Occupational safety and health, green chemistry, and sustainability: a review of areas of convergence.

With increasing numbers and quantities of chemicals in commerce and use, scientific attention continues to focus on the environmental and public health consequences of chemical production processes and exposures. Concerns about environmental stewardship have been gaining broader traction through emphases on sustainability and "green chemistry" principles. Occupational safety and health has not been fully promoted as a component of environmental sustainability. However, there is a natural convergence of green chemistry/sustainability and occupational safety and health efforts. Addressing both together can have a synergistic effect. Failure to promote this convergence could lead to increasing worker hazards and lack of support for sustainability efforts. The National Institute for Occupational Safety and Health has made a concerted effort involving multiple stakeholders to anticipate and identify potential hazards associated with sustainable practices and green jobs for workers. Examples of potential hazards are presented in case studies with suggested solutions such as implementing the hierarchy of controls and prevention through design principles in green chemistry and green building practices. Practical considerations and strategies for green chemistry, and environmental stewardship could benefit from the incorporation of occupational safety and health concepts which in turn protect affected workers.

NIOSH safe handling of hazardous drugs guidelines becomes state law.

Although guidelines for protecting health care workers from the dangers of hazardous drugs have been in existence for more than 25 years, there is tremendous inconsistency in compliance by oncology professionals. One reason for the discrepancy is the voluntary, nonpunitive nature of these guidelines. In 2012, Washington State became the first in the United States to mandate and enforce the National Institute for Occupational Safety and Health guidelines.

Historical background of the child labor regulations: strengths and limitations of the agricultural hazardous occupations orders.

The purpose of this paper is to review the background of key legislative and regulatory milestones of the initial laws and federal child labor provisions limiting hazardous work by children in agriculture up to the more recent developments contributing to the proposed updates to the agricultural hazardous occupations orders. A summary of the key changes are described and the significant differences between agricultural and nonagricultural regulations are highlighted. Recommendations for future policy are provided.

Guidelines for determining probability of causation under the Energy Employees Occupational Illness Compensation Program Act of 2000; revision of guidelines on non-radiogenic cancers. Final rule.

In a notice of proposed rulemaking published in the Federal Register on March 21, 2011, the Department of Health and Human Services (HHS) proposed to treat chronic lymphocytic leukemia (CLL) as a radiogenic cancer under the Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA) (76 FR 15268). Under this final rule, CLL will be treated as being potentially caused by radiation and hence as potentially compensable under EEOICPA. HHS reverses its decision to exclude CLL from such treatment.

Internal dose reconstruction under Part B of the energy employees compensation act.

The reconstruction of internal doses under Part B of the Energy Employees Occupational Illness Compensation Program Act differs in multiple ways from that used in a typical operational setting. There are, for example, no limits at or above which doses must be assessed; all doses, including unmonitored or potentially undetected doses, must be reconstructed. In addition, the primary dose of concern is that delivered to the organ in which the cancer originated, and only the dose delivered to that organ prior to the time the cancer was diagnosed is relevant. Additional challenges are presented in the requirement to partition dose by radiation type and energy rather than by radionuclide, the need to include any potential dose that could have been received but was unmonitored or undetected, the inability to collect follow-up samples, and, in many cases, a general lack of information regarding the employee's work history, such as specific duties or location within a site. To overcome these challenges, the NIOSH dose reconstruction program has adopted a set of default values that include assumptions that are favorable to the claimant when there is more than one plausible choice. Due to the large number of claims that must be reconstructed, efforts are continuously underway to expedite the rate at which they can be processed. This is being achieved by taking advantage of situations in which it can be documented that more detailed evaluations would not change the outcome of the adjudication of the claim.

Carpal tunnel syndrome as an occupational disease.

BACKGROUND: Symptoms related to carpal tunnel syndrome (CTS) represent common patient complaints for many primary care physicians. However, there is a surprising lack of guidelines on diagnosing occupational CTS readily accessible to primary care physicians. This article aims to fill part of that void by reviewing historical aspects of occupational CTS, leading up to more current epidemiologic studies of the association of CTS with occupational ergonomic risk factors. METHODS: The English medical literature was reviewed on the relationship between CTS and occupational ergonomic risk factors. Recent legislative initiatives are discussed. Guidelines of diagnosing and managing occupational CTS are outlined. RESULTS: Many studies are divided regarding whether CTS is associated with highly repetitive/forceful/vibration work. However, a subset of patients presenting with symptoms related to CTS probably has occupational CTS. These patients can be objectively diagnosed and successfully treated and are able to return to work. CONCLUSIONS: By being armed with knowledge regarding the background of CTS and by following simple diagnosis and treatment guidelines, the family practitioner should be able to manage many patients presenting with work-related CTS.

Evaluation of the NIOSH draft method 5525 for determination of the total reactive isocyanate group (TRIG) for aliphatic isocyanates in autobody repair shops. National Institute for Occupational Safety and Health.

This paper evaluates the performance of the NIOSH draft method 5525 for analysis of monomeric and TRIG aliphatic isocyanates in autobody repair shops. It was found that an optimized pH gradient enhanced noticeably the resolution and, therefore, identification of aliphatic isocyanates. Samples proved to be very stable for at least a year when stored at -13 degrees C in the freezer, and no major stability problems were found for the MAP reagent. The detector response factor RSD for selected MAP ureas was 40% in the fluorescence (FLD), 3% in the UV at 254 nm (UV254), and 1% in the UV at 370 nm (UV370). The mean FLD/UV254 and UV254/UV370 detector response ratios of standards were 31.7 (RSD = 37.8) and 17.1 (RSD = 5.4), respectively. The FLD/UV254 ratio in bulks varied from 0.41 to 1.97 times the HDI monomer ratio. The mean UV254/UV370 ratio in bulks was 16.1 (range 14.1 to 19.2, N = 38). Mean (range) recovery of 92 (91.2-93.2)% was found for the N3300 (isocyanurate) spiked on 25 mm quartz fiber filters in the range 0.07 to 2.2 microg NCO ml(-1). Mean (range) recovery for impingers was 100.7 (91.7-106.0)% for N3300 in the concentration range of 0.018 to 2.5 microg NCO ml(-1) and 81.0 (76.1-89.1)% for IPDI in the concentration range of 0.016 to 1.87 microg NCO ml(-1). Analytical method precision was 3.4% and mean bias 7.4% (range = 0-25%). The NIOSH draft method 5525 provides flexibility, enhanced sensitivity and specificity, powerful resolution, and very small compound-to-compound variability in the UV254, resulting in a more reliable identification and quantification of aliphatic isocyanates.

The rise and fall of occupational medicine in the United States.

Thirty years ago, occupational medicine was one of the smallest of all the medical specialties, ignored by most physicians and medical schools. Occupational physicians were more likely to have entered the field through career transition than by residency training. In 1970, governmental agencies sought to transform occupational medicine into a major clinical specialty. Influential groups projected a need for large numbers of physicians in the field. Residency training was expanded, as were other teaching programs. However, industry and its workers' compensation insurance partners were not widely included in these plans. For that reason, among others, many physicians entering the field met with disappointment. About half the corporate positions for occupational physicians have disappeared in the last decade. Private practice opportunities turned out to be much more limited than planners had anticipated. Attempts to bring occupational medicine into the curriculum of the medical schools failed. Many of the residency programs that had been created are now closing. The proposal that occupational medicine create a joint specialty with environmental medicine is not widely accepted by the rest of medicine. Because so few physicians obtain board certification, it appears that the specialty of occupational medicine is returning to its former obscurity.

Workers' response to risk notification.

Since 1988, the National Institute for Occupational Safety and Health (NIOSH) has notified workers who were subjects in occupational epidemiology studies of the study findings ("worker notification"). This paper describes seven notifications and the worker's reactions to them. The chemicals of interest in the studies were: carbon monoxide, o-toluidine, bis-chloromethyl ether, polychlorinated biphenyls, cadmium, acid mist, and dioxin. Materials describing the study results were sent to 15,958 subjects who were notified of their increased risk of arteriosclerotic heart disease, bladder cancer, lung cancer, melanoma, kidney dysfunction, laryngeal cancer, all cancers combined, or soft tissue sarcoma. Workers provided feedback via telephone calls, and for three notifications, by postcards containing workers' comments and ratings of the notification materials. The percentage of telephone calls received from notified workers ranged from 0.3% to 3.8%, and the percentage returning postcards ranged from 8.8% to 17.6%. The two largest categories of callers were those with questions about their disease risk (30%) or who reported on their health status (25%). Most of the comments on postcards (26%) were complimentary or expressed appreciation for receiving the letters; reports of ill health were second (20%). A majority (66%) rated the notification materials well done. Few of the callers (5%) requested information on legal issues. Most (85%) did not find the materials, which ranged in reading level from sixth to ninth grade, too hard to read, although 15% reported difficulty reading them. Although this response system was effective in producing some input from workers, its limitation is that respondents may not be representative of all notified workers. However, such information is useful because there are few data on the effects of notifications on workers.

Tuberculosis in the workplace: a labor perspective.

It was not until several health care unions petitioned OSHA for a bloodborne pathogen standard in 1986 that OSHA began to play a major role in regulating the health care industry. The authors examine the Service Employees International Union's current effort to urge OSHA to develop a standard to protect workers from occupational exposure to TB. They also cover ramifications of the CDC's revised guidelines for preventing the transmission of TB in health care settings.

Worker notification: lessons from the past.

The methodological choices being made in current worker notification programs are influenced in both obvious and subtle ways by certain ground-breaking notifications carried out during the 1970s and 1980s. A lore has built up concerning these cases. Their names are heavy with implied meaning. As worker notification gains in acceptance and frequency, some of those newly interested in the area will be unfamiliar with these early cases, their significance, and their lessons. To help provide a context for these proceedings, six landmark worker notifications are briefly described here. Different cases might have been chosen; more cases might have been added. However, these six give a flavor of the struggles, trials, triumphs, and insights that have marked worker notification's passage through recent history.