Determinants of heat-related injuries in Australian workplaces: Perceptions of health and safety professionals.

INTRODUCTION: Hot workplace environments can lead to adverse health effects and contribute to a range of injuries. However, there is limited contextual understanding of heat-related injury occurrence. Gaining the perspectives of occupational health and safety professionals (HSPs) may elucidate the issue and inform targeted interventions. METHODS: A cross-sectional national online survey was conducted in Australia to characterise HSP perceptions of heat-related injuries; current preventive measures; training, policies and guidelines; and perspectives on barriers for prevention. Results were analysed descriptively and a log-Poisson regression model was used to identify risk factors associated with HSP reported injury occurrence, assessed through prevalence ratio (PR). RESULTS: Of the 307 HSP survey participants, 74% acknowledged the potential for increased risk of occupational injuries in hot weather. A variety of injury types and mechanisms were reported, including manual handling injuries, hand injuries, wounds or lacerations, and loss of control of power tools. Correlates of reported heat-related injuries included working in the sun without shade [PR: 1.26; 95% CI: 1.07-1.48] and too few rest breaks [PR: 1.28; 95% CI: 1.04-1.44]. Other factors of significance were inadequate hydration; issues with personal protective equipment (PPE) and poor supervision of workers. Only 42% reported that adequate heat training was available and 54% reported the provision for outdoor work to cease in extreme temperatures. It was acknowledged that the frequency of injuries could be reduced with wider adoption of self-pacing, and work/rest regimes. Perceived barriers for prevention included: lack of awareness of physical injury risks, and management concerns about productivity loss and/or deadlines. CONCLUSION: The findings indicate a range of potentially modifiable work and organisational risk factors such as more suitable PPE and better supervision. More attention to these factors, in conjunction with traditional interventions to reduce heat effects, could enhance injury prevention and labour productivity in people working in hot environments.

Using a Qualitative Phenomenological Approach to Inform the Etiology and Prevention of Occupational Heat-Related Injuries in Australia.

Epidemiological evidence has shown an association between exposure to high temperatures and occupational injuries, an issue gaining importance with environmental change. The aim of this study was to better understand contributing risk factors and preventive actions based on personal experiences. Interviews were conducted with 21 workers from five Australian states using a critical phenomenological approach to capture the lived experiences of participants, whilst exploring contextual factors that surround these experiences. Two case studies are presented: a cerebrovascular injury and injuries among seasonal horticulture workers. Other accounts of heat-related injuries and heat stress are also presented. Risk factors were classified as individual, interpersonal and organizational. In terms of prevention, participants recommended greater awareness of heat risks and peer-support for co-workers. Adding value to current evidence, we have provided new insights into the etiology of the health consequences of workplace heat exposure with workers identifying a range of influencing factors, prevention measures and adaptation strategies. Underpinning the importance of these are future climate change scenarios, suggesting that extended hot seasons will lead to increasing numbers of workers at risk of heat-stress and associated occupational injuries.

Geographical variation in risk of work-related injuries and illnesses associated with ambient temperatures: A multi-city case-crossover study in Australia, 2005-2016.

BACKGROUND: The thermal working environment can have direct and in-direct effects on health and safety. Ambient temperatures have been associated with an increased risk of occupational injuries but it is unknown how the relationship can vary by weather, location and climate. OBJECTIVES: To examine the relationship between ambient temperatures and work-related injury and illness compensation claims in three Australian cities: Melbourne and Perth (temperate climate) and Brisbane (subtropical climate) in order to determine how hot and cold weather influences the risk of occupational injury in Australia. METHODS: Workers' compensation claims from each city for the period 2005 to 2016 were merged with local daily weather data. A time-stratified case-crossover design combined with a distributed lag non-linear model was used to quantify the impacts of daily maximum temperature (Tmax) on the risk of work-related injuries and illnesses. RESULTS: Compared to the median maximum temperature (Tmax), extremely hot temperatures (99th percentile) were associated with a 14% (95%CI: 3-25%) increase in total workers' compensation claims in Melbourne, but there were no observed effects in Brisbane or Perth, with the exception of traumatic injuries that increased by 17% (95%CI: 3-35%) during extreme heat in Perth. For extremely low temperatures (1st percentile), there was a protective effect in Brisbane (RR 0.89; 95%CI: 0.81-0.98), while no effects were observed in Melbourne or Perth. CONCLUSION: The relationship between injury and ambient temperature appears to be variable depending on location and climate. In general, work-related injuries and illnesses appear to be more common at higher temperatures than lower temperatures. Adopting adaptation and prevention measures could reduce the social and economic burden of injury, and formulating effective measures for dealing with high temperatures should be prioritised given the predicted increase in the frequency and intensity of hot weather.

Characterising the impact of heatwaves on work-related injuries and illnesses in three Australian cities using a standard heatwave definition- Excess Heat Factor (EHF).

BACKGROUND AND AIMS: Heatwaves have potential health and safety implications for many workers, and heatwaves are predicted to increase in frequency and intensity with climate change. There is currently a lack of comparative evidence for the effects of heatwaves on workers' health and safety in different climates (sub-tropical and temperate). This study examined the relationship between heatwave severity (as defined by the Excess Heat Factor) and workers' compensation claims, to define impacts and identify workers at higher risk. METHODS: Workers' compensation claims data from Australian cities with temperate (Melbourne and Perth) and subtropical (Brisbane) climates for the years 2006-2016 were analysed in relation to heatwave severity categories (low and moderate/high severity) using time-stratified case-crossover models. RESULTS: Consistent impacts of heatwaves were observed in each city with either a protective or null effect during heatwaves of low-intensity while claims increased during moderate/high-severity heatwaves compared with non-heatwave days. The highest effect during moderate/high-severity heatwaves was in Brisbane (RR 1.45, 95% CI: 1.42-1.48). Vulnerable worker subgroups identified across the three cities included: males, workers aged under 34 years, apprentice/trainee workers, labour hire workers, those employed in medium and heavy strength occupations, and workers from outdoor and indoor industrial sectors. CONCLUSION: These findings show that work-related injuries and illnesses increase during moderate/high-severity heatwaves in both sub-tropical and temperate climates. Heatwave forecasts should signal the need for heightened heat awareness and preventive measures to minimise the risks to workers.

The effects of ambient temperatures on the risk of work-related injuries and illnesses: Evidence from Adelaide, Australia 2003-2013.

BACKGROUND: The thermal environment can directly affect workers' occupational health and safety, and act as a contributing factor to injury or illness. However, the literature addressing risks posed by varying temperatures on work-related injuries and illnesses is limited. OBJECTIVES: To examine the occupational injury and illness risk profiles for hot and cold conditions. METHODS: Daily numbers of workers' compensation claims in Adelaide, South Australia from 2003 to 2013 (n = 224,631) were sourced together with daily weather data. The impacts of maximum daily temperature on the risk of work-related injuries and illnesses was assessed using a time-stratified case-crossover study design combined with a distributed lag non-linear model. RESULTS: The minimum number of workers' compensation claims occurred when the maximum daily temperature was 25 °C. Compared with this optimal temperature, extremely hot temperatures (99th percentile) were associated with an increase in overall claims (RR: 1.30, 95%CI: 1.18-1.44) whereas a non-significant increase was observed with extremely cold temperatures (1st percentile, RR: 1.10 (95%CI: 0.99-1.21). Heat exposure had an acute effect on workers' injuries whereas cold conditions resulted in delayed effects. Moderate temperatures were associated with a greater injury burden than extreme temperatures. CONCLUSION: Days of very high temperatures were associated with the greatest risks of occupational injuries; whereas moderate temperatures, which occur more commonly, have the greatest burden. These findings suggest that the broader range of thermal conditions should be considered in workplace injury and illness prevention strategies.

Lung function reductions associated with motor vehicle density in chronic obstructive pulmonary disease: a cross-sectional study.

BACKGROUND: Motor vehicle-related air pollution can potentially impair lung function. The effect of pollution in people with compromised pulmonary function such as in COPD has not been previously investigated. To examine the association of lung function with motor vehicle density in people with spirometrically determined COPD in a cross-sectional study. METHODS: In 2004-06, The North West Adelaide Health Study (NWAHS), a biomedical cohort of adults assessed pre and post-bronchodilator spirometry (n = 3,103). Traffic density, obtained from the motor vehicle inventory maintained by the South Australian Environment Protection Authority, was expressed as the daily numbers of vehicles travelling within a 200 m diameter zone around participants' geocoded residences. RESULTS: In subjects with COPD (FEV1/FVC <0.7, n = 221, 7.1 %), increasing daily vehicle density was associated with statistically significant decreases in lung function parameters after adjustment for smoking and socio-economic variables. Mean (95 % CI) post-bronchodilator % predicted FEV1 was 81 % (76-87) in the low (≤7179/day) compared with 71 % (67-75) in the high (≥15,270/day) vehicle exposure group (p < 0.05). Linear regression analysis in all subjects with COPD showed significant decrements in post-bronchodilator FEV1/FVC ratio and % predicted FEV1 of 0.03 and 0.05 % respectively per daily increase in 1000 vehicles. In men with COPD (n = 150), the corresponding reductions were 0.03 and 0.06 %. Smaller, non-significant decrements were seen in females. No difference was seen in those without COPD. CONCLUSIONS: Vehicle traffic density was associated with significant reductions in lung function in people with COPD. Urban planning should consider the health impacts for those with pre-existing respiratory conditions.

The link between noise perception and quality of life in South Australia.

Environmental noise is a significant risk factor for a range of short- and long-term adverse health outcomes such as annoyance, cognitive development impairment, sleep disturbance, cardiovascular effects, and psychiatric problems. The aim of this study was to gather standardized quality of life (QOL) data hitherto rarely correlated with noise annoyance by source category. To provide an evidence-base for environmental noise policy development, a representative state-based survey was undertaken in South Australia (SA). A total of 3015 face-to-face interviews were conducted, using a questionnaire addressing noise sources, distances to busy roads and standardized measures of perceived annoyance and QOL. Population weighted descriptive survey and regression analysis. The most common sources of noise annoyances were road transport (27.7%, using a Likert scale, aggregating "little" to "extreme" annoyance), neighbors (22.0%), construction noise (10.0%), air conditioner noise (5.8%), rail transport noise (4.7%), and industry (3.9%). Using the QOL instrument, all eight health dimensions were significantly decreased for those reporting high noise annoyance ("very much" to "extreme") in relation to road transport and neighbors compared to those reporting low annoyance ("none" to "moderate") from these sources. Noise annoyance is common in the SA general population, and the evidence for a strong association with QOL reinforces the need for environmental noise management at a population basis.

Musculoskeletal pain and discomfort and associated worker and organizational factors: a cross-sectional study.

BACKGROUND: Musculoskeletal disorders are a leading cause of work-related ill health, and a major cost burden for the individual, industry and the community. Despite the broad range of risk factors that have been identified, most studies have focused only on specific occupations or categories of risk factors, meaning that there is limited understanding of the relative contributions of individual and organisational, physical and psychosocial factors. OBJECTIVE: This cross-sectional survey of workers in medium-to-large workplaces in South Australia sought to examine a broad range of factors within various workplaces and industries. PARTICIPANTS: 404 workers from 29 workgroups and 23 separate companies participated in the research. METHODS: Questionnaires were administered face-to-face, assessing demographic and job characteristics, safety climate, musculoskeletal pain and discomfort (MSPD) and job satisfaction. Potential predictors were grouped in terms of personal/job and organizational characteristics and associations with MSPD examined. RESULTS: A considerable proportion of workers (40%) had experienced MSPD in the last 7 days and 15% had experienced severe MSPD. In a multivariate model, four variables were found to be significantly associated with MSPD, namely being aged > or =40 years (adjusted odds ratio=1.73), overall job satisfaction (negatively associated) (AOR=0.37), medium (vs. large) company size (AOR=1.80) and workgroup safety climate score (negatively associated) (AOR=0.58). CONCLUSIONS: The results confirm a link between non-physical factors and work-related musculoskeletal disorders, suggesting that these factors should received increased attention as part of overall health and safety strategies. Organizations should give greater consideration to both the satisfaction of their employees and organizational factors that set the tone for safety climate.

The impact of summer temperatures and heatwaves on mortality and morbidity in Perth, Australia 1994-2008.

Climate change projections have drawn attention to the risks of extreme heat and the importance of public health interventions to minimise the impact. The city of Perth, Western Australia, frequently experiences hot summer conditions, with recent summers showing above average temperatures. Daily maximum and minimum temperatures, mortality, emergency department (ED) presentations and hospital admissions data were acquired for Perth for the period 1994 to 2008. Using an observed/expected analysis, the temperature thresholds for mortality were estimated at 34-36°C (maximum) and 20°C (minimum). Generalised estimating equations (GEEs) were used to estimate the percentage increase in mortality and morbidity outcomes with a 10°C increment in temperature, with adjustment for air pollutants. Effect estimates are reported as incidence rate ratios (IRRs). The health impact of heatwave days (three or more days of ≥35°C) was also investigated. A 9.8% increase in daily mortality (IRR 1.098; 95%CI: 1.007-1.196) was associated with a 10°C increase in maximum temperature above threshold. Total ED presentations increased by 4.4% (IRR 1.044; 95%CI: 1.033-1.054) and renal-related ED presentations by 10.2% (IRR 1.102; 95%CI: 1.071-1.135) per 10°C increase in maximum temperature. Heatwave days were associated with increases in daily mortality and ED presentations, while total hospital admissions were decreased on heatwave days. Public health interventions will be increasingly important to minimise the adverse health impacts of hot weather in Perth, particularly if the recent trend of rising average temperatures and more hot days continues as projected.

Heat and health in Adelaide, South Australia: assessment of heat thresholds and temperature relationships.

BACKGROUND: Climate change projections have highlighted the need for public health planning for extreme heat. In Adelaide, South Australia, hot weather is characteristic of summer and heatwaves can have a significant health burden. This study examines the heat thresholds and temperature relationships for mortality and morbidity outcomes in Adelaide. METHODS: Daily maximum and minimum temperatures, daily mortality, ambulance call-outs, emergency department (ED) presentations and hospital admissions were obtained for Adelaide, between 1993 and 2009. Heat thresholds for health outcomes were estimated using an observed/expected analysis. Generalized estimating equations were used to estimate the percentage increase in mortality and morbidity outcomes above the threshold temperatures, with adjustment for the effects of ozone (O(3)) and particulate matter<10 µm in mass median aerodynamic diameter (PM(10)). Effect estimates are reported as incidence rate ratios (IRRs). RESULTS: Heat-related mortality and morbidity become apparent above maximum and minimum temperature thresholds of 30 °C and 16 °C for mortality; 26 °C and 18 °C for ambulance call-outs; and 34 °C and 22 °C for heat-related ED presentations. Most health outcomes showed a positive relationship with daily temperatures over thresholds. When adjusted for air pollutants, a 10 °C increase in maximum temperature was associated with a 4.9% increase in daily ambulance call-outs (IRR 1.049; 95% CI 1.027-1.072), and a 3.4% increase in mental health related hospital admissions (IRR 1.034; 95% CI 1.009-1.059) for the all-age population. Heat-related ED presentations increased over 6-fold per 10 °C increase in maximum temperature. Daily temperatures were also associated with all-cause and mental health related ED presentations. Associations between temperature over thresholds and daily mortality and renal hospital admissions were not significant when adjusted for ozone and PM(10); however at extreme temperatures mortality increased significantly with increasing heat duration. CONCLUSIONS: Heat-attributable mortality and morbidity are associated with elevated summer temperatures in Adelaide, particularly ambulance call-outs, mental health and heat-related illness.

Worker exposure and a risk assessment of malathion and fenthion used in the control of Mediterranean fruit fly in South Australia.

In 2001, an outbreak of Mediterranean fruit fly in Adelaide was controlled by South Australian Government workers applying organophosphorus insecticides (OPs) to domestic gardens. Residents made claims of adverse effects associated with allegations that worker application practices were poor and led to contamination of homes, residents and pets. The concerns led to a Parliamentary enquiry, the suspension of OP applications for fruit fly control, and the investigation of alternative methods of combating fruit fly in metropolitan Adelaide. The extent of exposure of workers and residents was not estimated. This paper describes a simulated application of the OPs concerned (fenthion and malathion) with measurements of potential exposure through inhalation, dermal contact and deposition of pesticides on surfaces. The data were used as part of a toxicological risk assessment to determine the likely impact of the use of these insecticides. Malathion, used as a 1% suspension in a protein bait mixture, was found to have little potential for airborne exposure, although some workers were found to have up to 0.315 microg/cm(2) malathion deposited on overalls (principally on forearms) and over 500 microg deposited on liner gloves and hats, respectively. Risks to workers and residents were low, with exposures likely to be a small fraction of the acceptable daily intake. Fenthion, used as a 0.05% foliar cover spray, was found between 0.02 and 0.23 mg/m(3) in air 10 m downwind from spray activity and was unlikely to pose a significant risk to residents, since exposures were of short durations of up to 20 min. Personal air samples of spray workers averaged 0.55 mg/m(3) (Workplace Exposure Standard 0.20mg/m(3)). Since workers were usually engaged in spraying for a large proportion of the day, this demonstrates the need for respiratory protective equipment. Maximum deposition of fenthion on workers overalls ranged from 0.06 to over 0.20 microg/cm(2), although little was found on gloves and hats, suggesting workers were skilled in avoiding the plume of overspray. Dialkyl phosphates (metabolites of OP insecticides) were not detected in urine of workers, and there were no changes observed in serum cholinesterase (SChE) enzyme activities 24h following the simulation. These data suggest absorption of OP insecticides by workers was negligible. Deposition on surfaces 5 and 10 m downwind ranged from none detected to 145 microg/cm(2), suggesting that exposure of residents and children in contact with contaminated surfaces (such as garden furniture or play equipment) is possible. Estimates of the potential dermal intake of fenthion by children from contaminated surfaces suggested that risks of acute and chronic effects are slight, since exposures may occur for short periods at intervals of approximately 10 days during fruit fly outbreaks.