thesynergist | NEWSWATCH
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CDC Links Cruise Ship Legionnaires' Outbreaks to Private Hot Tubs
Separate outbreaks of Legionnaires’ disease that affected 12 passengers on board cruise ships have been traced to hot tubs on private balconies, according to a CDC report. The outbreaks occurred on two vessels starting in November 2022. All 12 passengers recovered, although 10 required hospitalization.
On the vessel that CDC designates Ship A, five cases of Legionnaires’ disease were identified among patients who traveled on the same voyage in November 2022. Three additional cases occurred among passengers on voyages in August and September 2023 and March 2024. Sampling and review of the ship’s cleaning and disinfection procedures found that all CDC’s requirements had been met, but the investigation focused only on the potable water system and the hot tubs in common areas. It wasn’t until the sixth passenger, who traveled in late summer 2023, reported using a private hot tub that CDC zeroed in on what was ultimately determined to be the source of the outbreak. Subsequent sampling found Legionella in six of 10 private hot tubs with concentrations in two tubs exceeding 1,000 colony-forming units per milliliter (CFU/mL).
CDC requirements for cleaning and disinfecting private hot tubs are not as stringent as they are for public facilities, the report notes. Private hot tubs need only “shock chlorination,” and CDC allows refilling to occur weekly or between occupancies, whichever is sooner. Public hot tubs, in contrast, must be continuously dosed with disinfectant and their pH monitored.
When CDC learned of the outbreak on Ship B, which affected passengers on voyages in January, February, and May 2024, the agency requested that the crew close all hot tubs, including both private and public facilities, and conduct sampling. Legionella was found in all eight private hot tubs on board, and two had concentrations greater than 10 CFU/mL.
According to the CDC report, despite the fact that both ships met current agency guidelines, the private hot tubs “were found to be operating for months in a manner conducive to Legionella growth, which included maintaining a water temperature in the Legionella growth range (77°F–113°F [25°C–45°C]) for multiple days without draining and [. . .] with no residual disinfectant.”
The cruise lines responsible for the ships in question have implemented changes as a result of the outbreaks. For private hot tubs, heating elements have been removed, and the tubs are filled only upon a passenger’s request, emptied after each use, and cleaned and disinfected more often. The CDC report recommends that cruise lines ensure that private hot tubs are included in every vessel’s water management plan and routinely tested for Legionella.
Cases of Legionnaires’ disease rose steadily in the United States between 2000 and 2018, from an incidence rate of less than 0.5 to 3.4 per 100,000 persons, according to CDC data. Incidence rates dropped during the COVID-19 pandemic to less than 2 per 100,000 in 2020 but rose again in 2021 to nearly 2.5 per 100,000.
Read more about the outbreaks in the Oct. 24 edition of CDC’s Morbidity and Mortality Weekly Report. CDC’s guidance for Legionella control is available on the agency's website. The guidance includes modules for hot tubs and cruise operations. Data on Legionnaires’ disease are published on the CDC website.
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Five Companies Ordered to Conduct PFAS Testing
EPA is requiring Innovative Chemical Technologies, Chemours, Daikin America, Sumitomo, and DuPont to conduct testing on a substance known as 6:2 fluorotelomer acrylate or 6:2 FTAc. This action is the fifth “test order” EPA has promulgated as part of its national testing strategy for per- and polyfluoroalkyl substances, or PFAS. Companies subject to test orders must either conduct testing as specified by EPA or submit information about the substance that the agency may not have considered.
6:2 FTAc is a component in plastics, resins, textiles, apparel, leather, and other chemicals. According to EPA, the chemical structure of 6:2 FTAc is similar to that of some carcinogens. Studies of rodents exposed to 6:2 FTAc suggest that it causes changes in blood cell counts, liver and kidney size, and animal behavior.
For more information, refer to EPA’s press release and national PFAS testing strategy.
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OSHA Rule Corrects Minor Errors in HazCom Standard
A final rule from OSHA dated Oct. 9 corrects minor errors in the agency’s hazard communication standard. According to OSHA, because the errors were mostly typographical in nature and correcting them does not impose new or different obligations on the regulated community, the agency can update the standard without initiating normal rulemaking procedures such as public notice and comment periods.
The errors include incorrect references to certain paragraphs. The new rule explains that OSHA has rearranged and renumbered the affected text so that the standard reflects the agency’s intent. The rule also removes a phrase that referred to the “transmission of labels by electronic or other technological means,” which was inadvertently incorporated into the standard.
Other errors occurred in the standard’s appendices. A table in appendix B was mislabeled, and in appendix C, OSHA inadvertently inserted hazard statements for aerosols instead of hazard statements for chemicals under pressure.
All changes are summarized in a table in the new rule. For more information, refer to the rule in the Federal Register. More information about the OSHA hazcom standard is available from the agency’s website.
OSHA’s update of the hazcom standard, which went into effect July 19, aligned it with the seventh revision of the United Nation’s Globally Harmonized System of Classification and Labelling of Chemicals (GHS). The rule was intended to improve the quality of information on chemical labels and safety data sheets so that workers and first responders could act more quickly in emergencies. For more information on the updated standard, read the article elsewhere in this issue.
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CSB to Investigate Chemical Fire at Georgia Facility
The U.S. Chemical Safety and Hazard Investigation Board (CSB) has sent a team to investigate the chemical fire that began on Sept. 29 at the Bio-Lab facility in Conyers, Georgia. As reported by the Associated Press, about 17,000 people were evacuated due to the fire at the chemical plant and more than 90,000 others located east of Atlanta were advised to shelter in place.
The facility manufactures pool and spa chemicals that contain the chlorinating agent trichloroisocyanuric acid. TCCA is soluble and breaks down slowly when used in large bodies of water, CSB explains, but when the substance “comes into contact with small amounts of water and does not dissolve, it can undergo a chemical reaction that generates heat, causing the decomposition of TCCA, which produces toxic chlorine gas.”
State and federal agencies monitored air quality in the area for chlorine and related compounds throughout the week, according to a press release issued Oct. 2 by the Georgia Emergency Management and Homeland Security Agency. “Some exceedances above the action level for chlorine” were detected around the Bio-Lab facility overnight into Oct. 2, the press release notes. The action level for chlorine is 0.5 parts per million, which EPA describes as “conservative and protective of the most vulnerable populations, including children.” GEMA/HS warned Metro Atlanta residents that they may smell chlorine, although chlorine levels in the air were safe.
Further information is available in CSB’s press release.
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Toolkit Intended to Help Construction Industry “Design Out” Hazards
A toolkit published in September by NIOSH is intended to help construction companies and contractors remove significant hazards for construction workers. The “Prevention through Design Toolkit for the Construction Industry” focuses on preventing falls, reducing struck-by incidents, and eliminating hazards in residential construction. NIOSH’s Prevention through Design (PtD) initiative promotes “designing out” or minimizing hazards and risks to prevent and control occupational injuries, illnesses, and fatalities. PtD “is the most reliable and effective way to protect workers,” NIOSH states.
The toolkit includes tables to help architects, design engineers, and resident engineers working with construction teams identify and eliminate potential hazards during the planning and design phase of projects. Companies, contractors, and others can improve PtD application and certainty in the scope of work when relevant controls are included as part of construction bids and contracts, NIOSH explains.
The toolkit is available from the NIOSH website.
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OSHA: Restructuring of Regional Offices Is Complete
As of Oct. 1, OSHA has completed changes to its regional operations, including the creation of a new regional office based in Birmingham, Alabama, which will oversee OSHA operations in that state as well as in Arkansas, Kentucky, Louisiana, Mississippi, Tennessee, and the Florida panhandle. The new office will address the region’s growing worker population and needs in industries like food processing, construction, heavy manufacturing, and chemical processing, OSHA explained in May, when the changes were announced. The agency also merged two regions and renamed all regions by geography.
“OSHA’s restructuring is intended to bring its offices closer to communities in need of services, and strengthen the agency’s presence in the southeastern U.S.,” the agency stated in October. “The agency also anticipates the restructuring will reduce its response time to complaints, fatalities, imminent danger, and significant events.”
OSHA merged Regions 9 and 10, naming it the San Francisco Region, to improve the agency’s ability to “deploy resources and serve workers.” Region 9 included American Samoa, Arizona, California, Guam, Hawaii, Nevada, and the Northern Mariana Islands. Alaska, Idaho, Oregon, and Washington made up Region 10.
OSHA’s new regional designations are the Boston Region, the New York City Region, the Philadelphia Region, the Atlanta Region, the Chicago Region, the Dallas Region, the Kansas City Region, the Denver Region, the San Francisco Region, and the Birmingham Region. A table in the agency’s October news release and a map from the OSHA website outline the new regional structure and boundaries.
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EPA to Require Replacement of All Lead Pipes Within 10 Years
A final rule issued by EPA in October requires most water systems in the United States to identify and replace all lead pipes, beginning no later than Oct. 30, 2027. Two-year extensions may be granted by state agencies or the EPA administrator. Most water systems must complete lead service line replacement no later than 10 years from the compliance date. The rule also lowers the action level for lead in water from 0.015 mg/L to 0.010 mg/L, which EPA says "will result in more water systems installing and re-optimizing optimal corrosion control treatment." The agency estimates that there are approximately 9.2 million lead service lines in use across the nation.
A statement issued by the American Water Works Association notes that removing the entirety of all lead service lines could be complicated by the fact that some service lines are partly on private property and not owned by a water utility. The rule requires water systems to replace all lead service lines that are “under their control,” and AWWA urges EPA to provide “further explanation to assure water utilities are operating within their legal authority.”
AWWA’s statement also indicates a potential gap between allocated funding and the cost of implementing the new rule. The organization estimates that the total cost of replacing lead service lines nationwide could exceed $90 billion, whereas a fact sheet (PDF) published by EPA notes that the Bipartisan Infrastructure Law provides $26 billion over five years to address lead in drinking water.
Several U.S. communities are already working to replace lead pipes, EPA’s news release explains. Milwaukee Water Works in Wisconsin is on track to replace 3,400 lead service lines this year, and Michigan’s Detroit Water and Sewerage Department is set to replace more than 8,000 lead service lines in 2024. The agency says its new rule will create jobs in local communities as water systems must accelerate the removal of affected pipes.
For more information on the new rule, see EPA’s webpage on lead and copper rule improvements.
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NIOSH Challenge Highlights Solutions to Improve Respirator Fit Testing
The winner of NIOSH’s Respirator Fit Evaluation Challenge is an app that detects leaks or gaps along the face seal of a respirator using an infrared camera, the agency announced in September. According to NIOSH, the second-place solution is “a low-cost, open source, quantitative fit tester” that combines a sampling probe with a particle counter to calculate fit measurements. The solution that placed third is “a continuous pressure/temperature sensor that uses machine learning to notify the user of a respirator’s fit condition” during wear.
NIOSH’s crowdsourcing competition was intended to find practical solutions to improve respirator fit testing. The first phase involved competitors submitting concept papers outlining their solutions. Those who moved on to the second phase developed and demonstrated prototypes. For the third and final phase of the competition, NIOSH evaluated functional prototypes.
When NIOSH announced the challenge, it stressed that small or disadvantaged workplaces often lack the resources to conduct initial and annual fit testing to ensure that workers are wearing respirator models and sizes that fit correctly. The agency noted that members of the public are increasingly wearing respirators for protection against infectious diseases, wildfire smoke, and pollution, without knowing whether the equipment provides adequate protection.
“The winning technologies were designed to provide immediate evaluation and feedback to users on the fit of filtering facepiece respirators, enhancing both safety and effectiveness in real-world settings,” NIOSH stated in a news release.
More information, including lists of winners from all three phases, can be found on the challenge website.
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EPA Finalizes Stronger Requirements for Dust-Lead Hazards
A final rule issued in October by EPA strengthens requirements related to identifying and cleaning up dust-lead hazards in homes and childcare facilities built before lead paint was banned in 1978. Under the new rule, any reportable level of lead in dust as analyzed by a laboratory recognized by the agency’s National Lead Laboratory Accreditation Program is considered hazardous. The rule also lowers the amount of lead that can remain in dust on floors, windowsills, and window troughs following abatement to 5 µg/ft2, 40 µg/ft2, and 100 µg/ft2, respectively. EPA describes these amounts as “the lowest levels that can be reliably and quickly measured in laboratories.”
The rule decouples the standard for the reportable level of lead in dust and the amount of lead that can remain in dust after abatement. According to the pre-publication copy of the new rule (PDF), dust-lead hazard standards will now be referred to as “dust-lead reportable levels,” and dust-lead clearance levels will now be described as “dust-lead action levels.”
EPA’s new rule also revises the definition of abatement. The agency’s recommendation for action related to lead in dust will now apply “when dust-lead loadings are at or above the action levels, rather than the hazard standards, as has been the case historically.”
The final rule will reduce the lead exposures of up to nearly 1.2 million people per year, EPA estimates, including approximately 178,000 to 326,000 children under the age of six. For more information, read EPA’s news release or webpage on the final rulemaking.
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EPA Rule Resets Exclusion Zone for Pesticide Applications
A final rule published by EPA in the Federal Register Oct. 4 restores requirements related to the application exclusion zone, or AEZ, under the agency’s Agricultural Worker Protection Standard. The AEZ is an area that workers and bystanders are prohibited from entering while pesticides are being applied. AEZ requirements were originally set in 2015 as an area extending 100 feet from pesticide application equipment. In 2020, the AEZ was limited to 25 feet for some applications.
The new rule reinstates AEZ provisions from the 2015 rule. If an individual enters the AEZ during application of pesticides, the rule requires the application to be suspended. The AEZ moves with the equipment, can extend into neighboring properties, and exists only during the application.
The new rule goes into effect Dec. 4. For more information, refer to EPA’s press release and the rule in the Federal Register.
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Maryland's New Heat Standard Is in Effect
A new standard developed by Maryland Occupational Safety and Health (MOSH) is intended to prevent heat illness among workers in the state. The regulation was recently published in the Maryland Register and went into effect on Sept. 30.
The standard applies to both indoor and outdoor workplaces where employees are exposed to a heat index of 80 F or higher. Certain emergency operations and essential services are exempt from the standard, and the regulation does not apply in spaces that have a mechanical ventilation system or fan that keeps the heat index below 80 F. The standard also does not apply to incidental exposures, which MOSH describes as instances “when an employee is not required to perform work activities for more than 15 consecutive minutes per hour.”
According to the Maryland Department of Labor, the regulation will be incorporated into the Code of Maryland Regulations as a new chapter titled “Heat Stress Standards." The standard includes requirements related to heat illness prevention and management plans, acclimatization, access to shade and drinking water, emergency response, and training.
Maryland joins a few other states—California, Colorado, Minnesota, Oregon, and Washington—that have standards for heat exposure. Maryland’s standard is not yet listed on federal OSHA’s heat standards webpage, but a PDF of the regulation can be found on the website of the Maryland Department of Labor.
Federal OSHA’s proposed heat rule, Heat Injury and Illness Prevention in Outdoor and Indoor Work Settings, was published in the Federal Register on Aug. 30. The public comment period is open until Jan. 14, 2025. Learn more by visiting the agency’s website.
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NIOSH Publishes Ergonomic Evaluation of Warehousing Tasks
A new health hazard evaluation (HHE) from NIOSH presents the recommendations of agency personnel who evaluated ergonomic hazards and musculoskeletal health symptoms of employees at a distribution facility for a logistics agency. The facility employed approximately 500 people to pick, pack, process, store, load, and unload parcels. At the invitation of facility managers, NIOSH visited the facility in January 2019. The HHE report is dated March 2024 but has only recently been made available on the agency website.
NIOSH personnel observed workers in several buildings. In some locations, equipment that could have helped with lifting tasks was either unused or not present. Work surfaces had limited adjustability, some employees worked off chairs and tables because their desks were occupied by printers and scales, and some workstations had broken chairs. Unused equipment forced employees to engage in longer or repeated lifting and carrying tasks. NIOSH noted possible trip and fall hazards and a lack of antifatigue mats in some areas. For office workers, computer monitors were placed at heights that required users to extend their necks.
Of 43 employees interviewed by NIOSH, 15 reported pain that was potentially work related, often in the back and shoulders. The HHE report recommends that the facility reduce risks for musculoskeletal disorders by ensuring conveyors are at appropriate heights, providing adjustable workstations and antifatigue mats, placing large items on pallets so they can be easily moved with equipment, and replacing broken chairs.
For more information, read the HHE report (PDF).
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Two Companies Voluntarily Rescind NIOSH Approvals for Certain N95s
NIOSH announced that it has honored the requests of the companies Innonix Technologies Limited and United States Mask LLC to voluntarily rescind some of their respirator approvals. As of Sept. 18, one United States Mask respirator, the N95 Model 1812, is no longer approved by NIOSH and may no longer be used, manufactured, assembled, sold, or distributed. The voluntary recission also affects two of Innonix Technologies’ approvals for N95 filtering facepiece respirators with an effective date of Sept. 19. Respirator users are encouraged to review the agency’s notices for Innonix Technologies and United States Mask for further information.
NIOSH’s certified equipment list can be used to confirm testing and certification approval numbers, which are printed on NIOSH-approved respirators. The website of the agency’s National Personal Protective Technology Laboratory provides a list of additional guidance documents intended to inform users of respiratory protective devices.