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Isocyanates such as toluene 2, 4-diisocyanate (TDI), methylene bisphenyl isocyanate (MDI), and hexamethylene diisocyanate (HDI) are known sensitizers and exposure to these chemicals can result in isocyanate-induced asthma—the leading cause of occupational asthma. A newly created exposure database was available containing occupational isocyanate measurements spanning 1981–1996 from Ontario and British Columbia (BC)—two of the largest provinces in Canada. The aim was to describe the historical measurements relative to exposure thresholds, ascertain differences in the data between provinces, and identify time trends. Descriptive statistics of the observations were summarized and stratified by isocyanate species and province. Chi-square tests and Student'st-testwere performed to determine differences between provinces. To investigate time trends in the odds of a measurement exceeding the limit of detection (LOD) and time-weighted average (TWA), mixed effects logistic regression models were constructed. In total, 6,984 isocyanate measurements were analyzed, the majority of which were below the LOD (79%). Overall, 8.3% of samples were in excess of the 2014 TLV-TWA of 0.005 ppm. Comparing the two provinces, the proportion of samples exceeding the LOD and TLV-TWA was greater in BC for all isocyanate species. Differences in time trends were also observed between provinces—the odds of a sample exceeding the TLV-TWA decreased over time in the case of MDI (Ontario only), TDI (both Ontario and BC), and other isocyanates (BC only). Our finding that a majority of the exposure measurements was below the LOD is similar to that reported by others. Differences between provinces may be due the fact that isocyanates are classified as a designated substance in Ontario and must adhere to specific exposure control regulations. Limitations of the database, such as finite number of variables and measurements available until 1996 only, presents challenges for more in-depth analysis and generalization of results. An argument is made that a Canadian occupational exposure database be maintained to facilitate risk assessments as well as for occupational epidemiology research. [ABSTRACT FROM PUBLISHER]

Occupational exposure to antineoplastic drugs has been documented to result in various adverse health effects. Despite the implementation of control measures to minimize exposure, detectable levels of drug residual are still found on hospital work surfaces. Cleaning these surfaces is considered as one means to minimize the exposure potential. However, there are no consistent guiding principles related to cleaning of contaminated surfaces resulting in hospitals to adopt varying practices. As such, this pilot study sought to evaluate current cleaning protocols and identify those factors that were most effective in reducing contamination on drug preparation surfaces. Three cleaning variables were examined: (1) type of cleaning agent (CaviCide®, Phenokil II™, bleach and chlorhexidine), (2) application method of cleaning agent (directly onto surface or indirectly onto a wipe) and (3) use of isopropyl alcohol after cleaning agent application. Known concentrations of antineoplastic drugs (either methotrexate or cyclophosphamide) were placed on a stainless steel swatch and then, systematically, each of the three cleaning variables was tested. Surface wipes were collected and quantified using high-performance liquid chromatography–tandem mass spectrometry to determine the percent residual of drug remaining (with 100% being complete elimination of the drug). No one single cleaning agent proved to be effective in completely eliminating all drug contamination. The method of application had minimal effect on the amount of drug residual. In general, application of isopropyl alcohol after the use of cleaning agent further reduced the level of drug contamination although measureable levels of drug were still found in some cases. [ABSTRACT FROM PUBLISHER]

Objective. We undertook a pilot study involving six British Columbian hospital pharmacies to determine if antineoplastic drug contamination of surfaces exists and whether residual drugs remain on these surfaces despite being cleaned.Methods. At each site, the pharmacy technician responsible for preparing the antineoplastic drugs was observed to determine which surfaces were contacted and to ascertain the frequency of contact. Surfaces observed to be most frequently contacted were subsequently wiped after drug preparation pre- and post-clean. The wipe samples were then analyzed by liquid chromatography tandem mass spectrometry to determine the amount of contamination. Cyclophosphamide (CP) and methotrexate (MTX) were used as representative markers to reflect overall antineoplastic drug contamination levels.Results. Fourteen of the 23 surfaces sampled pre-clean (61%) were contaminated with either MTX or CP. The pre-clean wipe samples had a geometric mean concentration of 0.0135 ng/cm2 for MTX (range

Excessive noise levels are a prevalent issue in food processing operations and, although there have been numerous studies on occupational noise, no single study has used a concurrent mixed-methods approach. Employing this study design allows for an understanding of the level of convergence (similarity) between measured noise levels and workers' attitudes and perceptions towards noise. This, in turn, allows for the identification of potential challenges with respect to the implementation of hearing conservation efforts. In this study, spot noise measurements were collected using a sound level meter. One-on-one interviews were conducted with workers to determine attitudes and perceptions towards noise in their workplaces. Subsequently, the results of the noise measurements (quantitative data) were integrated with the survey responses (qualitative data) to identify convergence. The majority of the noise measurements were found to exceed 85 dBA-the criterion mandated by the local occupational health and safety legislation. Although all study participants felt that it was noisy in the workplace, a large proportion of respondents indicated that the noise was not bothersome. With workers' perception being contradictory to the measured noise levels, it is a challenge to implement hearing conservation measures unless changes are made to raise the awareness of the risks associated with excessive noise exposure.

This article outlines the steps taken to deliver standardized infection control and occupational health training to all healthcare workers across a Canadian health authority, using an online module developed by a multidisciplinary team. The course had to meet a diverse variety of learner needs, be relevant to day-to-day practice, be accessible, as well as fulfill healthcare guidelines for both infection control and occupational health. The course was designed to be interactive and uses a wide variety of techniques to engage the learner such as video clips describing use of personal protective equipment, and drop-and-drag technology. Since implementation in 2006, the course has been endorsed by stakeholders and used in staff clinical orientations, for residents, for student placements, and for physicians as part of their hospital privileges, as well as healthcare workers across the health authority. Results of the user satisfaction survey (N=280) showed that the course was relevant and simple to navigate. Observations (N=117) of personal protective equipment donning and doffing of staff post-course showed that the module effectively transferred knowledge. Analysis of the interview results (N=50) suggested that making the course required would be seen as an incentive and visible sign of management commitment to safety. Development of the module was instructive both for the learners and the online infection control/education team. The implementation process provided insight into how best to deliver and evaluate healthcare content while ensuring that the product is user friendly. The process underscored the importance of engaging key stakeholders. With this course, learning of infection control principles has been made more efficient and enjoyable.

We used observational evaluation to assess the ability of an online learning course to effectively transfer knowledge on personal protective equipment (PPE) selection and removal. During orientations for new hospital staff, 117 participants applied either airborne, droplet, or contact precautions in mock scenarios. Postcourse, all 3 scenarios demonstrated improvement in PPE sequence scores (P = .001); moreover, hand hygiene also was more frequent during both donning and doffing of PPE (P < .001).