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Flame retardants have been associated with endocrine disorders, thyroid disruption, reproductive toxicity, and immunological interference. Through dismantling and recycling electronics and electric products, flame retardants can be released into the air and settle on work surfaces which may lead to dermal exposure. Hand wipe sampling is commonly used to evaluate dermal exposure. This study assesses the removal efficiency of wipes on the hands of recycling employees, and to compare the efficacy of two common surface wipe sampling materials. We used three sequential hand wipes and quantified the percentage of flame retardants that was removed by each hand wipe in the sequence. Two common wipe materials (gauze and twill) were used to compare the ability to remove flame retardants. The wipes were collected from 12 employees at a U.S. electronics recycling facility immediately at the end of their shift, prior to washing their hands. Results show that although the first wipe removed the highest median percent of the sum of the three wipes for most flame retardants, there was a wide range of the percentages of total individual flame retardants removed by both gauze (4%-98%) or twill hand wipe (1%-89%). Approximately half of the flame retardants a high percentage (>50%) removed by the second and third wipes. This suggests that a single wipe is not sufficient to characterize the extent of dermal contamination. The average of the total amount of flame retardants removed by twill wipes was greater than the average using gauze, but the difference was not statistically significant.

Coaches spend long hours training gymnasts of all ages aided by polyurethane foam used in loose blocks, mats, and other padded equipment. Polyurethane foam can contain flame retardant additives such as polybrominated diphenyl ethers (PBDEs), to delay the spread of fires. However, flame retardants have been associated with endocrine disruption and carcinogenicity. The National Institute for Occupational Safety and Health (NIOSH) evaluated employee exposure to flame retardants in four gymnastics studios utilized by recreational and competitive gymnasts. We evaluated flame retardant exposure at the gymnastics studios before, during, and after the replacement of foam blocks used in safety pits with foam blocks certified not to contain several flame retardants, including PBDEs. We collected hand wipes on coaches to measure levels of flame retardants on skin before and after their work shift. We measured flame retardant levels in the dust on window glass in the gymnastics areas and office areas, and in the old and new foam blocks used throughout the gymnastics studios. We found statistically higher levels of 9 out of 13 flame retardants on employees' hands after work than before, and this difference was reduced after the foam replacement. Windows in the gymnastics areas had higher levels of 3 of the 13 flame retardants than windows outside the gymnastics areas, suggesting that dust and vapor containing flame retardants became airborne. Mats and other padded equipment contained levels of bromine consistent with the amount of brominated flame retardants in foam samples analyzed in the laboratory. New blocks did not contain PBDEs, but did contain the flame retardants 2-ethylhexyl 2,3,4,5-tetrabromobenzoate and 2-ethylhexyl 2,3,4,5-tetrabromophthalate. We conclude that replacing the pit foam blocks eliminated a source of PBDEs, but not 2-ethylhexyl 2,3,4,5-tetrabromobenzoate and 2-ethylhexyl 2,3,4,5-tetrabromophthalate. We recommend ways to further minimize employee exposure to flame retardants at work and acknowledge the challenges consumers have identifying chemical contents of new products. Keywords: Flame retardants, Foam, Gymnastics, Organophosphate flame retardants, Hand wipes, Polybrominated flame retardants

In January 2011 the National Institute for Occupational Safety and Health (NIOSH) received a request from three employees in the inpatient oncology unit of a university hospital in Wisconsin concer...

Many metals found in electronic scrap are known to cause serious health effects, including but not limited to cancer and respiratory, neurologic, renal, and reproductive damage. The National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention performed three health hazard evaluations at electronic scrap recycling facilities in the U.S. to characterize employee exposure to metals and recommend control strategies to reduce these exposures. We performed air, surface, and biological monitoring for metals. We found one overexposure to lead and two overexposures to cadmium. We found metals on non-production surfaces, and the skin and clothing of workers before they left work in all of the facilities. We also found some elevated blood lead levels (above 10 micrograms per deciliter), however no employees at any facility had detectable mercury in their urine or exceeded 34% of the OELs for blood or urine cadmium. This article focuses on sampling results for lead, cadmium, mercury, and indium. We provided recommendations for improving local exhaust ventilation, reducing the recirculation of potentially contaminated air, using respirators until exposures are controlled, and reducing the migration of contaminants from production to non-production areas. We also recommended ways for employees to prevent taking home metal dust by using work uniforms laundered on-site, storing personal and work items in separate lockers, and using washing facilities equipped with lead-removing cleaning products.

The National Institute for Occupational Safety and Health (NIOSH) surveyed a randomly selected sample of electronic scrap (e-scrap) recycling facilities nationwide to characterize work processes, exposures, and controls. Despite multiple attempts to contact 278 facilities, only 47 responded (17% response rate). Surveyed facilities reported recycling a wide variety of electronics. The most common recycling processes were manual dismantling and sorting. Other processes included shredding, crushing, and automated separation. Many facilities reported that they had health and safety programs in place. However, some facilities reported the use of compressed air for cleaning, a practice that can lead to increased employee dust exposures, and some facilities allowed food and drinks in the production areas, a practice that can lead to ingestion of contaminants. Although our results may not be generalizable to all US e-scrap recycling facilities, they are informative regarding health and safety programs in the industry. We concluded that e-scrap recycling has the potential for a wide variety of occupational exposures particularly because of the frequent use of manual processes. On-site evaluations of e-scrap recyclers are needed to determine if reported work processes, practices, and controls are effective and meet current standards and guidelines. Educating the e-scrap recycling industry about health and safety best practices, specifically related to safe handling of metal dust, would help protect employees.

Recently there has been increased attention among both the public and health professionals regarding the potential role of mycotoxins, primarily from fungi of the genus Stachybotrys, as etiologic agents related to illness among persons exposed in the indoor (nonindustrial) environment. Recommendations for the remediation of buildings are being made based in part on reported health effects believed to be due to mycotoxins. A search of NIOSHTIC (a literature database maintained by the National Institute for Occupational Safety and Health) and MEDLINE (from 1965 to present) for literature related to fungi, mycotoxins, and the indoor environment was conducted. References from relevant articles also were reviewed. This strategy yielded a total of 13 articles. Important issues concerning exposure assessment and case definitions are inadequately addressed in the literature reviewed, making it difficult to implicate mycotoxins as a cause of building-related illness. The literature review indicates that currently there is inadequate evidence supporting a causal relationship between symptoms or illness among building occupants and exposure to mycotoxins. Research involving the identification and isolation of specific fungal toxins in the environment and in humans is needed before a more definitive link between health outcomes and mycotoxins can be made.

The National Institute for Occupational Safety and Health (NIOSH) received a request from the United States Fish and Wildlife Service (FWS) to determine if there is a relationship between acoustic neuroma and fish hatchery work. The request was triggered by a report from an FWS employee who suspected the possibility of such an association. Investigators used data provided by the personnel office of the FWS to calculate the incidence of acoustic neuroma among fish hatchery workers, and then to compare it with national rates. Four confirmed cases of acoustic neuroma were found among former fish hatchery workers. The overall incidence was estimated to be 15.41 per 100,000 person-years. This rate is more than 15 times higher than the rate among the general population. Even so, the small number of cases, as well as other factors, preclude the NIOSH from concluding that there is a definite cause-and-effect relationship. Further study is warranted.

The disaster environment frequently presents rapidly evolving and unpredictable hazardous exposures to emergency responders. Improved estimates of exposure and effect from biomonitoring can be used to assess exposure–response relationships, potential health consequences, and effectiveness of control measures. Disaster settings, however, pose significant challenges for biomonitoring. A decision process for determining when to conduct biomonitoring during and following disasters was developed. Separate but overlapping decision processes were developed for biomonitoring performed as part of occupational health investigations that directly benefit emergency responders in the short term and for biomonitoring intended to support research studies. Two categories of factors critical to the decision process for biomonitoring were identified: Is biomonitoring appropriate for the intended purpose and is biomonitoring feasible under the circumstances of the emergency response? Factors within these categories include information needs, relevance, interpretability, ethics, methodology, and logistics. Biomonitoring of emergency responders can be a valuable tool for exposure and risk assessment. Information needs, relevance, and interpretability will largely determine if biomonitoring is appropriate; logistical factors will largely determine if biomonitoring is feasible. The decision process should be formalized and may benefit from advance planning.

Background The National Institute for Occupational Safety and Health (NIOSH) conducted a health hazard evaluation (HHE) of a water-damaged school in New Orleans (NO), Louisiana. Our aim in this evaluation was to document employee health effects related to exposure to the water-damaged school, and to determine if VCS testing could serve as a biomarker of effect for occupants who experienced adverse health effects in a water-damaged building. Methods NIOSH physicians and staff administered a work history and medical questionnaire, conducted visual contrast sensitivity (VCS) testing, and collected sticky-tape, air, and dust samples at the school. Counting, culturing, and/or a DNA-based technology, called mold-specific quantitative PCR (MSQPCR), were also used to quantify the molds. A similar health and environmental evaluation was performed at a comparable school in Cincinnati, Ohio which was not water-damaged. Results Extensive mold contamination was documented in the water-damaged school and employees (n = 95) had higher prevalences of work-related rashes and nasal, lower respiratory, and constitutional symptoms than those at the comparison school (n = 110). VCS values across all spatial frequencies were lower among employees at the water-damaged school. Conclusions Employees exposed to an extensively water-damaged environment reported adverse health effects, including rashes and nasal, lower respiratory, and constitutional symptoms. VCS values were lower in the employees at the water-damaged school, but we do not recommend using it in evaluation of people exposed to mold. Am. J. Ind. Med. 55:844–854, 2012. This article is a U.S. Government work and is in the public domain in the USA.

Objective: To evaluate both the cholinesterase monitoring program and newer field methods of determining coumaphos exposure among tick eradication workers. Methods: Measured blood cholinesterase by the Ellman and field testing methods and tested urine for chlorferon pre- and postshift; conducted personal air sampling, patch sampling of clothing, and wipe sampling of hands for coumaphos. Results: Fifteen workers had normal plasma cholinesterase and acetylcholinesterase levels. No significant changes occurred pre- to postshift. High correlation was found between plasma cholinesterase and acetylcholinesterase levels by field testing and Ellman methods (r = 0.91, P < 0.01 and r = 0.63, P < 0.01, respectively). Chlorferon levels rose 4 to 6 hours after use (P < 0.01). Airborne coumaphos was detected in only one sample, in a trace amount. The majority of patch and hand wipe samples detected coumaphos. Conclusions: Dermal exposure to coumaphos resulted in significant increases in urinary metabolites of coumaphos.

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. Am. J. Ind. Med. 49:119–126, 2006. Published 2006 Wiley-Liss, Inc.

Objective To review and summarize current evidence regarding the proper role of immunoassays in clinical assessments of exposure to fungi and health effects related to fungal exposure. Data Sources We reviewed relevant scientific investigations and previously published reviews concerning this topic. Study Selection The authors' clinical, laboratory, and public health experiences were used to evaluate relevant data for scientific merit. Results Testing to determine the presence of IgE to specific fungi may be a useful component of a complete clinical evaluation in the diagnosis of illnesses that can be caused by immediate hypersensitivity such as allergic rhinitis and asthma. Detection of IgG to specific fungi has been used as a marker of exposure to agents that may cause illnesses such as hypersensitivity pneumonitis. However, the ubiquitous nature of many fungi and the lack of specificity of fungal antigens limit the usefulness of these types of tests in the evaluation of potential building-related illness and fungal exposure. Specific serologic tests (such as tests for cryptococcal antigen, coccidioidal antibody, and Histoplasma antigen) have been shown to be useful in the diagnosis of some fungal infections, but these are the exception not the rule. Conclusions There is currently not enough scientific evidence to support the routine clinical use of immunoassays as a primary means of assessing environmental fungal exposure or health effects related to fungal exposure. Health care providers who care for persons expressing concerns about the relationship of symptoms to potential exposure to fungi are advised to use immunoassay results with care and only as an adjunct to a comprehensive approach to patient care.

Background Two workers from a headlight subassembly plant developed severe peripheral neuropathy. These workers had extensive, but brief (1–2 months) dermal and inhalational exposure to nitromethane, a solvent. Methods Environmental sampling was performed for nitromethane and ethyl cyanoacrylate. Medical records, including electrodiagnostic studies, were reviewed. Literature on nitromethane, ethyl cyanoacrylate, and other exposures in the workplace was reviewed. Results Electromyography and nerve conduction studies performed on these patients were consistent with a severe, axonal neuropathy. No etiology was discovered despite an extensive medical evaluation. Environmental sampling revealed exposure to nitromethane at the threshold limit value. Conclusions The history of acute onset of severe peripheral neuropathy temporally associated with exposure to nitromethane is suggestive of a toxic neuropathy. While it cannot be definitively concluded that these two workers developed peripheral neuropathy secondary to exposures at work, occupational exposure to nitromethane appears to be the most likely etiology. Am. J. Ind. Med. 40:107–113, 2001. © 2001 Wiley-Liss, Inc.

Exposure to natural rubber latex may cause immediate hypersensitivity reactions. Published latex sensitization prevalence rates range from 2.9% to 22% among health care workers, and from 0.12% to about 20% of occupationally unexposed populations. In this study, self-administered questionnaires addressed job and personal characteristics, glove use, and symptoms in two groups of hospital workers: those who regularly used latex gloves and those who did not. Serum was tested for latex-specific immunoglobulin E. Air, surface, and air-filter dust samples for natural rubber latex were collected. The prevalence of latex sensitization was 6.3% in the non-users and 6.1% in the latex glove users (P = 0.9); 81.3% of sensitized workers were atopic compared with 59.5% of non-sensitized workers (P < 0.05). Reporting of work-related hand dermatitis was more common in the latex glove users (23.4%) than in the non-users (4.9%), as were rhino-conjunctivitis (16.3% and 7.9%, respectively, [P < 0.01]), and hand urticaria (9.9% and 2.1%, respectively, [P < 0.01]). There was no significant difference in work-related symptoms between the sensitized and non-sensitized workers. Environmental concentrations of latex were higher in the work areas of the non-sensitized workers, but higher in the clinical than in the non-clinical areas. Occupational latex glove use was not a risk factor for sensitization.

As part of a health hazard evaluation (HHE), the National Institute for Occupational Safety and Health (NIOSH) performed a study at a commercial bakery designed to evaluate allergic sensitization to bakery associated allergens (BAA; alpha-amylase, [AA]; wheat, [W], or flour dust, [FD]). Sera was obtained from 96 employees, dichotomized as having low exposure (N=33) or high (or past) exposure (N=63) to BAA. Workers were evaluated for atopy (AlaTOP®, total IgE), and serum-specific IgE (AA, FD, and W; IMMULITE® 2000). There was no significant difference in the prevalence of atopy between groups by AlaTOP® (47% of high exposure vs. 41% of low exposure, p=0.6) or total IgE (3.9 kU/L [high exposure] compared to 3.7 kU/L [low exposure], p=0.5). At an IMMULITE® specific IgE cutoff of > 0.35 kU/L, there was significantly greater prevalence of positive specific IgE to W. When an IMMULITE® positive cutoff of >0.10 was used, significantly greater prevalence (p