Prevention of COVID-19 in workers: preparation, precaution, and protection

In May 2023 the World Health Organization (WHO) Director General announced the "end" of the COVID-19 Public Health Emergency of International Concern. Although the scale of the pandemic was unprecedented in living memory, it had not been unforeseen. Previous outbreaks of viral respiratory disease have shown important lessons regarding the need to protect healthcare workers (HCW), and research has also been undertaken into the relative effectiveness of control measures and their resource implications. Relevant guidance for worker protection, including HCW protection, which existed at the onset of the COVID-19 pandemic was disregarded both at international and national governmental levels. In many countries there were significant systemic flaws in strategy, culture, and resource availability, and hence in overall preparedness. When the pandemic struck, many experts and organizations advocated a precautionary approach with regard to worker protection, consistent with good occupational hygiene science, practice, and standards. In many Asian countries, protective measures were relatively stringent. However, many workers were left unprotected especially as the WHO, the United States, the United Kingdom, and other governments did not pursue adequate COVID-19 protective measures at work. As the pandemic progressed, improvements in protection were patchy. A notable lack of protection arose from the underestimation of the contribution of aerosol exposure to infection risks, particularly among HCWs providing routine care of potentially infectious patients. A disciplined strategy of source control, pathway control (such as ventilation), and receptor control notably Respiratory Protective Equipment is needed, as well as worldwide vaccination, to contend with this pandemic. Control measures appropriate to the risk of infections transmitted through the air will remain necessary in the longer term, as well as adaptations in the workplace to take account of long-term COVID-19 morbidity and new work practices.

A control banding method for chemical risk assessment in occupational settings in France

Background

This study describes a method whose aim is to help companies assess the chemical occupational risks related to labeled products and industrial chemical emissions. The method is intended to be used by industrial hygienists at the scale of one company. Both inhalation and cutaneous exposure routes are taken into account.

Methods

The method relies on a control-banding scheme. A work situation is described by exposure parameters such as the process or the local exhaust ventilation and by the hazard of the product. Each possible value of the parameters is associated with a "band," which is associated with an integer value. The multiplication of these values results in a score, which represents a priority for intervention. The higher the score, the more the situation warrants investigation for implementing prevention measures, such as chemical substitution and the addition of local exhaust ventilation. To simplify communication, the priority is associated with a colored priority band: red for "very high priority," orange for "high priority," and green for "moderate priority." The priority bands are computed for all work situations performed in a company.

Results

An example of the use of this method is described in a French façade insulation company.

Conclusion

A tool named Seirich was developed to implement this method and promote good practices for helping industrial hygienists in the prioritization of interventions for reducing chemical risk in France.

Managing Nanomaterials in the Workplace by Using the Control Banding Approach

Nanomaterials offer new technical and commercial opportunities. However, they may also pose risks to consumers and the environment and raise concerns about occupational health and safety. An overview of the standardization in the area of nanomaterials is presented. Focus is given to the standard ISO/TS 12901-2:2014, which describes the use of a control banding approach for controlling the risks associated with occupational exposures to nano-objects and their aggregates and agglomerates greater than 100 nm. The article also presents a case study on a textile finishing company that implements two chemical finishes containing nanomaterials. A risk analysis was conducted to assess the hazards associated with workers handling nanomaterials. Control banding was applied, and measures such as appropriate ventilation and use of protective equipment are proposed to mitigate risks. In some cases, additional measures, such as a closed booth and smoke extractor, are required. The safety data sheets are a primary source of information on how to handle and care for products containing nanomaterials, but the information provided is still limited in terms of the specific hazards and risks posed by nanomaterials.

Application of Inorganic Nanomaterials in Cultural Heritage Conservation, Risk of Toxicity, and Preventive Measures

Nanotechnology has allowed for significant progress in architectural, artistic, archaeological, or museum heritage conservation for repairing and preventing damages produced by deterioration agents (weathering, contaminants, or biological actions). This review analyzes the current treatments using nanomaterials, including consolidants, biocides, hydrophobic protectives, mechanical resistance improvers, flame-retardants, and multifunctional nanocomposites. Unfortunately, nanomaterials can affect human and animal health, altering the environment. Right now, it is a priority to stop to analyze its advantages and disadvantages. Therefore, the aims are to raise awareness about the nanotoxicity risks during handling and the subsequent environmental exposure to all those directly or indirectly involved in conservation processes. It reports the human-body interaction mechanisms and provides guidelines for preventing or controlling its toxicity, mentioning the current toxicity research of main compounds and emphasizing the need to provide more information about morphological, structural, and specific features that ultimately contribute to understanding their toxicity. It provides information about the current documents of international organizations (European Commission, NIOSH, OECD, Countries Normative) about worker protection, isolation, laboratory ventilation control, and debris management. Furthermore, it reports the qualitative risk assessment methods, management strategies, dose control, and focus/receptor relationship, besides the latest trends of using nanomaterials in masks and gas emissions control devices, discussing their risk of toxicity.

Occupational Exposure to Incidental Nanomaterials in Metal Additive Manufacturing: An Innovative Approach for Risk Management

The benefits of metal 3D printing seem unquestionable. However, this additive manufacturing technology brings concerns to occupational safety and health professionals, since recent studies show the existence of airborne nanomaterials in these workplaces. This article explores different approaches to manage the risk of exposure to these incidental nanomaterials, on a case study conducted in a Portuguese organization using Selective Laser Melting (SLM) technology. A monitoring campaign was performed using a condensation particle counter, a canning mobility particle sizer and air sampling for later scanning electron microscopy and energy dispersive X-ray analysis, proving the emission of nano-scale particles and providing insights on number particle concentration, size, shape and chemical composition of airborne matter. Additionally, Control Banding Nanotool v2.0 and Stoffenmanager Nano v1.0 were applied in this case study as qualitative tools, although designed for engineered nanomaterials. This article highlights the limitations of using these quantitative and qualitative approaches when studying metal 3D Printing workstations. As a result, this article proposes the IN Nanotool, a risk management method for incidental nanomaterials designed to overcome the limitations of other existing approaches and to allow non-experts to manage this risk and act preventively to guarantee the safety and health conditions of exposed workers.

NanoSafe III: A User Friendly Safety Management System for Nanomaterials in Laboratories and Small Facilities

Research in nanoscience continues to bring forward a steady stream of new nanomaterials and processes that are being developed and marketed. While scientific committees and expert groups deal with the harmonization of terminology and legal challenges, risk assessors in research labs continue to have to deal with the gap between regulations and rapidly developing information. The risk assessment of nanomaterial processes is currently slow and tedious because it is performed on a material-by-material basis. Safety data sheets are rarely available for (new) nanomaterials, and even when they are, they often lack nano-specific information. Exposure estimations or measurements are difficult to perform and require sophisticated and expensive equipment and personal expertise. The use of banding-based risk assessment tools for laboratory environments is an efficient way to evaluate the occupational risks associated with nanomaterials. Herein, we present an updated version of our risk assessment tool for working with nanomaterials based on a three-step control banding approach and the precautionary principle. The first step is to determine the hazard band of the nanomaterial. A decision tree allows the assignment of the material to one of three bands based on known or expected effects on human health. In the second step, the work exposure is evaluated and the processes are classified into three "nano" levels for each specific hazard band. The work exposure is estimated using a laboratory exposure model. The result of this calculation in combination with recommended occupational exposure limits (rOEL) for nanomaterials and an additional safety factor gives the final "nano" level. Finally, we update the technical, organizational, and personal protective measures to allow nanomaterial processes to be established in research environments.

Risk Assessment of Nano-Flame Retardants Coating in the Selected Construction Industry of Iran by Control Banding Approach

Background:

There is a wide range of challenges through the use of nano-material in buildings. By developing construction industries the use of flame retardant nano-materials is a hurdle for human health. However occupational exposure measurement is not applicable for nano-particles monitoring. Risk assessment is an alternative method for industrial hygiene strategies. In this study, we use the control banding approach for risk assessment of 3 nano-fire retardant (NFR) in the building industry.

Methods:

We used control banding as a risk assessment approach for decision making about nano-materials in the building industry. The risk of nano-fire retardants such as monokote accelerator, monokote Z-106 G and monokote Z-106 HY in the construction industry was studied. The level of risk was evaluated by the matrix of hazard severity and probability score. Hazard severity was scored by toxicological information. The probability score was estimated by the state work operation.

Results:

A score of hazard severity in monokot Z-106 HY was higher than other nano-materials. The probability score of spraying tasks was lower than mixing and transportation tasks. The results show the application of all nano-materials had the higher risk level in transportation and mixing tasks. The risk level of monokote accelerator and monokote Z-106 G in spraying task is lower than monokot Z-106 HY.

Conclusions:

There is a high risk level for studied nano-materials in the coating tasks of the construction industry. In conclusion, powerful controlling strategies such as the substitution of nano-materials was suggested to decrease the risk of nano-fire retardants.

Occupational Exposure to Ultrafine Particles in Metal Additive Manufacturing: A Qualitative and Quantitative Risk Assessment

Ultrafine particles (UFPs) can be released unintentionally during metal additive manufacturing (AM). Experts agree on the urgent need to increase the knowledge of the emerging risk of exposure to nanoparticles, although different points of view have arisen on how to do so. This article presents a case study conducted on a metal AM facility, focused on studying the exposure to incidental metallic UFP. It intends to serve as a pilot study on the application of different methodologies to manage this occupational risk, using qualitative and quantitative approaches that have been used to study exposure to engineered nanoparticles. Quantitative data were collected using a condensation particle counter (CPC), showing the maximum particle number concentration in manual cleaning tasks. Additionally, scanning electron microscopy (SEM) and energy dispersive X-ray analyzer (EDS) measurements were performed, showing no significant change in the particles’ chemical composition, size, or surface (rugosity) after printing. A qualitative approach was fulfilled using Control Banding Nanotool 2.0, which revealed different risk bands depending on the tasks performed. This article culminates in a critical analysis regarding the application of these two approaches in order to manage the occupational risk of exposure to incidental nanoparticles, raising the potential of combining both.

Review and Improvement of Chemical Hazard Risk Management of Korean Occupational Safety and Health Agency

In 2012, the Korean Occupational Safety and Health Agency developed Chemical Hazard Risk Management (CHARM) as a risk assessment tool. This study aims to reorganize the CHARM technique by complementing its logical loopholes, while evaluating the risk to enterprises and verifying this technique by applying it to some enterprises in Korea. The optimized technique changed the method of quantitative assessment and evaluation criteria, matched the risk level with the required control level, and specified the use of control practice. For the target enterprises, for several assessment methods, risk levels, hazard bands, exposure bands, and the risk assessment results were derived, and the same types of options were compared. Fewer informational methods resulted in more conservative results of risk levels and hazard bands. Since the control status of the enterprises could not be confirmed and the substances handled at the target enterprises were limited in this study, a follow-up study should be performed with more target materials and additional information on the current control status of the enterprises.

The Development of a Covid-19 Control Measures Risk Matrix for Occupational Hygiene Protective Measures

The British Occupational Hygiene Society (BOHS) Covid-19 Working Group developed a control banding matrix to provide guidance for employers and others to help assess the risks of Covid-19 infection during the pandemic. The matrix was based on occupational hygiene principles and the judgement of the occupational health practitioners involved; since objective data on workers’ exposure were unavailable. Users of the matrix identify one of five exposure categories based on generic job descriptions and example occupations, and these categories are linked to generic guidance on interventions at source, on the exposure pathway and for individual workers. The risk matrix was published on the BOHS website and the guidance has been downloaded more than 2000 times. The matrix has had limited evaluation for reliability, but the data suggest that the highest exposure ranked jobs were associated with higher age-standardized mortality in Britain during the pandemic. However, there was considerable variability in exposure assignments between assessors, which underlines the need for the control guidance to be precautionary. The BOHS calls on academic researchers to undertake further work to validate the reliability of the tool.

Comparison of the Qualitative and the Quantitative Risk Assessment of Hazardous Substances Requiring Management under the Occupational Safety and Health Act in South Korea

The risk assessment of hazardous substances has become increasingly important for the efficient prevention and management of various diseases or accidents caused by increased amounts of hazardous substances in the workplace. In this study, risk assessment was conducted for 36 kinds of hazardous substances requiring management by using qualitative and quantitative risk assessments. Qualitative risk assessment was performed by multiplying the exposure level class by the hazard class according to the Korea Occupational Safety and Health Agency’s (KOSHA) Chemical Hazard Risk Management (CHARM). The quantitative risk assessment was followed by a four-step risk assessment system presented in the Guidelines for Hazard Risk Assessment of Chemicals (KOSHA GUIDE W-6-2016). In the quantitative assessments, we presented a new method of classifying risk levels into four steps, much like qualitative assessments. In this study, the quantitative risk assessment was considered difficult to predict through qualitative risk assessment. Therefore, it is necessary to perform a quantitative risk assessment after a qualitative risk assessment for a higher level of risk assessment.

Selecting Controls for Minimizing SARS-CoV-2 Aerosol Transmission in Workplaces and Conserving Respiratory Protective Equipment Supplies

With growing evidence of inhalation of small infectious particles as an important mode of transmission for SARS-CoV-2, workplace risk assessments should focus on eliminating or minimizing such exposures by applying the hierarchy of controls. We adapt a control banding model for aerosol-transmissible infectious disease pandemic planning to encourage the use of source and pathway controls before receptor controls (personal protective equipment). Built on the recognition that aerosol-transmissible organisms are likely to exhibit a dose-response function, such that higher exposures result from longer contact times or higher air concentrations, this control banding model offers a systematic method for identifying a set of source and pathway controls that could eliminate or reduce the need for receptor controls. We describe several examples for workers at high risk of exposure in essential or return to work categories. The goal of using control banding for such workers is to develop effective infection and disease prevention programs and conserve personal protective equipment.

Exposure Models for REACH and Occupational Safety and Health Regulations

Model tools for estimating hazardous substance exposure are an accepted part of regulatory risk assessments in Europe, and models underpin control banding tools used to help manage chemicals in workplaces. Of necessity the models are simplified abstractions of real-life working situations that aim to capture the essence of the scenario to give estimates of actual exposures with an appropriate margin of safety. The basis for existing inhalation exposure assessment tools has recently been discussed by some scientists who have argued for the use of more complex models. In our opinion, the currently accepted tools are documented to be the most robust way for workplace health and safety practitioners and others to estimate inhalation exposure. However, we recognise that it is important to continue the scientific development of exposure modelling to further elaborate and improve the existing methodologies.

Longitudinal follow-up of health effects among workers handling engineered nanomaterials: a panel study

BACKGROUND

Although no human illness to date is confirmed to be attributed to engineered nanoparticles, occupational epidemiological studies are needed to verify the health effects of nanoparticles. This study used a repeated measures design to explore the potential adverse health effects of workers handling nanomaterials.

METHODS

Study population was 206 nanomaterial-handling workers and 108 unexposed controls, who were recruited from 14 nanotechnology plants. They were followed up no less than two times in four years. A questionnaire was used to collect potential confounders and detailed work conditions. Control banding was adopted to categorize risk level for each participant as a surrogate marker of exposure. Health hazard markers include cardiopulmonary dysfunction markers, inflammation and oxidative damage markers, antioxidant enzymes activity, and genotoxicity markers. The Generalized Estimating Equation model was applied to analyze repeated measurements.

RESULTS

In comparison to the controls, a significant dose-dependent increase on risk levels for the change of superoxide dismutase (p<0.01) and a significant increase of glutathione peroxidase change in risk level 1 was found for nanomaterial-handling workers. However, the change of cardiovascular dysfunction, lung damages, inflammation, oxidative damages, neurobehavioral and genotoxic markers were not found to be significantly associated with nanomaterials handling in this panel study.

CONCLUSIONS

This repeated measurement study suggests that there was no evidence of potential adverse health effects under the existing workplace exposure levels among nanomaterials handling workers, except for the increase of antioxidant enzymes.

Control Banding Tools for Engineered Nanoparticles: What the Practitioner Needs to Know

Control banding (CB) has been widely recommended for the selection of exposure controls for engineered nanomaterials (ENMs) in the absence of ENM-specific occupational exposure limits (OELs). Several ENM-specific CB strategies have been developed but have not been systematically evaluated. In this article, we identify the data inputs and compare the guidance provided by eight CB tools, evaluated on six ENMs, and assuming a constant handling/use scenario. The ENMs evaluated include nanoscale silica, titanium dioxide, silver, carbon nanotubes, graphene, and cellulose. Several of the tools recommended the highest level of exposure control for each of the ENMs in the evaluation, which was driven largely by the hazard banding. Dustiness was a factor in determining the exposure band in many tools, although most tools did not provide explicit guidance on how to classify the dustiness (high, medium, low), and published data are limited on this topic. The CB tools that recommended more diverse control options based on ENM hazard and dustiness data appear to be better equipped to utilize the available information, although further validation is needed by comparison to exposure measurements and OELs for a variety of ENMs. In all CB tools, local exhaust ventilation was recommended at a minimum to control exposures to ENMs in the workplace. Generally, the same or more stringent control levels were recommended by these tools compared with the OELs proposed for these ENMs, suggesting that these CB tools would generally provide prudent exposure control guidance, including when data are limited.

An Assessment of the Robustness of the COSHH-Essentials (C-E) Target Airborne Concentration Ranges 15 Years on, and Their Usefulness for Determining Control Measures

The Health and Safety Executive (HSE) in Great Britain (GB), in association with its stakeholders, developed the Control of Substances Hazardous to Health (COSHH)-Essentials (C-E) control banding tool in 1998. The objective was to provide a simple tool for employers, particularly small and medium-sized enterprises (SMEs), to help select and apply appropriate measures for the adequate control of exposure to hazardous substances. The tool used hazard classification information (R-phrases) to assign substances to one of five health hazard groups, each with its respective 'target airborne concentration range'. The validity of the allocation of substances to a target airborne concentration range was demonstrated at the time using 111 substances that had a current health-based Occupational Exposure Limit (OEL) in GB. The C-E control banding approach remains an important tool to complement exposure assessment/monitoring and the selection and use of suitable control measures for hazardous substances. These include engineering controls and personal protective equipment (PPE). The C-E based control banding approach has been adopted around the world. This paper extends the original validation exercise, using a greater number of chemical substances, to establish whether the target airborne concentration ranges remain appropriate. This is of particular interest in light of the introduction of the Globally Harmonized System (GHS) for classification, in which R-phrases have now been replaced by hazard-statements (H-statements). The validation exercise includes substances with OELs published by nine bodies internationally; and the Derived No-Effect Levels (DNELs) assigned by registrants under the European Union-Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) Regulations. When compared against 8-hour TWA OELs for 850 substances drawn from nine bodies and a limited number of DNELS, the C-E target airborne concentration ranges remain valid. This comparative work also informs a wider consideration around the practicality and the applicability of the C-E generic approach to facilitate the implementation of good practice control for a wide range of substances (more than 95%) which do not have any recognized OEL.

Green Jobs: Definition and Method of Appraisal of Chemical and Biological Risks

In the wake of sustainable development, green jobs are developing rapidly, changing the work environment. However a green job is not automatically a safe job. The aim of the study was to define green jobs, and to establish a preliminary risk assessment of chemical substances and biological agents for workers in Quebec. An operational definition was developed, along with criteria and sustainable development principles to discriminate green jobs from regular jobs. The potential toxicity or hazard associated with their chemical and biological exposures was assessed, and the workers' exposure appraised using an expert assessment method. A control banding approach was then used to assess risks for workers in selected green jobs. A double entry model allowed us to set priorities in terms of chemical or biological risk. Among jobs that present the highest risk potential, several are related to waste management. The developed method is flexible and could be adapted to better appraise the risks that workers are facing or to propose control measures.

Proposal of a new risk assessment method for the handling of powders and nanomaterials

A new approach to assess the risks inherent in the implementation of powders, including nanomaterials, has been developed, based on the OHB (Occupational Hazard Band) method which is widely spread in the chemical industry. Hazard classification has not been modified; only the control of exposure has been worked at. The method applies essentially to the prevention of the exposures to airborne materials, whatever their particle size. The method considers exposure based on seven parameters which take into account the characteristics of the materials used, their emission potential, the conditions of use, as well as classic parameters of exposure characterization like duration and frequency. The method is a pragmatic exploitation of the state-of-art and of available data, bearing in mind that a lot of them are not easily accessible to factory operators. The result of the reflection is then positioned on a hazard versus exposure matrix from which 4 levels of priority of action are defined, as in the classical OHB method used to manage pure chemical risk. This approach fills a gap in terms of risk assessment and avoids jeopardizing all that has been set up for years, while introducing new elements of decision making accessible to all operators.