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Gimeno Ruiz de Porras D, Patel J, Conway S, Pompeii L, Mitchell LE, Carson A, Whitehead LW, Han I, Zock JP, Henneberger PK, Patel R, De Los Reyes J, Delclos GL. A Qualitative Assessment of Changes in Occupational Exposures Among Healthcare Facility Workers. Workplace Health Saf 2024:21650799241284085. [PMID: 39440680 DOI: 10.1177/21650799241284085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024]
Abstract
Adult-onset asthma, notably prevalent among healthcare professionals, especially nurses, is often attributed to occupational factors such as exposure to cleaning agents. Studies consistently underscore the substantial role of such exposure in work-related asthma among hospital staff. We aimed to (a) identify and characterize current practices in cleaning and aerosolized medication administration; (b) assess changes in practices since a similar 2003 study of Texas healthcare workers; and (c) identify factors contributing to diverse exposures within healthcare job categories. We conducted focus groups with 38 participants in 6 healthcare settings, analyzing current practices, changes since 2003, and factors contributing to exposure diversity. We used a three-step approach for data analysis, including sociodemographic characterization, a scissor-and-sort technique for exposure description, and qualitative content analysis. Participants were primarily healthcare providers (76%) and housekeepers/cleaners (11%) who reported exposure to aerosolized medications, cleaning products, adhesives, and solvents. Participants reported transitioning from cleaning practices to new formulas with reduced odors and shifting from spray cleansers to wipes. Personal protective equipment (PPE) used during cleaning tasks varied, with training differing among job categories. Aerosolized medication administration varied among facilities, with reported medication types and protocol changes over time. The results emphasized the significance of maintaining uniform protection, disseminating knowledge, and consistently adhering to PPE protocols in the healthcare environment. Addressing the identified gaps in comprehension and potential sources of exposure variability requires additional focus on occupational health and safety initiatives.
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Affiliation(s)
- David Gimeno Ruiz de Porras
- Department of Environmental and Occupational Health, UT School of Public Health San Antonio, The University of Texas Health Science Center at San Antonio (UT Health San Antonio), San Antonio, TX, USA
- Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Jenil Patel
- Southwest Center for Occupational and Environmental Health, Department of Environmental and Occupational Health Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA
- Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth Houston), Dallas, TX, USA
| | | | - Lisa Pompeii
- Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Laura E Mitchell
- Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth Houston ), Houston, TX, USA
| | - Arch Carson
- Southwest Center for Occupational and Environmental Health, Department of Environmental and Occupational Health Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA
| | - Lawrence W Whitehead
- Southwest Center for Occupational and Environmental Health, Department of Environmental and Occupational Health Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA
| | - Inkyu Han
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Jan-Paul Zock
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Paul K Henneberger
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Preventio, Morgantown, WV, USA
| | - Riddhi Patel
- Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth Houston ), Houston, TX, USA
| | - Joy De Los Reyes
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA
| | - George L Delclos
- Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
- Southwest Center for Occupational and Environmental Health, Department of Environmental and Occupational Health Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA
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McElheny KD, Little D, Taylor D, Manzi JE. Communicable Illness Mitigation Strategies for Traveling Elite Sporting Organizations. Sports Health 2021; 14:532-537. [PMID: 34292110 DOI: 10.1177/19417381211032226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Transmission of communicable diseases observed in sporting organizations is often preventable. Early detection, isolation, and treatment can significantly diminish time lost. Until recently, there has been a paucity of standardized guidelines outlining feasible, preventable measures to protect both athletes and staff from contagious illnesses. Therefore, the purpose of this narrative was to highlight optimal prevention practices for transmission mitigation, with a particular focus on hygiene activity and travel considerations in professional sporting organizations. EVIDENCE ACQUISITION Current recommendations from the Centers for Disease Control and Prevention and peer-reviewed journals. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 5. RESULTS Communicable illness prevention strategies begin at the level of sufficient personal hygiene practices. Common area surface cleaning recommendations, including shared equipment sanitization between usage as well as designated equipment use to specific athletes, should be considered to minimize cross-contamination, in particular, for liked-position players. Intelligent design for shared areas can include redistributing the layout of communal spaces, most feasibly, spreading locker designation a minimum distance of 6 ft from one another. Travel considerations can include placing most susceptible passengers closest to window seating, boarding last and exiting first. Team physicians should have knowledge of essential personnel medical histories in an effort to risk stratify staff members and players in the setting of communicable disease. CONCLUSION Providing a framework for illness management and prevention is important when considering the effects on player health, missed time, performance, and overall cost. Containment of commonly observed communicable illnesses can be optimized with sufficient personal hygiene practices, common area surface cleaning recommendations, intelligent design for shared areas, travel and hotel considerations, as well as appropriate screening tools and isolation techniques. STRENGTH OF RECOMMENDATION TAXONOMY (SORT) B.
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Affiliation(s)
- Kathryn D McElheny
- Hospital for Special Surgery, New York, New York.,New York Mets Baseball Club, Queens, New York
| | - Dean Little
- New York Mets Baseball Club, Queens, New York
| | - David Taylor
- United States Olympic and Paralympics Committee, Colorado Springs, Colorado.,Golden State Warriors Basketball Club, San Francisco, California
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Golden E, Maertens M, Hartung T, Maertens A. Mapping Chemical Respiratory Sensitization: How Useful Are Our Current Computational Tools? Chem Res Toxicol 2020; 34:473-482. [PMID: 33320000 DOI: 10.1021/acs.chemrestox.0c00320] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chemical respiratory sensitization is an immunological process that manifests clinically mostly as occupational asthma and is responsible for 1 in 6 cases of adult asthma, although this may be an underestimate of the prevalence, as it is under-diagnosed. Occupational asthma results in unemployment for roughly one-third of those affected due to severe health issues. Despite its high prevalence, chemical respiratory sensitization is difficult to predict, as there are currently no validated models and the mechanisms are not entirely understood, creating a significant challenge for regulatory bodies and industry alike. The Adverse Outcome Pathway (AOP) for respiratory sensitization is currently incomplete. However, some key events have been identified, and there is overlap with the comparatively well-characterized AOP for dermal sensitization. Because of this, and the fact that dermal sensitization is often assessed by in vivo, in chemico, or in silico methods, regulatory bodies are defaulting to the dermal sensitization status of chemicals as a proxy for respiratory sensitization status when evaluating chemical safety. We identified a data set of known human respiratory sensitizers, which we used to investigate the accuracy of a structural alert model, Toxtree, designed for skin sensitization and the Centre for Occupational and Environmental Health (COEH)'s model, a model developed specifically for occupational asthma. While both models had a reasonable level of accuracy, the COEH model achieved the highest balanced accuracy at 76%; when the models agreed, the overall accuracy was 87%. There were important differences between the models: Toxtree had superior performance for some structural alerts and some categories of well-characterized skin sensitizers, while the COEH model had high accuracy in identifying sensitizers that lacked identified skin sensitization reactivity domains. Overall, both models achieved respectable accuracy. However, neither model addresses potency, which, along with data quality, remains a hurdle, and the field must prioritize these issues to move forward.
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Affiliation(s)
- Emily Golden
- Center for Alternatives to Animal Testing (CAAT), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, United States
| | - Mikhail Maertens
- Center for Alternatives to Animal Testing (CAAT), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, United States
| | - Thomas Hartung
- Center for Alternatives to Animal Testing (CAAT), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, United States.,CAAT-Europe, University of Konstanz, 78464 Konstanz, Germany
| | - Alexandra Maertens
- Center for Alternatives to Animal Testing (CAAT), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, United States
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Cullinan P, Muñoz X, Suojalehto H, Agius R, Jindal S, Sigsgaard T, Blomberg A, Charpin D, Annesi-Maesano I, Gulati M, Kim Y, Frank AL, Akgün M, Fishwick D, de la Hoz RE, Moitra S. Occupational lung diseases: from old and novel exposures to effective preventive strategies. THE LANCET RESPIRATORY MEDICINE 2017; 5:445-455. [PMID: 28089118 DOI: 10.1016/s2213-2600(16)30424-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/22/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023]
Abstract
Occupational exposure is an important, global cause of respiratory disease. Unlike many other non-communicable lung diseases, the proximal causes of many occupational lung diseases are well understood and they should be amenable to control with use of established and effective approaches. Therefore, the risks arising from exposure to silica and asbestos are well known, as are the means of their prevention. Although the incidence of occupational lung disease has decreased in many countries, in parts of the world undergoing rapid economic transition and population growth-often with large informal and unregulated workforces-occupational exposures continue to impose a heavy burden of disease. The incidence of interstitial and malignant lung diseases remains unacceptably high because control measures are not implemented or exposures arise in novel ways. With the advent of innovative technologies, new threats are continually introduced to the workplace (eg, indium compounds and vicinal diketones). In developed countries, work-related asthma is the commonest occupational lung disease of short latency. Although generic control measures to reduce the risk of developing or exacerbating asthma are well recognised, there is still uncertainty, for example, with regards to the management of workers who develop asthma but remain in the same job. In this Review, we provide recommendations for research, surveillance, and other action for reducing the burden of occupational lung diseases.
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Affiliation(s)
- Paul Cullinan
- Department of Occupational and Environmental Medicine, Imperial College, London, UK; MRC-PHE Centre for Environment and Health, London, UK
| | - Xavier Muñoz
- Servei de Pneumologia, Hospital Universitari Vall d'Hebron (CIBER de Enfermedades Respiratorias), Barcelona, Spain; CIBER de Enfermedades Respiratorias, Barcelona, Spain
| | - Hille Suojalehto
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Raymond Agius
- Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Surinder Jindal
- Department of Respiratory Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Division of Medicine, and Division of Respiratory Medicine, Umeå University, Umeå, Sweden
| | - Denis Charpin
- Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France; INSERM, Aix-Marseille Université, Marseille, France
| | - Isabella Annesi-Maesano
- Epidémiologie des Maladies Respiratoires et Allergiques, iPLESP INSERM et UPMC, Paris, France
| | - Mridu Gulati
- Section of Pulmonary, Critical Care, and Sleep Medicine, and Yale Occupational and Environmental Medicine Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Yangho Kim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Arthur L Frank
- Division of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA, USA
| | - Metin Akgün
- Department of Chest Diseases, Ataturk University School of Medicine, Erzurum, Turkey
| | - David Fishwick
- Centre for Workplace Health, University of Sheffield, Sheffield, UK
| | - Rafael E de la Hoz
- Department of Preventive Medicine, Division of Occupational and Environmental Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Subhabrata Moitra
- Department of Respiratory Medicine and Allergology, Faculty of Clinical Sciences, Lund University Lund, Sweden; Department of Pneumology, Allergy and Asthma Research Centre, Kolkata, India.
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Montano D. Chemical and biological work-related risks across occupations in Europe: a review. J Occup Med Toxicol 2014; 9:28. [PMID: 25071862 PMCID: PMC4113130 DOI: 10.1186/1745-6673-9-28] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/17/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Work-related health inequalities are determined to some extent by an unequal exposure to chemical and biological risk factors of disease. Although their potential economic burden in the European Union (EU-25) might be substantial, comprehensive reviews focusing on the distribution of these risks across occupational groups are limited. Thus, the main objective of this review is to provide a synopsis of the exposure to chemical and biological hazards across occupational groups. In addition, main industrial applications of hazardous substances are identified and some epidemiological evidence is discussed regarding societal costs and incidence rates of work-related diseases. METHODS Available lists of carcinogens, sensitisers, mutagens, reprotoxic substances and biological hazards were consulted. For each work-related hazard the main industrial application was identified in order to assess which ISCO occupational groups may be associated with direct exposure. Where available, information on annual tonnage production, risk assessment of the substances and pathogens, and other relevant data were collected and reported. RESULTS Altogether 308 chemical and biological hazards were identified which may account to at least 693 direct exposures. These hazards concentrate on the following major occupational groups: technicians (ISCO 3), operators (ISCO 8), agricultural workers (ISCO 6) and workers in elementary occupations (ISCO 9). Common industrial applications associated with increased exposure rates relate among others to: (1) production or application of pigments, resins, cutting fluids, adhesives, pesticides and cleaning products, (2) production of rubber, plastics, textiles, pharmaceuticals and cosmetics, and (3) in agriculture, metallurgy and food processing industry, Societal costs of the unequal distribution of chemical and biological hazards across occupations depend on the corresponding work-related diseases and may range from 2900 EUR to 126000 EUR per case/year. CONCLUSIONS Risk of exposure to chemical and biological risks and work-related disease incidence are highly concentrated on four occupational groups. The unequal burden of exposure across occupations is an important contributing factor leading to health inequalities in society. The bulk of societal costs, however, are actually being borne by the workers themselves. There is an urgent need of taking into account the health impact of production processes and services on workers' health.
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Affiliation(s)
- Diego Montano
- Faculty of Medicine, Senior professorship “Work Stress Research”, Duesseldorf University, Universitaetsstr. 1, Duesseldorf, Germany
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