NIOSH Investigates Hospital, Ergonomic, and Opioid Hazards

The National Institute for Occupational Safety and Health (NIOSH) fielded 221 requests for Health Hazard Evaluations (HHEs) in 2018, according to a recently released annual report. The 34 HHE reports published last year examined hazards ranging from hospital disinfectants and repetitive pharmacy tasks to emergency responders’ exposure to opioids.

NIOSH teams performed 32 site inspections, visiting 29 workplaces in 18 states.

Hospital Disinfectants

NIOSH investigators evaluated exposures to a new cleaning product used in a multispecialty hospital where exposed employees reported symptoms that included burning eyes, nose, and throat; cough; dizziness; exacerbation of asthma; headache; nausea; nose bleeds; runny nose; and skin burns and rashes.

Investigators looked at the use of a sporicidal product containing hydrogen peroxide, peracetic acid, and acetic acid and found that:

• The sporicidal product was used predominantly by the environmental services staff and not the nursing and ancillary staff;
• Investigators detected hydrogen peroxide, peracetic acid, and acetic acid in all full-shift air samples; and
• Employees reported that splashes and spills of the cleaning product resulted in eye or skin irritation.

Employees also reported no ventilation in some of the bathrooms they cleaned, and investigators observed staff cleaning closets in units that had no supply or return airflow.

NIOSH published its findings in an article, “Health problems and disinfectant product exposure among staff at a large multispecialty hospital,” in the American Journal of Infection Control.

The investigators recommended that workers at the hospital:

• Wear extended-cuff nitrile or rubber gloves and goggles or a face shield when using cleaning supplies;
• Not use a spray bottle to apply disinfectant products;
• Report any symptoms to a healthcare provider; and
• Report unventilated patient rooms or bathrooms to supervisors.

Pharmacy Ergonomics

NIOSH conducted another HHE investigation at a health clinic pharmacy to examine musculoskeletal disorders (MSDs) among pharmacy employees who repeatedly opened and closed child-resistant medication bottles.

Repetitive-motion injuries were the most common recordable injury among pharmacy department employees. NIOSH investigators noted hand and neck symptoms and conditions that were consistent with work-related MSDs.

NIOSH’s recommendations for employees and supervisors included:

• Utilizing adjustable-height workstations;
• Alternating between computer work and repetitive-motion pharmacy tasks;
• Increasing employee and supervisor training on MSDs and ergonomics; and
• Reporting work-related health and safety concerns to supervisors.

Opioid Investigations

HHE teams performed 13 opioid-related investigations last year. Investigators looked into several emergency responder and law enforcement personnel concerns, including:

• Potential exposures in crime laboratories to synthetic opioids and other controlled substances;
• Potential fentanyl exposures at airport screening operations;
• Potential exposure to fentanyl among medical investigators;
• Potential exposure to fentanyl and other opioids among corrections workers from ventilation at a jail;
• Impact of traumatic events and stressors, including an increased number of opioid responses by first responders; and
• Health effects from unintentional occupational exposure to opioids and other illicit drugs among responders.

NIOSH developed guidance for emergency responders that covered safe standard operating procedures, training, and personal protective equipment (PPE) recommendations. The PPE recommendations for emergency medical technicians (EMTs), firefighters, and law enforcement officers cover possible exposures during prehospital medical care, routine law enforcement duties, investigations and evidence collection, and special operations and decontamination. NIOSH also produced a video for emergency responders that showed body-camera footage of police officers succumbing to the effects of incidental opioid exposure.

NIOSH’s recommendations for emergency responders and their employers include:

• Attending periodic training to discuss exposure prevention methods;
• Coordinating joint training with other local emergency response agencies;
• Developing new or modifying existing policies and procedures for responses involving illicit drugs; and
• Reporting possible exposures to illicit drugs to supervisors as well as reporting any health effects resulting from exposures.

Other NIOSH Publications

NIOSH’s HHE activity also led to a number of specialty publications and tools for employers, including:

• A new poster about controlling the health hazards of working with nanomaterials;
• New fact sheets on the risks of rhabdomyolysis among structural and wildland firefighters; and
• Indoor environmental quality assessment tools for dampness and mold in schools and general buildings.