Sentinel Event Notification System For Occupational Risks Research Articles

Magnitude and characteristics of acute paraquat- and diquat-related illnesses in the US: 1998–2013

BackgroundParaquat and diquat are among the most commonly used herbicides in the world. ObjectivesDetermine the magnitude, characteristics, and root causes for acute paraquat- and diquat-related illnesses in the US MethodsIllnesses associated with paraquat or diquat exposure occurring from 1998 through 2011 were identified from the Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides Program, the California Department of Pesticide Regulation (CDPR) Pesticide Illness Surveillance Program (PISP), and the Incident Data System (IDS). Cases identified by the National Poison Data System (NPDS) were reviewed for the years 1998–2003 and 2006–2013. ResultsA total of 300 paraquat- and 144 diquat-related acute illnesses were identified by SENSOR, PISP, and IDS. NPDS identified 693 paraquat- and 2128 diquat-related acute illnesses. In SENSOR/PISP/IDS, illnesses were commonly low severity (paraquat=41%; diquat=81%); however, SENSOR/PISP/IDS identified 24 deaths caused by paraquat and 5 deaths associated with diquat. Nineteen paraquat-related deaths were due to ingestion, seven of which were unintentional, often due to improper storage in beverage bottles. In SENSOR/PISP/IDS, paraquat and diquat-related acute illnesses were work-related in 68% (n=203) and 29% (n=42) of cases, respectively. When herbicide application site was known, the vast majority of acute paraquat-related illnesses (81%) arose from agricultural applications. Common root causes of illness were failure to use adequate personal protective equipment (PPE), application equipment failure, and spill/splash of herbicide. ConclusionsAlthough the magnitude of acute paraquat/diquat-related illnesses was relatively low, several fatalities were identified. Many illnesses could be prevented through stricter compliance with label requirements (e.g. ensuring proper herbicide storage and PPE use), and through enhanced training of certified applicators.

Gender differences in acute pesticide‐related illnesses and injuries among farmworkers in the United States, 1998–2007

Farmworkers have a high risk for acute pesticide-related illness and injury, and the rate among female farmworkers is approximately twice as high as that among males. Surveillance data were used to identify reasons for this gender difference. We identified acute pesticide-related illness and injury cases among farmworkers from the Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides Program and the California Department of Pesticide Regulation. Gender-specific associations with acute pesticide-related illness and injury were assessed using chi-square tests. National Agricultural Workers Survey data were also examined. The over-representation of females among farmworker illness and injury cases was confined to females who did not handle pesticides (non-handlers). Female non-handler farmworkers who were affected were more likely to be working on fruit and nut crops, to be exposed to off-target pesticide drift, and to be exposed to fungicides and fumigants compared to males. Although there is an increased risk for acute pesticide-related illness and injury among female farmworkers, the absolute number of farmworkers with acute pesticide-related illness and injury is far higher among males than females. Furthermore, farmworkers have little or no control over many of the identified contributing factors that led to illness and injury. Stringent enforcement of existing regulations and enhanced regulatory efforts to protect against off-target drift exposures may have the highest impact in reducing acute pesticide-related illness and injury among farmworkers.

Acute illnesses associated with exposure to fipronil—surveillance data from 11 states in the United States, 2001–2007

Introduction. Fipronil is a broad-spectrum phenylpyrazole insecticide widely used to control residential pests and is also commonly used for flea and tick treatment on pets. It is a relatively new insecticide and few human toxicity data exist on fipronil. Objective. This paper describes the magnitude and characteristics of acute illnesses associated with fipronil exposure. Methods. Illness cases associated with exposure to fipronil-containing products from 2001 to 2007 were identified from the Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides Program and the California Department of Pesticide Regulation. Results. A total of 103 cases were identified in 11 states. Annual case counts increased from 5 in 2001 to 30 in 2007. Of the cases, 55% were female, the median age was 37 years, and 11% were <15 years old. The majority (76%) had exposure in a private residence, 37% involved the use of pet-care products, and 26% had work-related exposures. Most cases (89%) had mild, temporary health effects. Neurological symptoms (50%) such as headache, dizziness, and paresthesia were the most common, followed by ocular (44%), gastrointestinal (28%), respiratory (27%), and dermal (21%) symptoms/signs. Exposures usually occurred from inadvertent spray/splash/spill of products or inadequate ventilation of the treated area before re‐entry. Conclusions. Our findings indicate that exposure to fipronil can pose a risk for mild, temporary health effects in various body systems. Precautionary actions should be reinforced to prevent fipronil exposure to product users.

Acute occupational pesticide-related illness in the US, 1998-1999: surveillance findings from the SENSOR-pesticides program.

Concern about the adverse public health and environmental effects of pesticide use is persistent. Recognizing the importance of surveillance for acute occupational pesticide-related illness, we report on surveillance for this condition across multiple states. Survey data collected between 1998 and 1999 were obtained from the seven states that conduct acute occupational pesticide-related illness surveillance as part of the Sentinel Event Notification System for Occupational Risks (SENSOR) program. Data were collected by these state programs in a standardized manner and analyzed. Acute occupational pesticide-related illness incidence rates for those employed in agriculture and those employed in non-agricultural industries were also calculated. Between 1998 and 1999, a total of 1,009 individuals with acute occupational pesticide-related illness were identified by states participating in the SENSOR-pesticides program. The mean age was 36 years, and incidence rates peaked among 20-24 year-old workers. The overall incidence rate was 1.17 per 100,000 full time equivalents (FTEs). The incidence rate among those employed in agriculture was higher (18.2/100,000 FTEs) compared to those employed in non-agricultural industries (0.53/100,000 FTEs). Most of the illnesses were of low severity (69.7%). Severity was moderate in 29.6% of the cases, and high in four cases (0.4%). Three fatalities were identified. Insecticides were responsible for 49% of all illnesses. Surveillance is an important tool to assess acute pesticide-related illness, and to identify associated risk factors. Our findings suggest that these illnesses continue to be an important occupational health problem, especially in agriculture. As such, greater efforts are needed to prevent acute occupational pesticide-related illness.

Surveillance of work‐related carpal tunnel syndrome in Massachusetts, 1992–1997: A report from the Massachusetts sentinel event notification system for occupational risks (SENSOR)

Background This surveillance study was undertaken to target efforts to prevent work-related carpal tunnel syndrome (WR-CTS) and to assess physician case-reports as a source of surveillance data. Methods Physician case-reports and workers’ compensation disability claims were used to document patterns of WR-CTS in Massachusetts from March 1992 to June 1997 by age, gender, industry, occupation, and calendar year. Characteristics of cases identified through the two data sources were compared. Results 4,836 cases of WR-CTS were ascertained; 6% were identified by both data sources. Whereas the two sets of cases were similar with respect to age and occupation categories, physician-reported cases were more likely male and employed in manufacturing. The number of compensation claims filed by women declined over time, and a substantial number of cases under age 25 years were identified. Manufacturing workers had the highest rates; the highest numbers of cases were employed in hospitals, grocery stores, and the insurance industry. Several technical/administrative support occupations likely to use video display terminals had both high rates and frequencies. Conclusion WR-CTS is a significant public health problem. Physician reports are useful in understanding problem magnitude and targeting specific establishments for intervention but are currently of limited use in targeting specific industries and occupations. Am. J. Ind. Med. 39:58–71, 2001. © 2001 Wiley-Liss, Inc.

Medical, personal, and occupational outcomes for work-related amputations in Minnesota

The Minnesota Sentinel Event Notification System for Occupational Risks (SENSOR) surveillance system has collected data on the medical, personal, and occupational outcomes associated with work-related amputations since 1992. SENSOR defined amputations as any finger amputation or the loss of any other body part; 832 workers were identified as having amputation injuries between 1994 and 1995 and 72% of these workers completed a telephone interview. Twenty percent of those injured required overnight hospitalization. Ninety-one percent of the cases reported having missed work, with 56% reporting missing ten or more days. Individuals working on their usual jobs at the time of injury were more likely to report less serious medical and occupational outcomes. Severe injuries were significantly associated with worse medical, personal, and occupational outcomes. Two groups of machines, material handling, and powered handtools were associated with a higher proportion of severe injuries.

Nature, incidence, and cause of work-related amputations in Minnesota.

The Minnesota Sentinel Event Notification System for Occupational Risks (SENSOR) has collected data on the nature, incidence, and cause of work-related amputation injuries that have taken place since 1992. SENSOR defined an amputation as any finger amputation or the loss of any other body part; 832 workers were identified as having amputation injuries between 1994 and 1995 and 72% of these workers completed telephone interviews. The amputation injury rate for Minnesota workers was 39 per 100,000 workers, with agriculture and manufacturing having the highest rates. Sixty-six percent of the injuries involved one finger; 14% involved two or more fingers. Persons working with machinery reported 73% of the injuries. A closer examination of the incidence and causes for amputation injuries shows that these were not random events. Reliance on human reactions to prevent injury is inadequate; therefore, additional research needs to be conducted.

Development of a surveillance program for occupational pesticide poisoning: lessons learned and future directions.

The authors describe the growth from 1987 through 1996 of the Occupational Pesticide Poisoning Surveillance Program at the Texas Department of Health. The program was initially based on a Sentinel Event Notification System for Occupational Risks (SENSOR) model, using sentinel providers to report cases, supplementing the passive reporting by physicians that was required by law. The model was evaluated after five years, and significant changes were implemented to improve case ascertainment. Current active surveillance methods emphasize collaboration with a number of agencies and organizations for identification of cases and follow-up. The number of confirmed occupational cases increased from 9 workers in 1987 to 99 workers in 1996. The evolution from a passive system to an active surveillance program expanded the number of reported cases and strengthened inter-agency collaborations.

Cost-effectiveness of hospital discharge records for reaching selected endpoints in the surveillance of silicosis.

The Sentinel Event Notification System for Occupational Risks (SENSOR) is a state/federal system for the surveillance and intervention of occupational conditions. The Ohio SENSOR program identifies silicosis cases from a number of data sources, although hospital discharge records have largely been considered the most successful means of carrying out SENSOR objectives. However, the cost-effectiveness of hospital discharge records has not been evaluated. Thus, a cost analysis was conducted to compare the effectiveness of hospital discharge records with other data sources for achieving prevention-related endpoints of silicosis surveillance. Total costs of reaching three endpoints (obtaining case names, identifying work sites, and identifying silica problems in work sites) were estimated retrospectively and measured in 1996 dollars for four data sources: hospital discharge records, physician reports, workers' compensation claims, and death certificates. Total costs were then divided by output for each source/endpoint combination to produce estimates of average costs. The average cost per case was $30 for hospital records, $212 for physician reports, $19 for workers' compensation claims, and $7 for death certificates. However, for identifying problem work sites, hospital records were most expensive at $2,883 per work site, compared with $2,558 for physician reports, $1,318 for workers' compensation claims, and $1,310 for death certificates. Hospital discharge records were least cost-effective for accomplishing prevention-related goals of surveillance. A change in the mix of resources applied to silicosis surveillance and intervention under SENSOR, i.e., a shift away from follow-up of hospital records toward more cost-effective methods for identifying work sites with silica problems may result in more efficient use of public health resources devoted to the prevention of silicosis.

The surveillance of work-related pesticide illness: an application of the Sentinel Event Notification System for Occupational Risks (SENSOR)

In response to limitations in state-based occupational disease surveillance, the California Department of Health Services developed a model for surveillance of acute, work-related pesticide illness. The objectives were to enhance case reporting and link case reports to preventive interventions. Elements from surveillance of communicable diseases and sentinel health events were used to integrate a model into the preexisting system in one agricultural country. Between 1988 and 1991, 45 Fresno County health care providers reported 230 suspected cases, of which 217 from 80 work sites met reporting guidelines. Risk factors were profiled from interviews of 81 prioritized case patients and 36 employers. Fifteen work sites were visited and 117 recommendations were made, of which 6% were identified in enforcement inspections. Pest management experts consulted with growers on reducing future pesticide use. Risk factors for pesticide illness were prevalent. Agricultural inspectors did not detect routine and serious hazards. Integrated pest management should be expanded and linked to occupational health. Agricultural enforcement personnel should be oriented and trained in occupational safety and health.

Surveillance and prevention of work‐related carpal tunnel syndrome: An application of the sentinel events notification system for occupational risks

In response to limitations in state-based, occupational disease surveillance, the California Department of Health Services developed a model for provider- and case-based surveillance of work-related carpal tunnel syndrome. The objectives were to enhance case reporting, identify risk factors and high-risk work sites, and link preventive interventions to work sites and the broader community. Using elements from surveillance of communicable diseases and sentinel health events, a model was integrated into the pre-existing reporting system in one California county. Between 1989 and 1991, 54 Santa Clara County health care providers reported 382 suspected cases, of which 365 from 195 work sites met reporting guidelines. Risk factors were profiled from interviews of 135 prioritized cases and 38 employers. Of 24 work sites prioritized for a free, voluntary, nonenforcement inspection, 18 refused and 6 completed an on-site visit. Sentinel Event Notification System for Occupational Risks (SENSOR) captured many cases not reported to the pre-existing reporting system. Case interviews indicated a profile of symptoms and signs, treatment, and exposure to uncontrolled occupational risk factors, including a lack of training on ergonomics hazards. Employer health insurance, rather than workers' compensation, was the apparent source of payment for most medical bills. Employers lacked knowledge and motivation to reduce ergonomic risks. Governmentally mandated occupational ergonomics standards are urgently needed.

Occupational Silicosis—Ohio, 1989-1994

Silicosis is a chronic lung disease associated with the inhalation and pulmonary deposition of dust that contains crystalline silica. Through the Sentinel Event Notification System for Occupational Risks (SENSOR)* program, CDC's National Institute for Occupational Safety and Health (NIOSH) is assessing practical models for implementing state-based surveillance of silicosis and linking follow-up intervention activities to surveillance reports. From 1989 through 1992, the Ohio Department of Health (ODH) SENSOR program identified silicosis cases through reports of Bureau of Workers' Compensation (BWC) claims, physician reports, and death certificates. The addition in 1993 of hospital discharge reports as an ascertainment source resulted in a substantial increase in the number of silicosis case reports identified annually (Table 1). This report describes the investigation of a case of occupational silicosis in Ohio and summarizes the impact of hospital-based reporting on surveillance for silicosis in Ohio during 1993-1994.

Occupational respiratory diseases in British Columbia, Canada in 1991.

234 cancer, and cardiac diseases.4 Despite their importance and the high socioeconomic impact of occupational disease,' surveillance programs are seldom used for the control and prevention of work related diseases.!8 Two basic approaches have been used in surveillance programs for occupational lung disease. One is based on voluntary reporting, and the other on regulation enforced reporting. Examples of voluntary reporting are the sentinel event notification system for occupational risks (SENSOR) operating in some parts of the United States since 1987,9 and the surveillance of work related and occupational respiratory diseases (SWORD) project set up in the United Kingdom in 1989.8 Examples of regulation enforced reporting are the registry for occupational diseases in Finland,610 and the mutual system for occupational accidents and diseases in Chile. In Canada, there is no surveillance program for occupational diseases. To evaluate the feasibility of a surveillance program for occupational lung diseases based on voluntary reporting by physicians, the Occupational and Environmental Lung Diseases Research Unit of the Department of Medicine, University of British Columbia, initiated a pilot project in 1991. This is a report of the findings during the first year.

Sentinel Event Notification System for Occupational Risks (SENSOR): the concept.

Although many states have laws that require health providers to report cases of occupational illness and injury, most states do not maintain a comprehensive system that actively identifies and targets potential sources of case reports and then responds to such reports. NIOSH has developed a Sentinel Event Notification System for Occupational Risks (SENSOR) that uses targeted sources of sentinel providers to recognize and report selected occupational disorders to a state surveillance center. SENSOR is a cooperative state-federal effort designed to develop local capability for preventing selected occupational disorders. To demonstrate the feasibility of this approach, NIOSH initially funded seven SENSOR projects in 1987 and three additional projects in early 1988 (Table 1). Currently, these projects are in the preliminary stages of organization and start-up, with some having begun to receive case reports. As funds become available, NIOSH intends to gradually expand the scope of the program to include additional states over the next several years.

Surveillance of Occupational Illness and Injury in the United States: Current Perspectives and Future Directions

Surveillance of occupational illness and injury is essential for targeting workplace prevention efforts. Surveillance systems should include mechanisms for standar- dized data collection, data analysis, and dissemination of results to “all who need to know.” In occupational health, surveillance systems are less developed than in communicable disease prevention. The disparity exists because occupational health surveillance is conceptually more complex and is limited by legal and social impediments. The National Institute for Occupational Safety and Health (NIOSH) has listed improvement in systems for occupational illness and injury surveillance as a top organizational priority. In this paper, we review current approaches to surveillance designed to identify cases of occupational illness or injury or to monitor secular trends. Gaps in the surveillance effort include the absence of a functional system for practitioner reporting of selected occupational disorders and a standard approach to collection of certain health data. NIOSH programs designed to address these limitations include a Sentinel Event Notification System for Occupational Risks (SENSOR) which links health care providers with state health departments for the purpose of reporting and follow-up of cases of occupational illness and injury. Other new programs are designed to improve the quality of existing data sources for use in surveillance and to develop new approaches to data collection.