Gravity steam reprocessing in healthcare facilities for the reuse of N95 respirators.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has significantly impacted the health of millions of people around the world. The shortage of personal protective equipment, including N95 respirators, in hospital facilities has put frontline healthcare professionals at high risk for contracting this virus. AIM: To develop a reproducible and safe N95 respirator reprocessing method that satisfies all presented regulatory standards and that can be directly implemented by hospitals using existing available equipment. METHODS: A non-toxic gravity steam reprocessing method has been developed for the reuse of N95 respirators consisting of 30 min of steam treatment at 121°C followed by 30 min of heat drying. Samples of model number 1860, 1860s, 1870+, and 9105 N95 respirators were either collected from hospitals (for microbiology testing) or purchased new (for functionality testing), with all functionality tests (i.e. filter efficiency, fit evaluation, and strap integrity) performed at the Centers for Disease Control and Prevention using standard procedures established by the National Institute for Occupational Safety and Health. FINDINGS: All tested models passed the minimum filter efficiency of 95% after three cycles of gravity steam reprocessing. The 1870+ N95 respirator model is the most promising model for reprocessing based on its efficient bacterial inactivation coupled with the maintenance of all other key functional respirator properties after multiple reprocessing steps. CONCLUSIONS: The gravity steam method can effectively reprocess N95 respirators over at least three reprocessing cycles without negatively impacting the functionality requirements set out by regulators. Enabling the reuse of N95 respirators is a crucial tool for managing both the current pandemic and future healthcare crises.

Evaluation of high blood pressure and obesity among US coal miners participating in the Enhanced Coal Workers' Health Surveillance Program.

Since 2005, the Enhanced Coal Workers' Health Surveillance Program (ECWHSP) has offered respiratory examinations to coal miners in a mobile examination unit. As little is known about the cardiovascular health of coal miners, we describe the prevalence of high blood pressure (BP) and obesity among ECWHSP participants. During 2015, 1402 ECWHSP health examinations were performed. The prevalence of BP consistent with hypertension (systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg), prehypertension (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg), and hypertensive crisis (systolic BP ≥ 180 mm Hg or diastolic BP ≥ 110 mm Hg) were calculated and compared with the US adult population using standardized morbidity ratios (SMRs). Most participants were male (N = 1317, 94%), White (N = 1303, 93%) and non-Hispanic (N = 1316, 94%). Thirty-one percent (N = 440) of participants had BP in the hypertensive range and 87% (N = 1215) were overweight/obese. Twenty-four participants (2%) had a BP reading consistent with a hypertensive crisis. Prevalence of obesity (52%, SMR = 1.52, 95% confidence interval = 1.41-1.64) and BP consistent with hypertension (31%, SMR = 1.60, 95% confidence interval = 1.45-1.76) was higher than the US adult population.The prevalence of obesity and BP consistent with hypertension in this population of coal miners is substantial, indicating a need for cardiovascular health interventions in coal mining communities.

Partnering strategies for childhood agricultural safety and health.

The National Institute for Occupational Safety and Health (NIOSH) has been the lead federal agency of the national Childhood Agricultural Injury Prevention Initiative (CAIPI) since the program's inception in 1996 and in this role, collaborated with numerous partners in childhood agricultural injury prevention activities. This collaboration has likely helped achieve the current reduction in childhood agricultural injury. The paper looks at existing groups with past and current childhood agricultural injury prevention activities for partnering strategies that could contribute to reducing the morbidity and mortality of childhood agricultural injuries. Based upon the review, suggestions are made for future partnering strategies to continue progress in this area.

Formative field experiments of a NIOSH alert to reduce the risks to firefighters from structural collapse: applying the cascade framework.

The authors report two field experiments aimed at testing the impact of government safety recommendations. Using a cascade framework from the Communication Matrix (McGuire, 1985, 1989), the study tested effects of reminder cards, message format, argument quality, and mailer types on indicators of reception, processing, and response. Systematic combinations of these variables were mailed to randomly selected firefighting units in the United States. Fire chiefs were contacted by phone to complete a survey within the next month (Experiment 1, N = 2,000, 44% completion; Experiment 2, N = 600; 77% completion). Results showed highest reception rates ( asymptotically equal to 50%) with one reminder card and the standard government low-graphics format and that greater reception produced stronger intentions. Processing was stronger with the standard government low-graphics format, and processing was correlated with more positive attitudes and intentions. Response indexes were favorable (>4 on -point scale) under all conditions. Outcomes are interpreted within the framework of a communication cascade model.

NIOSH research efforts to prevent musculoskeletal disorders in the healthcare industry.

Healthcare workers, including orthopaedic nurses, face a number of risk factors in the workplace for musculoskeletal disorders such as back and shoulder injuries. These disorders are associated with excessive back and shoulder loading due to manual patient handling, applying excessive forces during pushing and/or pulling of objects, required use of awkward postures during patient care, and working long hours and shiftwork. No healthcare workers are immune from injury because workers in all clinical areas are exposed to occupational risk factors, including hospitals, nursing homes, emergency services, critical care, operating rooms, orthopaedic units, and home healthcare environments. This article includes a summary of the scientific efforts of the researchers and their partners at the National Institute for Occupational Safety and Health (NIOSH) in evaluating and developing the best practice recommendations for reducing risk of these disorders for exposed workers. The studies conducted by NIOSH researchers and their partners approach the problem from a variety of perspectives, ranging from comprehensive epidemiological studies examining the effectiveness of implementation of a safe patient handling and movement program to laboratory studies evaluating the biomechanical stress associated with using patient handling equipment, and education training programs for use in schools of nursing to educate new workers about safe work practices. Results of these studies have provided scientific evidence that significant occupational risks for musculoskeletal disorders exist and that effective interventions are available to reduce the risk for these workers.

Formaldehyde and leukemia: an improbable causal relationship.

Formaldehyde has been the subject of numerous toxicological and epidemiological investigations for almost 25 years. Though most toxicology studies have focused on the effects of the chemical on the nasal tract and respiratory system, epidemiology investigations have been more extensive evaluating the association between formaldehyde and cancers not only of the nasal cavities, nasopharynx, and lung, but also of the brain, prostate, pancreas, and hematopoietic system. Recently, three studies have been published which report on the possible association between exposure to formaldehyde and an increased incidence of leukemia, specifically myeloid leukemia. The article summarizes the results of these three studies, evaluates the evidence for causality based on recognized epidemiologic criteria, and provides an assessment that the association between formaldehyde and the increased incidence of leukemia reported in these studies is not plausible.

The Lone Ranger rides again, this time followed by a federal posse.

The Centers for Disease Control and Prevention proposed guidelines regarding the high-efficiency particulate air-filtered respirator have raised many questions that the healthcare worker has found difficult to answer. This product commentary addresses questions related to material that the respiratory protection program should include; provides information related to the physical exam before the use of the respirator; and explains the types of respirators. Cost issues also are discussed.

Implications of OSHA's reliance on TLVs in developing the air contaminants standard.

This paper evaluates the decision by the Occupational Safety and Health Administration (OSHA) to base its Air Contaminants Standard on the threshold limit values (TLVs) of the American Conference of Governmental Industrial Hygienists. Contrary to the claim made by OSHA in promulgating the standard, the TLV list was not the sole available basis for a generic standard covering toxic air contaminants. The National Institute for Occupational Safety and Health (NIOSH) presented data indicating that the TLVs were insufficiently protective for 98 substances. NIOSH Recommended Exposure Limits (RELs) were available for 59 of these substances. The ratio of PEL to REL ranged up to 1,000, with a median of 2.5 and a mean of 71.4. OSHA excluded 42 substances from the standard altogether despite the availability of NIOSH RELs, solely because no TLV had been established.