Workplace exposure to bioaerosols in podiatry clinics

Occupational Risks of Podologists: A Combined Assessment of VOCs, Vibration, Noise Levels and Health Complaints

Podologists are exposed to many occupational hazards, including volatile organic compounds (VOCs) from insole manufacturing and noise/vibration during nail or tissue grinding. In this study, VOCs, noise, and vibration were measured in five podiatry clinics and three offices. Questionnaires were administered to 23 podologists and 19 office workers to inquire about their pain, ocular, skin and respiratory complaints. The results showed that the podologists' exposure to the total VOC concentrations was approximately twice as high as that of the office workers. The podologists' complaints regarding pain were found to be correlated with ambient noise and hand-arm vibration levels. Ocular, skin, and respiratory complaints were also found to be correlated with total VOC concentrations. These results suggest that VOCs, noise and vibration in the working environment may impair podologists' health and that they have an intensifying effect on each other, increasing the severity of health issues.

Fungal bioaerosol as an occupational hazard in the podiatrist's workplace

Previous studies have reported the potential emission of nail dust to the indoor air of the podiatrist's workplace during nail drilling procedures. The main objective of this study was to analyse the fungal bioaerosol present in the indoor air of podiatry rooms, including during the nail drilling procedure. Seventeen private clinics were sampled in Madrid during spring and summer. The most prevalent filamentous fungi detected were Cladosporium spp. and Penicillium spp. in both seasons. The presence of Trichophyton rubrum and Trichophyton interdigitale was reported in samples during the drilling procedures, establishing a positive association with the clinical suspicion of onychomycosis (p = 0.002) and the utilization of aspiration systems (p=0.04). The present study concludes that airborne fungal concentrations in podiatrist's clinics are consistent with national and international guidance. Occupational exposure to dermatophytes may briefly occur during definite periods across the daily activity despite the use of dust aspiration systems.

Fit factor of masks used by Physicians in Clinical Settings

Background: Usually, physicians use filtering respirators in clinical settings to a lesser extent than other simpler surgical masks. The study aim was to determine the fit factor of surgical and other types masks commonly used in clinical settings compared with FFP3 filtering respirators. Materials and Methods: A cross-sectional study was carried out recruiting a total sample of 78 physicians. Fit factor was measured to determine particles count into masks compared to particles count outside of the masks meanwhile physicians carried out a protocol composed by 8 exercises as well as the global fit factor total scores. First, fit factor was analyzed with the usual surgical masks used by physicians in clinical settings. Second, fit factor was determined with the proposed FFP3 filtering respirators. Results: Most participants (97%) used surgical masks. Statistically significant differences (P<0.001) with an effect size from moderate to large (d=0.61-1.00) were shown for fit factors in the different exercises and total scores between surgical and other masks (3.2±5.0) and FFP3 filtering respirators (40.7±37.8). Generally, FFP3 filtering respirators showed a higher fit factor in the different exercises and total scores compared to the commonly used surgical and other types masks in clinical settings. Conclusions: Despite most physicians used surgical masks in clinical settings, filtering FFP3 masks showed a higher fit factor in the different exercises and total scores compared with the used surgical masks and filtering respirators such as FFP1, FFP2 and other types in clinical settings.

Detection of dermatophytes in human nail and skin dust produced during podiatric treatments in people without typical clinical signs of mycoses

Pedicures are the most common cosmetic foot treatment. Many pedicurists and podiatrists suffer from respiratory infections and diseases such as asthma, sinusitis, chronic cough and bronchitis. Skin and nail dust may play an important role in the development of occupational diseases and the transmission of mycosis to other clients. To examine the presence of dermatophytes in nail and skin dust produced during podiatric treatments of people without typical symptoms of mycosis and to assess the epidemiological hazards of tinea pedis for podiatrists as well as other clients. Seventy-seven samples underwent direct microscopy and culture. The results of direct microscopy were positive in 28/77 samples (36.36%) and doubtful in 3/77 (3.9%). Fungi were cultured from 36/77 samples (46.75%), including 8/77 (10.3%) positive for dermatophytes (Trichophyton rubrum-6 isolates and Trichophyton mentagrophytes-2). Material collected during podiatric treatments is potentially infected by pathogenic fungi; thus, there is a need to protect both workers who perform such treatments, as well as other clients, to prevent the transmission of pathogens in the Salon environment. Exposure to this occupational hazard may increase not only the risk of respiratory infections but also increase asthmatic or allergic reactions to Trichophyton.

Evaluation of the Survivability of Microorganisms Deposited on Filtering Respiratory Protective Devices under Varying Conditions of Humidity

Bioaerosols are common biological factors in work environments, which require routine use of filtering respiratory protective devices (FRPDs). Currently, no studies link humidity changes in the filter materials of such devices, during use, with microorganism survivability. Our aim was to determine the microclimate inside FRPDs, by simulating breathing, and to evaluate microorganism survivability under varying humidity conditions. Breathing was simulated using commercial filtering facepiece respirators in a model system. Polypropylene melt-blown nonwoven fabrics with moisture contents of 40%, 80%, and 200%, were used for assessment of microorganisms survivability. A modified AATCC 100-2004 method was used to measure the survivability of ATCC and NCAIM microorganisms: Escherichia coli, Staphylococcus aureus, Bacillus subtilis, Candida albicans and Aspergillus niger. During simulation relative humidity under the facepiece increased after 7 min of usage to 84%-92% and temperature increased to 29-30 °C. S. aureus survived the best on filter materials with 40%-200% moisture content. A decrease in survivability was observed for E. coli and C. albicans when mass humidity decreased. We found that B. subtilis and A. niger proliferated for 48-72 h of incubation and then died regardless of the moisture content. In conclusion, our tests showed that the survivability of microorganisms on filter materials depends on the amount of accumulated moisture and microorganism type.

Contaminants in human nail dust: an occupational hazard in podiatry?

Background

There has been limited literature indicating that podiatrists’ health may be at risk from exposure to human nail dust. Previous studies carried out in the UK have shown that large amounts of dust become airborne during the human nail drilling procedure and are present in the air up to 10 hours after a clinical session. This increases the risk of Respiratory Tract (RT) infection for the practitioner.

Methods

This study used a nasal swabbing technique and fungal culture to determine whether podiatrists (n = 50) had the same microbes present in their nasal cavities as non-podiatry health professional control group (n = 45). All swabs were cultured, counted and identified for each subject. Survey data of use and type of nail drill, type of mask used and frequency of change over a two week period.

Results

The results showed podiatrists had a greater range of microbes in their nasal cavities although the controls had greater overall numbers of organisms. The known pathogen and common mould, Aspergillus fumigatus was ost commonly found fungus within the podiatric group with 44% of the group having the fungus present. All nail drills used by the podiatrists had some form of dust extraction (except one). Of concern was 17% (n = 8) of the podiatrists did not use a mask at all whilst drilling and seemed unaware of any infection control issues. Simple disposable masks were the most frequently worn with only half being changed after each patient further increasing the cross infection risk

Conclusion

The high levels of Aspergilus contamination is a significant finding in the podiatry group as this fungus is small enough to enter the tissue of the nasal cavity and as a small particle will stay airborne in the room for up to 16 hours. Aspergilus has been shown to cause brain and soft tissue tumours in extreme cases. The high levels of upper respiratory track problems reported in the literature may well be caused by this fungal agent. The non use and use of inappropriate masks by podiatrists is clearly an occupational hazard to their health and well being.

Measurement of endotoxins in bioaerosols at workplace: a critical review of literature and a standardization issue

Endotoxins are lipopolysaccharides found in the outer membrane of most Gram-negative bacteria and cyanobacteria. Worker exposure to endotoxins has been shown in a number of work situations and is associated with both respiratory and systemic pathologies. The lack of an occupational exposure limit is mainly due to the absence of a standard protocol at the international level for sampling and analyzing airborne endotoxins. The bibliographic review in this article takes an exhaustive look at the current knowledge on measuring airborne endotoxins. It shows that, despite several reference documents at the international level, the methods used to measure endotoxin exposure differ considerably from one laboratory to another. Standardization is necessary to reduce interlaboratory variability and, ultimately, to improve the use of interstudy data. The bibliographic review presents the current status of standardization for airborne endotoxin measurement methods in the workplace and summarizes areas for further research. This article is both a reference document for all operators wishing to use such methods and a working document to build international consensus around the measurement of airborne endotoxins.