Use Of Respiratory Protection Research Articles

Engineering Case Report

During the emergency work at the Fukushima Daiichi Atomic Power Plant, Tokyo Electric Power Company (TEPCO) and the Japanese government experienced various problems in radiological exposure management for emergency workers. Radiological exposures resulted from the inappropriate use of respiratory protection, the improper use of protective garments, and insufficient worker training. Among the efforts to reduce external exposure, there were problems associated with the control of working hours, the effective use of a radiation shielding, and the lack of well-prepared work plans. To reduce the exposure dose, the following lessons should be shared with other atomic power plants (APPs) and various stakeholders: (a) to prevent internal exposure, it is necessary to monitor the radioactive concentration of the workplace indoor air during an emergency, to stockpile and use appropriate respiratory protection and train newcomers how to use, fit, and fit-test the respirators; (b) to prevent unnecessary beta-ray exposure, liquid-proof garments should be mandatory when workers handle contaminated water; (c) to reduce external exposure, it is indispensable to develop well-prepared work plans prior to the work and to monitor the ambient dose rate of the work area to develop proper working procedures; (d) the earlier deployment of remote-controlled vehicles and the utilization of tungsten shielding vests can contribute to exposure reduction. Further research and development of remote-controlled devices to monitor and survey affected areas are urgently required.

Awareness and practices regarding zoonotic influenza prevention in Romanian swine workers

Swine workers may play a key role in transmission of zoonotic influenza viruses. At the same time, little is known about the extent and effectiveness of influenza prevention programs for these at-risk workers. To characterize practices and attitudes regarding zoonotic influenza transmission among swine workers in Romania. We conducted a convenience survey of swine workers in Romania. The confidential survey included questions about awareness of zoonotic influenza risk, work tasks performed, flu vaccination status, and reported influenza-like illness. A total of 103 workers at seven farms completed the survey. The percentage of workers reporting concern about either contracting influenza from pigs or giving influenza to pigs was 78% and 70%, respectively. Although 60% of workers reported having a sick-leave policy at work, only 7% of workers reported receiving seasonal influenza vaccination during the past flu season. Only 5% of the workers reported flu-like illness during the past year while 3% of workers reported that pigs appeared sick with influenza over the same time period. The majority of workers reported using protective overalls and rubber boots during swine work, with lower rates of use of gloves. Reported use of respiratory protection was rare, and use of any personal protective equipment did not differ when pigs appeared ill. Despite awareness and concern regarding zoonotic influenza, Romanian swine workers report low rates of influenza vaccine or respiratory protection. As part of global pandemic influenza preparedness, enhanced prevention programs for swine workers should address such gaps.

Change in Lung Function over Time in Male Metropolitan Firefighters and General Population Controls: A 3‐year Follow‐up Study

Previous studies in firefighters have been contradictory regarding their course of lung function over time. The aim of this ongoing study is to investigate how changes in lung function over time in male metropolitan firefighters compare with those in population controls, and to explore associations between firefighters' use of personal respiratory protection devices during occupational exposures and their risk of accelerated lung function decline. A prospective comparison of FEV1 (forced expiratory volume in 1 second) and FVC (forced vital capacity) was performed between 281 firefighters and 933 population controls. Logistic regression models were used to compare changes from baseline of FEV1 and FVC after 3 years and risk of accelerated decline between the cohorts. Within the firefighter cohort, risk of accelerated decline was compared between subgroups based on use of respiratory protection devices. Controls showed similar mean annual declines for FEV1 and FVC across age categories, whereas firefighters aged <45 years showed increasing values over time (p=0.040). Firefighters had a lower odds of accelerated FEV1 decline compared with controls (OR=0.60, 95%CI 110.44; 0.83), but firefighters who never or rarely used respiratory protection during fire knockdown had a higher odds of accelerated FEV1 decline compared with those who used it often or frequently (OR=2.20, 95%CI 1.02; 4.74). Younger generations of firefighters showed an increase in lung function relative to older colleagues, while population controls consistently showed decline of lung function across all ages. Firefighters who reported to be incompliant in using respiratory protection showed an increased risk of accelerated FEV1 decline.

Physiologic and other effects and compliance with long-term respirator use among medical intensive care unit nurses

BackgroundLong-term use of respiratory protection may be necessary, but compliance may be low, and physiologic effects have not been well evaluated.MethodsTen nurses participated; physiologic effects, subjective symptoms, and compliance with wearing an N95 alone or with a surgical mask overlay were assessed. Longitudinal analysis based on multivariate linear regression models assessed changes in outcome variables (CO2, O2, heart rate, perceived comfort items, compliance measures, and others). Analyses compared changes over time, and compared wearing only an N95 to wearing an N95 with a surgical mask overlay.ResultsMost nurses (90%, n = 9) tolerated wearing respiratory protection for two 12-hour shifts. CO2 levels increased significantly compared with baseline measures, especially when comparing an N95 with a surgical mask to only an N95, but changes were not clinically relevant. Perceived exertion; perceived shortness of air; and complaints of headache, lightheadedness, and difficulty communicating also increased over time. Almost one-quarter (22%) of respirator removals were due to reported discomfort. N95 adjustments increased over time, but other compliance measures did not vary by time. Compliance increased on day 2, except for adjustments, touching under the N95, and eye touches.ConclusionLong-term use of respiratory protection did not result in any clinically relevant physiologic burden for health care personnel, although many subjective symptoms were reported. N95 compliance was fairly high.

REACH II: Respirator Evaluation in Acute Care Hospitals

The purpose of REACH II is to assess hospitals’ respiratory protection programs (RPPs) and healthcare workers’ use of respiratory protection. The study focuses on adherence to OSHA standards and CDC recommendations, which address employee medical evaluations, fit testing and training; the proper selection, use, maintenance, and inspection of respirators; and regular program evaluation and risk assessments.

Hypersensitivity pneumonitis withMycobacterium aviumcomplex among spa workers

The New Mexico Department of Health (NMDOH) investigated the cause of two cases of hypersensitivity pneumonitis (HP) in spa maintenance workers with laboratory confirmed Mycobacterium avium complex (MAC). The investigation occurred in tandem with worker protection and swimming pool regulatory investigations by the New Mexico Environment Department at the spa where the workers were employed. The investigation was conducted in order to identify unreported cases, exposure source(s), and to prevent further worker exposure. NMDOH surveyed 57 spa employees about symptoms and exposures, categorized jobs according to self-reported exposure to water, and computed odds ratios for symptom reporting by exposure category. Environmental isolates from spa water and filter swabs were cultured and compared to patient isolates by the Environmental and Applied Microbiology Team, Centers for Disease Control and Prevention (CDC). Workers with the highest exposure reported more HP-like symptoms (OR = 9.6), as did intermediate exposure workers (OR = 6.5), compared to workers with no aerosolized water exposure. Two of 13 environmental isolates were closely related to one of the patient isolates. Workers were likely exposed during spray cleaning of cartridge filters in a poorly ventilated work space. Recommendations include inhibiting organism growth in spa systems, assuring the use of respiratory protection, and adequately ventilating work spaces where filters and equipment are cleaned.

Respirator Use Among US Farm Operators: Evidence from the 2006 Farm and Ranch Safety Survey

ABSTRACT The objective of this study was to estimate the national prevalence of respirator use among primary farm operators in the United States. The authors analyzed the 2006 Farm and Ranch Safety Survey data collected for 12,278 actively farming primary farm operators. Weighted prevalence and adjusted prevalence ratios (PRs) of respirator use were calculated by farm operator characteristics, farm characteristics, and selected exposures/hazards. Of the estimated 2.1 million farm operators, 37.2% used a respirator on their farm. Respirator use prevalence was significantly higher among operators aged 16–34 years than those aged ≥65 years (46.9% vs. 30.0%; PR = 1.6); male than female operators (39.0% vs. 24.4%; PR = 1.6); operators managing crop farms than operators managing livestock farms (40.9% vs. 33.7%; PR = 1.2); and operators managing farms with value of sales ≥$100,000 than operators managing farms with value of sales ≤$9999 (57.4% vs. 31.4%; PR = 1.8). Of the operators who used a respirator, 69.9% used while working in a dusty environment, 22.6% used while applying/handling pesticides, and 30.4% used while doing other farm-related activities. These results show that an estimated one third of operators used respirators in 2006, and respirator use is most frequent among operators working in a dusty environment. Additional research identifying specific exposures for which respirators or dust masks are used, barriers to respirator or dust mask use, motivators for wearing respirators, and opportunities to increase the use of respiratory protection among farm operators, particularly on smaller farms, is needed.

Immunologic mechanisms in the adaptation of swine farm workers to their work environment

Swine building exposure causes inflammatory reactions that appear to be attenuated with prolonged periods of contact. The mechanisms behind this adaptation to a dusty and endotoxin-rich environment are poorly understood. Our aim was to compare levels of selected inflammatory mediators in swine farm workers at times with differences in exposure. Participants had blood sampling done before and after each of three work shifts-two in winter and one in summer. Before one of the winter visits they had avoided pulmonary exposure to the swine buildings by wearing respiratory protection for 4 d. The other visits were done after non-protected periods of work. Protein and mRNA concentrations were measured in blood. Mixed models were used for the statistics. During summer higher concentrations of mRNA to IL-8, lymphocyte function-associated antigen 1 and bactericidal/permeability-increasing protein (BPI) were observed. BPI mRNA increased only over the work shift after the unprotected winter period (P = 0.039). BPI decreased from elevated levels across the shift after use of respiratory protection (P = 0.003), but was unchanged during the other two visits. The findings suggest possible roles for these proteins in adaptation to the swine building environment after repeated exposures.

The Experience of Miners Relocated to Alternative Positions due to Silicosis in the Andean of CODELCO, Chile, 2010

ObjectivesTo understand the personal experiences of mine workers that have experienced job relocation due to silicosis at the Andina Division of Corporación Nacional del Cobre (CODELCO), Chile. The purpose of the study was to provide useful information for the development of new local, business and public policies for the care of workers with silicosis.MethodsA qualitative study based on a practical case study of 5 workers. The information was collected by means of structured individual interviews. The method of analysis was phenomenology.ResultsThe corporal axis was the most commented upon. It included awareness of the illness, body pains, fatigue, and antagonistic mood disorders (sadness, or the difficulty in finding meaning in life). As far as personal relationships, there was evidence of strong relationships with family, coworkers and friends, as well as extended family. Over all, the experience of relocation was positive with periods of impatience and uncertainty. The job reassignment provided a new and pleasant context for the relocated workers and in the process improved their perception of their quality of life.ConclusionsA multidisciplinary team should attend mine workers relocated because of silicosis by addressing the mental and physical aspects of their disease, along with the integral participation of close family members. It is suggested that this investigation be maintain over time to record the personal experiences in the medium-term, adding new cases with the intention of shedding more light on the phenomenon being studied. As a preventive measure, continual workshops are needed on the proper use of respiratory protection in addition, a group of monitors is required.

Assessment of Air Quality During Mastoidectomy

The Occupational Health and Safety Administration (OSHA) outlines specific requirements governing the use of respiratory protection for workers dealing with dust or other aerosolized compounds. Health care workers may be exposed to bone dust produced during otologic procedures, creating an occupational hazard. The purpose of this research was to quantify the total suspended particulate matter (TSPM) and respirable particulate matter (PM(5)) created during cortical mastoidectomy and investigate whether the concentration of aerosolized dust during mastoidectomy would require the use of a particulate respirator. Cadaveric study to assess air quality during cortical mastoidectomy. Temporal bone laboratory. A simple mastoidectomy was performed on 3 cadaveric temporal bones. Suspended particulate concentration was measured using gravimetric filter methodology for TSPM and PM(5). Concentration of particulate exposure was compared between mannequins positioned near the surgical field with a standard surgical mask, surgical respirator, or controls. The average total particulate matter concentration during cortical mastoidectomy was 1.89 mg/m(3). The average quantity of respirable particles was below detection levels. The calculated particulate exposure concentrations for TSPM and PM(5) did not exceed OSHA's requirement for respirator use. The particulate respirator prevented exposure to bone particulates compared with controls (P = .028). The concentration of bone dust produced during cortical mastoidectomy is below regulatory guidelines for use of particulate respirators. However, experimental studies show the use of a surgical respirator may decrease particulate exposure.

Assessment of Air Quality During Mastoidectomy

Objectives. The Occupational Health and Safety Administration (OSHA) outlines specific requirements governing the use of respiratory protection for workers dealing with dust or other aerosolized co...

Prevention of Occupational Respiratory Symptoms Among Certified Safe Farm Intervention Participants

ABSTRACT Certified Safe Farm (CSF) is a multifaceted intervention including clinical Occupational and wellness screening, education, and on-farm safety audits with set safety standards, and performance incentives. Five years of respiratory health outcomes are reported in 150 CSF intervention farmers and 158 matched controls. Standardized health interviews and occupational histories were analyzed with descriptive statistics to determine prevalence rates. There was a 100% response rate from the standardized telephone interviews, and respectively a 94% and 89 % response rate from the self-administered occupational health history questionnaire for the CSF intervention and the comparison population. The overall rate for occupational respiratory conditions was 17/100 person-years. At baseline there was no difference between the prevalence of respiratory symptoms between the CSF and control groups. However, over the course of the intervention, the CSF farmers increased their use of personal protective respiratory equipment at work, and experienced fewer episodes of acute symptoms of organic dust toxic syndrome (ODTS). The Certified Safe Farm intervention appeared to affect increased use of respiratory protection and decreased symptoms of ODTS.

Respiratory Issues in Beef and Pork Production: Recommendations From an Expert Panel

This paper summarizes “Respiratory Issues in Confined Feeding Operations,” a panel discussion at the Agricultural Safety and Health Council of America/National Institute for Occupational Safety and Health conference, “Be Safe, Be Profitable: Protecting Workers in Agriculture,” Dallas/Fort Worth, Texas, January 27–28, 2010. Occupational exposure to confined animal feeding operations is associated with cough, wheezing, and shortness of breath. Published data shows that 20% to 40% of hog confinement workers experience such symptoms, although most are able to continue working in this industry. Endotoxin is one component of hog barn dust that is associated with respiratory disease in workers. Endotoxin levels on cattle feedlots can also be in the range linked with occupational lung disease. The cattle industry has not yet prepared guidance documents for producers, in part because much less is known about the prevalence of lung disease in its workers. However, the pork industry provides information for pork producers on reducing their respiratory health risks through a multifaceted approach, including the use of respirators. Some jobs cannot be done safely without respiratory protection, such as entering manure pits. It is less clear for other jobs when respirators should be worn. Use of respiratory protection should be considered but not mandated for all persons working in close proximity to livestock in dusty conditions. A respiratory protection program may also serve as a cost effective biosecurity measure to protect animals from human pathogens such as influenza virus. Proper design and management of barn ventilation systems is critical for maintaining temperature and humidity levels for optimal animal growth; as well as decreasing the level of gases and respirable dusts. The pork and the cattle industries support occupational health and safety; however, the governmental guidance and recommendations for such programs are limited for the agricultural industries as a whole. The industries should lead the way in the effort to improve respiratory protection for workers. Overall, a team approach that includes input from managers, workers, and veterinarians is important for the reduction of respiratory hazards on livestock farms.

Prevalence of beryllium sensitization among aluminium smelter workers

Beryllium exposure occurs in aluminium smelters from natural contamination of bauxite, the principal source of aluminium. To characterize beryllium exposure in aluminium smelters and determine the prevalence rate of beryllium sensitization (BeS) among aluminium smelter workers. A population of 3185 workers from nine aluminium smelters owned by four different aluminium-producing companies were determined to have significant beryllium exposure. Of these, 1932 workers participated in medical surveillance programmes that included the serum beryllium lymphocyte proliferation test (BeLPT), confirmation of sensitization by at least two abnormal BeLPT test results and further evaluation for chronic beryllium disease in workers with BeS. Personal beryllium samples obtained from the nine aluminium smelters showed a range of <0.01-13.00 μg/m(3) time-weighted average with an arithmetic mean of 0.25 μg/m(3) and geometric mean of 0.06 μg/m(3). Nine workers were diagnosed with BeS (prevalence rate of 0.47%, 95% confidence interval = 0.21-0.88%). BeS can occur in aluminium smelter workers through natural beryllium contamination of the bauxite and further concentration during the refining and smelting processes. Exposure levels to beryllium observed in aluminium smelters are similar to those seen in other industries that utilize beryllium. However, compared with beryllium-exposed workers in other industries, the rate of BeS among aluminium smelter workers appears lower. This lower observed rate may be related to a more soluble form of beryllium found in the aluminium smelting work environment as well as the consistent use of respiratory protection.

From the Editors

<i>From the Editors</i>

Characterizing the Risk of Infection from Mycobacterium tuberculosis in Commercial Passenger Aircraft Using Quantitative Microbial Risk Assessment

Quantitative microbial risk assessment was used to predict the likelihood and spatial organization of Mycobacterium tuberculosis (Mtb) transmission in a commercial aircraft. Passenger exposure was predicted via a multizone Markov model in four scenarios: seated or moving infectious passengers and with or without filtration of recirculated cabin air. The traditional exponential (k = 1) and a new exponential (k = 0.0218) dose-response function were used to compute infection risk. Emission variability was included by Monte Carlo simulation. Infection risks were higher nearer and aft of the source; steady state airborne concentration levels were not attained. Expected incidence was low to moderate, with the central 95% ranging from 10(-6) to 10(-1) per 169 passengers in the four scenarios. Emission rates used were low compared to measurements from active TB patients in wards, thus a "superspreader" emitting 44 quanta/h could produce 6.2 cases or more under these scenarios. Use of respiratory protection by the infectious source and/or susceptible passengers reduced infection incidence up to one order of magnitude.

Protection Against Breathing Dust: Behavior Over Time in Californian Farmers

The aim of this study was to determine whether Californian farmers changed respiratory protective behaviors over time and the personal characteristics associated with protective behaviors. We surveyed 588 farmers longitudinally from 1993 to 2004. Questions included frequency of protective mask or respirator use in dusty conditions and the percentage of time the farmers drove a tractor with a closed cab. To assess longitudinal associations between protective behaviors and potential covariates, general estimating equation modeling was used with adjustment for subject age, study date, and other covariates. Only 25% of the farmers were "very" concerned about respiratory risks. Over time, any use of a dust mask or respirator decreased significantly, from 54% in 1993 to 37% in 2004 (p-value < or = 0.0001), while consistent use of respiratory protection was maintained by 20% of the cohort. Use of a closed-cab tractor increased slightly from 14% in 1993 to 17% in 2004 (p-value = 0.04). Farmers who were ex-smokers and those concerned about respiratory risk were more likely to consistently use a dust mask or respirator. However, the more acreage or time spent in dust, the less likely farmers were to use protection. Closed-cab tractor use was associated with higher salary, more time driving tractors, and larger acreage farmed. Emission reduction remains a priority. Exposure reduction by closed-cab tractor use was not associated with perception of respiratory risk. As mask or respirator use was most positively associated with respiratory concern, more effort needs to be concentrated on educating farmers about long-term respiratory health risks, and providing more user-friendly personal protective equipment.

Employment status and use of respiratory protection among metalworkers, solderers and welders

Objectives: Reported associations of self-employment with occupational injury and cerebrovascular disease suggest that worker safety and health precautions may vary by occupational status. The authors assessed the extent to which...

The Effect of Microbiological Containment Systems on Dexterity

Microbiology laboratories use containment equipment such as safety cabinets and isolators or respiratory protective equipment to protect workers against aerosol infection hazards. There is a perception among microbiologists that the use of containment equipment reduces dexterity to a point where the risks associated with using sharps are increased. Thus, in a situation where it is essential to use sharps, the use of respiratory protection is frequently the favored method of operator protection. Using three methods of manual dexterity testing, the effect of latex gloves, a positive pressure respirator, and three forms of containment equipment, (a Class II safety cabinet, a half suit, and a flexible film isolator) were tested against performance in these tests using bare hands in 10 subjects. The study was extended to additionally assess Class III cabinets using 20 subjects. With the exception of latex gloves, the personal protective equipment and containment equipment all had a statistically significant detrimental effect on manual dexterity compared with working solely with bare hands. The use of containment systems, especially barrier containment systems such as Class III cabinets and isolators, significantly reduces dexterity and may increase the chance of accidents. The use of positive pressure respirators with double gloves also affects dexterity but to a lesser extent. The use of sharps should be minimized within containment equipment. Risk assessment may be required to address the comparative risk of aerosol and needlestick infection with different agents to choose the most appropriate containment systems.

Screening Events to Reduce Farmers' Hazardous Exposures

Dairy farmers may be exposed to high levels of noise and dust. Protections against these hazards exist, but many farmers do not use them. An intervention consisting of hearing and respiratory screenings combined with personalized education was implemented. This study evaluates the impact of this intervention on farmers' self-reported use of personal protective equipment (PPE) and implementation of noise and dust abatement. Participants were screened as to noise (n=209) or dust (n=392) hazards and use of PPE. Following this, they were counseled on PPE use, and identification and reduction of noise or dust hazards. Counselors sought a pledge from the farmers to eliminate hazards and increase PPE use. Farmers were subsequently surveyed and asked whether they had implemented the changes. At baseline, 70% (146/209) of farmers exposed to high levels of noise reported poor use ("sometimes", "rarely", or "never") of hearing protection. Results indicated that two months after intervention, 25.2% (28/111) of these subjects had successfully improved their PPE use. At baseline, 79% (311/392) offarmers reported poor use of respiratory protection, with 27.3% (41/150) showing improvement in PPE use within the same time. Strategies to reduce noise hazards were identified by 92.8% (194/209) of hearing screening attendees; 13.2% (18/136) successfully reduced or removed exposure. These values for dust screening attendees were 98.2% (385/392) and 30.7% (54/176), respectively. Use of this intervention appears to be an effective method for increasing PPE use on the farm. However, it is not effective for reducing noise hazards.