NIOSH eNews

From the Director’s Desk

John Howard, M.D.
Director, NIOSH

Take Time to Acclimatize Workers in Hot Environments

The typically hotter temperatures of July and August (and often into September), which last for days or weeks with little or no relief, are still ahead of us in more temperate parts of the United States. While some may be enjoying summer vacations somewhere cool, many workers will be outside laboring in the extreme heat. It is important for employers to make the effort to protect their workers from heat-related illnesses, such as heat exhaustion and the often fatal heat stroke. To see if recent (2008–2013) cases of occupational heat-related fatalities have occurred near you, see OSHA’s Heat Fatalities map.

Providing workers with rest periods in shaded or cool areas, ensuring they have access to water or other hydrating beverages, and training workers to recognize symptoms of heat-related illness are all important. However, employers should also take the opportunity to acclimatize workers who will be spending time in the heat. Acclimatization is the beneficial, physiological adaptations that occur during repeated exposure to a hot environment. These adaptations may include increased sweating efficiency, stabilization of the circulation, and the ability to perform work with lower core temperature and heart rate. If workers are not acclimatized, then they may more quickly show signs of heat stress and have difficulty replacing water lost in sweat.

As part of their heat illness prevention program, employers should implement an acclimatization plan for new and returning workers. The level of acclimatization and the time it takes to become acclimatized vary depending on the fitness level and the total heat stress (i.e., metabolic and environmental) experienced by the worker. To acclimatize workers, exposure to the hot environment should gradually be increased over a 7 to 14 day period. For new workers, the schedule should involve no more than 20% exposure on Day 1 and no more than 20% increase on each additional day. For workers who have had previous experience with the job, the schedule should be no more than 50% exposure on Day 1, 60% on Day 2, 80% on Day 3, and 100% on Day 4.

Acclimatization can be maintained for a few days when the worker is not in the hot environment, such as when they go home for the weekend. However if the worker is away for a longer period (e.g., week-long vacation), then many of the beneficial adaptations from acclimatization may be lost. It is also important for employers to understand that extreme heat events or heat waves can result in previously acclimatized workers no longer having the appropriate physiological adaptations for the new higher temperatures of the environment. During extreme heat events, adjusted work-rest schedules may be required to allow workers the extra time needed to cool down. In addition, the workers should be provided with hydrating beverages and encouraged by their supervisors to take frequent hydration and rest breaks.

Hot environments can be dangerous, but employers may be able to decrease the risk of heat-related illness at their workplace by providing workers with the opportunity to acclimatize, providing hydrating beverages such as water, and encouraging hydration and rest breaks.

For more information on acclimatization and preventing heat-related illnesses, read the Criteria for a Recommended Standard: Occupational Exposure to Hot Environments(Ch. IV, Section A-5, “Acclimatization to Heat,” p. 35; Ch. VI, Section B-3, “Enhancing Tolerance to Heat,” p. 69).

Also available is the draft NIOSH Criteria for a Recommended Standard: Occupational Exposure to Heat and Hot Environments. The draft is an update of the above 1986 NIOSH criteria document. It includes new information related to risk factors, heat stroke, and physiological monitoring and also examples of heat-related health hazard evaluation reports and case studies.

Additional heat-related resources can be found on the NIOSH Heat Stress topic page and OSHA’s Campaign to Prevent Heat Illness in Outdoor Workers.

NIOSH Launches Buy Quiet Website

NIOSH announces the official launch of its Buy Quiet website. Buy Quiet is a prevention initiative that encourages companies to purchase or rent quieter machinery and tools to reduce worker noise exposure. The initiative also provides information on equipment noise levels and encourages manufacturers to design quieter equipment. www.cdc.gov/niosh/topics/buyquiet/

NIOSH Research Makes ASSE Cover Story

NIOSH researcher Mike Flynn’s article, “Safety and the Diverse Workforce: Lessons from NIOSH’s Work with Latino Immigrants,” was the June cover feature of the American Society of Safety Engineers’ (ASSE) Professional Safety journal. The article describes the importance of understanding the communication needs of working populations whose first language is not English and using that understanding to tailor and convey meaningful occupational safety information. http://www.asse.org/professionalsafety/index.php#undefined

New NIOSH Web Page on O-toluidine

Ortho-toluidine (o-toluidine) is a man-made chemical that can cause cancer. It is important to limit occupational exposures. Learn more about o-toluidine and how to keep workers safe. /niosh/topics/oT/

Call for Nominations 2015 Safe-in-Sound Excellence in Hearing Loss Prevention Awards™

Nominations are now being accepted for the 2015 Safe-in-Sound Excellence in Hearing Loss Prevention Awards™. The awards are given by NIOSH in partnership with the National Hearing Conservation Association to recognize excellence in hearing loss prevention. The deadline for self-nominations is September 8. Additional information is available at www.safeinsound.us.

Registration is NOW OPEN for 1st International Symposium to Advance TOTAL WORKER HEALTH

The NIOSH Office for Total Worker Health is excited to announce that registration is NOW OPEN for the 1st International Symposium to Advance TOTAL WORKER HEALTH™. The symposium will be held October 6–8 on the campus of the National Institutes of Health in Bethesda, Maryland. Join more than 500 scientists and practitioners from around the world and learn the state of the science and practice using a coordinated approach that integrates health protection and health promotion. To register and learn more about the symposium, visit www.eagleson.org/totalworkerhealth.

Contact the NIOSH PtD Initiative Today

Update: In the June issue of NIOSH eNews (/niosh/enews/enewsV12N2.html), we announced the arrival of our new coordinator for the NIOSH Prevention Through Design (PtD) Initiative. We regret that the provided email address, JBach@cdc.gov, returned error messages to senders. The address is now functional, and Mr. Jonathan Bach awaits your contributions to the PtD effort!

NIOSH Congratulates

NIOSH Researcher Receives Charles C. Shepard Science Award

NIOSH researcher Dr. Matt Wheeler and Miami University researcher Dr. John Bailer won the U.S. Centers for Disease Control and Prevention’s 2014 Charles C. Shepard Science Awards in the category of data methods and study design. Their journal article, “An Empirical Comparison of Low-dose Extrapolation from Points of Departure (POD) Compared to Extrapolations Based Upon Methods that Account for Model Uncertainty,” was published in the October 2013 issue of Regulatory Toxicology and Pharmacology, pages 75–82. http://www.sciencedirect.com/science/article/pii/S0273230013001013

NORA

Pilot Study of Smartphone Sound Measurement Apps

Interactions between the NORA Manufacturing Sector Council, NIOSH Manufacturing Program, and the NIOSH Hearing Loss Program fostered a NIOSH pilot study to examine the performance and applicability of smartphone sound measurement apps. The study included 10 apps available in June 2013. The results were reported in a peer-reviewed paper (http://scitation.aip.org/content/asa/journal/jasa/135/4/10.1121/1.4865269), which currently is the #1 viewed/downloaded paper on the journal’s website with over 5,500 full-text downloads. A popular NIOSH science blog on the subject (http://blogs.cdc.gov/niosh-science-blog/2014/04/09/sound-apps/#_blank) has over 7,400 views. And a Twitter campaign (#soundmeterapps) reached 320,000 accounts. For more information, contact Thais Morata, TMorata@cdc.gov.

Fire Fighter Fatality Investigation Program Reports

Captain Suffers Fatal Heart Attack during Fire Control Training—North Carolina

On October 14, 2013, a 48-year-old male career fire department captain suffered a fatal heart attack during practice drills. The captain was an instructor with the department’s 6-month fire fighter recruit program. After completing six live fire drills wearing full turnout gear and self-contained breathing apparatus, the captain became ill and complained of chest pain. After 43 minutes of resuscitation efforts at the scene, the captain was pronounced dead. Given the captain’s previously unidentified coronary artery disease, NIOSH investigators concluded that the physical stress of the training probably triggered a coronary artery plaque rupture. The rupture likely caused a blood clot that occluded his coronary artery, causing the fatal heart attack. /niosh/fire/reports/face201325.html

Two Career Lieutenants Killed and Two Career Fire Fighters Injured Following a Flashover at an Assembly Hall Fire—Texas

On February 15, 2013, a 36-year-old male career lieutenant (Victim #1) and a 54-year-old male career lieutenant (Victim #2) were killed and two career fire fighters were seriously injured at an assembly hall fire. Upon arrival, Victim #1 and his probationary fire fighter advanced a hoseline inside to find the seat of the fire. They both ran low on air and started to exit. For an unknown reason, Victim #1 was unable to follow the hoseline and he became separated from his probationary fire fighter. Victim #1 radioed for help and the rapid intervention team (RIT), was immediately deployed to locate Victim #1. The RIT followed the hoseline in and was able to locate Victim #1, who was responsive. While dragging Victim #1 toward the exit, the RIT was caught in a flashover. Victim #1 did not survive his injuries. Victim #2 and the other two RIT members were transferred to a regional burn center for extensive treatment where Victim #2 later succumbed to his injuries. /niosh/fire/reports/face201304.html

Volunteer Fire Fighter Found Unresponsive With His Facepiece Off Dies Eight Days Later—Maryland

On April 24, 2013, a 24-year-old male volunteer fire fighter was injured while fighting a residential structure fire and died eight days later at a metropolitan trauma center. The victim was part of the crew that first arrived on-scene. The victim and another fire fighter immediately began searching for an occupant reported to be trapped on the second floor. As other fire fighters stretched hoselines to fight the fire, they heard a personal alert safety system alarm and then called a “Mayday.” They found the downed fire fighter with his gloves, helmet, hood, and facepiece removed. Soon after the fire fighter was removed, the civilian was found dead. NIOSH investigators identified the following contributing factors that led to this fire fighter fatality: the civilian at risk in the structure, blocked access/egress (due to hoarding, which added to the fuel load), loss of crew integrity, and the victim did not have a radio. /niosh/fire/reports/face201313.html

Volunteer Fire Chief Struck and Killed on Interstate Highway while Directing Traffic—Pennsylvania

On April 27, 2013, a 45-year-old male volunteer fire chief died after being struck by a vehicle on an interstate highway. The victim’s department was dispatched to assist a neighboring fire department working a motor vehicle incident. The victim’s department was ordered by the incident commander to shut down both southbound travel lanes to allow for an aeromedical helicopter to land on the interstate. The victim responded to the scene in his personal vehicle, used it to block the southbound travel lanes, and diverted approaching traffic onto an off-ramp. A motorist, allegedly under the influence, drove around the victim’s vehicle, striking and killing him. The victim was not wearing a high-visibility retro-reflective vest and a traffic incident management area had not been established. /niosh/fire/reports/face201312.html

News from Our Partners

AOHP Releases Updated Safe Patient Handling Resource Guide

The Association of Occupational Health Professionals in Healthcare (AOHP) recently published the third edition of Beyond Getting Started: A Resource Guide for Implementing a Safe Patient Handling Program in the Acute Care Setting to promote the health and safety of healthcare personnel and patients across the nation. This guide cites NIOSH research and recommendations. http://aohp.org/aohp/Portals/0/Documents/ToolsForYourWork/free_publications/Beyond%20Getting%20Started%20Safe%20Patient%20Handling%20-%20May%202014.pdf.pdf

New Hampshire Behavioral Risk Factor Surveillance System Survey

Healthcare workers are presumed to have good health behaviors because they are more knowledgeable than others about the consequences of certain choices affecting their health, conventional wisdom holds. With the important addition of industry and occupation questions on the New Hampshire Behavioral Risk Factor Surveillance System survey, these behaviors can be explored and compared with behaviors of other working adults in New Hampshire. Insight into risk prevalence within this population may reveal how public health messages are perceived and followed and whether public health goals are achievable. While New Hampshire healthcare workers were significantly more likely to report an influenza vaccination during the past year when compared with the rest of the working respondents, the proportion was only 60.7%. Healthy People 2020 goals are to increase this proportion to 90%. To read the report, visit http://www.dhhs.nh.gov/dphs/hsdm/ohs/documents/healthbehav-hcw-2014.pdf.

New Mexico Occupational Health Surveillance Program

The New Mexico Occupational Health Surveillance Program has a new tool for disseminating data and information to healthcare providers, occupational health professionals, industry, worker groups, and others. The Occupational Health in New Mexico eBulletin is distributed to subscribers on a quarterly basis. The first eBulletin highlighted New Mexico’s occupational notifiable conditions and how to report, while the second provided information about the collection of occupation and industry in the Behavioral Risk Factor Surveillance System. The most recent bulletin highlights the Occupational Health Indicators for 2011. Visit nmhealth.org/go/ohsp to see past e-bulletins and to sign up to receive the Summer 2014 eBulletin release.

OSHA Schedules Stakeholder Meeting to Gather Information on Proposed Standard for Emergency Response and Preparedness

The Occupational Safety and Health Administration has scheduled an informal stakeholder meeting to gather information as it develops a proposed standard for emergency response and preparedness. The meeting will be held July 30 at 9 a.m. at the U.S. Department of Labor, 200 Constitution Ave., NW, Washington, DC 20210. The meeting will not include formal presentations but instead will be conducted as a group discussion. OSHA will focus on issues such as scope and approach surrounding emergency response and preparedness. If needed, a second session will be held July 31. Those interested in attending can register at http://ersregistration.pec1.net/, by facsimile, or by mail. See the Federal Register notice for registration details. The registration deadline is July 2.

r2p Corner

New NIOSH Partnership with U.S. Forest Service—Missoula Technology and Development Center

NIOSH and the U.S. Department of Agriculture, U.S. Forest Service (USFS), Missoula Technology and Development Center (MTDC), signed a new partnership agreement to advance worker safety and health among wildland fire fighters. NIOSH and USFS/MTDC will have the opportunity to coordinate and collaborate safety and health research among wildland fire fighters. For more information, contact Corey Butler at (303) 236-5953 or crbutler@cdc.gov.

Health Hazard Evaluation (HHE) Program Update

Evaluation of Metals, Solvents, Formaldehyde, Ventilation, and Ergonomic Risks During the Manufacture of Electrical Cable Accessories

The HHE Program received a request from employees at a manufacturer of premolded cable accessories who were concerned about chemical exposures, poor ventilation, and ergonomic risks during rubber molding, plastic extrusion, soldering, and painting. HHE investigators talked to employees about their health and work, reviewed injury and illness logs, looked at work practices and processes, inspected ventilation systems, collected air samples for solvents and air and surface wipes for metals, and evaluated workstations for ergonomic risk factors. Some employees working with irritants and solvents reported eye and upper respiratory symptoms, headaches, and lightheadedness. The HHE investigators found deficiencies in the plant’s ventilation system that included holes in the ductwork, disconnected ducts, and broken dampers. Air levels of chemicals were low except for one toluene air sample on a spray painter. The evaluation noted that many employees had a combination of forceful exertion, repetitive movements, and twisting and bending that put them at risk for musculoskeletal disorders. HHE Program investigators recommended

• Repairing the ventilation system deficiencies
• Providing exhaust ventilation to the drying racks used for painted parts
• Installing a conveyor to help load parts, and use a tool to move parts into the collection bin

A link to this final report is available at /niosh/hhe/whats_new.html.

Evaluation of Indoor Environmental Quality in a Medical Office Building

The HHE Program received a request from employees at a medical office building. They were concerned about indoor environmental quality and exposure to sewer gas, specifically hydrogen sulfide. The building was surrounded by sewer manholes that had been identified as sources of odors. We measured hydrogen sulfide, carbon dioxide, temperature, and humidity levels throughout the building. The investigators also performed a technical inspection of the building’s heating, ventilation, and air-conditioning system. The investigators found problems with duct dampers, heat pumps, and the computerized control system; outdoor air supplied to each floor was not uniformly distributed; and temperature and humidity were within ANSI/ASHRAE recommended levels. The evaluation found odor sources, such as dry drain traps and manholes, within and near the building. HHE Program investigators recommended

• Fixing the ventilation problems and testing and balancing the system
• Replacing the cast-iron plumbing pipe with polyvinyl chloride pipe
• Creating an employee and employer health and safety committee and holding regular meetings

A link to this final report is available at /niosh/hhe/whats_new.html.

What’s New on the NIOSH Science Blog? Join the Discussion Today!

• National Doughnut Day
  http://blogs.cdc.gov/niosh-science-blog/2014/06/06/doughnutday/
• Safety Sustainability
  http://blogs.cdc.gov/niosh-science-blog/2014/06/10/safety-sustainability/

Federal Register Notices of Public Meetings and Public Comment

Virtual Reality to Train and Assess Emergency Responders—Revision
The notice was posted on May 16. Written comments should be received within 60 days.
https://federalregister.gov/a/2014-11313

National Occupational Research Agenda (NORA) 2016 Decade Review—New
The notice was posted on May 27. Written comments should be received within 60 days.
https://federalregister.gov/a/2014-12114

Musculoskeletal Disorders (MSD) Intervention Effectiveness in Material Handling Operations—Revision
The notice was posted on June 4. Written comments should be received within 60 days.
https://federalregister.gov/a/2014-12838

For a listing of NIOSH official publications for rules, proposed rules, and notices, go to www.cdc.gov/niosh/fedreg.html.

New NIOSH Communication Products

• The State of the National Initiative on Prevention through Design
  /niosh/docs/2014-123/
• Preventing Worker Injuries and Deaths From Backing Construction Vehicles and Equipment at Roadway Construction Worksites
  /niosh/docs/wp-solutions/2014-125/

Presentations and Abstracts

American Association of Textile Chemists and Colorists
Oral presentations must be submitted by July 21. Poster presentations must be submitted by November 7.
http://www.aatcc.org/ic/gen_info2015.cfm

Upcoming Conferences and Workshops

8th Annual National Conference on Health Communication, Marketing and Media
August 19–21, Atlanta, GA http://www.nphic.org/

2014 National Safety Council Congress & Expo
September 13–19, San Diego, CA http://www.congress.nsc.org/nsc2014/public/enter.aspx

International Symposium to Advance Total Worker Health™
October 6–8, Bethesda, MD /niosh/twh

24th Annual Meeting of the International Society of Exposure Science
October 12–16, Cincinnati, OH http://ises2014.org/index.html

62nd International Association of Emergency Managers Annual Conference
November 14–19, San Antonio, TX http://www.iaem.com/page.cfm?p=events/annual-conference

American Association of Textile Chemists and Colorists
March 24–26, 2015, Savannah, GA http://www.aatcc.org/default.cfm

FDIC 2015 Conference
April 20–25, 2015, Indianapolis, IN http://www.fdic.com/index.html#showcase_2

A comprehensive list of upcoming conferences can be found at www.cdc.gov/niosh/exhibits.html.

Did You Know?

Did you know that July is HIV Awareness Month? NIOSH offers resources including engineering controls and work practices to prevent occupational exposures to blood and other body fluids that may contain HIV. /niosh/topics/bbp/