Potential risk factors associated with COVID-19 in health care workers.

BACKGROUND: Health care workers (HCWs) have been recognized as being at higher risk for coronavirus disease 2019 (COVID-19) infection; however, relevant factors and magnitude have not been clearly elucidated. AIM: This study was aimed to describe COVID-19 infections among hospital employees at a large tertiary care hospital located in Ontario, Canada from March to July 2020, towards better understanding potential risk factors. METHODS: Data on all HCWs with either a positive COVID test or a high-risk exposure from March to July 2020 were analyzed. HCWs with positive COVID test results and high-risk exposures were described. Those who developed COVID-19 following high-risk exposure were compared to those who did not. Data were also analyzed to determine trends over time. RESULTS: Over the period of observation, 193 staff (2% of total working staff) had a positive COVID-19 test. Incidence of HCW infections closely followed community incidence. Overall, 31% of COVID-19 cases were deemed occupationally acquired. Of these, 41% were acquired from a patient, with the remainder (59%) from fellow staff. Over the same period, 204 staff were identified as having a high-risk exposure. The majority of exposures (55%) were patient-associated, with the remaining (45%) resulting from staff-to-staff contact. Overall, 13% went on to develop COVID-19. Of these cases, 58% were patient-associated and 42% were a result of staff-to-staff transmission. CONCLUSIONS: HCWs are at risk for work-related COVID-19. Given the number of infections attributed to staff-staff transmission, greater attention could be paid to implementing prevention measures in non-clinical areas.

Estimating the burden of lung cancer in Canada attributed to occupational radon exposure using a novel exposure assessment method.

OBJECTIVE: Exposure to radon causes lung cancer. The scope and impact of exposure among Canadian workers have not been assessed. Our study estimated occupational radon exposure in Canada and its associated lung cancer burden. METHODS: Exposed workers were identified among the working population during the risk exposure period (1961-2001) using data from the Canadian Census and Labour Force Survey. Exposure levels were assigned based on 12,865 workplace radon measurements for indoor workers and assumed to be 1800 mg/m3 for underground workers. Lung cancer risks were calculated using the Biological Effects of Ionizing Radiation (BEIR) VI exposure-age-concentration model. Population attributable fractions were calculated with Levin's equation and applied to 2011 Canadian lung cancer statistics. RESULTS: Approximately 15.5 million Canadian workers were exposed to radon during the risk exposure period. 79% of exposed workers were exposed to radon levels < 50 Bq/m3 and 4.8% were exposed to levels > 150 Bq/m3. We estimated that 0.8% of lung cancers in Canada were attributable to occupational radon exposure, corresponding to approximately 188 incident lung cancers in 2011. CONCLUSIONS: The lung cancer burden associated with occupational radon exposure in Canada is small, with the greatest burden occurring among those exposed to low levels of radon.

Electronic Waste Recycling: Occupational Exposures and Work-Related Health Effects.

PURPOSE OF REVIEW: Electronic waste (e-waste) is a global public health challenge. E-waste recycling workers may be exposed to chemical, physical, ergonomic, and psychosocial hazards. This review provides an overview of recent research on occupational exposures in e-waste recycling and work-related health effects that can impact e-waste workers. RECENT FINDINGS: E-waste workers are exposed to a variety of chemicals including metals, particulates, persistent organic compounds, and flame retardants. Exposure varies according to job task with higher exposures observed for dismantling and burning e-waste. Exposure to job stress and physical hazards (e.g., noise) also occurs. Many studies have measured workers' exposure in the e-waste recycling industry; fewer have investigated health effects. Biological measures were reported more often than external exposure measures. In order to protect workers, efforts are required to better understand exposures and their health effects. Removing hazardous materials from electronic equipment and reducing e-waste production would benefit workers, communities, and the environment.

Burden of non-melanoma skin cancer attributable to occupational sun exposure in Canada.

PURPOSE: Outdoor workers are exposed daily to solar ultraviolet radiation, an important contributor in the development of non-melanoma skin cancer. This study aimed to quantify the health burden of non-melanoma skin cancers among outdoor workers in Canada. METHODS: Solar ultraviolet radiation exposure and estimates of exposure levels were applied to employment information from Canada census data to determine the exposed population in the risk exposure period (1961-2001). Risk estimates were drawn from meta-analyses selected based on quality and relevance to the current study. Population-attributable fractions were calculated using Levin's equation and attributable cases were estimated based on incidence data reported by the Canadian Cancer Society. RESULTS: In 2011, 6.31% (4556 cases) of non-melanoma skin cancer cases were estimated to be attributable to occupational exposure to solar ultraviolet radiation. The majority of these cases occurred in men in the agriculture or construction industries. CONCLUSIONS: These estimates of the burden of non-melanoma skin cancer in Canada identify the need for further prevention efforts, particularly in agriculture and construction. Introducing workplace sun safety measures could be an important area for policy development.

Silica exposure in a mining exploration operation.

BACKGROUND: Though there is extensive research on occupational exposure in production mines, there is limited information on exposure during the exploration phase of mining. METHODS: Air samples were collected in a core processing facility in Northern Ontario, Canada. All samples were analyzed for respirable dust (NIOSH 0600) and respirable crystalline silica (NIOSH 7602). Mean exposure levels were estimated and differences in exposure between work areas were investigated. RESULTS: Sixteen personal and nine area air samples were collected. Respirable dust exposure ranged from < LOD to 2.24mg-m-3; respirable silica exposure ranged from < LOD to 0.055mg-m-3. Silica concentrations were higher among workers in the core cutting and core sorting (pulp and reject) areas, as compared to those in the core logging area. CONCLUSIONS: Workers employed in core processing facilities as part of mining exploration activities are exposed to respirable silica; exposure controls may be needed.

Skin and respiratory symptoms among workers with suspected work-related disease.

BACKGROUND: Many workers are exposed to chemicals that can cause both respiratory and skin responses. Although there has been much work on respiratory and skin outcomes individually, there are few published studies examining lung and skin outcomes together. AIMS: To identify predictors of reporting concurrent skin and respiratory symptoms in a clinical population. METHODS: Patients with possible work-related skin or respiratory disease were recruited. An interviewer- administered questionnaire collected data on skin and respiratory symptoms, health history, smoking habits, workplace characteristics and occupational exposures. Predictors of concurrent skin and respiratory symptoms were identified using multiple logistic regression models adjusted for age, sex and atopy. RESULTS: In total, 204 subjects participated; 46% of the subjects were female and the mean age was 45.4 years (SD = 10.5). Most subjects (n = 167, 82%) had possible work-related skin disease, compared with 37 (18%) subjects with possible work-related respiratory disease. Subjects with a history of eczema (OR 3.68, 95% CI 1.7-7.8), those from larger workplaces (OR 2.82, 95% CI 1.8-7.4) and those reporting respirator use at work (OR 2.44, 95% CI 1.2-4.8) had significantly greater odds of reporting both work-related skin and respiratory symptoms. Current smoking was also associated with reporting concurrent skin and respiratory symptoms (OR 2.57, 95% CI 1.2-5.8). CONCLUSIONS: Workers reported symptoms in both systems, and this may be under-recognised both in the workplace and the clinic. The association between history of eczema and concurrent skin and respiratory symptoms suggests a role for impaired barrier function but needs further investigation.

Educational intervention among farmers in a community health care setting.

BACKGROUND: Farmers are at increased risk of developing work-related respiratory diseases including asthma, but little is known about their occupational health and safety (OHS) knowledge and exposure prevention practices. Educational interventions may improve knowledge and practice related to prevention. AIMS: To determine the feasibility of an educational intervention for farmers in a community health centre setting. METHODS: This was a pilot study. Farmers were recruited by the community health centre and completed a questionnaire on symptoms, OHS knowledge and exposure prevention practices. The intervention group received education on work-related asthma and exposure control strategies, and was offered spirometry and respirator fit testing. All subjects were asked to repeat the questionnaire 6 months later. RESULTS: There were 68 study participants of whom 38 formed the intervention group. At baseline, almost 60% of farmers reported having received OHS training and were familiar with material safety data sheets (MSDSs); fewer (approximately 40%) reported knowledge of OHS legislation and availability of MSDSs. Approximately, two-thirds of subjects reported using respiratory protection. The response rate for repeating the questionnaire was 76% in the intervention group and 77% in the controls. Among the intervention subjects, statistically significant increases were observed in reported safety training, familiarity and availability of MSDSs and knowledge of OHS legislation. CONCLUSIONS: Gaps in OHS knowledge were observed. The educational intervention on OHS knowledge and exposure prevention practices in the community health centre setting was feasible. Larger, more-controlled studies should be undertaken as this study suggests a positive effect on OHS knowledge and prevention practices.

Occupational contact allergens: are they also associated with occupational asthma?

BACKGROUND: Workplace exposures that can potentially cause both allergic occupational contact dermatitis (AOCD) and occupational asthma (OA) are not clearly identified. METHODS: Occupational contact allergens (OCAs) were identified using North American Contact Dermatitis Group (NACDG) data. Reference documents and systematic reviews were used to determine whether each OCA had been reported to potentially cause OA. The presence or absence of a sensitizer notation in occupational hygiene reference documents was also examined. RESULTS: The 10 most common OCAs were: epoxy resin*, thiuram, carba mix, nickel sulfate*, cobalt chloride*, potassium dichromate*, glyceryl thioglycolate, p-phenylenediamine*, formaldehyde* and glutaraldehyde*. Seven (indicated by *) were determined to be possible causes of OA. Information on sensitizing potential from OH reference materials contained conflicting information. CONCLUSIONS: Several common OCAs can also potentially cause OA. Inhalation and dermal exposures to these agents should be controlled and both OA and AOCD should be considered as possible health outcomes. Increased consistency in sensitizer notations is needed.