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Retention of the home care (HC) aide workforce is essential to meet the needs of our aging population. Some studies suggest that improving HC safety could increase job retention. This study objective was to explore qualitatively the connection between aide and client safety and factors impacting this care relationship. Data consisted of audio-recorded, verbatim responses to open-ended questions of two focus groups with aides ( n = 10), two in-person interviews with HC agency managers, and 37 phone interviews with those working in (aides, n = 16; managers, n = 12) and receiving (clients, n = 9) HC. Clients reported home layout and accessibility as safety concerns. Aides and managers reported that client family members can make the care job more challenging. The aide-client connection was affected by communication style, family and HC agency support, allotted care time, and job task boundaries. Interventions that address the safety of both clients and aides can influence HC job satisfaction and retention.

Background Home care (HC) services are crucial to the health and social wellbeing of older adults, people with disabilities, and the chronically ill. Although the HC sector is growing rapidly in the USA, there is high job turnover among the HC aide workforce. HC provides an important alternative to facility-based care, yet it has often been overlooked within the larger health care system: most recently, in COVID-19 pandemic planning. The objective of the study was to characterize qualitatively the impact of the COVID-19 pandemic on three key HC stakeholders: clients, aides, and agency managers. Methods The study included 37 phone interviews conducted during April – November 2020: HC clients (n = 9), aides (n = 16), and agency managers (n = 12). All interviews were audio recorded and transcribed verbatim. Qualitative analysis of the transcripts followed the grounded theory approach. The interview transcriptions were coded line-by-line into hierarchical themes with NVivo 12 software which allowed weighting of themes based on the number of interviews where they were coded. Results Fear of infection and transmission among HC clients and aides were strong themes. Infection prevention and control became the top priority guiding day-to-day business operations at agencies; sourcing adequate personal protective equipment for staff was the most urgent task. HC aides expressed concerns for their clients who showed signs of depression, due to increased isolation during the pandemic. The disappearance of comforting touch – resulting from physical distancing practices – altered the expression of compassion in the HC aide-client care relationship. Conclusions The findings suggest that the pandemic has further increased psychosocial job demands of HC aides. Increased isolation of clients may be contributing to a wider public health problem of elder loneliness and depression. To support the HC stakeholders during the on-going COVID-19 pandemic, for future pandemic planning or other health emergencies, it is important to improve HC aide job retention. This action could also ease the serious care services shortage among the growing population of older adults.

Home care (HC) aide visits to clients' homes often involve cleaning and disinfecting (CD) bathrooms. Some ingredients in CD household products are associated with respiratory illness, including sodium hypochlorite (bleach) and quaternary ammonium compounds (quats). "Green" products may be safer for the environment, however there are limited quantitative evaluations of their respiratory risks. This study assessed airborne concentrations and time profiles of total volatile organic compounds (TVOC) and chlorine generated during typical bathroom cleaning performed by aides using conventional and green products. Aides performed cleaning tasks in a simulated residential bathroom constructed in an environmental air sampling laboratory. A balanced experimental design involved each aide coming to the lab for four visits during which she performed two 20-min cleaning sessions using one of three CD products (bleach-based, 1-5% sodium hypochlorite by weight; quats-based, 0.1-1% by weight quaternary ammonium compounds; and "green," 0.05% by weight thymol, a component of botanical thyme oil) or distilled water as a control. TVOC and chlorine direct reading instruments were attached to aides with sample inlets located in the breathing zone. Ten-second averages of TVOC and chlorine gas concentrations and instantaneous peak concentrations were recorded for the sessions' duration. TVOC concentrations by methods of CD application (spraying, streaming, wiping) also were evaluated. The study completed 169 air sampling sessions with 22 aides. The quats-based product generated more than twice the average TVOC concentrations (mean = 1,210 ppb) than the bleach-based (mean = 593 ppb) or green (mean = 498 ppb) products. Each product generated TVOC concentrations that rose rapidly within the first few minutes of application. Spraying produced the highest TVOC exposures, wiping the lowest. Thirteen aides (65%) experienced peak chlorine exposures above the OSHA PEL ceiling limit (1 ppm) when using the bleach-based product. HC aides may experience respiratory hazards from use of conventional or green CD products formulated with bleach or other respiratory irritants and sprayed in small, poorly ventilated spaces typical of bathrooms. Spraying should be avoided.

Purpose of Review To identify important home care (HC) aide occupational safety and health (OSH) hazards and examine how addressing these can improve aide health and the delivery of HC services overall. Specifically, this review seeks to answer: Why is HC aide OSH important? What are the most significant OSH challenges? How can improving HC aide OSH also improve the safety and health of their clients? What implications do the findings have for future research? Recent Findings HC is one of the fastest growing US industries. Aides comprise its largest workforce and are increasingly needed to care for the rapidly aging population. There is an aide shortage due in part to instabilities in HC work organization and to serious job-specific hazards, resulting in aides losing work time. Recent social, economic, and technological factors are rapidly changing the nature of HC work, creating OSH hazards similar to those found in nursing homes. At the same time, aides are experiencing social and economic inequities that increase their vulnerability to OSH hazards. These hazards are also a burden on employers who are challenged to recruit, retain, and train aides. OSH injuries and illness interrupt the continuity of care delivery to clients. Many OSH hazards also put HC clients and families at risk. Summary A new framework and methodologies are needed to assess aide and client safety together in order to guide future HC research, policies, and practices. Government, industry, and labor commitment is needed to fund and coordinate a comprehensive, multidisciplinary research program.

Home health and home care (HH&HC) agencies provide essential medical and supportive services to elders and people with disabilities, enabling them to live at home. Home-based care is an important alternative to facility-based care, especially for infection prevention during the COVID-19 pandemic. The majority of the HH&HC workforce is comprised of aides, who also are vulnerable to COVID-19. There are limited data on the COVID-19 experience of HH&HC agencies, clients and aides. A survey of Massachusetts HH&HC agency managers was conducted June 1 to 30, 2020 to assess the impact of COVID-19 on agencies, clients, and aides early in the pandemic and to identify needs for future pandemic planning. Of the 94 agencies with completed surveys, most (59.6%) provided services to clients with COVID-19 and 3-quarters (73.7%) employed aides who tested positive for COVID-19, were symptomatic, and/or quarantined. Most agencies (98.7%) experienced a decrease in demand for home visits, reflecting clients’ concern about infection, family members assuming care duties, and/or aides being unavailable for work. Simultaneously, managers’ workloads increased to develop more extensive infection prevention policies, procedures and workforce training and sourcing scarce personal protective equipment (PPE). The COVID-19 pandemic imposed substantial new infection prevention responsibilities on HH&HC agencies, clients, and aides. Specific HH&HC needs for future pandemic planning include complete information on the infection status of clients; ready access to affordable PPE and disinfectants; and guidance, tools, and training tailored for the industry. HH&HC should be incorporated more fully into comprehensive healthcare and public health pandemic planning.

INTRODUCTION Home care (HC) aide is among the fastest-growing jobs. Aides often work in long-term care relationships with elders or people with disabilities in clients' homes, assisting with daily activities. The purpose of this mixed-methods paper is to elucidate aides' experiences around the boundary-challenging behaviors of clients asking for services beyond aides' job duties and to identify possible interventions. METHODS A cross-sectional survey of HC aides in Massachusetts (n = 1249) provided quantitative data. Post-survey qualitative data were collected from nine HC aide focus groups (n = 70) and seven in-depth interviews with HC industry and labor representatives. RESULTS Quantitatively, aides who reported often being asked to do tasks outside their job duties were more likely to report abuse (prevalence ratio [PR] = 1.93; 95%CI: 1.47-2.52 for verbal, PR = 1.81; 95%CI: 1.13-2.91 for physical/sexual) and pain/injury with lost work time or medical care (PR = 1.58; 95%CI: 1.11-2.25). They were also less likely to want to remain in their job (PR = 0.94; 95%CI: 0.89-1.00) or recommend it to others (PR = 0.94; 95%CI: 0.90-0.98). Qualitative data showed that clients' requests for tasks beyond job duties were frequent and can lead to injuries, abuse, and psychosocial stress. Yet, requests often reflected genuine need. Helping clients stay at home, compassion, and feeling appreciated contributed to job satisfaction; therefore, aides can feel conflicted about refusing requests. CONCLUSION Client task requests outside HC services are a complex problem. Employer support, training, care plans, and feeling part of a care team can help aides navigate professional boundaries while delivering high quality care.

ObjectiveViolence from care recipients and family members, including both verbal and physical abuse, is a serious occupational hazard for healthcare and social assistance workers. Most workplace violence studies in this sector focus on hospitals and other institutional settings. This study examined verbal abuse in a large home care (HC) aide population and evaluated risk factors.MethodsWe used questionnaire survey data collected as part of a larger mixed methods study of a range of working conditions among HC aides. This paper focuses on survey responses of HC aides (n=954) who reported on verbal abuse from non-family clients and their family members. Risk factors were identified in univariate and multivariable analyses.ResultsTwenty-two per cent (n=206) of aides reported at least one incident of verbal abuse in the 12 months before the survey. Three factors were found to be important in multivariable models: clients with dementia (relative risk (RR) 1.38, 95% CI 1.07 to 1.78), homes with too little space for the aide to work (RR 1.52, 95% CI 1.17 to 1.97) and predictable work hours (RR 0.74, 95% CI 0.58 to 0.94); two additional factors were associated with verbal abuse, although not as strongly: having clients with limited mobility (RR 1.35, 95% CI 0.94 to 1.93) and an unclear plan for care delivery (RR 1.27, 95% CI 0.95 to 1.69). Aides reporting verbal abuse were 11 times as likely to also report physical abuse (RR 11.53; 95% CI 6.84 to 19.45).ConclusionsVerbal abuse is common among HC aides. These findings suggest specific changes in work organisation and training that may help reduce verbal abuse.

ObjectivesExcessive heat exposure poses significant risks to workers in hot climates. This study assessed the intensity and duration of heat stress exposure among workers performing residential construction in southeastern Saudi Arabia (SA) during the summer, June–September 2016. Objectives were to: identify work factors related to heat stress exposure; measure environmental heat exposure at the construction sites; assess the heat stress risk among workers using the wet bulb globe temperature (WBGT) index; and determine if temperature-humidity indices can be appropriate alternatives to WBGT for managing heat stress risk at the construction sites.MethodsWorksite walkthrough surveys and environmental monitoring were performed, indoors and outdoors, at 10 construction sites in Al-Ahsa Province. A heat stress exposure assessment was conducted according to the American Conference of Governmental Industrial Hygienists (ACGIH®) guidelines, which uses the WBGT index. WBGT measurements from two instruments were compared. Alternative heat stress indices were compared to the WBGT: the heat index (HI) and humidex (HD) index.ResultsConstruction workers were exposed to excessive heat stress, indoors and outdoors over a large part of the work day. Complying with a midday outdoor work ban (12–3 p.m.) was not effective in reducing heat stress risk. The highest intensity of exposure was outdoors from 9 a.m. to 12 p.m.; a period identified with the highest hourly mean WBGT values (31–33°C) and the least allowable working time according to ACGIH® guidelines. Comparison of the alternative indices showed that the HI is more reliable than the HD as a surrogate for the WBGT index in the climate studied.ConclusionThe extreme heat exposure represents a serious risk. The severity of heat stress and its impact are projected to increase due to climate change, emphasizing the need for immediate improvement of the current required protective measures and the development of occupational heat stress exposure guidelines in SA.

Background Precarious work is a broad definition for non-standard employment, often including unstable and insecure positions where workers permanently experience uncertainty; these types of jobs are growing steadily around the planet. Since the coup d’état in 1973, Chile has experienced a series of structural economic changes framed by neoliberal ideas cemented in the “Constitution of Pinochet.” Precarious work in Chile is a direct consequence of these ideas. This multidimensional phenomenon has progressively been entering employment areas where it was not previously present. As a result, there has been a rise in work precarization and its full impact on health is not well known. The goal of this study was to estimate the association of work precariousness with mental health outcomes in Chilean workers. Methods Data were obtained from the Chilean Survey of Work and Health 2009–2010 (ENETS). Only valid records of salaried workers (excluding hourly-only or commission-only workers) in the private sector without missing values were included (n = 1900). After applying appropriate sampling weights, 1,461,727 workers were represented. Mental health was estimated as anxiety/depression levels using the 12-item General Health Questionnaire (GHQ-12). A multilevel multivariate generalized linear mixed model (GLMM) with negative binomial and log link distribution was used to study the association between precariousness and depression/anxiety. Results Looking at the overall precariousness scale (range from zero to four), we observed an increase of approximately 34% in the depression/anxiety score (scale range from 0 to 36) for every unit on the precarious work overall scale (Relative Risk = 1.34, 95% CI = 1.28, 1.42) controlling for age, sex, and occupational group. Conclusion Precarious work was associated with anxiety and depression as measured with the 12-item General Health Questionnaire. Controlling for demographic variables changed neither the direction nor the magnitude of the association.

Saudi Arabia (SA) is one of the hottest countries in the world. This study was conducted to assess the impact of summer heat stress in Southeastern SA on short-term kidney injury (KI) among building construction workers and to identify relevant risk factors. Measurements of urinary albumin-creatinine ratio (ACR), height, weight, hydration, symptoms, daily work and behavioral factors were collected in June and September of 2016 from a cohort of construction workers (n = 65) in Al-Ahsa Province, SA. KI was defined as ACR &ge, 30 mg/g. Multivariate linear regression analysis was used to assess factors related to cross-summer changes in ACR. A significant increase in ACR occurred among most workers over the study period, incidence of KI was 18%. Risk factors associated with an increased ACR included dehydration, short sleep, and obesity. The findings suggest that exposure to summer heat may lead to the development of KI among construction workers in this region. Adequate hydration and promotion of healthy habits among workers may help reduce the risk of KI. A reduction in work hours may be the most effective intervention because this action can reduce heat exposure and improve sleep quality.

Background Home care aides perform personal care and homemaking services in client homes, including cleaning and disinfection (C&D). Although C&D are performed to remove soil and dust, they are increasingly performed for infection prevention. Many C&D products contain respiratory irritants. The objective of this study was to evaluate 2 commercial products for C&D effectiveness on common household surfaces in seniors' homes. Methods Two C&D visits were conducted in 46 seniors' homes. One visit applied a bleach-containing cleaning product and the other applied an environmentally preferable product. Before and after C&D, the study team performed organic soil bioluminometer measurements on surfaces and collected cotton swab and wipe samples for total bacteria count, Staphylococcus aureus, and Clostridium difficile identification. Results Both products removed microorganisms from tested surfaces. S aureus was found in 7 households, 1 strain of which was methicillin-resistant. Both products removed S aureus from all surfaces. Bleach-containing products removed somewhat more soil than environmentally preferable products, although results were statistically significant for only 1 surface. Conclusions The study showed similar, not identical, C&D performance for 2 cleaning products with potentially different consequences for respiratory health. Additional research is needed to develop robust recommendations for safe, effective C&D in home care.

Objective To evaluate all available literature and develop a pooled estimate of the risk of sharps injuries (SI) among home care (HC) nurses and aides. Methods A systematic literature search was conducted and relevant articles were reviewed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Primary outcome data from studies identified by the systematic review were pooled using a random effects model to calculate a summary measure of SI risk for nurses and for aides. Results Five articles were included in the final analysis. Nurses had a 5.25% weighted average risk of experiencing at least one SI in the past year while working in HC (95% confidence interval [CI]: 3.11% to 7.40%); aides pooled SI risk was 1.74% (95% CI: 0.72% to 2.77%). Conclusions Combining findings of all available studies demonstrates that there is a serious risk of SI among both the HC nurses and aides.

Objectives Home care (HC) aides constitute an essential, rapidly growing workforce. Technology advances are enabling complex medical care at home, including procedures requiring the percutaneous use of sharp medical devices, also known as sharps. Objectives were to quantify risks of sharps injuries (SI) in a large HC aide population, compare risks between major occupational groups, and evaluate SI risk factors. Methods A questionnaire survey was administered to aides hired by HC agencies and directly by clients. One thousand one hundred seventy-eight aides completed questions about SI and potential risk factors occurring in the 12 months before the survey. SI rates were calculated and Poisson regression models identified risk factors. Results Aides had a 2% annual risk of experiencing at least 1 SI (95% confidence interval [CI], 1.1-2.6). Client-hired aides, men, and immigrants had a higher risk than their counterparts. Risk factors among all HC aides included helping a client use a sharp device (rate ratio [RR], 5.62; 95% CI, 2.75-11.50), observing used sharps lying around the home (RR, 2.68; 95% CI, 1.27-5.67), and caring for physically aggressive clients (RR, 2.82; 95% CI, 1.36-5.85). Conclusions HC aides experience serious risks of SI. Preventive interventions are needed, including safety training for clients and their families, as well as aides.

Objectives Assess the impact of summer heat exposure (June–September) on residential construction workers in Al-Ahsa, Saudi Arabia by evaluating (i) heart rate (HR) responses, hydration status, and physical workload among workers in indoor and outdoor construction settings, (ii) factors related to physiological responses to work in hot conditions, and (iii) how well wet-bulb globe temperature-based occupational exposure limits (WBGTOELs) predict measures of heat strain. Methods Twenty-three construction workers (plasterers, tilers, and laborers) contributed 260 person-days of monitoring. Workload energy expenditure, HR, fluid intake, and pre- and postshift urine specific gravity (USG) were measured. Indoor and outdoor heat exposures (WBGT) were measured continuously and a WBGTOEL was calculated. The effects of heat exposure and workload on heart rate reserve (HRR), a measure of cardiovascular strain, were examined with linear mixed models. A metric called ‘heat stress exceedance’ (HSE) was constructed to summarize whether the environmental heat exposure (WBGT) exceeded the heat stress exposure limit (WBGTOEL). The sensitivity and specificity of the HSE as a predictor of cardiovascular strain (HRR ≥30%) were determined. Results The WBGTOEL was exceeded frequently, on 63 person-days indoors (44%) and 91(78%) outdoors. High-risk HRR occurred on 26 and 36 person-days indoors and outdoors, respectively. The HSE metric showed higher sensitivity for HRR ≥30% outdoors (89%) than indoors (58%) and greater specificity indoors (59%) than outdoors (27%). Workload intensity was generally moderate, with light intensity work more common outdoors. The ability to self-pace work was associated with a lower frequency of HRR ≥30%. USG concentrations indicated that workers began and ended their shifts dehydrated (USG ≥1.020). Conclusions Construction work where WBGTOEL is commonly exceeded poses health risks. The ability of workers to self-pace may help reduce risks.

Introduction In the United States, home care (HC) aide is one of the fastest growing jobs. Aides perform both personal care and cleaning and disinfection (C and D) tasks in the clients’ homes. There is clear scientific evidence of asthma and other respiratory effects with C and D work. This presentation demonstrates how mixed research methods assessed the nature of C and D work and health-related exposures in HC. Methods The Safe Home Care Project conducted 9 focus groups comprising 80 HC aides and 5 in-depth interviews with HC employers’ and workers’ representatives. All focus groups and interviews were audio-recorded and transcribed verbatim. Computer-assisted thematic analysis of all transcripts was conducted. The results informed the development of (i) the microbiology field study in 46 seniors’ homes to measure micro-organisms and soil on common household surfaces and how effectively ‘green’ and bleach-containing products cleaned these surfaces, and (ii) the laboratory study to measure airborne C and D product exposures among HC aides (n=20) who performed C and D tasks in a simulated bathroom with 4 different products. Result HC aides sanitise bathrooms and kitchens frequently. Bleach-containing products are commonly applied and HC clients mostly decide which C and D products are used. The microbiology study showed that both ‘green’ and bleach-containing products removed micro-organisms on tested surfaces. The laboratory study showed that the bleach-containing cleaning product generated high airborne chlorine exposures: over 60% of the aides exceeded 1 ppm for chlorine -- a permissible exposure limit of the US Occupational Safety and Health Administration. Discussion Mixed methods research techniques provide complementary data for assessing and characterising C and D exposures in HC. Use of bleach-containing products can generate high airborne chlorine exposures. Chlorine is a respiratory irritant. It seems prudent to limit the unnecessary use of bleach in HC and carefully discern -- on a client-by-client basis -- whether bleach is needed for infection prevention.

Introduction By 2030 one billion people worldwide will be 65 years of age or older. While populations in industrially-developed countries are ageing rapidly, the most dramatic increases are occurring in developing countries. Because most elders prefer to be cared for at home, these profound demographic shifts are driving a global need for home care (HC) at an unprecedented rate. As a result, HC aide jobs are among the fastest growing occupations and yet their occupational safety and health (OSH) experience is nearly invisible. The Safe Home Care Project at the University of Massachusetts, Lowell USA, funded by the US National Institute for Occupational Safety and Health, was established to protect and promote the OSH of the HC workforce. Methods We used mixed methods ranging from focus groups to large scale OSH questionnaire surveys, microbiology field studies, and laboratory experimental studies of chemical, biologic, and biomechanical hazards. These studies were performed among HC aides and elders who are HC recipients. Results HC aides experience numerous OSH hazards similar to hospitals and nursing homes: back injuries from patient lifting; needlestick injuries; respiratory irritant exposures from cleaning and disinfecting; and serious encounters with violence from patients or family members. Aides also experience hazards not seen in institutional settings: exposure to second-hand smoke, risk of fire from patients smoking cigarettes while on oxygen, patients re-using needles for injections and storing them improperly, and lack of medical equipment for patient lifting. Overall, we found that high quality care delivery depends significantly on HC aide safety. Discussion HC aides need OSH protections. Despite OSH challenges, the great majority of aides report high job satisfaction due to meaningful relationships with patients and families and to the relative autonomy compared to institutional care work. Interventions should enhance these beneficial aspects of HC work as well as improve OSH.

Home care tasks, such as patient lifting and transferring, involve forceful exertions and awkward postures and may increase the risk of low back injury. Sixteen home care aides completed simulated client transfers between a bed and wheelchair using a manual transfer method and four transfer devices. Findings suggested that high (bed) to low (wheelchair) transfers produced significant lower hand forces than low to high transfers, while the hand forces using the Beasy board and the Tyvek board were less than the manual’s during transfers in both directions. Average trunk flexion speeds were significantly slower while using devices than using the manual method during these transfers. The usability survey suggests that the Beasy board required less exertion and would be preferred for future client visits.

Objectives In countries with ageing populations, home care (HC) aides are among the fastest growing jobs. There are few quantitative studies of HC occupational safety and health (OSH) conditions. The objectives of this study were to: (1) assess quantitatively the OSH hazards and benefits for a wide range of HC working conditions, and (2) compare OSH experiences of HC aides who are employed via different medical and social services systems in Massachusetts, USA. Methods HC aides were recruited for a survey via agencies that employ aides and schedule their visits with clients, and through a labour union of aides employed directly by clients or their families. The questionnaire included detailed questions about the most recent HC visits, as well as about individual aides’ OSH experiences. Results The study population included 1249 HC aides (634 agency-employed, 615 client-employed) contributing information on 3484 HC visits. Hazards occurring most frequently related to musculoskeletal strain, exposure to potentially infectious agents and cleaning chemicals for infection prevention and experience of violence. Client-hired and agency-hired aides had similar OSH experiences with a few exceptions, including use of sharps and experience of verbal violence. Conclusions The OSH experience of HC aides is similar to that of aides in institutional healthcare settings. Despite OSH challenges, HC aides enjoy caring for others and the benefits of HC work should be enhanced. Quantification of HC hazards and benefits is useful to prioritise resources for the development of preventive interventions and to provide an evidence base for policy-setting.

Background The Cleaning and Disinfecting in Healthcare Working Group of the National Institute for Occupational Safety and Health, National Occupational Research Agenda, is a collaboration of infection prevention and occupational health researchers and practitioners with the objective of providing a more integrated approach to effective environmental surface cleaning and disinfection (C&D) while protecting the respiratory health of health care personnel. Methods The Working Group, comprised of >40 members from 4 countries, reviewed current knowledge and identified knowledge gaps and future needs for research and practice. Results An integrated framework was developed to guide more comprehensive efforts to minimize harmful C&D exposures without reducing the effectiveness of infection prevention. Gaps in basic knowledge and practice that are barriers to an integrated approach were grouped in 2 broad areas related to the need for improved understanding of the (1) effectiveness of environmental surface C&D to reduce the incidence of infectious diseases and colonization in health care workers and patients and (2) adverse health impacts of C&D on health care workers and patients. Specific needs identified within each area relate to basic knowledge, improved selection and use of products and practices, effective hazard communication and training, and safer alternatives. Conclusion A more integrated approach can support multidisciplinary teams with the capacity to maximize effective and safe C&D in health care.

OBJECTIVETo estimate the summary effectiveness of different needle-stick injury (NSI)-prevention interventions.DESIGNWe conducted a meta-analysis of English-language articles evaluating methods for reducing needle stick, sharp, or percutaneous injuries published from 2002 to 2012 identified using PubMed and Medline EBSCO databases. Data were extracted using a standardized instrument. Random effects models were used to estimate the summary effectiveness of 3 interventions: training alone, safety-engineered devices (SEDs) alone, and the combination of training and SEDs.SETTINGHealthcare facilities, mainly hospitalsPARTICIPANTSHealthcare workers including physicians, midwives, and nursesRESULTSFrom an initial pool of 250 potentially relevant studies, 17 studies met our inclusion criteria. Six eligible studies evaluated the effectiveness of training interventions, and the summary effect of the training intervention was 0.66 (95% CI, 0.50–0.89). The summary effect across the 5 studies that assessed the efficacy of SEDs was 0.51 (95% CI, 0.40–0.64). A total of 8 studies evaluated the effectiveness of training plus SEDs, with a summary effect of 0.38 (95% CI, 0.28–0.50).CONCLUSIONTraining combined with SEDs can substantially reduce the risk of NSIs.Infect Control Hosp Epidemiol2015;36(7):823–829

The Safe Home Care Project investigated both qualitatively and quantitatively a range of occupational safety and health hazards, as well as injury and illness prevention practices, among home care aides in Massachusetts. This article reports on a hazard identified by aides during the study's initial focus groups: smoking by home care clients on long-term oxygen therapy. Following the qualitative phase we conducted a cross-sectional survey among 1,249 aides and found that medical oxygen was present in 9 percent of aide visits (314 of aides' 3,484 recent client visits) and that 25 percent of clients on oxygen therapy were described as smokers. Based on our findings, the Board of Health in a local town conducted a pilot study to address fire hazards related to medical oxygen. Medical oxygen combined with smoking or other sources of ignition is a serious fire and explosion hazard that threatens not only workers who visit homes but also communities.

Objectives While there is evidence of asthma and other respiratory illness among workers performing cleaning and disinfecting (C and D) of environmental surfaces in healthcare and in residential and institutional settings, quantitative measurements of C and D exposures are limited. Previously, we found that 80% of home care (HC) aide visits to clients’ homes involve C and D; commonly-used C and D products contain bleach, a respiratory irritant. Objectives of this study were to measure quantitatively airborne exposures generated during C and D tasks performed by HC aides using a bleach-containing product. The work reported here is part of a larger evaluation of exposures and respiratory effects of a range of C and D products and practices and their efficacy in reducing pathogens in HC. Methods A bathroom was constructed in a laboratory according to home building construction specifications. Twenty HC aides were recruited from employer agencies to perform C and D tasks for 20 min sessions in the bathroom following typical HC practices using a C and D spray product containing bleach (1%–5% by weight sodium hypochlorite). Aides wore a vest holding a direct-reading instrument to measure chlorine breathing-zone concentrations as they performed C and D on tub/shower, toilet, and sink. Results Maximum chlorine concentrations generated during the 20 min sessions ranged from 0.35ppm to 3.40ppm. The tub/shower C and D task produced the highest exposures. The US Occupational Safety and Health Administration ceiling limit for chlorine is 1 ppm; nearly 70% of the aides conducted a C and D session exceeding this value. Conclusions C and D in HC using a product containing bleach can produce over-exposure to chlorine, a respiratory irritant.

Background Home care (HC) aide is the fastest growing occupation, yet job hazards are under-studied. This study documents the context of HC aide work, characterizes occupational safety and health (OSH) hazards, and identifies preventive interventions using qualitative methods. Methods We conducted 12 focus groups among aides and 26 in-depth interviews comprising 15 HC agency, union, and insurance company representatives as well as 11 HC recipients in Massachusetts. All focus groups and interviews were audio-recorded, transcribed, and coded with NVIVO software. Results Major OSH concerns were musculoskeletal disorders from client care tasks and verbal abuse. Performing tasks beyond specified job duties may be an OSH risk factor. HC aides' safety and clients' safety are closely linked. Client handling devices, client evaluation, care plan development, and training are key interventions for both aides' and clients' safety. Conclusions Promoting OSH in HC is essential for maintaining a viable workforce. Am. J. Ind. Med. 57:445–457, 2014. © 2013 Wiley Periodicals, Inc.

Background Many newly constructed green buildings (GB) are certified using the United States Green Building Council (USGBC) Leadership in Energy and Environmental Design (LEED) rating system for new construction and major renovation which focuses on architectural and mechanical design to conserve energy, reduce environmental harm, and enhance indoor quality for occupants. This study evaluated the preventive maintenance (PM) worker occupational safety and health (OSH) risks related to the design of GB. Methods PM job hazard analyses (JHA) were performed on the tasks required to operate and maintain five GB features selected from 13 LEED certified GB. A 22-item JHA and OSH risk scoring system were developed. Results Potentially serious OSH hazards included: green roofs made of slippery material without fall protection; energy recovery wheels and storm water harvesting systems in confined spaces; skylights without guard rails; and tight geothermal well mechanical rooms constraining safe preventive practices. Conclusions GB can present PM OSH risks and these should be eliminated in the building design phase. Am. J. Ind. Med. 56:410–423, 2013. © 2013 Wiley Periodicals, Inc.

Objectives We developed a conceptual framework, called the Care Bond (CareBond), to describe the relationship between healthcare worker and patient safety during the delivery of care and how psychosocial, work organisational and other occupational safety and health (OSH) factors can impact this relationship. We applied the framework in a population of home care (HC) aides in order to: 1) determine whether the CareBond could be measured quantitatively and 2) test the hypothesis that OSH factors can influence the CareBond. Methods We developed the CareBond framework based on our previous studies and a review of the scientific literature. We evaluated the CareBond using a questionnaire in a cross-sectional survey of HC aides. Questionnaire responses used to measure dimensions of the CareBond were analysed using Principal Components Analysis; impacts of OSH factors on the CareBond were evaluated using Poisson regression. Results 1,249 HC Aides completed the questionnaire and contributed information on 3,484 patient care visits. Three major dimensions of the CareBond were identified: HC worker safety, patient safety and collaboration. OSH conditions that weakened the CareBond included lack of equipment for patient mobility, prevalence ratio (PR) = 0.94; 95% confidence interval (CI) = 0.90, 0.99; experiencing slip, trip and falling hazards during the patient care visit (PR = 0.68; CI = 0.57, 0.81); presence of uncontrolled pets (PR = 0.78; CI = 0.64, 0.94); catching a patient while falling (PR = 0.94; CI = 0.87, 1.02); caring for a patient on home dialysis (PR = 0.70; CI = 0.52, 0.95); requirement of mopping the floors during the patient care visit (PR = 0.94; CI = 0.89, 1.00); and exposure to faeces (PR = 0.90; CI = 0.84, 0.97). Conclusions The CareBond is a promising framework for characterising and quantifying the connexion between HC worker and patient safety. Factors that weaken the CareBond can be targeted for preventive interventions to improve OSH and quality of care.

Background and objectives Due to a rapidly ageing population, homecare (HC) aide is one of the fastest growing occupations in the USA. Exposures to occupational safety and health (OSH) hazards are challenging to evaluate in complex home-based care environments and among a mobile, socially diverse workforce. This presentation demonstrates how qualitative and quantitative research methods complement each other when assessing and characterising (i) multiple OSH hazards (ii) possible interventions, and (iii) dimensions of HC work that impact both HC aide and patient safety. Methods In Massachusetts, USA, we conducted 12 focus groups with HC aides and 26 in-depth interviews with HC agency managers, labour unionists, workers’ compensation representatives, and HC clients. All focus groups and interviews were audio-recorded and transcribed verbatim. Structured, computer-assisted thematic analysis of all transcripts was performed and the results guided a cross-sectional survey questionnaire design administered among HC aides (n = 1,249). Nine post-survey focus groups and seven interviews interpreted the quantitative survey findings and then informed a laboratory-based experimental design study to assess musculoskeletal strain in the use of assistive slide board devices among HC aides (N = 16). Results The qualitative and quantitative data showed that the most concerning OSH exposures among HC aides were client handling and mobility tasks associated with back injuries and other musculoskeletal disorders (MSDs), verbal abuse, falls inside and outside the home, clients on oxygen addicted to smoking, second-hand smoke, bloodborne pathogens, and use of strong cleaning chemicals. Ergonomic assistive devices to prevent MSDs and in-service trainings were assessed as the most promising short-term interventions. Post-survey focus groups and interviews provided interpretation of the quantitative exposure estimates, possible determinants, and recommendations for future research. Conclusions Combined qualitative and quantitative research techniques provide complementary data for more comprehensive characterisation of OSH exposures and intervention opportunities in complex work environments with a mobile, socially-diverse workforce.

Objectives While cleaning and disinfecting (C&D) are essential for infection prevention (IP) in healthcare, there is increasing evidence that C&D chemicals cause occupational respiratory illness. An international working group (WG) on C&D in healthcare was engaged by the U.S. National Institute for Occupational Safety and Health to identify research needs to develop an integrated framework for effective IP and occupational health (OH) protection for healthcare workers (Quinn, WG Co-Chair). This presentation describes the WG and a study of C&D among home care (HC) aides which was guided by WG recommendations. Study objectives were to: 1) identify the extent to which C&D is performed by HC aides, 2) assess C&D respiratory hazards, and 3) compare the effectiveness of conventional versus “green” C&D products to reduce pathogens in the home environment. Methods HC aides completed a survey including questions about C&D product use and respiratory hazards occurring during their HC visits. In an environmental laboratory, airborne exposures from C&D products were assessed during simulated cleaning tasks. In a microbiology laboratory, cleaning effectiveness (removal of soil) and disinfection effectiveness (reduction in microorganisms) on common household surface materials were compared using bleach, a “green” product, and a do-it-yourself (DIY) mixture. Results The survey population included 1,249 HC aides contributing information on 3,484 HC visits. Aides performed CD an additional 15% used other irritant chemicals. Environmental assessment of CD peak exposures to chlorine could exceed occupational exposure limits. Microbiology assessment found that bleach and a “green” product effectively removed soil and reduced E. coli and S. aureus; the DIY mixture was less effective. Conclusions An integrated IP-OH approach to assessing C&D exposures, as recommended by the WG, can provide more comprehensive prevention strategies.

Background Often in exposure assessment for epidemiology, there are no highly accurate exposure data and different measurement methods are considered. The objective of this study was to use various statistical techniques to explore agreement between individual reports and expert ratings of workplace exposures in several industries and investigate the sociodemographic influences on this agreement. Methods A cohort of 1,282 employees at 4 industries/14 worksites answered questions on workplace physical, chemical, and psychosocial exposures over the past 12 months. Occupational hygienists constructed job exposure matrices (JEMs) based on worksite walkthrough exposure evaluations. Worker self-reports were compared with the JEMs using multivariable analyses to explore discord. Results There was poor agreement between the self-reported and expert exposure assessments, but there was evidence that agreement was modified by sociodemographic characteristics. Several characteristics including gender, age, race/ethnicity, hourly wage and nativity strongly affected the degree of discord between self-reports and expert raters across a wide array of different exposures. Conclusions Agreement between exposure assessment tools may be affected by sociodemographic characteristics. This study is cross-sectional and therefore, a snapshot of potential exposures in the workplace. Nevertheless, future studies should take into account the social contexts within which workplace exposures occur. Am. J. Ind. Med. 53:1019–1031, 2010. © 2010 Wiley-Liss, Inc.

Background Sharps injuries (SI) and other blood/body fluid exposures (BBFE) present bloodborne pathogen risks for home healthcare (HHC) workers. While SI and BBFE are sufficiently frequent in HHC to be serious public health concerns, even moderately large surveys can still have insufficient power to identify risk factors. In this study, a new conceptual model for using near-misses for SI and BBFE was developed and its utility in statistical analyses of SI and BBFE risk factors was evaluated. Methods A survey of HHC nurses (n = 787) and aides (n = 282) gathered data on the numbers of SI, BBFE, and near-misses in the past year. Questions focused on the circumstances leading up to the SI, BBFE, and near-misses. After evaluating the hypothesis that near-misses and events lie along the same causal pathway, we combined these outcomes to estimate their association with an important risk factor: employment status. Results There were similar frequencies of risk factors for the events SI, BBFE, and their near-misses, suggesting that they may share common causal pathways. Combined data on events and near-misses confirmed our hypothesis that part-time and temporary HHC aides were at higher risk than full-timers. Conclusions Analyses combining injuries and near-misses may be useful in risk factor investigations. Am. J. Ind. Med. 53:1119–1127, 2010. © 2010 Wiley-Liss, Inc.

Aims and background Evidence of the association between leukemia and benzene exposure has been provided by several epidemiological studies. An increased risk of breast cancer among women exposed to benzene has also been suggested. The aim of this study was to analyze breast cancer risk in a cohort of 1,002 women exposed to benzene in a shoe factory in Florence, Italy, where an excess of leukemia in men was reported. Methods The cohort of women at work on January 1st, 1950, was followed from 1950 to 2003 for mortality and from 1985 to 2000 for incidence of breast cancer. For a sub-cohort of 797 women, cumulative exposure to benzene was available. Results Standardized mortality ratios were obtained for the 797 women for whom information on cumulative exposure was available. For those with 40 ppm-year and ≥30 year latency period category, the standardized mortality ratio was 166.0 (95% CI, 62.3–442.2, based on 4 deaths). The standardized incidence ratio for women with a latency period 40 ppm-years and a latency period Conclusions The study moderately supports the hypothesis that benzene represents a risk factor for breast cancer.

Research on societal determinants of health suggests the existence of an "inverse hazard law," which we define as: "The accumulation of health hazards tends to vary inversely with the power and resources of the populations affected." Yet, little empirical research has systematically investigated this topic, including in relation to workplace exposures. We accordingly designed the United for Health study (Greater Boston Area, Massachusetts, 2003-2004) to investigate the joint distribution and health implications of workplace occupational hazards (dust, fumes, chemical, noise, ergonomic strain) and social hazards (racial discrimination, sexual harassment, workplace abuse). Focusing on blood pressure as our health outcome, we found that among the 1202 low-income multi-racial/ethnic working class participants in our cohort - of whom 40% lived below the US poverty line - 79% reported exposure to at least one social hazard and 82% to at least one high-exposure occupational hazard. Only sexual harassment, the least common social hazard, was associated with elevated systolic blood pressure (SBP) among the women workers. By contrast, no statistically significant associations were detectable between the other additional highly prevalent social and occupational hazards and SBP; we did, however, find suggestive evidence of an association between SBP and response to unfair treatment, implying that in a context of high exposure, differential susceptibility to the exposure matters. These results interestingly contrast to our prior findings for this same cohort, in which we found associations between self-reported experiences of racial discrimination and two other health outcomes: psychological distress and cigarette smoking. Likely explanations for these contrasting findings include: (a) the differential etiologic periods and pathways involving somatic health, mental health, and health behaviors, and (b) the high prevalence of adverse exposures, limiting the ability to detect significant associations. As clarified by the "inverse hazard law," to understand health inequities, research is needed that contrasts exposures and health status population-wide, not just among those most inequitably exposed.

Home health care (HHC) is growing rapidly and yet health and safety conditions of HHC clinicians are poorly understood. Study of this workforce presents unique challenges because it is decentralised, often part-time and mobile. As part of a larger project on sharps injuries and blood exposures in HHC, this paper addresses the challenges of recruiting a large cohort of HHC nurses and aides and describes novel cross-sectional survey methodology. Recruitment was conducted with cooperation from eight HHC agencies and two labour unions. Intensive personal contacts and a financial incentive ($25) were employed. Some groups of HHC clinicians could be contacted only by mail, while others were contacted during a promotional “mini-fair” at their agency. A total of 1772, 18-page health and safety surveys were distributed and 1225 usable surveys were collected. This 69% overall response rate is better than that in many recent health surveys. Survey returns were highest (67—91%) where promotional events were held. The mailing-only strategy generated lower response rates (53—55%), despite the same financial incentive. Despite the challenges of reaching out to the decentralised HHC workforce, adequate response to a detailed health survey is possible, using appropriate techniques and with the close cooperation of employers and labour unions.

Home health care is one of the fastest growing industries in the United States. Approximately 20,000 provider agencies deliver home health care services to 7.6 million individuals with acute illness, long-term health conditions, permanent disability, or terminal illness. The home health care setting poses many challenges that likely increase the risk of sharps injuries. Home health nurses face unique challenges in preventing and reporting sharps injuries in the home. This article examines the nature of and risk factors for sharps injuries in the home health care setting, the scope of the problem, the legislative and regulatory framework relevant to sharps injuries, and the role of occupational health nurses in promoting a culture of safety to prevent sharps injuries and bloodborne pathogen exposures.

Objective— To evaluate the accuracy of numerical rating (NRS) and visual analogue (VAS) scoring scales compared with force plate gait analysis and agreement between observers for each scoring scale. Study Design— Experimental study. Animals— Mixed breed dogs (n=21) with a right limb tibial osteotomy repaired with an external fixator. Methods— Three small-animal veterinarians with orthopedic training scored lameness using NRS and VAS before surgery, and at 4 and 8 weeks after surgery. Peak force and impulse were determined at the same time points using a force plate. Agreement between observers and with force plate data was assessed. Significance was set at P≤.05. Results— Agreement was generally low among observers for both NRS and VAS scores. When evaluated at each time point, an acceptable level of agreement was present only at 4 weeks after surgery. Only impulse had a significant relationship with some of the observers' subjective scores. No significant relationships between any observer's scores and force plate data existed if very lame dogs were omitted. Conclusions— Subjective scoring scales do not replace force plate gait analysis. Agreement is low unless lameness is severe, and each observer uses an individually unique scale. Subjective scoring scales most accurately reflect force plate gait analysis when lameness is severe. Clinical Relevance— Subjective lameness scoring scales may not accurately reflect lameness and do not replace force plate gait analysis. Observers must stay the same during the duration of a study for accurate analyses.

Despite research on work and health having a long-standing concern about unjust exposures and inequitable burdens of disease, there are few studies that document the joint distribution and health effects of physical and psychosocial hazards (e.g., noise, dusts, fumes, and job strain) and social hazards (e.g., racial discrimination and gender harassment) encountered at work. Also, there is a paucity of data on how these exposures, singly and combined, are distributed in relation to sociodemographic characteristics including race/ethnicity, gender, socioeconomic position, and nativity. This article presents a conceptual model for redressing these knowledge gaps and describes recruitment strategies and the characteristics of study participants in the United for Health study. Working with labor unions, the authors recruited 14 (67%) of 21 worksites from manufacturing, meat processing, retail, and transportation, and 1,282 workers (72% response rate), of whom 62 percent were men, 36 percent were women, 39 percent were black, 23 percent were Hispanic, 25 percent were white, 31% earned less than a living wage, 40 percent were below the poverty level, and 23 percent had less than a high school education.

Background Home healthcare is one of the fastest growing sectors in the United States. Percutaneous injuries from sharp medical devices (sharps) are a source of bloodborne pathogen infections among home healthcare workers and community members. Sharps use and disposal practices in the home are highly variable and there is no comprehensive analysis of the system of sharps procurement, use and disposal in home healthcare. This gap is a barrier to effective public health interventions. The objectives of this study were to i) identify the full range of pathways by which sharps enter and exit the home, stakeholders involved, and barriers for using sharps with injury prevention features; and ii) assess the leverage points for preventive interventions. Methods This study employed qualitative research methods to develop two systems maps of the use of sharps and prevention of sharps injuries in home healthcare. Twenty-six in-depth interview sessions were conducted including home healthcare agency clinicians, public health practitioners, sharps device manufacturers, injury prevention advocates, pharmacists and others. Interview transcripts were audio-recorded and analyzed thematically using NVIVO qualitative research analysis software. Analysis of supporting archival material also was conducted. All findings guided development of the two maps. Results Sharps enter the home via multiple complex pathways involving home healthcare providers and home users. The providers reported using sharps with injury prevention features. However, home users’ sharps seldom had injury prevention features and sharps were commonly re-used for convenience and cost-savings. Improperly discarded sharps present hazards to caregivers, waste handlers, and community members. The most effective intervention potential exists at the beginning of the sharps systems maps where interventions can eliminate or minimize sharps injuries, in particular with needleless treatment methods and sharps with injury prevention features. Manufacturers and insurance providers can improve safety with more affordable and accessible sharps with injury prevention features for home users. Sharps disposal campaigns, free-of-charge disposal containers, and convenient disposal options remain essential. Conclusions Sharps injuries are preventable through public health actions that promote needleless treatment methods, sharps with injury prevention features, and safe disposal practices. Communication about hazards regarding sharps is needed for all home healthcare stakeholders.

Objective Blue-collar workers are more likely to smoke, smoke more heavily, and have less success in quitting compared to white-collar workers, and this occupational gap is growing over time. Effective smoking cessation interventions among blue-collar workers are needed to address growing class-based disparities. Methods We used a pre–post study design to test feasibility and effect size of a smoking cessation trial in a union apprenticeship training program for iron workers (n=337). The 4-month intervention drew upon a health promotion–health protection model for smoking cessation among blue-collar workers. We conducted pairwise analyses to assess pre–post intervention differences in 7-day point prevalence smoking abstinence measured 1 month after intervention was completed. Additional secondary outcomes, including smoking frequency, intensity, intention and self-efficacy to quit, were also assessed. Results Baseline smoking prevalence was 41%. We observed a 19.4% post-intervention quit rate among baseline smokers. There were statistically significant positive changes pre- and post-intervention in intention to quit smoking, self-efficacy to quit, and a reduction in the number of days smoked. Participation in pro-active intervention components was associated with a three-fold (OR = 3.0, 1.15, 7.83) increase in the likelihood of quitting. Overall, participation in intervention components was low. Conclusions Labor union apprenticeship programs represent a promising venue for smoking cessation interventions, particularly those that draw upon a health promotion–health protection model.

Environmental policies that do not consider global gender dimensions often create benefits for some people and ecosystems but result in costs for others, in particular women, at some point along the global chain of production and consumption. This article is intended to begin a dialogue about the importance of including gender analysis in the design of cleaner production strategies. We review global development policy and its critiques that have identified a need for gender awareness and analysis. This examination provides a backdrop for a discussion of how to include gender analysis in cleaner production planning and implementation. We invite researchers and practitioners to enter this dialogue to further the field and develop effective tools and policies to analyze gender dynamics, support gender equity, and find environmentally sound solutions that are sustainable for the long-term.

Article-at-a-Glance Background Meridian Health developed interactive protocols using computerized physician order entry (CPOE), providing clinicians with a concurrent clinical decision-support tool that helps increase compliance with evidence-based guidelines. Interactive Decision Support Guidelines for acute myocardial infarction (AMI) were developed into interactive protocols that prompt the physician to administer aspirin and a beta-blocker at the time of admission to patients who present with suspected AMI but offer the opportunity to document contraindications instead. By March 2005 all three Meridian hospitals had implemented the AMI interactive protocol. Seventeen interactive clinical decision-support protocols are now in use across six categories of care. Results Compliance rates for the AMI guidelines increased by 10% within two months of implementation and have been at 100% in all months when the interactive protocols have been used. Meridian is also seeing a steady climb in the number of total orders physicians are placing online, increasing as much as 46% at one hospital. Discussion Meridian physicians now recognize that CPOE is a valuable tool in improving patient safety through its interactive protocols. It has also enabled Meridian to analyze usage patterns as part of its continuous process improvement methodology. Conclusion The use of interactive protocols using CPOE represents an innovative approach to improving patient safety.

Background: Exposure to metalworking fluids has been previously associated with prostate cancer mortality in a cohort of autoworkers. Our objective was to further explore this finding in a study of prostate cancer incidence in the same cohort, with reduced misclassification of outcome. Methods: We conducted a nested case-control study in the General Motors cohort of autoworkers. Incident cases of prostate cancer (n = 872) were identified via the Michigan Cancer Registry from 1985 through 2000. Controls were selected using incidence-density sampling with 5:1 ratio. Using cumulative exposure (mg/m 3 -years) as the dose metric, we first examined varying lengths of lags (0-25 years). Then, we evaluated consecutive windows of exposure: 25 or more years before risk age, and fewer than 25 years. We used penalized splines to model the relative risk as a smooth function of exposure, and adjusted for race and calendar year of diagnosis in a Cox model. Results: Risk of prostate cancer increased with exposure to soluble and straight fluids 25 years or more before risk age but not with exposure in the last 25 years. The relationship with soluble fluids was piecewise linear, with a small increase in risk at lower exposures followed by a steeper rise. By contrast, the relationship with straight fluids was linear, with a relative risk of 1.12 per 10 mg/m 3 -years of exposure (95% confidence interval = 1.04-1.20). Conclusions: Exposure to oil-based fluids, soluble and straight, is modestly associated with prostate cancer risk among autoworkers, with a latency period of at least 25 years.

A joint China-U.S. symposium entitled “Integrating Occupational and Environmental Health” was organized by the Department of Science and Technology of Hebei Province, PRC, and the Department of Work Environment at the University of Massachusetts Lowell, U.S.A. A framework called “Sustainable Production” was proposed by U.S. participants to link environmental and worker protection. Sustainable production focuses on systems of production that integrate concerns for the long-term viability of the environment, worker health and safety, the community, and the economic performance of firms and other enterprises. The disciplines of environmental and occupational health and safety were brought together by Chinese participants under the unifying theme of the development, implementation, and impact of new technologies. As production processes are increasingly concentrated in China, collaboration among U.S. and Chinese environmental and occupational health and safety professionals is ever more essential.

Background Metalworking fluids (MWF) are used for lubrication during metal manufacturing. Previous studies have observed increased risks of several cancers among MWF-exposed workers. We hypothesized that MWF may be associated with risk of breast cancer because they can contain carcinogenic or endocrine-disrupting chemicals. Methods We conducted a case-control study nested in a cohort of 4,680 female automobile workers employed for at least 3 years between 1/1/41 and 1/1/85, with follow-up through 1994. Cases were identified using the National Death Index (NDI), Michigan cancer registries, and company records. Detailed quantitative MWF exposure data were available for each subject, although data on known breast cancer risk factors were not. Results Ninety-nine cases of breast cancer and 626 matched controls were identified. There was a weak positive association between lifetime cumulative exposure to soluble MWF and breast cancer risk, but no evidence of association with either straight or synthetic fluids. When exposure was divided into time-windows, the association was strongest for soluble MWF in the decade preceding diagnosis. Controlling for earlier exposures, there was an odds ratio of 1.18 (95% CI = 1.02–1.35) per mg/m3-year of cumulative exposure to soluble MWF in this 10-year period. Conclusion This hypothesis-generating study provides some preliminary evidence for an association between exposure to soluble MWF and increased risk of breast cancer. Additional studies of MWF and breast cancer, with data on known breast cancer risk factors, are warranted. Am. J. Ind. Med. 47:153–160, 2005. © 2005 Wiley-Liss, Inc.