluation

• Provide medical evaluation ASAP • Testing for HBV, HCV, HIV• HIV/HBV PEP when indicated

• Identify source individual, if possible• Obtain consent for blood test

• Provide information to healthcare provider• Routes of entry• Employee’s job duties• Copy of the regulation

Employer Responsibility:

Medical Evaluation and Follow-up

• Provide in writing to employer: • Employee has been informed of the results

• Employee has been informed of any medical conditions resulting from exposure

• All specific findings or diagnoses are confidential to employee

Healthcare Provider’s Responsibility:

October 2014

Ebola

On The Horizon• Silica?• Noise?• Confined Space

in Construction?

Quiz• CO PEL is ___ ppm.• Name one place where cadmium can be found .

______________• ____% Oxygen is in normal air.• Which color smoke from a diesel engine is a concern?

__________________• Overexposure can occur in less than ____ minutes

when torch cutting lead painted surfaces• The Short Term Exposure Limit (STEL) is for ____

minutes