Biologically hazardous agents at work and efforts to protect workers' health: a review of recent reports

Shift work and menstruation: A meta-analysis study

Background

Shift work is a potential risk factor for women's reproductive health. Evidence suggests that shift work is associated with menstrual disorders, reproductive disturbances, and adverse pregnancy outcomes. However, previous studies did not systematically examine the results of menstrual irregularities, dysmenorrhea, and early menopause at the same time.

Objective

To determine the relationship between shift work and women's menstrual characteristics (e.g., irregular menstruation, dysmenorrhea, and early menopause).

Methods

Four databases (PubMed, Embase, Cochrane, and Web of Science) were searched up to December 2022. The study characteristics and risk assessment values of the literature were extracted from 21 studies that met the criteria. Odds ratios (ORs), relative risks (RRs), hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated to assess the relationship between shift work exposure and menstruation. The included studies were evaluated for heterogeneity, publication bias, sensitivity analysis, and subgroup analysis.

Results

A total of 21 studies with 195,538 female participants, including 16 cross-sectional studies and 5 cohort studies, were included in this meta-analysis. According to the quality evaluation, the included research had high methodological quality. The overall ORs of shift work for the likelihood of irregular menstruation and dysmenorrhea were 1.30 (95% CI, 1.23-1.36) (I2 = 41.9%, P < 0.05) and 1.35 (95% CI, 1.04-1.75) (I2 = 73.0%, P < 0.05), respectively. There was a significant positive association between shift work and the risk of early menopause (HR = 1.09, 95% CI, 1.04-1.14), without significant heterogeneity (I2 = 0.0%, P > 0.05).

Conclusions

This meta-analysis indicated that shift workers have significantly higher odds of menstrual disorders, dysmenorrhea, and early menopause. This study focuses on female reproductive health and has broad implications for adjusting optimal working hours and shift schedules for female workers.

A Systematized Overview of Published Reviews on Biological Hazards, Occupational Health, and Safety

Introduction

The COVID-19 pandemic turned biological hazards in the working environment into a global concern. This systematized review of published reviews aimed to provide a comprehensive overview of the specific jobs and categories of workers exposed to biological hazards with the related prevention.

Methods

We extracted reviews published in English and French in PubMed, Embase, and Web of Science. Two authors, working independently, subsequently screened the potentially relevant titles and abstracts recovered (step 1) and then examined relevant full texts (step 2). Disagreements were resolved by consensus. We built tables summarizing populations of exposed workers, types of hazards, types of outcomes (types of health issues, means of prevention), and routes of transmission.

Results

Of 1426 studies initially identified, 79 studies by authors from every continent were selected, mostly published after 2010 (n = 63, 79.7%). About half of the reviews dealt with infectious hazards alone (n = 38, 48.1%). The industrial sectors identified involved healthcare alone (n = 16), laboratories (n = 10), agriculture (including the animal, vegetable, and grain sectors, n = 32), waste (n = 10), in addition of 11 studies without specific sectors. The results also highlighted a range of hazards (infectious and non-infectious agents, endotoxins, bioaerosols, organic dust, and emerging agents).

Conclusion

This systematized overview allowed to list the populations of workers exposed to biological hazards and underlined how prevention measures in the healthcare and laboratory sectors were usually well defined and controlled, although this was not the case in the agriculture and waste sectors. Further studies are necessary to quantify these risks and implement prevention measures that can be applied in every country.

Cancer risks in a population-based study of agricultural workers: results from the Taiwan's Farmers and Health Cohort study

OBJECTIVE

The purpose of this study was to assess cancer risk among agricultural workers compared to the general population.

METHODS

The study utilized data from Farmers' Health Insurance (FHI) in Taiwan, which enrolled agricultural workers (N=1 175 149). The enrolled workers were matched to a general population (N=1 175 149) of the same age, gender, township, and enrollment year. The study population was linked to the National Cancer Registry to identify new cancer cases between 2000 and 2018. The Cox proportional hazards model was used to estimate the hazard ratio and 95% confidence interval for outcomes.

RESULTS

During the study period, 136 913 new cancers among agricultural workers were identified. The study found that male farmers had an increased cancer risk, including lymphocytic leukemia, chronic myelogenous leukemia, non-Hodgkin's lymphoma (NHL), oral cancer, lip cancer, esophagus cancer, rectum and rectosigmoid junction cancer, liver and intrahepatic bile duct cancer, lung cancer, trachea and bronchi cancer, and other non-melanoma skin cancer, even when considering the latency period. Female farmers had an elevated risk of multiple myeloma and other non-melanoma skin cancer. Moreover, only lymphoma, NHL, other lymphoid, and multiple myeloma, were both found to occur at different insurance periods.

CONCLUSIONS

This study provides farmer cancer patterns and risk, adding to the evidence that farmers are at increased risk of certain types of cancer, especially for hematological cancers. As exposure varies by farm operation type, individual farmer exposure may vary widely. Further understanding of the complex relationship between occupational exposure, environmental factors, and lifestyle factors is needed.

Prevalence and Determinants of Work-Related Injuries Among Healthcare Workers in Jeddah, Saudi Arabia

Background and objective Work-related injuries (WRIs) are a major occupational health issue among healthcare workers (HCWs) worldwide. Unsafe work environments, including physical, chemical, and biological hazards, are significant contributing factors to WRIs. However, the prevalence of WRIs among HCWs in Jeddah, Saudi Arabia, and their associated risk factors remain largely unexplored. In light of this, this study aimed to investigate the prevalence of WRIs and associated risk factors among HCWs in Jeddah, Saudi Arabia. Methods This was an analytic cross-sectional study conducted at secondary hospitals of the Ministry of Health (MOH) in Jeddah by using a self-administered questionnaire to measure the prevalence of WRIs and their related factors. The Chi-squared test was used to compare variables. A p-value <0.05 was considered statistically significant. Results The study involved 387 participants, of whom 283 (73.1%) were female. Most of the participants (n=226, 58.4%) agreed that personal protective equipment (PPE) was always available at their hospitals. Approximately two-thirds (n=251, 64.9%) agreed that they always used PPE. The overall prevalence of WRIs was 52%, with back injuries (32.6%), eye/mouth splashes (20.4%), and needle stick injuries (19.9%) being the most common. Years of work experience (p=0.014), type of profession (p<0.001), training in safety management (p=0.028), working hours (p=0.0001), working shifts (p=0.001), PPE availability (p=0.010), and sharp container availability (p=0.030) were significantly associated with WRIs. Conclusion This study revealed a high prevalence of WRIs among HCWs in Jeddah, Saudi Arabia, with back injuries, eye/mouth splashes, and needle stick injuries being the most common types. The study also found that the injuries were significantly associated with the type of profession, experience, work hours, and shifts as well as the availability of safety management and equipment such as sharp containers and PPE.

Prussian Blue Sensor for Bacteria Detection in Personal Protection Clothing

Biological hazards can be defined as substances that endanger the life of any living organism, most notably humans, and are often referred to as biohazards. Along with the use of personal protective equipment (PPE), early detection of contact is essential for the correct management and resolution of a biological threat, as well as lower mortality rates of those exposed. Herein, Prussian blue (PB) was evaluated as a functional compound applied on polyester knits to act as an on-site sensor for bacteria detection. In order to study the best compound concentration for the intended application, polymeric solutions of 0.5, 1 and 2 g/L were developed. The three conditions tested displayed high abrasion resistance (>2000 cycles). The bacterial sensing capacity of the coated knits was assessed in liquid and solid medium, with the functionalised substrates exhibiting the capability of detecting both Gram-positive and Gram-negative bacteria and changing colours from blue to white. Evaluation of water repellence and chemical penetration resistance and repellence was also performed in polyester functionalised with PB 0.5 and 1 g/L. Both knits showed a hydrophobic behaviour and a capacity to resist to penetration of chemicals and level 3 repellence effect for both acid and base chemicals.

Occupational health surveillance and detection of emerging occupational diseases among Taiwan farmers, through analysis of national-based farmers' and medico-administrative databases

OBJECTIVES

The purpose of this study was to identify occupational injuries and diseases associated with agriculture in Asia, to provide a reference for prevention and hypotheses for future research.

METHODS

We matched data on agricultural workers (n = 963,124) enrolled in Taiwan's national Farmers Health Insurance since its inception in 1989, to general population controls of the same age, gender, and township. The study population was linked to the National Health Insurance Research Database from 2001 to 2016 for inpatient cases. Logistic regression was used to assess odds ratios for outcomes.

RESULTS

Farmers had 2.76 times the risk of mycotic corneal ulcer (95% CI: 1.96-3.87) and 1.65 times the risk of typhus fever infections (95% CI: 1.47-1.85) compared to the general population. The odds ratio for poisonous animal bites was 2.22 (95% CI: 2.07-2.38), for falling into a storm drain or manhole was 2.04 (95% CI: 1.30-3.20), and for toxic effects from pesticides was 2.01 (95% CI: 1.92-2.11). The toxic effects of organophosphate and carbamate insecticides were correlated with the cultivation of rice, fruit trees, and flowers. Q fever and motorcycle accidents were associated with fruit tree cultivation.

CONCLUSIONS

The study identifies agricultural occupational injuries and diseases that may inform occupational health policy and the development of prevention priorities to prevent occupational hazards for farmers.

Trends in Occupational Infectious Diseases in South Korea and Classification of Industries According to the Risk of Biological Hazards Using K-Means Clustering

Against the backdrop of the COVID-19 pandemic, it is necessary to identify these risks and determine whether the current level of management is appropriate to respond to the risk of biological hazards depending on the occupation. In this study, the incidence and fatality rates of occupational diseases were calculated using industrial accident statistics of South Korea, and trends by year using joinpoint regression and relative risk by industry using k-means clustering were evaluated for infectious diseases. We found that infectious diseases had the third highest incidence and fourth highest fatalities among all occupational diseases. In the incidence rate, joinpoints appeared in 2009 and 2018, and the annual percent change changed to 7.79, -16.63, and 82.11. The fatality rate showed a consistent increase with an annual percent change of 4.37, but it was not significant. Industries were classified into five groups according to risk, and the legal control measures of certain industries were not sufficient. Follow-up studies are needed to rectify the structural limitations of industrial accident statistics.

Detection of bacterial contaminants via frequency manipulation of amino-groups functionalized Fe3O4nanoparticles based resonant sensor

Bacterial infections have a large impact on public health. Through this study, we report on the development of complementary split-ring resonators (CSRR) supplemented by functionalized nanoparticles to detect bacteria in the aqueous medium. Iron oxide (Fe₃O₄) nanoparticles were functionalized with amino groups using (3-aminopropyl) triethoxysilane (APTES) to form (APTES@Fe₃O₄) nanoparticles, which have a specific affinity towards the bacterial species. This affinity was evaluated using theEscherichia coli (E. coli)andStaphylococcus aureus (S. aureus)bacterial species. The resonant sensor was tuned at 430 MHz and the CSRR sensor bed was further activated using APTES@Fe₃O₄nanoparticles. Bacterial detection was studied over a range of concentrations from 2.66 x 10⁹cells to 2.66 x 10⁸cells. The sensor actively responded to small changes in bacterial concentration, showing an overall shift in resonance frequency of ~ 44 MHz (~ 40 MHz / cell count) forE. coliand ~ 55 MHz (50.43 MHz / cell count) forS. aureus. Dextran sulphate and Chitosan were used as the references. The magnetic character of the conjugated system exhibited strong interaction of the bacterial species with APTES@Fe₃O₄, justifying the high selectivity towards these species. This demonstrates the feasibility of a sensitive, fast, portable device, against the traditionally used time-consuming bio-assays.

Development of an Indexed Score to Identify the Most Suitable Sampling Method to Assess Occupational Exposure to Fungi

The sampling approach is of utmost importance to obtain data regarding microbial viability and truly assess workers’ potential health effects. The purpose of this assessment is to create a score which will provide up-to-date information to identify the most suitable sampling method to assess occupational exposure to fungi. Data from a sampling campaign performed at Firefighters Headquarters (FFH) was analysed and a score was calculated from one (1) to three (3) for five (5) distinct sample parameters: (a) accuracy; (b) complexity of the field work; (c) cost; (d) complexity in laboratory work; and (e) time taken since the fieldwork until obtaining the fungal contamination characterization. The statistical analysis allowed us to conclude that settled dust and Andersen six-stage were the best sampling methods to perform the assessment of the occupational exposure to fungi at FFH, when considering the number of species. As for the final score, the results showed that surface swabs were the best sampling method. The results obtained for surface swabs highlights the low complexity of this processing combined with the fact that it is a low-cost sampling method. This study reinforces the need to use a wide array of sampling methods when assessing occupational exposure to fungal contamination to ensure an accurate risk characterization.

Microbial contamination in waste collection: Unveiling this Portuguese occupational exposure scenario

Previous studies anticipated that microorganisms and their metabolites in waste will increase as a consequence of a decreased collection frequency and due to differences in what kind of waste is bagged before collection leading to an increased exposure of workers handling the waste. This study aim was to investigate the microbial contamination present in the waste collection trucks (WCT) and in the support facilities (waste collection station - WCS). It was applied a multi-approach protocol using active (air sampling by impingement and impaction) and passive (surface swabs, electrostatic dust cloths and settled dust) sampling methods. The screening of azole-resistance, the investigation of mycotoxins and the assessment of the elicited biological responses in vitro were also carried out aiming recognizing the possible health effects of waste collection drivers. SARS-CoV-2 detection was also performed. In WCS only air samples had contamination in all the four sampling sites (canteen, operational removal core, operational removal center, and administrative service). Among all the analyzed matrices from the WCT a higher percentage of total bacterial counts and Gram-was detected in swabs (66.93%; 99.36%). In WCS the most common species were Penicillium sp. (43.98%) and Cladosporium sp. (24.68%), while on WCT Aspergillus sp. (4.18%) was also one of the most found. In the azole resistance screening Aspergillus genera was not observed in the azole-supplemented media. SARS-CoV-2 was not detected in any of the environmental samples collected, but Aspergillus section Fumigati was detected in 5 samples. Mycotoxins were not detected in EDC from WCS, while in WCT they were detected in filters (N = 1) and in settled dust samples (N = 16). In conclusion, our study reveals that a comprehensive sampling approach using active and passive sampling (e.g. settled dust sampling for a representative mycotoxin evaluation) and combined analytic methods (i.e., culture-based and molecular) is an important asset in microbial exposure assessments. Concerning the waste collection exposure scenario, the results of this study unveiled a complex exposure, particularly to fungi and their metabolites. Aspergillus section Fumigati highlight the significance of targeting this section in the waste management industry as an indicator of occupational health risk.

Optimization Study of Sampling Device for Semi-Volatile Oil Mist in the Industrial Workshop

A large number of metalworking fluids in industrial manufacturing processes generate high-concentrations of oil mist pollution, which is a typical semi-volatile aerosol and is generally composed of liquid particles and volatile gas components. Long-term exposure to oil mist pollution brings a series of occupational diseases to workers. For the semi-volatile aerosol, the traditional filter sampling method will lead to particle volatilization, which underestimates the concentration of particles and overestimates the concentration of gas. Therefore, this study combined the advantages of the electrostatic method and the Tenax tube adsorption method, to develop a more accurate measurement technology. First, a dichotomous sampler that could efficiently separate the gas and liquid phases of aerosols was optimized through a numerical model, which was validated by literature results. Next, a test table for oil mist sampling was built with a sampler which was fabricated by 3D printing, and the performance of the sampler was evaluated. The results show that the sampling technique can separate the gas and particulate phases of the oil mist efficiently and accurately. Compared with the traditional single sampling methods, the new sampler can better determine the true concentration of oil mist.

Diversity of tick species (Acari: Ixodidae) in military training areas in Southeastern Brazil

Tick-borne pathogens belong to one of the two main groups of occupational biohazards, and occupational exposure to such agents puts soldiers at risk of zoonotic infections, such as those caused by rickettsiae. There are few studies on acarological fauna and occupational risk in military areas in Brazil. Thus, the present study aimed to analyze the diversity of ticks present in the military training areas of municipalities in the Southeast Region of Brazil. The ticks were collected from the selected areas using the dragging and flagging techniques as well as by visual detection on the operators' clothing, and environmental information was also recorded. A total of ten species were collected from the 66 surveyed areas, belonging to five genera and nine species: Amblyomma sculptum, Amblyomma dubitatum, Amblyomma brasiliense, Amblyomma longirostre, Amblyomma aureolatum, Dermacentor nitens, Rhipicephalus spp., Ixodes spp. and Haemaphysalis spp. The frequent presence of tick species in military training areas along with traces and sightings of wild animals, most commonly capybaras (Hydrochoerus hydrochaeris), in most of the studied areas, indicates high levels of exposure of the military to tick vectors of spotted fever group rickettsiae and the possible occurrence of infections among the troops.

Occupation-Related Biological Health Hazards and Infection Control Practices among Indian Veterinarians

Veterinarians experience different types of health hazards from their occupation. Studies on the prevalence and occurrence of biological health hazards in veterinary medicine in India are scant and probably underreported. Thus, we sought to assess the biological health hazards and infection control practices (ICPs) among veterinarians from the states of Gujarat and Maharashtra, India. A cross-sectional survey was conducted among veterinarians (n = 562) from Gujarat and Maharashtra states in India to identify biological health hazards and ICPs for the prevention of occupational health hazards during 2016–2017 by personally contacting them. Responses regarding a biological hazard and ICPs were recorded. Descriptive analysis was attempted, and continuous variables are presented as the mean ± SD. Categorical variables are reported as counts and percentages (%). Most of the veterinarians (49.3%) worked in the field and were continuously exposed to different types of biological health hazards, especially zoonoses, ranging from mild and self-limiting to fatal diseases (e.g., brucellosis (subclinical and clinical form) and rabies (fatal)) without common prophylactic vaccinations, such as rabies and tetanus. While inquiring medical health status of the veterinarians, only 35.8% of the total respondents underwent a routine medical health checkup within the past year, and 56.9% did not receive a routine dose of an anthelmintic for deworming. Forty-nine percent of the respondents took all necessary precautions, including wearing an apron, facemask, and gloves. In contrast, 10.2% of the respondents wore only an apron, and 8.4% of respondents did not take any precautions while performing their day-to-day work. In total, 40.2% of the respondents followed the proper method of handwashing, that is, washing hands between patient examinations. In contrast, 27.9% of the respondents washed their hands once after completing the work. The majority of the respondents (87.7%) reported an urgent need for occupational hazards and safety (OHS) training in continued veterinary education (CVE) programs. The present study demonstrates that veterinarians in the states of Gujarat and Maharashtra in India pay less attention to their own health that may increase the risk of occupation-related biological health hazards. These results suggest that safety and ICPs are not prioritized, which are serious concerns. These findings may be useful for developing policies to prevent occupationally related biological health hazards among veterinarians in India.

Occupational Health and Safety Statistics as an Indicator of Worker Physical Health in South African Industry

Operations in general industry, including manufacturing, expose employees to a myriad of occupational health hazards. To prevent exposure, occupational health and safety regulations were enacted, with both employers and workers instituting various risk reduction measures. The analysis of available occupational disease and injury statistics (indicators of worker physical health) can be used to infer the effectiveness of risk reduction measures and regulations in preventing exposure. Thus, using the READ approach, analyses of occupational disease and injury statistics from South African industry, derived from annual reports of the Compensation Fund, were conducted. The publicly available database of occupational disease and injury statistics from the South African general industry is unstructured, and the data are inconsistently reported. This data scarcity, symptomatic of an absence of a functional occupational disease surveillance system, complicates judgement making regarding the effectiveness of implemented risk reduction measures, enacted occupational health and safety regulations and the status of worker physical health from exposure to workplace hazards. The statistics, where available, indicate that workers continue to be exposed to occupational health impacts within general industry, notwithstanding risk reduction measures and enacted regulations. In particular, worker physical health continues to be impacted by occupational injuries and noise-induced hearing loss. This is suggestive of shortcomings and inefficiencies in industry-implemented preventive measures and the regulatory state. A robust national occupational disease surveillance system is a regulatory tool that should detect and direct policy responses to identified occupational health hazards.

Structural Discrimination in Pandemic Policy: Essential Protections for Essential Workers

An inordinate number of low wage workers in essential industries are Black, Hispanic, or Latino, immigrants or refugees - groups beset by centuries of discrimination and burdened with disproportionate but preventable harms during the COVID-19 pandemic.

Cytotoxicity of filtering respiratory protective devices from the waste sorting industry: A comparative study between interior layer and exhalation valve

Filtering respiratory protection devices (FRPD) are mandatory for workers to wear in the Portuguese waste-sorting industry. Previous results regarding microbial contamination found on FRPD interior layer raised the question of whether microbial contamination from the exhalation valve would also have cytotoxicity effects. Since the FRPD exhalation valves are very close to workers' nose and mouth, they represent a source of exposure to bioburden by inhalation. This study aimed to evaluate the cytotoxicity of the microbial contamination present in the FRPD exhalation valves. For this purpose, the cytotoxicity effects were determined through the MTT assay in two different cell lines (human A549 epithelial lung cells, and swine kidney cells) and compared with previous results obtained with FRPD interior layers. The contamination present in the FRPD exhalation valves presented some cytotoxicity on epithelial lung cells, suggesting the inhalation route as a potential route of exposure through the use of FRPD in the waste-sorting industry. Half-maximal (50%) inhibitory concentration (IC50) values were lower for FRPD interior layer than exhalation valves in lung cells, with overall cytotoxicity lower in exhalation valves when compared to interior layer (z = -4.455, p = 0.000). Higher bacterial counts in TSA were correlated with lower IC50 values, thus, higher cytotoxicity effect in lung cells. No statistically significant differences were detected among different workplaces.

Prevalence of urinary symptoms and infections among traditional tannery workers in the Fez city of Morocco: case–control study

Background

Many work activities such as leather tanning include hazards to work. Among these, biological hazards are particularly important and pose a serious problem to human health and environment. The aims of this study were to estimate the prevalence of dysuria and urinary tract infections among tannery workers and to identify their risk factors.

Methods

This observational survey was conducted among 220 tannery workers and 220 age-matched control group from Fez city in Morocco. Reported urinary symptoms, demographic and professional information were obtained by a standardized questionnaire collected from participants and were then compared among the two groups. The logistic regression model was used to explore the interaction between variables with significant association.

Results

The most common symptoms reported by tannery workers and controls were dysuria (36.4% vs. 1.8%, p < 0.001), voiding frequency (15.5% vs. 0.9%, p < 0.001) and incontinence (3.2% vs. 0.5%, p < 0.001). A positive urinary culture was seen in 3.64% of the tannery workers but not in the controls (0%). E-coli was the only species. Multivariate logistic regression showed that exposure to biological hazards increased significantly the odds of dysuria by 6.76 times (CI 1.112–41.78; p = 0.038) but rather, low or normal weight was a protective factor of dysuria (OR 0.53; CI 0.249–0.950; p = 0.035).

Conclusion

Multiple working conditions including exposure to biological hazards may cause an increase in urogenital disorders in the tannery workers. A significantly higher prevalence of urinary symptoms among male workers demand serious attention and further investigation.

Biological risk assessment: A challenge for occupational safety and health practitioners during the COVID-19 (SARS-CoV-2) pandemic

BACKGROUND

The COVID-19 global pandemic brought several challenges to occupational safety and health practice. One of these is the need to (re)assess the occupational risks, particularly, biological risks.

OBJECTIVE

The purpose of this work is to promote guidance to occupational safety and health practitioners when conducting a biological risk assessment in this context.

METHODS

The main steps of the biological risk assessment are explained with some inputs regarding the novelty posed by SARS-CoV-2 and an example of a qualitative risk assessment method is presented. Also, its application to two different activities was exemplified.

RESULTS

In both cases, the assessment considered that vulnerable workers were working from home or in medical leave. The results showed low or medium risk level for the assessed tasks. For medium risk level, additional controls are advised, such maintain social distancing, sanitize instruments/equipment before use, use proper and well-maintained PPE (when applicable), and promote awareness sessions to spread good practices at work. Employers must be aware of their obligations regarding biological risk assessment and OSH practitioners must be prepared to screen and link the abundance of scientific evidence generated following the outbreak, with the technical practice.

CONCLUSIONS

This paper could be an important contribution to OSH practice since it highlights the need to (re)assess occupational risks, especially biological risk, to ensure a safe return to work, providing technical guidance.

The hierarchy of preventive measures to protect workers against the COVID-19 pandemic: A review

BACKGROUND

The high spread rate of coronaviruses, specifically severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has raised concerns about the spread of the disease in crowded occupational environments. The risk of occupational exposure to coronavirus depends on the type of industry and the nature of work. Currently, most countries are working for reactivating their economies and need to improve working conditions for a safe situation during the COVID-19 pandemic.

OBJECTIVE

The present work aimed to investigate the current engineering and administrative control measures, which are necessary to protect workers against COVID-19 in workplaces.

METHODS

The current strategies, including engineering control, administrative control, personal protective equipment, and their efficiencies, were reviewed and discussed.

RESULTS

Reviewing the literature indicated that a collection of control approaches should be implemented for an effective control of the virus. Control measures could be selected based on the risk of exposure to COVID-19. The results also revealed that relying solely on a specific control measure could not effectively control the outbreak.

CONCLUSION

In conclusion, employers and health professionals must continually monitor international and local guidelines to identify changes in recommendations to make their workplaces safer. Establishment of an expert team in any workplace for the implementation of more effective control measures is warranted, as well.

Cytotoxic effect of filtering respiratory protective devices from the waste sorting industry: is in vitro toxicology useful for risk characterization?

The use of Filtering Respiratory Protective Devices (FRPD) is mandatory in Portugal to protect workers from the waste industry of harmful exposures. Deleterious health effects of exposure to bioburden via inhalation and/or ingestion include respiratory symptoms and nephrotoxicity. Between January and February 2019, 118 FRPD samples were collected in one waste sorting industry and characterized regarding microbial contamination and cytotoxicity, defined as cell metabolic activity, through the MTT colorimetric assay (3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide). Cytotoxic effect was classified according to percentage of extinction values with respect to the control group, as follows: absent (≥90); low (80%-90%, +); medium (60%-79%, ++); and high (below 60%, +++). For 113 samples the MTT assay revealed a cytotoxic effect in A549 cells, of which 81 presented high cytotoxicity. In SK cells, a cytotoxic effect was observed in 56 samples, of which five displayed a high cytotoxic effect. Several moderate (p < 0.05) to strong (p < 0.01) correlations were found between higher bacterial and fungal counts both in interior layers (fungi and bacteria) and in exhalation valves (fungi) of FRPD samples and reduced cell metabolic activity of SK cells. On the basis of the obtained results for the cytotoxic effect of FRPD samples on two different cells lines, it was determined that A549 cells exhibited a cytotoxic effect for a higher number of FRPD, whereas the SK cells model correlated better with the other assessed parameters, namely, bacterial and fungal counts and conditions of FRPD use. Although the results are not conclusive on the most appropriate cell line to assess FRPD cytotoxicity, they reinforce the importance of in vitro toxicology in exposure assessments to determine the cytotoxicity of mixtures of contaminants, for better risk characterization and selection of appropriate risk management measures.

Let’s get back to work: Preventive biological cycle management of COVID-19 in the workplace

BACKGROUND: The primary response to the coronavirus (COVID-19) pandemic has been to minimize social contact through lockdown measures. The closure of non-essential businesses to tackle the spread of the coronavirus has had negative consequences for the global economy, production, and employment. OBJECTIVE: To outline how known occupational health principles can be used for preventative management of the coronavirus in workplaces to support resumption of work. METHODS: A discussion of current knowledge of COVID-19, the cost of the lockdown strategy, and preventative biological cycle management. RESULTS: The evidence-based literature indicates that biological cycle management can control the risk of coronavirus infection, provide a suitable and sufficient exit strategy from lockdown, and support getting employees back to work. Adherence to personal protective equipment standards has been insufficient, indicating a need for workplace investment and education. CONCLUSION: Imposed restrictions on workplace operations can be lifted without compromising worker health and safety when a workplace commits to practicing the three principles of biological cycle management.

Bibliometric Study of Technology and Occupational Health in Healthcare Sector: A Worldwide Trend to the Future

Since the eighties, technological tools have modified how people interact in their environment. At the same time, occupational safety and health measures have been widely applied. The European Agency for Safety and Health at Work considers that information and communication technologies are the main methods to achieve the goals proposed to improve working life and the dissemination of good practices. The principal objective was to determine the trends of publications focused on these technologies and occupational safety in the healthcare sector during the last 30 years. A bibliometric study was carried out. The 1021 documents showed an increased trend per country, especially for the United States (p < 0.001) and year (p < 0.001). The citations per year showed significant differences between citations of articles published before 2007 (p < 0.001). The year was also linked to the increase or decrease of articles (72.2%) and reviews (14.9%) (p < 0.001). The analysis of journal co-citations also showed that the main journals (such as Infection Control and Hospital Epidemiology) were linked to other important journals and had a major part in the clusters formed. All these findings were discussed in the manuscript and conclusions were drawn.

Investigating the risk factors for contraction and diagnosis of human tuberculosis in Indonesia using data from the fifth wave of RAND's Indonesian Family Life Survey (IFLS-5)

Tuberculosis (TB) is a globally widespread disease, with approximately a quarter of the world's population currently infected (WHO, 2018). Some risk factors, such as HIV status, nutrition and body mass index, have already been thoroughly investigated. However, little attention has been given to behavioural and/or psychological risk factors such as stress and education level. This study investigated the risk factors for TB diagnosis by statistical analyses of publicly available data from the most recent wave of the Indonesian Family Life survey (IFLS-5) conducted in 2015. Out of 34,249 respondents there were 328 who reported having TB. For comparison and completeness, variables were divided into levels: individual-, household- and community-level variables. The most prominent and interesting variables found to influence TB diagnosis status (on each level) were investigated, and a logistic regression was subsequently developed to understand the extent to which each risk factor acts as a predictor for being diagnosed with TB. Age, health benefit or insurance, stress at work and living in a rural area all showed significant association with TB diagnosis status. This study's findings suggest that suitable control measures, such as schemes for improving mental health/stress reduction and improved access to health care in rural areas should be implemented in Indonesia to address each of the key factors identified.

Workplace Biological Risk Assessment: Review of Existing and Description of a Comprehensive Approach

Biological risks potentially affect workers in multiple occupational sectors through their exposure to pathogenic agents. These risks must be carefully assessed to prevent adverse health effects. This article identifies and critically analyzes approaches that manage the qualitative evaluation of biological risk (EvBR) as part of occupational health and safety prevention, for which no standard method yet exists. Bibliographic and computing references were searched to identify qualitative EvBR approaches, which were then analyzed based on defined criteria, such as the risks studied and the type of assessment. Approaches proposing the most representative types of assessment were analyzed. EvBR approaches in an occupational setting were identified in 32 sources. “Workstation analysis” combined with “assessment by risk level” were the most common approaches. The predominant risk descriptors (RDs) were defined in a characterized and quantifiable way, and a variety of hazard levels and exposure indices were created. Overall, the risk was determined by summing or multiplying the hazard level and exposure indicators. The results confirmed that no methodological consensus currently exists regarding the EvBR and no approach has yet been described that integrates all the parameters to allow for a full assessment of biological risk. Based on the detailed analysis of the existing data, the present paper proposes a general approach.

Occupational hazards, health conditions and personal protective equipment used among healthcare workers in hospitals, Thailand

This cross-sectional study aimed to evaluate occupational hazards, health conditions and personal protective equipment used among healthcare workers. Information from the sample size of 1,128 healthcare workers were collected using questionnaires. The healthcare workers participated in this study were from five departments including inpatient, outpatient, surgery and anesthesia, nutrition service and hospital support services departments in five hospitals in Thailand. The results indicated that the majority of healthcare workers were female; these healthcare workers work 9.0 to 11.1 hours/day on average and were exposed to several chemical, biological and physical hazards. The healthcare workers in the nutrition service department reported the highest percentage of musculoskeletal disorder and respiratory problems. The highest percentage of skin problems were reported by healthcare workers in surgery and anesthesia department. The results showed musculoskeletal disorder, respiratory and skin problem significantly differed among healthcare workers in the five departments including the wrists/hands (p = 0.024), upper back (p = 0.009), chest pain symptoms (p = 0.004), and dry/wound symptoms (p = 0.013). Healthcare workers did not have adequate protection from work-related hazards in their workplace. Health education programs, control measures and organizational policies should be implemented to mitigate the hazards for healthcare workers in hospitals.

Awareness, Knowledge, Attitude and Preventive Practice of Leptospirosis Among Healthy Malaysian and Non-Malaysian Wet Market Workers in Selected Urban Areas in Selangor, Malaysia

Leptospirosis has been reported as an endemic in most tropical countries. Among high risk occupations, leptospirosis includes workers in agriculture and domestic animal industries. Environmental hygiene in the wet market has established a link between the presence of rodents with probability of leptospirosis infection. This study was aimed to compare the level of knowledge, attitude and preventive practice against leptospirosis between healthy Malaysian and non-Malaysian wet market workers in selected wet markets in urban areas of Selangor. A cross-sectional study in the determined area was conducted with the participation of 147 respondents. The respondents were randomly chosen from the list provided by the state agency that regulates these markets. A self-administered bilingual validated questionnaire (English and Bahasa Melayu) was distributed to the selected respondents. There were 68 (48.3%) Malaysian respondents and 79 (53.7%) non-Malaysian respondents. The majority of them were males, who attained formal education and were less than 40 years old. Meanwhile, the respondents earned less than RM3000. Among the Malaysian respondents, 80.9% were aware of leptospirosis as compared to 17.7% of the non-Malaysian colleagues (p < 0.05). All items of knowledge showed that the Malaysian respondents scored higher as compared to non-Malaysian respondents. On attitude towards infection prevention, most Malaysian respondents had a positive attitude, while most non-Malaysian respondents had undecided perception on the majority of crucial attitude items. In practicing preventive measures, there was a marked significant difference in proportion between Malaysian and non-Malaysian respondents for items on “Specific Protection and Isolation at Source.” There was a significant gap on knowledge, attitude and preventive practice among Malaysian workers as compared to non-Malaysian workers. Therefore, it was highly recommended the health promotion implementation should also provide specific focus on non-Malaysian workers.

Survival of Microorganisms on Filtering Respiratory Protective Devices Used at Agricultural Facilities

Bioaerosol is a threat at workplaces, therefore the selection and safe use of filtering facepiece respirators (FFRs) is important in preventive activities. The aim of the study was to assess the survival of microorganisms on materials used for FFRs construction. The parameters for microorganism growth under model conditions were described using the Gompertz equation, model verification was also carried out using FFRs at the farmers' workplaces. We found that the factors determining a high survival of microorganisms were as follows: moisture corresponding to the conditions of use and storage of FFRs at workplaces, the presence of sweat and organic dust; inorganic dust and addition of biocide in nonwovens limited the growth of microorganisms, resulting in a shortening of the stationary growth phase and decreased cell numbers (5-6 log). Dust concentration at workplaces was higher than EU occupational exposure limit values and WHO recommendations for airborne particulate matter. Microbial contaminations of the air (103-104 CFU/m3), settled dust (104-106 CFU/g) and FFRs (105 CFU/4cm2) during the grain harvest were high, the main contamination being bacteria (actinomycetes, Pseudomonas fluorescens) and xerophilic fungi. A high correlation was found between the number of microorganisms and the weight of dust on FFRs (R2 = 0.93-0.96).

Effectiveness of engineering interventions in decreasing worker exposure to metalworking fluid aerosols

Machine industry accounts for the highest proportion of primary industry in Taiwan. Long-term exposure to metalworking fluid aerosols may pose significant threats to the health of workers. The aims of this study were to verify the efficacy of intervention methods in reducing airborne bacterial concentrations as well as effects on aerosol particle size distribution. This study evaluated airborne bacterial concentrations in a large precision machinery factory in Taichung, Taiwan, before and after the implementation of intervention methods. The installation of local exhaust systems and improvement of the operation mode were used as intervention methods. Concentration and size distribution of bacteria in the metal working environment were assessed using Andersen one-stage and six-stage viable impactors, respectively. The analytical results indicate that most bacterial concentrations were less than the recommended concentrations in the indoor air quality standards (500 CFU/m³) proposed by the United States Association of Advancing Occupational and Environmental Health (US ACGIH) before the installation of local exhaust systems. There was no significant difference in bacterial concentrations before and after the installation of the local exhaust and the intervention effect on reducing bacterial exposure was not as expected. The bacterial concentrations were significantly lowered in the Z region after improving the operation mode. The particle size of bioaerosols <7.0 μm was also substantially reduced. Improper operation modes are likely to expose employees to higher concentrations of bacteria within a short time period. It recommends adjusting the metal processing methods and proper use of air spray guns for decreasing high airborne bacterial concentrations exposure.

Knowledge of Biosafety Among Workers in Private and Public Clinical and Research Laboratories in Morocco

Introduction

This study was conducted to assess the biosafety knowledge among laboratory staff working in Morocco.

Methods

A cross-sectional study was conducted among all laboratory staff in public and private clinical diagnostic and research laboratories between December 5, 2018, and January 5, 2018. Data were collected using a self-administered questionnaire distributed via Google Form.

Results

A total of 235 participants completed the study questionnaire with an estimated response rate of 19%. Overall, 79% of respondents had a high or intermediate level of knowledge. Only 17.4% had participated in prior formal biosafety training courses. The level of knowledge did not differ significantly with gender or activity sector, but it increased with work experience. Knowledge was generally intermediate for signage and principles of biosafety levels (42.1%), low for distinction between technical operations that could pose a risk by generating aerosols (30.2%), and high for wearing personal protective equipment and its components (92.8%). There was a very high level of knowledge on proper waste sorting (100%).

Conclusion

These findings underline the need for establishing a biosafety policy and strengthening biosafety training programs in laboratories in Morocco.

Trend analysis and factors associated with biological injuries among health care workers in Southern Italy

Background:

Biological injuries are the most common and serious among health care workers.

Objectives:

This study aims to estimate the injuries’ incidence, job distribution and temporal trend in a hospital in Southern Italy.

Methods:

Data on accidents, collected from January 2010 to December 2016, were analyzed. Poisson distribution was used to calculate incidence rates and respective 95% confidence intervals. Trends were analyzed using the Joinpoint regression model. A multiple logistic regression model was used to identify factors associated with injuries.

Results:

Three hundred and thirty-five injuries were reported from 2010 to 2016, occurring mainly in the morning (54%) and frequently caused by needlestick (70%). We observed a significant decline in the incidence rates of the total amount of injuries (ACP=-11.3; 95% CI: -16.3 - -5.9), for nurses (ACP=-15.7; 95% CI: -24.3 - -6.2) and for health and social care assistants (ACP=-13.2; 95% CI: -23.1 - -2.0). Among male physicians the risk of biological accident was higher than female physicians (OR=3.67; 95% CI:1.9-7.1), while among male nurses the risk was lower than among female nurses (OR=0.31; 95% CI: 0.17-0.59). For the nursing category, “afternoon” and “night” represented risk factors with OR=2.19 (95% CI: 1.2-3.7) and OR=8.8 (95% CI: 3.4-22.8) respectively. For physicians, surgical intervention was a risk factor (OR=7.71; 95% CI: 3.2-18.4).

Conclusions:

Our findings confirm the need for continuous monitoring and improved control of work-related exposures, both for health and the associated costs.

Efficacy of radiant catalytic ionization to reduce bacterial populations in air and on different surfaces

Air contamination by biological agents is often observed in medical or veterinary facilities and industrial plants. Bioaerosols may sediment and pose the surface contamination. Microorganisms present on them may become a source of infections among humans and food contamination. This study determined the use of oxidative gases, including ozone and peroxide, generated by the Radiant Catalytic Ionization (RCI) cell for the inactivation of Acinetobacter baumannii, Escherichia coli, Enterococcus faecalis, Pseudomonas aeruginosa, Salmonella Enteritidis, Listeria monocytogenes, Staphylococcus aureus, Streptococcus epidermidis, Bacillus subtilis, Clostridium sporogenes, Candida albicans, Aspergillus niger and Penicillium chrysogenumon in air and on different surfaces. Results showed that oxidative gases produced by the RCI cell reduced all tested microorganisms. The full elimination of studied microorganisms from the air was obtained for E. coli and C. albicans. RCI also proved to be an effective method of eliminating microbes from the examined surfaces. Regarding of the species, strains origin and the type of surface, the reduction rate ranged from 19.0% for C. albicans to over 99% for A. baumanii. For both, air and surface, the most resistant to RCI was C. sporogenes spores, for which the percentage reduction rate ranged from -2.6% to 71.2% on the surfaces and was equal 71.7% in the air.

Performance of materials used for biological personal protective equipment against blood splash penetration

For occupational safety, healthcare workers must select and wear appropriate personal protective equipment (PPE), protective clothing, and masks as countermeasures against exposure to infectious body fluids and blood splash. It is important for healthcare workers to ensure the protective performance of each PPE against penetration of pathogens. The International Standards Organization (ISO) 22609 test evaluates the effectiveness of medical facemasks to protect against penetration of splashed synthetic blood. However, in this method, the protective performance is determined only visually, without quantification of leaked liquid volume. Therefore, in this study, we modified the ISO 22609 test method to quantify the volume of leaked liquid and obtain a more accurate assessment of the protection performance. We tested non-woven and woven materials used for masks or protective clothing, and the performance of each material was classified using this new method. We found that the quantity of leaked synthetic blood was dependent on the structural characteristics of each material. These findings will allow healthcare workers to select the most appropriate PPE for a given situation or task.

Invasive Meningococcal Disease on the Workplaces: a systematic review

Background and aims of the work: Invasive Meningococcal Disease (IMD) represents a global health threat, and occupational settings have the potential to contribute to its spreading. Therefore, here we present the available evidences on the epidemiology of IMD on the workplaces.

METHODS

The following key words were used to explore PubMed: Neisseria meningitidis, meningococcus, meningococcal, invasive meningococcal disease, epidemiology, outbreaks, profession(al), occupation(al).

RESULTS

We identified a total of 12 IMD cases among healthcare workers (HCW), 44 involving biological laboratory workers (BLW), 8 among school personnel, and eventually 27 from other settings, including 3 large industrial working populations. Eventual prognosis of BLW, particularly the case/fatality ratio, was dismal. As clustered in time and space, data about school cases as well as industrial cases seem to reflect community rather than occupational outbreaks. In general, we identified a common pattern for HCW and BLW, i.e. the exposure to droplets or aerosol containing N meningitidis in absence of appropriate personal protective equipment (PPE) and/or microbiological safety devices (MSD) (e.g. cabinets). Post-exposure chemoprophylaxis (PEC) was rarely reported by HCW (16.7%) workers, and never by BLW. Data regarding vaccination status were available only for a case, who had failed requested boosters.

CONCLUSIONS

The risk for occupational transmission of IMD appears relatively low, possibly as a consequence of significant reporting bias, with the exception of HCW and BLW. Improved preventive measures should be implemented in these occupational groups, in order to improve the strict use of PPE and MSD, and the appropriate implementation of PEC.

Occupational airborne exposure in relation to Chronic Obstructive Pulmonary Disease (COPD) and lung function in individuals without childhood wheezing illness: A 50-year cohort study

BACKGROUND

Evidence from longitudinal population-based studies relating occupational exposure to the full range of different forms of airborne pollutants and lung function and airway obstruction is limited.

OBJECTIVE

To relate self-reported COPD and lung function impairment to occupational exposure to different forms of airborne chemical pollutants in individuals who did not have childhood wheeze.

METHODS

A prospective cohort study was randomly selected in 1964 at age 10-15 years and followed up in 1989, 1995, 2001 and 2014 (aged 58-64) by spirometry and respiratory questionnaire. Occupational histories were recorded in 2014 and occupational exposures assigned using an airborne chemical job exposure matrix. The risk of COPD and lung function impairment was analyzed in subjects, who did not have childhood wheeze, using logistic and linear regression and linear mixed effects models.

RESULTS

237 subjects without childhood wheeze (mean age 60.6 years, 47% male) were analyzed. There was no association between any respiratory outcomes and exposure to gases, fibers, mists or mineral dusts and no consistent associations with exposure to fumes. Reduced FEV₁ was associated with longer duration (years) of exposure to any of the six main pollutant forms - vapors, gases, dusts, fumes, fibers and mists (VGDFFiM) with evidence of a dose-response relationship (p-trend=0.004). Exposure to biological dusts was associated with self-reported COPD and FEV₁<Lower Limit of Normal (LLN) (adjusted odds ratio [95%CI] 4.59 [1.15,18.32] and 3.54 [1.21,10.35] respectively), and reduced FEF_25-75% (adjusted regression coefficients [95% CIs] -9.11 [-17.38, -0.84] respectively). Exposure to vapors was associated with self-reported COPD and FEV₁<LLN (adjOR 6.46 [1.18,35.37] and 4.82 [1.32,17.63]). Longitudinal analysis demonstrated reduced FEV₁ and FEF_25-75% associated with exposure to biological dusts or vapors.

CONCLUSIONS

People with no history of childhood wheezing who have been occupationally exposed to biological dusts or vapors or had longer duration of lifetime exposure to any VGDFFiM are at a higher risk of reduced lung function at age 58-64 years. Occupational exposure to biological dusts or vapors also increased the risk of self-reported COPD.

Invasive Meningococcal Disease on the Workplaces: a systematic review

Background and aims of the work: Invasive Meningococcal Disease (IMD) represents a global health threat, and occupational settings have the potential to contribute to its spreading. Therefore, here we present the available evidences on the epidemiology of IMD on the workplaces.

METHODS

The following key words were used to explore PubMed: Neisseria meningitidis, meningococcus, meningococcal, invasive meningococcal disease, epidemiology, outbreaks, profession(al), occupation(al).

RESULTS

We identified a total of 12 IMD cases among healthcare workers (HCW), 44 involving biological laboratory workers (BLW), 8 among school personnel, and eventually 27 from other settings, including 3 large industrial working populations. Eventual prognosis of BLW, particularly the case/fatality ratio, was dismal. As clustered in time and space, data about school cases as well as industrial cases seem to reflect community rather than occupational outbreaks. In general, we identified a common pattern for HCW and BLW, i.e. the exposure to droplets or aerosol containing N meningitidis in absence of appropriate personal protective equipment (PPE) and/or microbiological safety devices (MSD) (e.g. cabinets). Post-exposure chemoprophylaxis (PEC) was rarely reported by HCW (16.7%) workers, and never by BLW. Data regarding vaccination status were available only for a case, who had failed requested boosters.

CONCLUSIONS

The risk for occupational transmission of IMD appears relatively low, possibly as a consequence of significant reporting bias, with the exception of HCW and BLW. Improved preventive measures should be implemented in these occupational groups, in order to improve the strict use of PPE and MSD, and the appropriate implementation of PEC.