Low-cost interventions to improve ventilation in long-term care facilities.

Residents of long-term care facilities are particularly vulnerable to communicable diseases. Low-cost interventions to increase air exchange rates (AERs) may be useful in reducing the transmission of airborne communicable diseases between long-term care residents and staff. In this study, carbon dioxide gas was used as a tracer to evaluate the AER associated with the implementation of low-cost ventilation interventions. Under baseline conditions with the room's door closed, the mean AER was 0.67 ACH; while baseline conditions with the door open had a significantly higher mean AER of 3.87 ACH (p < 0.001). Subsequently opening a window with the door open increased mean AER by 1.49 ACH (p = 0.012) and adding a fan in the window further increased mean AER by 1.87 ACH (p < 0.001). Regression analyses indicated that the flow rate of air entering through the window, both passively and through the use of a fan, was significantly associated with an increase in AER (p < 0.001). These results indicate that low-cost interventions that pull outside air into resident rooms were effective in improving the air exchange rates in these facilities. While implementation of these interventions is dependent on facility rules and isolation requirements of residents with airborne communicable diseases, these interventions remain viable options for long-term care facilities to improve resident room ventilation without requiring costly ventilation system upgrades.

Improving human health outcomes with a low-cost intervention to reduce exposures from lead acid battery recycling: Dong Mai, Vietnam.

This study details the first comprehensive evaluation of the efficacy of a soil lead mitigation project in Dong Mai village, Vietnam. The village's population had been subject to severe lead poisoning for at least a decade as a result of informal Used Lead Acid Battery (ULAB) recycling. Between July 2013 to February 2015, Pure Earth and the Centre for Environment and Community Development (Hanoi, Vietnam) implemented a multi-faceted environmental and human health intervention. The intervention consisted of a series of institutional and low-cost engineering controls including the capping of lead contaminated surface soils, cleaning of home interiors, an education campaign and the construction of a work-clothes changing and bathing facility. The mitigation project resulted in substantial declines in human and environmental lead levels. Remediated home yard and garden areas decreased from an average surface soil concentration of 3940mg/kg to <100mg/kg. One year after the intervention, blood lead levels in children (<6 years old) were reduced by an average of 67%-from a median of 40.4µg/dL to 13.3µg/dL. The Dong Mai project resulted in significantly decreased environmental and biological lead levels demonstrating that low-cost, rapid and well-coordinated interventions could be readily applied elsewhere to significantly reduce preventable human health harm.

Confined space ventilation by shipyard welders: observed use and effectiveness.

Shipbuilding involves intensive welding activities within enclosed and confined spaces, and although ventilation is commonly used in the industry, its use and effectiveness has not been adequately documented. Workers engaged in welding in enclosed or confined spaces in two shipyards were observed for their use of ventilation and monitored for their exposure to particulate matter. The type of ventilation in use, its placement and face velocity, the movement of air within the space, and other ventilation-related parameters were recorded, along with task characteristics such as the type of welding, the welder's position, and the configuration of the space. Mechanical ventilation was present in about two-thirds of the 65 welding scenarios observed, with exhaust ventilation used predominantly in one shipyard and supply blowers predominantly in the other. Welders were observed working in apparent dead-spaces within the room in 53% of the cases, even where ventilation was in use. Respiratory protection was common in the two shipyards, observed in use in 77 and 100% of the cases. Welding method, the proximity of the welder's head to the fume, and air mixing were found to be significantly associated with the welder's exposure, while other characteristics of dilution ventilation did not produce appreciable differences in exposure level. These parameters associated with exposure reduction can be assessed subjectively and are thus good candidates for training on effective ventilation use during hot work in confined spaces. Ventilation used in confined space welding is often inadequate for controlling exposure to welding fume.

Characterization of Naturally Occurring Alpha-Diketone Emissions and Exposures at a Coffee Roasting Facility and Associated Retail Café.

BACKGROUND: Alpha-diketones such as diacetyl and 2,3-pentanedione have been used as artificial flavorings in a variety of industries and are produced naturally when food products such as coffee beans are roasted. Exposure to these compounds has been associated with bronchiolitis obliterans, a rare and severe respiratory disease. In the current paper, we (i) evaluate which steps in the coffee production process are associated with the highest alpha-diketone emissions at a small craft coffee roaster and associated café, (ii) determine the extent to which direct-reading measurements of CO, CO2, and total volatile organic compounds (VOCs) can serve as lower-cost surrogate indicators for diacetyl concentrations, and (iii) conduct a limited emissions study to quantify the effect that the process variable of roast type has on diacetyl emissions from grinding beans. METHODS: Exposure and area concentration data for diacetyl and 2,3-pentanedione were collected over 4 days of sampling at a single coffee roaster and associated café. Additional measurements of café patrons' exposure to diacetyl were collected in seven other craft roastery/cafes in Seattle, WA. For the emissions experiments, integrated area air samples for diacetyl were collected using sorbent tubes over 30-min intervals for each roast type with the sorbent tubes positioned next to a grinder placed in an exposure chamber. Sorbent tubes were analyzed for alpha-diketones using gas chromatography-mass spectrometry. A photoionization detector (PID) was also used to measure continuous total VOC concentrations at the coffee roastery, and during each grinding experiment. RESULTS: Diacetyl concentrations in five of the seven personal samples from the craft roastery were above the United States National Institute of Occupational Safety and Health (NIOSH) Recommended Exposure Limit (REL) of 5 ppb as an 8-h time-weighted average (TWA)-and one of the seven personal samples exceeded the NIOSH REL for 2,3-pentanedione-9.3 ppb as an 8-h TWA. Median diacetyl and 2,3-pentanedione emissions were highest at the bagging machine followed by the grinder, roaster, barista, and background areas. The arithmetic mean diacetyl concentrations from the seven personal samples collected from café patrons was 3.96 ppb, suggesting that diacetyl exposure poses a negligible health risk to café patrons. Correlations between diacetyl and total VOCs, CO, and CO2 showed that diacetyl was well correlated with total VOCs, but poorly correlated with CO and CO2. Based on our limited emissions study, French roast was associated with the highest mass emission factor of diacetyl. CONCLUSIONS: Results from the exposure assessment study indicated that coffee production workers at this facility had elevated exposures to diacetyl and 2,3-pentanedione compared to recommended guidelines, whereas baristas and café patrons received lower exposures. Area sampling showed that the areas with the highest alpha-diketone emissions were the grinder and the bagging machine, which are both areas associated with tasks involving ground roasted coffee. Future research could focus on designing and evaluating effective engineering controls, in the form of local exhaust ventilation, with the goal of reducing alpha diketone exposures, as well as conducting similar studies at other small-scale craft coffee roasters and cafés to better understand the variability in these emissions and exposures within these types of facilities.

Occupational exposure to polybrominated diphenyl ethers (PBDEs) and other flame retardant foam additives at gymnastics studios: Before, during and after the replacement of pit foam with PBDE-free foams.

Coaches spend long hours training gymnasts of all ages aided by polyurethane foam used in loose blocks, mats, and other padded equipment. Polyurethane foam can contain flame retardant additives such as polybrominated diphenyl ethers (PBDEs), to delay the spread of fires. However, flame retardants have been associated with endocrine disruption and carcinogenicity. The National Institute for Occupational Safety and Health (NIOSH) evaluated employee exposure to flame retardants in four gymnastics studios utilized by recreational and competitive gymnasts. We evaluated flame retardant exposure at the gymnastics studios before, during, and after the replacement of foam blocks used in safety pits with foam blocks certified not to contain several flame retardants, including PBDEs. We collected hand wipes on coaches to measure levels of flame retardants on skin before and after their work shift. We measured flame retardant levels in the dust on window glass in the gymnastics areas and office areas, and in the old and new foam blocks used throughout the gymnastics studios. We found statistically higher levels of 9 out of 13 flame retardants on employees' hands after work than before, and this difference was reduced after the foam replacement. Windows in the gymnastics areas had higher levels of 3 of the 13 flame retardants than windows outside the gymnastics areas, suggesting that dust and vapor containing flame retardants became airborne. Mats and other padded equipment contained levels of bromine consistent with the amount of brominated flame retardants in foam samples analyzed in the laboratory. New blocks did not contain PBDEs, but did contain the flame retardants 2-ethylhexyl 2,3,4,5-tetrabromobenzoate and 2-ethylhexyl 2,3,4,5-tetrabromophthalate. We conclude that replacing the pit foam blocks eliminated a source of PBDEs, but not 2-ethylhexyl 2,3,4,5-tetrabromobenzoate and 2-ethylhexyl 2,3,4,5-tetrabromophthalate. We recommend ways to further minimize employee exposure to flame retardants at work and acknowledge the challenges consumers have identifying chemical contents of new products.

Childhood Lead Exposure from Battery Recycling in Vietnam.

BACKGROUND: Battery recycling facilities in developing countries can cause community lead exposure. OBJECTIVE: To evaluate child lead exposure in a Vietnam battery recycling craft village after efforts to shift home-based recycling outside the village. METHODS: This cross-sectional study evaluated 109 children in Dong Mai village, using blood lead level (BLL) measurement, parent interview, and household observation. Blood samples were analyzed with a LeadCare II field instrument; highest BLLs (≥45 µg/dL) were retested by laboratory analysis. Surface and soil lead were measured at 11 households and a school with X-ray fluorescence analyzer. RESULTS: All children had high BLLs; 28% had BLL ≥45 µg/dL. Younger age, family recycling, and outside brick surfaces were associated with higher BLL. Surface and soil lead levels were high at all tested homes, even with no recycling history. Laboratory BLLs were lower than LeadCare BLLs, in 24 retested children. DISCUSSION: In spite of improvements, lead exposure was still substantial and probably associated with continued home-based recycling, legacy contamination, and workplace take-home exposure pathways. There is a need for effective strategies to manage lead exposure from battery recycling in craft villages. These reported BLL values should be interpreted cautiously, although the observed field-laboratory discordance may reflect bias in laboratory results.

The effect of local exhaust ventilation controls on dust exposures during concrete cutting and grinding activities.

This study assessed the effectiveness of commercially available local exhaust ventilation (LEV) systems for controlling respirable dust and crystalline silica exposures during concrete cutting and grinding activities. Work activities were performed by union-sponsored apprentices and included tuck-point grinding, surface grinding, paver block and brick cutting (masonry saw), and concrete block cutting (hand-held saw). In a randomized block design, implemented under controlled field conditions, three ventilation rates (0, 30, and 75 cfm) were tested for each tool. Each ventilation treatment was replicated three times in random order for a total of nine 15-min work sessions per study subject. With the exception of the hand-held saw, the use of LEV resulted in a significant (p < 0.05) reduction in respirable dust exposure. Mean exposure levels for the 75 cfm treatments were less than that of the 30 cfm treatments; however, differences between these two treatments were only significant for paver block cutting (p < 0.01). Although exposure reduction was significant (70-90% at the low ventilation rate and 80-95% reduction at the high ventilation rate), personal respirable dust [corrected] exposures remained very high: 1.4-2.8 x PEL (permissible exposure limit) at the low ventilation rate and 0.9-1.7 x PEL at the high ventilation rate. Exposure levels found under actual field conditions would likely be lower due to the intermittent nature of most job tasks. Despite incomplete control LEV has merit, as it would reduce the risk of workers developing disease, allow workers to use a lower level of respiratory protection, protect workers during short duration work episodes reduce exposure to nearby workers, and reduce clean-up associated dust exposures.

The efficacy of local exhaust ventilation for controlling dust exposures during concrete surface grinding.

This study assessed the effectiveness of a commercially available local exhaust ventilation (LEV) system for controlling respirable dust and crystalline silica exposures during concrete grinding activities. Surface grinding was conducted at six commercial building construction sites in Seattle, WA, by cement masons. Time-integrated filter samples and direct reading respirable dust concentrations were collected using a cyclone in line with a direct reading respirable dust monitor. Personal exposure levels were determined with and without LEV, one sample directly after the other. A total of 28 paired samples were collected in which three different dust collection shroud configurations were tested. Data obtained with a direct reading respirable dust monitor were adjusted to remove non-work task-associated dust exposures and was subsequently used to calculate the exposure reduction achieved. The application of LEV resulted in a reduction in the overall geometric mean respirable dust exposure from 4.5 to 0.14 mg/m(3), a mean exposure reduction of 92%. Despite the effective control of dust generated during surface grinding, 22 and 26% of the samples collected while LEV was being used were greater than the 8 h time-weighted average permissible exposure limit (Occupational Safety and Health Administration) and threshold limit value (American Congress of Governmental Industrial Hygienists) for respirable crystalline silica, respectively.

Evaluation of exposure and health care worker response to nebulized administration of tgAAVCF to patients with cystic fibrosis.

A study was conducted to assess health care worker exposure to tgAAVCF during the aerosolized administration of this experimental gene transfer agent in clinical trials for the treatment of cystic fibrosis (CF). tgAAVCF is a recombinant adeno-associated virus (AAV) genetically engineered to contain the human CF transmembrane conductance regulator cDNA. Study subjects included eight health care workers involved in the administration of tgAAVCF in a phase II study and 12 control health care workers who were involved with the treatment of CF patients, but not administration of the study drug. The exposure assessment entailed the determination of personal and area airborne tgAAVCF concentrations. In addition, serologic status of the health care workers was evaluated throughout the study for the presence of antibodies to AAV. A symptom survey was also completed by both the active and control health care workers. Air samples were analyzed by an infectivity assay (active vector) and a DNA polymerase chain reaction amplification procedure (vector DNA). Air monitoring was conducted during 13 tgAAVCF and seven placebo administrations. Active vector and vector particles were detected in four of 51 and 48 of 51 air samples collected during the administration of tgAAVCF, respectively. Based on the airborne vector particle concentration, the workers' exposure was estimated to be 0.0006% of the administered dose. At this level of exposure, the prevalence of symptoms was very low, the spectrum was similar in both study groups and did not result in any reported negative health effects.