Glutaraldehyde exposures among workers making bioprosthetic heart valves.

Exposure to glutaraldehyde is a recognized cause of work-related asthma. An investigation was undertaken to describe exposure to glutaraldehyde among workers making bioprosthetic heart valves and to make recommendations for prevention. At the two largest heart valve manufacturing facilities in California, the work process was observed; employer representatives and glutaraldehyde-exposed workers were interviewed; and employer written records, including company-generated industrial hygiene data, were analyzed. Approximately 600 female workers had continuous airborne exposure to glutaraldehyde over the course of every work shift and the routine potential for skin and eye contact with glutaraldehyde while making heart valves. Employee short-term (15-min) glutaraldehyde exposures were all well below the current regulatory ceiling level (0.20 ppm). Overall, approximately 40% of the glutaraldehyde-related job tasks involved exposures above the American Conference of Industrial Hygienists threshold limit value ceiling of 0.05 ppm; the majority (71.4% and 83.3%, depending on the company) involved exposures greater than 0.015 ppm. At one company, two cases of physician-diagnosed asthma were recorded by the employer in the previous 5-year period; these reports met the surveillance case definition for new-onset, work-related asthma associated with a known asthma inducer. Factors that contributed to worker exposure included large exposed surface areas of glutaraldehyde under agitation; working with glutaraldehyde-treated tissue in proximity to workers' breathing zones; manual pouring and disposal of glutaraldehyde solutions without local exhaust ventilation, eye protection, and waste neutralization; and prolonged use of latex gloves. Workers making bioprosthetic heart valves are at risk for occupationally acquired asthma. Employers should implement additional engineering controls to minimize workers' exposures to at least below a level of 0.015 ppm, an appropriate glove to prevent workers' skin exposure to glutaraldehyde, consistent and universal use of eye protection, and a medical surveillance program for glutaraldehyde-exposed workers.

Pesticide illness among flight attendants due to aircraft disinsection.

BACKGROUND: Aircraft "disinsection" is the application of pesticides inside an aircraft to kill insects that may be on board. Over a 1-year period, California's tracking system received 17 reports of illness involving flight attendants exposed to pesticides following disinsection. METHODS: Interviews, work process observations, and a records review were conducted. Illness reports were evaluated according to the case definition established by the National Institute for Occupational Safety and Health. RESULTS: Twelve cases met the definition for work-related pesticide illness. Eleven cases were attributed to the "Residual" method of disinsection, i.e., application of a solution of permethrin (2.2% w/w), solvents (0.8%), and a surfactant (1.4%); the method of disinsection could not be determined for one case. CONCLUSIONS: The aerosol application of a pesticide in the confined space of an aircraft cabin poses a hazard to flight attendants. Nontoxic alternative methods, such as air curtains, should be used to minimize disease vector importation via aircraft cabins. Employers should mitigate flight attendant pesticide exposure in the interim.