Managing SARS-CoV-2 transmission risk in workplace COVID-19 outbreaks.

OBJECTIVES: A Coronavirus disease 2019 (COVID-19) workplace outbreak is a risk to the health of workers and business continuity. To minimise this risk, companies have implemented risk management measures (RMMs) designed to mitigate SARS-CoV-2 transmission within the workforce. The objective of this work was to gather insights into the application of RMMs in non-healthcare workplaces and to improve understanding of the practical barriers to their implementation. METHODS: Data were collected using a pre-designed framework from 12 volunteer workplaces through discussions with staff responsible for site safety and during site visits to observe the RMMs and work processes. To evaluate ventilation effectiveness, measurements for carbon dioxide (CO2) were taken during the site visit and logged over an extended period in selected occupied areas. RESULTS: RMMs that were implemented well included working at home for office and other non-production staff, provision, and use of face coverings, provision for hand hygiene, and as methods became commonly available, carrying out testing for infected people. However, maintaining adequate physical distancing in many production areas proved difficult because established factory layouts cannot be easily changed and there is often a need for workers to be close to each other to communicate. A major shortcoming identified was the understanding and application of measures to improve workplace ventilation. Rapidly installing and/or upgrading mechanical ventilation systems during a pandemic may not be practical and ideally should be considered in building design. Measuring CO2 in occupied workspaces proved to be a useful tool for identifying areas with potentially inadequate ventilation. CONCLUSIONS: Preventing workplace attendance by identifying infected individuals is challenging, making effective RMMs crucial to mitigating virus transmission. The effectiveness of individual RMMs can be uncertain; therefore, it is necessary to adopt multilayered RMMs. Successful implementation relies on measures that are specific to individual workplaces, identified by accurate risk assessment, regularly reviewed for effectiveness, and worker compliance. Establishing suitable risk mitigation policies and providing staff supervision are vital to ensure the sustained and effective implementation of RMMs. For RMMs that require technical understanding, such as workplace ventilation systems, specialist support may be necessary to ensure effective implementation.

A SARS-CoV-2 outbreak in a public order and safety training facility in England, June 2021.

BACKGROUND: The public order and safety (POS) sector remains susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks, as workplace attendance is typically compulsory and close physical contact is often needed. Here, we report on a SARS-CoV-2 outbreak with an attack rate of 39% (9/23), which occurred between 19 and 29 June 2021 among a cohort of new POS recruits participating in a mandatory 18-week training programme in England. METHODS: The COVID-OUT (COVID-19 Outbreak investigation to Understand Transmission) study team undertook a multidisciplinary outbreak investigation, including viral surface sampling, workplace environmental assessment, participant viral and antibody testing, and questionnaires, at the two associated training facilities between 5 July and 24 August 2021. RESULTS: Environmental factors, such as ventilation, were deemed inadequate in some areas of the workplace, with carbon dioxide (CO2) levels exceeding 1,500 ppm on multiple occasions within naturally ventilated classrooms. Activities during safety training required close contact, with some necessitating physical contact, physical exertion, and shouting. Furthermore, most participants reported having physical contact with colleagues (67%) and more than one close work contact daily (97%). CONCLUSIONS: Our investigation suggests that site- and activity-specific factors likely contributed to the transmission risks within the POS trainee cohort. Potential interventions for mitigating SARS-CoV-2 transmission in this POS training context could include implementing regular rapid lateral flow testing, optimizing natural ventilation, using portable air cleaning devices in classrooms, and expanding use of well-fitted FFP2/FFP3 respirators during activities where prolonged close physical contact is required.

A SARS-CoV-2 outbreak investigation at a storage and distribution centre in England: an assessment of worker- and workplace-related risk factors.

An outbreak of SARS-CoV-2 (1 March to 10 May 2021) with an attack rate of 26.5% among approximately 1150 workers at a storage and distribution centre in England prompted a multidisciplinary outbreak investigation (5 May to 6 August 2021), with the aim of better understanding worker- and workplace-related risk factors for viral transmission in the warehousing sector. Overall, environmental factors (e.g., ventilation, humidity and temperature) were assessed to be appropriate at the facility. Nevertheless, 39 (51.3%) surface samples from across the site tested positive for low/ very low levels of SARS-CoV-2 RNA (Ct value ≥ 32.0 for all). Among the study participants, of whom 35.6% were confirmed or suspected cases, 95.5% reported having received COVID-19 prevention training, 100.0% reported handwashing, and 80.0% reported use of face coverings at work. Notably, 43.9% and 19.0% reported working with a symptomatic and a positive contact respectively. Furthermore, 80.5% and 46.3% had concerns regarding reduction in their income and future unemployment, respectively, due to self-isolation. The findings of this study suggest that, in addition to targeted workplace infection control measures and tailored work area specific risk assessments, an enhanced and equitable sick leave policy may help limit presenteeism and viral transmission in large workplaces.

Health and Safety Executive research on wood dust exposure controls in British manufacturing.

To generate new intelligence on occupational exposure to wood dust in woodworking manufacturing activities in Britain, the Health and Safety Executive (HSE) performed 22 occupational hygiene site visits to assess exposure and exposure controls between 2014 and 2017. The work aimed to characterise good practice and therefore sites with a poor health and safety record, as identified from HSE inspection records, were not invited to participate. Sites selected covered furniture production, joinery, saw milling, and boat building and repair. Twenty-three follow-up telephone interviews were also carried out across 15 of the companies with supervisors and managers to explore how they tried to promote good practice among the workforce, and if there are any potential challenges encountered. The aim of the interviews was to gain a better understanding of how to enable organisations to improve the management of wood dust exposure. This study found that 6.0% of all wood dust exposure measurements (15 out of 252) were above 5 mg/m³, and 17.6% of exposures to hardwood dust or mixtures of hardwood and softwood dust (38 out of 216) were above 3 mg/m³ (the then current and future workplace exposure limits). Sanding, cleaning, and maintenance activities were of particular concern. Improvements to exposure controls are required, in particular, improvements to local exhaust ventilation controls for hand-held power tools and hand sanding. The management, selection, and use of respiratory protective equipment were poor. All the managers and supervisors recognised that exposure to wood dust can pose serious health risks, and that controls were crucial to protecting workers' health. The findings from the telephone interviews suggest that supervision and provision of information about the health effects of exposure to wood dust were common approaches that organisations used to raise awareness and promote good practice, in relation to managing wood dust exposure. Worker attitudes towards controls, such as perceptions that they hinder task completion and habitual ways of working, were identified as factors influencing the use of controls. Risk communication approaches that focus on increasing workers' awareness of their susceptibility to ill-health using credible sources, such as peers, can help enhance the uptake of messages on the use of controls. Financial constraints were identified as a challenge to improving the control of wood dust, particularly for small companies.

A COVID-19 Outbreak in a Large Meat-Processing Plant in England: Transmission Risk Factors and Controls.

The meat-processing industry had frequent COVID-19 outbreaks reported worldwide. In May 2021, a large meat-processing plant in the UK had an outbreak affecting 4.1% (63/1541) of workers. A rapid on-site investigation was conducted to understand the virus transmission risk factors and control measures. This included observational assessments of work activities, control measures, real-time environmental measurements and surface microbial sampling. The production night-shift attack rate (11.6%, 44/380) was nearly five times higher than the production day-shift (2.4%, 9/380). Shared work transport was provided to 150 staff per dayshift and 104 per nightshift. Production areas were noisy (≥80 dB(A)) and physical distancing was difficult to maintain. Face visors were mandatory, additional face coverings were required for some activities but not always worn. The refrigeration system continuously recirculated chilled air. In some areas, the mean temperature was as low as 4.5 °C and mean relative humidity (RH) was as high as 96%. The adequacy of ventilation in the production areas could not be assessed reliably using CO2, due to the use of CO2 in the packaging process. While there were challenges in the production areas, the observed COVID-19 control measures were generally implemented well in the non-production areas. Sixty surface samples from all areas were tested for SARS-CoV-2 RNA and 11.7% were positive. Multi-layered measures, informed by a workplace specific risk assessment, are required to prevent and control workplace outbreaks of COVID-19 or other similar respiratory infectious diseases.

A SARS-CoV-2 outbreak in a plastics manufacturing plant.

BACKGROUND: A SARS-CoV-2 outbreak with an attack rate of 14.3% was reported at a plastics manufacturing plant in England. METHODS: Between 23rd March and 13th May 2021, the COVID-OUT team undertook a comprehensive outbreak investigation, including environmental assessment, surface sampling, molecular and serological testing, and detailed questionnaires, to identify potential SARS-CoV-2 transmission routes, and workplace- and worker-related risk factors. RESULTS: While ventilation, indicated using real-time CO2 proxy measures, was generally adequate on-site, the technical office with the highest localized attack rate (21.4%) frequently reached peaks in CO2 of 2100ppm. SARS-CoV-2 RNA was found in low levels (Ct ≥35) in surface samples collected across the site. High noise levels (79dB) were recorded in the main production area, and study participants reported having close work contacts (73.1%) and sharing tools (75.5%). Only 20.0% of participants reported using a surgical mask and/or FFP2/FFP3 respirator at least half the time and 71.0% expressed concerns regarding potential pay decreases and/or unemployment due to self-isolation or workplace closure. CONCLUSIONS: The findings reinforce the importance of enhanced infection control measures in manufacturing sectors, including improved ventilation with possible consideration of CO2 monitoring, utilising air cleaning interventions in enclosed environments, and provision of good-quality face masks (i.e., surgical masks or FFP2/FFP3 respirators) especially when social distancing cannot be maintained. Further research on the impacts of job security-related concerns is warranted.

Investigation of a SARS-CoV-2 Outbreak at an Automotive Manufacturing Site in England.

Workplace-related outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to occur globally. The manufacturing sector presents a particular concern for outbreaks, and a better understanding of transmission risks are needed. Between 9 March and 24 April 2021, the COVID-19 (coronavirus disease 2019) Outbreak Investigation to Understand Transmission (COVID-OUT) study undertook a comprehensive investigation of a SARS-CoV-2 outbreak at an automotive manufacturing site in England. The site had a total of 266 workers, and 51 SARS-CoV-2 infections. Overall, ventilation, humidity, and temperature at the site were assessed to be appropriate for the number of workers and the work being conducted. The company had implemented a number of infection control procedures, including provision of face coverings, spacing in the work, and welfare areas to allow for social distancing. However, observations of worker practices identified lapses in social distancing, although all were wearing face coverings. A total of 38 workers, including four confirmed cases, participated in the COVID-OUT study. The majority of participants received COVID-19 prevention training, though 42.9% also reported that their work required close physical contact with co-workers. Additionally, 73.7% and 34.2% had concerns regarding reductions in future income and future unemployment, respectively, due to self-isolation. This investigation adds to the growing body of evidence of SARS-CoV-2 outbreaks from the manufacturing sector. Despite a layered COVID-19 control strategy at this site, cases clustered in areas of high occupancy and close worker proximity.

Exposure to Respirable Crystalline Silica in the GB Brick Manufacturing and Stone Working Industries.

The aim of this work was to benchmark respirable crystalline silica (RCS) exposures in brick manufacturing and stone working sectors in Great Britain. This will contribute to a larger programme of work, which will be used to better understand the role of health surveillance in preventing the development of further cases of silicosis and chronic obstructive pulmonary disease. This work was undertaken by means of site visits to measure RCS and respirable dust exposures and assess exposure controls. In addition, historic exposure reports from the sites were collated to allow assessment of exposure trends. The survey, which was conducted in 20 sites (10 from each sector), found that in both sectors over 20% of the measured exposures exceeded the UK RCS 8-hour time-weighted averaged workplace exposure limit (WEL) of 0.1 mg/m3. In the stone sector over 40% of the 8 h time-weighted average RCS exposures were above the RCS WEL compared to 20% in the brick manufacturing sector. In the stone sector, 61% of RCS exposures where water suppression was present exceeded the RCS WEL. This indicates that a variety of exposure controls will be required to control RCS exposures, including respiratory protective equipment (RPE). The use of RPE in situations where RCS exposure exceeded the RCS WEL was more prevalent in stone working than in the brick sector. There were differences associated with RPE and the use of other exposure controls in both sectors. The contextual information in historic consultant's exposure reports was generally limited, with exposure controls either not mentioned or not fully described. This affects the usefulness of exposure monitoring to dutyholders. This work will provide information on exposures allowing construction of lifetime exposure estimates for use in analysis of the health effects data. A second survey to the sites is planned to determine how exposures have altered.

Exposure to Diisocyanates and Their Corresponding Diamines in Seven Different Workplaces.

Biological monitoring to assess exposure to diisocyanates in the workplace is becoming increasingly widespread due to its relative ease of use and ability to look at all exposure routes. Currently, biological monitoring measures the corresponding isocyanate-derived diamine in urine, after hydrolysis. Because of this, any exposure to the diamines themselves released during the industrial process could confound the assessment of diisocyanate exposure. This paper reports an initial assessment of the extent of diamine formation and exposure during different processes involving diisocyanates including casting, grouting, core making, spray painting, foam blowing, and floor screeding. Air monitoring and glove analysis were conducted for both the relevant diisocyanate (measured as total NCO) and its corresponding diamine; urine samples were analysed (after hydrolysis) for the isocyanate-derived diamine. Processes that generated aerosols (as demonstrated by impinger analysis) such as spray painting and foam blowing were associated with the detection of diamines. Those processes that did not generate aerosols (casting, grouting, core making, and screeding) had no diamines detected, either in air or on gloves. In spray-painting tasks, diamines were a minor component (<15%) of the ambient concentration whereas in the foam blowing processes, where water is added to the process, diamine generation is more marked (up to eight times the airborne NCO concentration). Some non-aerosol processes gave rise to substantial diamine levels in urine (in exceedance of international guidance values, >5 µmol mol-1 creatinine) despite airborne levels being well within occupational exposure limits (20 µg m-3 total NCO in Great Britain); measurement data and statistical modelling indicated that skin absorption was the most likely exposure route. Foam blowing exposures were more complex, but urinary levels were greater than those expected from diisocyanate inhalation alone (measured as total NCO). This study provides evidence that biological monitoring for diisocyanates based on measuring the corresponding diamine in urine is valid, although any co-exposure to diamines themselves should be considered when interpreting results. It also demonstrates the potential for substantial skin absorption of diisocyanates in certain processes such as floor screeding and foam production.

The use of bio-monitoring to assess exposure in the electroplating industry.

Workers in the electroplating industry are potentially exposed to a range of hazardous substances including nickel and hexavalent chromium (chromium VI) compounds. These can cause serious health effects, including cancer, asthma and dermatitis. This research aimed to investigate whether repeat biological monitoring (BM) over time could drive sustainable improvements in exposure control in the industry. BM was performed on multiple occasions over 3 years, at 53 electroplating companies in Great Britain. Surface and dermal contamination was also measured, and controls were assessed. Air monitoring was undertaken on repeat visits where previous BM results were of concern. There were significant reductions in urinary nickel and chromium levels over the lifetime of this work in the subset of companies where initially, control deficiencies were more significant. Increased risk awareness following provision of direct feedback to individual workers and targeted advice to companies is likely to have contributed to these reductions. This study has shown that exposures to chromium VI and nickel in the electroplating industry occur via a combination of inhalation, dermal and ingestion routes. Surface contamination found in areas such as canteens highlights the potential for transferral from work areas, and the importance of a regular cleaning regime.

Airborne emissions of carcinogens and respiratory sensitizers during thermal processing of plastics.

OBJECTIVES: Thermoplastics may contain a wide range of additives and free monomers, which themselves may be hazardous substances. Laboratory studies have shown that the thermal decomposition products of common plastics can include a number of carcinogens and respiratory sensitizers, but very little information exists on the airborne contaminants generated during actual industrial processing. The aim of this work was to identify airborne emissions during thermal processing of plastics in real-life, practical applications. METHODS: Static air sampling was conducted at 10 industrial premises carrying out compounding or a range of processes such as extrusion, blown film manufacture, vacuum thermoforming, injection moulding, blow moulding, and hot wire cutting. Plastics being processed included polyvinyl chloride, polythene, polypropylene, polyethylene terephthalate, and acrylonitrile-butadiene-styrene. At each site, static sampling for a wide range of contaminants was carried out at locations immediately adjacent to the prominent fume-generating processes. RESULTS: The monitoring data indicated the presence of few carcinogens at extremely low concentrations, all less than 1% of their respective WEL (Workplace Exposure Limit). No respiratory sensitizers were detected at any sites. CONCLUSIONS: The low levels of process-related fume detected show that the control strategies, which employed mainly forced mechanical general ventilation and good process temperature control, were adequate to control the risks associated with exposure to process-related fume. This substantiates the advice given in the Health and Safety Executive's information sheet No 13, 'Controlling Fume During Plastics Processing', and its broad applicability in plastics processing in general.

MDHS 25 revisited: part 2, modified sampling and analytical procedures applied to HDI-based isocyanates.

The method that is probably the most commonly used worldwide for the determination of total organic isocyanates (NCO) in air is the Health and Safety Executive method, MDHS 25/3, Organic Isocyanates in Air, and its variants. This paper summarizes some of the research and development work carried out by Health and Safety Laboratory on this method since its publication in 1999 with the eventual aim of incorporating this work in an updated version of MDHS 25 (i.e. MDHS 25/4). The work falls into two main areas: use of liquid chromatography/mass spectrometry (LC/MS) as an alternative to liquid chromatography with electrochemical and ultraviolet/visible detection (LC/EC/UV) and evaluation of 'solid-phase' sampling techniques as an alternative to the impinger-filter combination stated in MDHS 25/3. This paper deals primarily with HDI-based NCO but some comments regarding aromatic NCO (MDI and TDI) are included for completeness. An LC/MS/MS version of MDHS 25/3 has been developed that gives improved performance to the 'classical' version of MDHS 25/3 using EC/UV detection. The LC/MS/MS offers significant advantages over the EC/UV version of MDHS 25/3 in that it is more sensitive, provides improved identification, and has been found to be easier to use. The solid-phase samplers evaluated were a double-thickness glass-fibre (GF/B) filter coated with 1-(2-methoxyphenyl)piperazine (MP) reagent in an IOM (Institute of Occupational Medicine) sampling head ('FIN-MP' sampler) and an MP-impregnated polyurethane foam sponge (PUF) with an MP-coated glass-fibre (GF/A) backup filter also in an IOM sampling head ('Rudzinski' sampler). Both samplers were found to give acceptable performance for the sampling of oligomeric HDI in workplace air and in laboratory simulations when compared to the impinger-filter combination at levels corresponding to the UK short-term limit (70 µg m(-3)). For practical reasons, the FIN-MP sampler was the preferred alternative.

Occupational exposure to dioxins at UK worksites.

Following a request from a Governmental Interdepartmental Group, the Health and Safety Executive undertook a polychlorinated dibenzo-p-dioxin (PCDD) and polychorinated dibenzofuran (PCDF) sampling exercise at several work sites in the UK. An initial survey suggested potential PCDD/F production at metal recycling sites, during cement manufacture, at municipal waste incinerators and landfill sites and during the use of thermal oxygen lances. PCDD/F sampling, using static and personal air samplers, revealed that the highest PCDD/F exposures were found at metal recycling sites, particularly aluminium recycling sites. The reasons for these results and the possible consequential intakes are discussed.