Protecting workers in the temporary staffing industry.

BACKGROUND: Workers hired through temporary staffing companies have a high rate of severe and fatal injuries despite the legally mandated, shared responsibility of the temporary staffing company and the host company to assure safe work. AIMS: The aim of this study was to elucidate the perspective of temporary staffing personnel on approaches to mitigating injury risk among the workers they hire. METHODS: Based on a conceptual model representing the interplay between work and health, we conducted a 'brainstorm' of temporary staffing personnel regarding perceived barriers to protecting temporary workers. A content/context analysis used standard qualitative methods, and the findings were triangulated with notes taken during the discussion. RESULTS: Temporary staffing employers describe loss of control of the working conditions once workers are placed at host/client companies. Further, they describe a contentious relationship between temporary staffing and host companies, where it is difficult to hold host companies to account. Other barriers to providing temporary workers with a safe work environment include the temp companies' lack of knowledge of site-specific hazards, the poor quality of onsite Occupational Safety and Health training, and ignoring Occupational Safety and Health Administration (OSHA) requirements. CONCLUSIONS: The perspective of temporary staffing companies should be considered to address the lack of cooperation and shifted responsibility described in this study. Policy and practice changes could include requiring contract language, implementing communication about safety, either sharing workers' compensation purchase or removing exclusive remedy protections from hosts, and prescribing safety training, such as an OSHA 10-h programme. Suggested interventions need further study.

Farm injuries in Ohio, 2003-2006: a report from the emergency medical services prehospital database.

Agriculture has among the highest numbers and rates of fatal and nonfatal traumatic injuries in the U.S. Surveillance is an integral part of injury prevention. However, traditional sources of surveillance data are incomplete and inaccurate in describing agricultural injuries. The goals of this research are to describe acute, traumatic farm injuries in Ohio utilizing the Ohio EMS prehospital (ambulance run) database, and to explore the database's utility in agricultural injury surveillance. Ohio mandates reporting of responses to every call for emergency medical services (EMS) in the state. A dataset containing every transported injury case from 2003-2006 was obtained A descriptive analysis of farm injuries was conducted and compared to existing surveillance sources. Of the total transported injuries, 15% (1714 injured individuals) came from farms. "Falls" were the most common cause of injury in all age groups except ages 15-24, in which "off-road vehicles" were most common. Other leading causes include "ridden animal", "machinery", and "caused by animal". These results are similar to other data sources. Strengths of EMS databases include mandatory reporting, low expense, and lack of need for employer or worker reporting. They may be used to look at injury severity, quality of acute care, resource allocation, and to assess the need for specialized training of EMS personnel. Limitations are lack of specificity for work-related agricultural injuries and variation in definitions of data elements. EMS prehospital databases are an important source of data for agricultural injury surveillance.

Eye injury in migrant farm workers and suggested hazard controls.

The eyes are a common site of injury in agricultural operations. Identification of the cause of injury is important to inform preventive interventions. The objective of this study was to describe the hazards and mechanisms of acute traumatic injury to the eyes of agricultural workers who are hired in farming operations on a seasonal basis. A review of the literature was performed to summarize the mechanisms of eye injuries in agriculture. Field observations and informal interviews were performed to verify the literature and to determine whether there are eye hazards for farm workers that have not been reported in the literature. Additional mechanisms of injury were elicited, and suggested methods of injury prevention are presented here.

Fatal falls in the US construction industry, 1990 to 1999.

The Occupational Safety and Health Administration's (OSHA's) Integrated Management Information System (IMIS) database allows for the detailed analysis of risk factors surrounding fatal occupational events. This study used IMIS data to (1) perform a risk factor analysis of fatal construction falls, and (2) assess the impact of the February 1995 29 CFR Part 1926 Subpart M OSHA fall protection regulations for construction by calculating trends in fatal fall rates. In addition, IMIS data on fatal construction falls were compared with data from other occupational fatality surveillance systems. For falls in construction, the study identified several demographic factors that may indicate increased risk. A statistically significant downward trend in fatal falls was evident in all construction and within several construction categories during the decade. Although the study failed to show a statistically significant intervention effect from the new OSHA regulations, it may have lacked the power to do so.

Health hazards of photography.

Photographers are exposed to chemical, physical, and psychological hazards during the course of their work. Photojournalists are at physical risk from motor vehicle crashes and work in war zones. Ergonomic risk comes from handling heavy equipment as well as work in awkward postures in dangerous positions. Darkroom exposure to chemical agents may lead to respiratory, allergic, and nervous system disease. Psychological problems come from chaotic work organization. Digital photography may reduce the prevalence of chemical exposure, although it may increase the risk of musculoskeletal illness. Simple hygiene measures may prevent illness in photographers. An increasing number of printed resources is available to professional and amateur photographers; this information may help them protect their health while they enjoy their art.

The occupational hazards of emergency physicians.

Emergency physicians are exposed to a variety of occupational hazards. Among these are infectious diseases, such the human immunodeficiency virus, hepatitis B and C viruses, and tuberculosis. Hepatitis G virus is transmissible but may not be a cause of illness. The likelihood of being exposed to these agents appears to be higher in the ED than other medical settings but estimates of the prevalence of these diseases in the ED vary, depending on the patient population served. Estimates of risk for contracting these infections are reviewed. Measures to prevent these exposures can reduce risk, but compliance is low, particularly for those involving changes in the behavior of emergency physicians (such as not recapping needles). Latex allergy is a hazard of health care workers. Its prevalence is reported to be quite high, but these findings are difficult to interpret in the absence of a universally accepted definition of the condition. Its prevalence in emergency physicians is not known. Other noninfectious hazards include workplace violence and exposure to nitrous oxide. The health effects of rotating shift work may put emergency physicians at increased risk of coronary artery disease and impaired reproductive health. Emotional stress is another hazard of emergency physicians, and may lead to burnout.

A state trauma registry as a tool for occupational injury surveillance.

The goal of occupational surveillance is to identify and determine the magnitude of work-related disease and injury and workplace hazards for the purposes of focusing prevention programs and tracking their effectiveness. There are a number of databases that collect information on pieces of the puzzle of workplace exposure and adverse health outcomes. Other than that for the fatalities, none of these datasets specifically describes the most severe occupational injuries or their attendant disability. The goal of this study was to evaluate the usefulness of the Illinois Trauma Registry (ITR) in the surveillance of occupational injuries. The entire dataset of the ITR was obtained from the Illinois Department of Public Health for the years 1993 and 1994. The occupational injuries were extracted and frequency distributions were determined for all demographic and health variables. Background population, employment, and death-rate data were obtained for the purpose of rate calculation and for comparison of raw data. Mean costs for acute occupational injuries were calculated. There were 5844 occupational cases, comprising 6.7% of the total group. The majority of injuries had occurred in males (86%), in urban settings (81%), and were of the "blunt" injury type. External cause (coded according to the International Classification of Diseases, 9th Revision, External Injury) categories for work-related injuries were "Cut/Struck," 39%; "Falls," 36%; "Transportation," 12%; "Environmental," 6%; "Violence," 3%; and the remainder, 5%. By definition, all cases were admitted to the hospital, with 62% classified as "minor," 28% "moderate," and the remaining 11% "severe" to "life threatening." Surgery was performed in 54%, and admission to a monitored bed or the intensive care unit occurred in 15%. Although 93% were discharged home, only 54% ambulated independently. Seven percent were not independent with regard to self-feeding status. The mean hospital charge was $10,802 (standard deviation, $31,438). A pyramidal model of the place of ITR cases in the universe of occupational injuries is presented. The ITR contains a unique set of variables that broaden our understanding of serious work-related injuries. It is recommended that these variables--"occupation," "type of industry," and "nature of injury"--be added to the ITR so that it may be linked with other databases to check its validity and completeness and to enhance its value in occupational surveillance.

Prevalence of work related musculoskeletal disorders in active union carpenters.

OBJECTIVES: To determine the prevalence and risk factors for work related musculoskeletal disorders among union carpenters. METHODS: A detailed questionnaire on musculoskeletal symptoms and work history was administered to 522 carpenters. The symptom questions assessed if carpenters experienced pain, numbness, or tingling in a particular body region. A subset of this group then received a physical examination of the upper extremities and knees. RESULTS: The study group was primarily white (94.9%) and male (97.8%) with a mean age of 42.3 years. The highest prevalence of work related musculoskeletal disorders cases by carpentry specialty ranged from 20%-24% for those doing drywall or ceiling, finishing or framing, and the building of concrete forms. Generally, as duration of employment increased, the prevalence of symptoms increased. An adjusted logistic regression analysis showed that the group with the longest (> or = 20 years) duration of employment in carpentry was significantly associated with work related musculoskeletal disorders of the shoulders (odds ratio (OR) 3.2, 95% confidence interval (95% CI) 1.1 to 8.9), hands or wrists (OR 3.1, 95% CI 1.1 to 8.4), and knees (OR 3.5, 95% CI 1.3 to 9.2). Also, analyses showed that carpenters who reported that they had little or no influence over their work schedule had significant increases of work related musculoskeletal disorders of the shoulders, hips, and knees with ORs of 1.9 (95% CI 1.1 to 3.2), 2.9 (95% CI 1.1 to 7.2), and 2.3 (95% CI 1.2 to 4.1), respectively. Feeling exhausted at the end of day was also a significant risk factor for work related musculoskeletal disorders of the knee (OR 1.8, 95% CI 1.1 to 3.1). Upper extremity disorders were the most prevalent work related musculoskeletal disorders reported among all carpenters. Drywall or ceiling activities involve a considerable amount of repetitive motion and awkward postures often with arms raised holding heavy dry walls in place, whereas form work is notable for extensive lumbar flexion and had the two highest rates of work related musculoskeletal disorders. The psychosocial element of job control was associated with both upper and lower extremity disorders. These union carpenters, who were relatively young, already were experiencing considerable work related physical problems. CONCLUSION: This study supports the need for vigilant ergonomic intervention at job sites and early ergonomic education as an integral part of apprenticeship school training to ensure that carpenters remain fit and healthy throughout their working lifetime.

Lead exposure in ironworkers.

In adults, lead toxicity is most commonly caused by occupation in a lead industry. Whereas lead toxicity has been described in workers who are involved in bridge rehabilitation, as of this date there has been no systematic evaluation published regarding the conditions responsible for lead toxicity in ironworkers. This is a report of a study designed to identify risk factors for elevated blood-lead levels in ironworkers. One hundred fifty members of a 2,400-member local ironworkers union volunteered to have their blood drawn for lead and zinc protoporphyrin analysis and to complete a questionnaire regarding demographics, health, and occupation. The relationships between these variables and blood-lead level were analyzed using student's t-test, chi-square, and logistic regression. Current work on a lead job, rivet busting as the predominant job task, and cigarette smoking were all found to be significantly associated with elevated blood-lead level. Whereas cigarette smoking and current work with lead have been previously identified as risk factors for toxicity, interventions to prevent lead toxicity in ironworkers should also focus on work practices during rivet busting.

Occupational lead exposure and hearing loss.

Studies of adults, children, and laboratory animals suggest an association between lead exposure and hearing loss. A causal relationship might direct mandated medical surveillance of lead-exposed workers to include audiometric testing. A cross-sectional, computerized dataset was obtained from a private occupational health screening company to examine the relationship between blood lead level and hearing loss. Audiometry and blood lead results were available for 183 workers. A statistically significant correlation was found between blood lead level and an elevated hearing threshold at 400 Hz (P = 0.03); no other frequencies showed such a correlation. This finding suggests either an interaction between nose exposure and lead, interaction of other exposure factors (such as cigarette smoking), or that factors other than biomechanical ones render the organ of Corti more susceptible at 4000 Hz. Further evaluation of these questions should be undertaken. Computerized databases created for worker surveillance may be a source for data useful for examining other causal connections in occupational settings.

HIV prophylaxis for health care workers.

The US Public Health Service (PHS) published new recommendations for preventing HIV seroconversion in health care workers suffering needle-stick injuries. In response, health care institutions across the United States are updating their internal protocols to meet the currently accepted standard of care in this area. We found the new guidelines lacking in critical definitions necessary to clarify practical applications in specific cases. We also found the recommendations of when to use one, two, or three drugs for post-exposure prophylaxis confusing. We report our university hospital's experience with needle-stick injuries over the past year. We propose modified guidelines that more finely stratify risk categories, define clinical variables which occur in practice, and simplify the algorithm for case management. The cost of managing our cases according to the modified guidelines are compared with management costs using the PHS guidelines. Potential costs of applying the PHS guidelines in our institution ranged from $68,994-$260,544; according to our modified guidelines, costs would range from $19,199-$54,749. We also present an analysis of the number of injured health care workers who need to be treated to prevent one case of seroconversion in the various risk stratifications.

Lead, chromium, and cadmium exposure during abrasive blasting.

An evaluation of lead, cadmium, and chromium exposure was conducted during abrasive blasting of a steel bridge to remove paint in preparation for repainting. Airborne lead concentrations were measured at several locations inside the containment structure, as well as near the workers' breathing zones. Airborne cadmium and chromium were also measured in the containment area. Blood lead levels were monitored in each worker. Airborne lead and cadmium levels in containment exceeded the Occupational Safety and Health Administration's permissible exposure limits by factors of 219 and 3.1, respectively. The use of supplied air-blasting helmets will not effectively reduce workers' lead exposure to the permissible exposure limits when airborne levels are as high as were measured in this study. Studies are needed to evaluate additional engineering controls and alternative paint removal methods. Evaluation of workers' exposure to lead and other hazardous metals is needed for projects involving abrasive blasting. Medical surveillance for cadmium and lead may be necessary for similar projects.

Occupational perilymph fistula.

A case of occupational perilymph fistula in an ironworker is described. The patient was lifting and lowering 200 pounds of steel when he developed sudden onset of vertigo. Surgical exploration of the middle ear demonstrated leakage of perilymph fluid from the round window. Grafting of the window led to improvement of symptoms, but the patient was unable to continue work as an ironworker due to difficulty with balance.

Echocardiography of the inferior vena cava in healthy subjects and in patients with cardiac disease.

Echocardiograms were recorded from the inferior vena cava (IVC) in 45 subjects: 10 normal subjects, 8 patients with cardiac volume overload due to anemia, 4 with severe right heart failure, 6 with significant tricuspid incompetence (TI), 7 with pericardial effusion (PE) and 10 with left-sided cardiac disease. The IVC was readily identified on the echo recordings made 1 to 2 cm below the junction of the hepatic veins. In normal subjects a double wave form was present on the IVC echogram for each beat: the waves corresponded to the "a' and "v' waves of the IVC pressure pulse tracing. The IVC diameter decreased on inspiration (P less than 0.01), particularly of the "x' descent (P less than 0.001). In patients with severe right heart dysfuction, the IVC was dilated (TI: P less than 0.02; PE: P less thaN 0.003; CMO: P less than 0.001), having lost its waveform and with diminished respiratory variation. There was, however, considerable overlap between the normal subjects and the different patient groups. In two of the patients with tamponade, the IVC did not empty upon inspiration, and pericardiocentesis was followed by a return of the waveform and normal respiratory changes. IVC dimensions were normal in patients with anemia and in those with left heart disease. The results of the study showed that the echogram may provide simple and useful measurements of IVC size and function.