Role of the Environmental Health Officer in CDCNIOSHs Health Hazard Evaluation Program

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Role of the Environmental Health Officer in
CDC/NIOSHs Health Hazard Evaluation Program

• LCDR Bradley King, MPH, CIH
• Industrial Hygienist, Hazard Evaluations and
  Technical Assistance Branch
• National Institute for Occupational Safety and
  Health

SAFER HEALTHIER PEOPLE
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Occupational Safety and Health Act of 1970
to assure so far as possible healthful working
conditions for every man and woman in the nation.

• Occupational Safety and Health Administration
  (OSHA) Regulatory Agency
• National Institute for Occupational Safety and
  Health (NIOSH) Research Agency

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What Is NIOSH?

• Organized within DHHS/CDC
• Federal agency charged with Occupational Safety
  and Health Responsibilities
• Research Surveillance
• Training Service
• 1200 employees representing disciplines including
  epidemiology, medicine, industrial hygiene,
  safety, psychology, engineering, chemistry, and
  statistics

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What Is NIOSH?

• Conducts research to
• identify
• evaluate
• prevent or control work-related problems
• Provides for education and training of
  professionals
• Recommends criteria for standards
• Responds to requests for investigations of
  workplace hazards (HHEs)

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NIOSH HHEs

• Respond to requests for assistance
• Provide current health hazard data to employers
  and employees
• Identify problems and offer workplace solutions
• Generate exposure and human toxicity data
• Precipitate research and development

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Who Can Request an HHE?

• Management
• Employees
• Union officials
• Govt. agencies

http//www.cdc.gov/niosh/hhe/
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How HHEs Resolve Problems

• Multi-disciplinary Approach

Health and Medicine Physician, Nurse, Vet
Officers
Industrial Hygiene Environmental Health Officers
Field and Lab Methods Development Scientist
Officers
Control Measures Engineer Officers
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Triage of HHE Requests

• Category I Outside scope of HHE Program
• Category II Invalid requests or those for which
  a site visit is unlikely to change assessment of
  problem or recommendations
• Category III Requests which will benefit from a
  site visit
• Category IV Requests requiring a complex on-site
  response

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Category I II HHE Requests

• No site visit performed
• Contact by telephone (to validate request or
  obtain additional information)
• Office-based response/consultation to resolve
  problem
• Requestor (and facility management) receive
  letter with enclosed information

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Category III IV HHE Requests

• Site visit(s) performed
• May involve
• Complex medical/epidemiologic and industrial
  hygiene/ exposure assessment investigations
• Descriptive
• Problem solving
• Hypothesis generating
• Development of new sampling and analytical
  methods
• Feasibility studies

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On-site ResponseMedical/Epidemiologic

• Interview workers
• Survey workers (questionnaire)
• Collect blood/urine
• Conduct medical exams and tests
• Review illness records

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On-site ResponseIndustrial Hygiene

• Observe processes, procedures, and work practices
• Talk to workers, supervisors, and managers
• Collect environmental samples
• Measure conditions
• Review exposure records
• Evaluate exposure controls

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Distribution of HHE Final Reports

• Sent to
• Requestor(s)
• Employee Representative(s)
• Employer
• OSHA
• State Health Depts.
• Announced in e-News
• Available through
• NIOSH website

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When an HHE Can Help

• New hazards, exposures, or processes
• Illnesses from an unknown cause
• Exposure to unregulated agents
• Adverse health effects at exposures less than
  current standards

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Environmental Health Officer Role in Evaluating
New Hazards

• Microwave popcorn facility
• Workers with obstructive lung disease
• Butter flavoring mixing room
• Microwave popcorn packaging area
• Multiple site visits conducted
• Medical tests spirometry, diffusing capacity,
  and chest x-rays
• Exposure assessment
• Engineering control assessment

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Microwave Popcorn Facility

• Medical results
• Worker lung obstruction significantly higher than
  national rates (3.3X all10.8X never-smokers)
• Diagnosis consistent with bronchiolitis
  obliterans
• Exposure assessment results
• Predominant ketone identified as diacetyl (an
  artificial butter flavoring)
• Diacetyl concentration ranged from ND to 98 ppm
• Engineering control assessment results
• Engineering controls reduced diacetyl
  concentrations to less than 1 ppm

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Microwave Popcorn Facility

• Conclusion
• Strong dose-response demonstrated between
  diacetyl exposure and lung obstruction
• Inhalation of butter flavoring chemicals is a new
  risk factor for bronchiolitis obliterans
• Actions/Impact
• NIOSH Alert published to inform the flavoring
  industry to take steps to prevent obstructive
  lung disease in workers who use or make flavorings

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Environmental Health Officer Role in Evaluating
an Illness of Unknown Cause

• Flexographic label printing facility
• Workers with blurred vision
• Multiple site visits conducted
• Medical tests Questionnaire survey and pre-and
  post-shift eye exams
• Exposure assessment

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Flexographic Label Printing Facility

• Medical results
• Post-shift abnormalities seen on eye examination
  (corneal opacity)
• Exposure assessment results
• Workers exposed to tertiary amine compounds
  (Dimethylisopropanolamine (DMIPA) and
  Dimethylaminoethanol)
• Total airborne tertiary amine concentrations
  ranged from 0.84 to 20 mg/m3

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Flexographic Label Printing Facility

• Conclusions
• Symptoms and eye abnormalities related to
  airborne concentration of total tertiary amines
• Corneal opacity due to direct deposition of DMIPA
  into the corneal epithelium (reversible)

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Flexographic Label Printing Facility

• Actions/Impact
• Facility diluted pH adjuster (which contained
  DMIPA) and the eye abnormalities resolved
• Recommended that MSDSs of tertiary
  amine-containing products be modified
• Alerted ophthalmologists of the adverse effects
  of these tertiary amine compounds

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Environmental Health Officer Role in Evaluating
an Unregulated Exposure

• Turkey processing facility
• Workers with eye and respiratory irritation
• Evisceration department
• Multiple site visits conducted
• Medical tests questionnaire survey and pre- and
  post-shift spirometry (dark meat department used
  as a control group)
• Exposure assessment trichloramine and soluble
  chlorine compounds

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Turkey Processing Facility

• Medical results
• Workers in the evisceration department had
  significantly more upper respiratory symptoms
• Exposure assessment results
• Airborne trichloramine and soluble chlorine
  concentrations were significantly higher in the
  evisceration department

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Turkey Processing Facility

• Conclusion
• Upper respiratory symptoms due to exposure to
  airborne trichloramine and soluble chlorine
  compounds unregulated chemicals
• Actions/Impact
• Recommendation to modify facility ventilation
  system
• Follow-up site visit showed reduction in
  contaminant concentrations and reported symptoms

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Environmental Health Officer Activities Beyond
HHEs

• International technical support
• Regulatory support and document review
• Committee membership (NIOSH/CDC/DHHS)
• Training occupational health professionals
• Response to public inquiries
• Emergency preparedness and response

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Emergency Response

• 1990s MO, NC, ND, and KY floods
• 2001 World Trade Center
• 2001 Anthrax, irradiated mail
• 2003 SARS
• 2005 Indonesian tsunami
• 2005 Hurricane Katrina
• 2005 Avian influenza
• 2006 Pandemic influenza preparedness
• 2006 NYC Anthrax case

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2006 NYC Anthrax

• On February 21, 2006, the Pennsylvania Department
  of Health (PDOH) reported to CDC and NYC
  Department of Health and Mental Hygiene a case of
  inhalation anthrax in a man who resided in New
  York City

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2006 NYC Anthrax

• The joint epidemiologic and environmental
  investigation sought to
• determine the source of exposure
• identify other persons who were exposed and
  required post-exposure prophylaxis
• enhance surveillance for additional cases through
  outreach to the medical community
• provide frequent updates and consistent messages
  regarding risk to the public

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2006 NYC Anthrax

• Environmental/Occupational Health team was tasked
  with characterizing the extent of contamination
  in
• cases apartment
• cases friends apartment
• cases workshop
• cases van

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2006 NYC Anthrax

• Surface wet swab, wet wipe, and vacuum samples
• Analyzed at NYCDOH and CDC laboratories
• both confirmed the presence of B. anthracis by
  culture and polymerase chain reaction
• All samples from the workspace were positive for
  B. anthracis
• Consistent with secondary contamination
• some samples from the patient's apartment (e.g.,
  shoes and entryway) and van (e.g., floorboard)
  tested positive for B. anthracis
• others were negative (e.g., most surfaces above
  ground level)

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Concluding Remarks

• Since 1971, the NIOSH HHE Program has completed
  more than 13,000 HHEs
• The NIOSH HHE Program is a unique resource for
  employees
• The ultimate impact of the NIOSH HHE Program are
  healthier workers and workplaces

The findings and conclusions in this presentation
are those of the author and do not necessarily
represent the views of the National Institute for
Occupational Safety and Health
SAFER HEALTHIER PEOPLE
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Concluding Remarks

• NIOSH E-news sign-up
• http//www.cdc.gov/niosh/enews/default.html
• ACKNOWLEDGMENT
• Mr. Ken Wallingford, CIH
• Deputy Branch Chief, HETAB

SAFER HEALTHIER PEOPLE
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Thank you!

QUESTIONS? LCDR Bradley King, MPH, CIH Centers
for Disease Control and Prevention National
Institute for Occupational Safety and Health 4676
Columbia Parkway, MS-R11 Cincinnati, OH
45226 ph. 513-841-4462 Bradley.King_at_cdc.hhs.gov