thesynergist | NEWSWATCH
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NIOSH Investigates Largest Documented Blastomycosis Outbreak in the United States
NIOSH’s investigation of the largest documented outbreak of blastomycosis in the United States, which was also the first associated with an industrial work site, is the subject of CDC’s Morbidity and Mortality Weekly Report (MMWR) for Jan. 2. Blastomycosis is a rare fungal disease caused by inhalation of Blastomyces spores. The outbreak involved 162 cases among workers at a paper mill in Delta Count, Michigan, between Nov. 1, 2022, and May 15, 2023. Eighteen workers with Blastomycosis were hospitalized, and one worker died.
Local public health officials were notified of a cluster of unusual pneumonia cases among paper mill workers on Feb. 28, 2023. All patients experienced respiratory symptoms beginning in January and February 2023 and had positive urine antigen tests for Blastomyces. In April, the management of the paper mill voluntarily paused production for three weeks to clean ventilation ducts and upgrade air filters, while NIOSH and other public health agencies conducted training on Blastomyces for mill workers. Management also requested NIOSH to conduct a health hazard evaluation (HHE) to investigate sources of Blastomyces exposure and recommend prevention and control measures. NIOSH conducted environmental and medical surveys and a ventilation assessment between March and August 2023.
Of the mill’s roughly 1,000 workers, 645 participated in NIOSH’s investigation. Twenty-five percent of participants were identified as having been ill with blastomycosis since Nov. 1. Cough, shortness of breath, fatigue, and fever or chills were the most reported symptoms. The last case was identified in May 2023, and on July 1, the outbreak was declared over. NIOSH estimated that 20 percent of all mill workers had blastomycosis.
Workers with blastomycosis tended to be younger and to have worked at the mill for a shorter tenure than workers without blastomycosis, NIOSH found. Workers in all areas of the mill were affected, including workers in administrative offices, but blastomycosis cases were highest among those who worked mainly around one of the paper machines and in the maintenance area.
Blastomyces was not detected in environmental samples taken from the mill’s HVAC system or the surrounding area. However, “the lack of positive samples from the mill does not rule out the presence of Blastomyces,” MMWR states, due to the difficulty of identifying the fungal spores in the environment.
Blastomyces is found in moist soil or decaying wood and leaves in the midwestern and southern United States, MMWR explains. The mill where the outbreak occurred was located on a river in a wooded area consistent with Blastomyces’ habitat. The fungus does not typically propagate indoors. Previous cases of occupational blastomycosis have been reported in outdoor industries, such as farming, construction, and landscaping.
The blastomycosis outbreak and HHE were the subject of an educational session at AIHA Connect 2024 in Columbus, Ohio, which predicted that the source of Blastomyces exposures was likely outside of the plant. An outbreak in an occupational setting like the mill was described as “unheard of.”
According to MMWR, “the specific environmental factors in or around the mill that led to this outbreak remain unknown.”
More information about the blastomycosis outbreak may be found in CDC’s MMWR.
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Compliance Guide Available for TSCA Workplace Chemical Protection Program
EPA recently released a resource intended to help companies comply with requirements for a workplace chemical protection program, or WCPP, under the Toxic Substances Control Act. The WCPP addresses unreasonable risk posed by chemical exposures to people in occupational environments.
Among the topics addressed in the guide are EPA’s existing chemical exposure limits (ECELs) and short-term exposure limits (STELs); ECEL action levels; occupational exposure monitoring; respirators; and personal protective equipment. The guide provides instructions for calculating time-weighted averages for ECELs and STELs, conducting initial and periodic monitoring, and implementing a PPE program and an exposure control plan.
WCPPs are features of recent EPA risk management rules. While the WCPP compliance guide offers general information, employers should also refer to the substance-specific rules for risk management requirements. The agency has also published compliance guides for specific substances including methylene chloride, trichloroethylene, and certain uses of perchloroethylene.
The compliance guide is available as a PDF.
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California Standards Board Adopts Permanent Silica Standard
The Occupational Safety and Health Standards Board, the standards-setting agency within the California Division of Occupational Safety and Health (Cal/OSHA), voted in late December to permanently adopt the state’s emergency temporary standard for silica. The standard is intended to protect people who work with artificial, human-made stone from the incurable, progressive lung disease silicosis, according to California’s Department of Industrial Relations.
The permanent silica standard “continues and strengthens” Cal/OSHA’s emergency temporary standard for the substance, DIR states. The emergency temporary standard was approved in December 2023 and required employers to implement engineering controls, training, and exposure monitoring for workers egaged in high-exposure tasks such as cutting, grinding, polishing, and cleanup of artificial and natural stone. According to DIR, the protections specified in the permanent standard “provide enhanced safety measures, improved monitoring for workers, and a stronger reporting process, along with other important provisions.”
More than 230 workers in the state have developed silicosis, including 14 workers who have died from the disease. Workers who cut artificial stone are at greatest risk for developing silicosis because the material may contain 93 percent or more crystalline silica, according to a Cal/OSHA fact sheet.
The Cal/OSHA permanent silica standard is available as a PDF. For more information, refer to DIR’s news release and the CA/OSHA fact sheet (PDF). Additional resources on silica are available from DIR’s website.
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EPA: Inhalation, Dermal Exposure to Formaldehyde Present Unreasonable Risk
In its final risk evaluation for formaldehyde, EPA states with “high confidence” that inhalation and dermal exposure to the chemical present unreasonable risk to workers, especially in settings where formaldehyde is made or used. The agency used skin sensitization to evaluate dermal exposure and examined the possibility for workers to develop skin sensitization following contact with formaldehyde through liquid products containing the substance. To evaluate acute air exposure to formaldehyde, EPA used sensory irritation, a health effect commonly used as a parameter for setting occupational exposure limits. The agency also recognizes the risk of long-term or chronic inhalation exposure to formaldehyde, which can reduce lung function, increase asthma and allergy-related conditions, and cause cancer.
The risk evaluation for formaldehyde underwent peer review by the Science Advisory Committee on Chemicals, which provides independent advice to the EPA administrator on risk assessments, methodologies, and approaches related to the Toxic Substances Control Act (TSCA). One area of concern identified by some peer reviewers was that the non-cancer chronic effects EPA used to calculate risk estimates for workers were based on effects observed in children. In response, EPA has based its unreasonable risk determination for formaldehyde to workers on acute, non-cancer effects, such as sensory irritation, due to peak inhalation exposures; non-cancer effects, such as skin sensitization, due to dermal exposures; and cancer risk due to long-term or chronic inhalation exposures.
As part of the risk management process, EPA plans to propose a rule under TSCA legislation intended to protect workers and others from the unreasonable risks of formaldehyde exposure. Additional information can be found in the agency’s news release.
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NIOSH Revokes Approvals for Six Filtering Facepiece Respirators
As of Dec. 31, 2024, NIOSH has revoked six approval numbers issued to the company Aegle PPE 1 LLC due to Aegle’s “[failure] to maintain their quality management system, resulting in a failure to execute their quality control system.” The agency’s notice affects filtering facepiece respirators with the approval numbers 84A-9314, 84A-9353, 84A-9368, 84A-9390, 84A-9391, and 84A-9395. Respirators bearing these revoked NIOSH approval numbers may no longer be used, manufactured, assembled, sold, or distributed.
The notice can be found on the website of the NIOSH National Personal Protective Technology Laboratory. NPPTL provides a list of additional guidance documents intended to inform users of respiratory protective devices.
Respirator users and others can use NIOSH’s certified equipment list to confirm testing and certification approval numbers, which are printed on NIOSH-approved respirators.
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NIOSH Releases Updated List of Hazardous Drugs in Healthcare Settings
NIOSH has released the 2024 update of its List of Hazardous Drugs in Healthcare Settings, a tool that helps employers identify drugs that are dangerous to the health and safety of workers who handle them. The new document revises the 2016 version of the list by removing seven drugs and adding 25, including 12 with special handling information provided by manufacturers. The drugs reviewed for this update were those that received new approvals or new safety warnings from the U.S. Food and Drug Administration’s Center for Drug Evaluation and Research between January 2014 and December 2015, NIOSH states.
Two drugs removed from the list are the type 2 diabetes medication liraglutide and the antineoplastic agent pertuzumab. NIOSH announced in January 2024 that it was considering removal of these drugs from the list and sought public comment on this action. Through its reevaluations, the agency had determined that the intrinsic molecular properties of liraglutide and pertuzumab and the nature of the specific hazards posed by exposure to these drugs mean that they are “not likely to pose [hazards] to workers in healthcare settings,” according to the Federal Register notice published at the time. A summary of all drugs removed from the 2024 version of the hazardous drug list and of all drugs moved to different tables may be found in pages 25–29 of the document.
The 2024 List of Hazardous Drugs in Healthcare Settings is available as a PDF. More information on the updated list is available in the agency’s news release.
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EPA Finalizes Worker and Community Protections from Ethylene Oxide
EPA has imposed new restrictions on uses of ethylene oxide (EtO), a pesticide used primarily to sterilize medical devices. The restrictions include the cancellation of certain uses and the establishment of an occupational exposure limit for EtO in commercial sterilization facilities of 0.5 ppm as an eight-hour time-weighted average (TWA). This OEL, which takes effect in 2028, will be lowered to 0.25 ppm by 2030 and 0.1 ppm by 2035. The current OSHA permissible exposure limit for EtO is 1 ppm, which was established in 1984.
EPA’s restrictions are part of an “interim decision” the agency reached during its review of EtO to determine whether it still meets the registration criteria under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA). When more data on occupational exposures become available, EPA may reevaluate its interim decision.
The interim decision terminates the use of EtO for museum, archival, and library materials; cosmetics; musical instruments; and beekeeping equipment. It limits the concentration of EtO used to sterilize new medical devices to 600 mg/L by 2035, and it requires areas where the substance is used to be serviced by a separate HVAC system. Workers involved in some high-exposure tasks must wear respiratory protection, and continuous monitoring is required throughout sterilization facilities. Healthcare facilities where EtO is used must ventilate it through exterior stacks to reduce exposure to workers.
The interim decision can be downloaded as a PDF from the regulatory docket. For more information, refer to EPA’s news release and the agency’s EtO webpage.
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Civil Penalties Adjusted for Inflation
A final rule published in the Federal Register by the United States Department of Labor in January raised the amounts of civil penalties that apply to MSHA and OSHA citations. The penalty amounts increased by approximately 2.6 percent.
The increases cover the gamut of OSHA violations, including serious, other-than-serious, willful, repeated, and failure to abate. OSHA state plans are required to maintain penalties that are at least as large as those of federal OSHA. The MSHA penalties whose amounts increased include violations of specific requirements in the Federal Mine Safety and Health Act.
The Labor Department calculated the adjustment based on the percent change in the consumer price index between October 2023 and October 2024. In addition to MSHA and OSHA, the adjustment applies to penalties assessed or enforced by the Employee Benefits Security Administration, the Office of Workers’ Compensation Programs, and the Wage and Hour Division.
For more information, view the rule in the Federal Register.
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EPA Releases Compliance Guides for New PCE Rule
Two guides published recently by EPA are intended to help workplaces comply with the agency’s new risk management rule for the solvent perchloroethylene (PCE), which became effective Jan. 17. The compliance guides are specific to dry cleaning and energized electrical cleaners, two examples of entities that may continue using PCE for some time under the new rule.
The rule requires most uses of PCE to be phased out in less than three years but allows for a 10-year phaseout for PCE’s uses in dry cleaning so small businesses have time to transition away from the chemical. The use of PCE to clean and degrease energized electrical equipment will be allowed to continue.
The compliance guide for dry cleaning outlines the agency’s recordkeeping requirements for dry cleaners, compliance dates for already owned machines, and information to help businesses identify dry-cleaning machines that use PCE. The dry cleaning compliance guide is also available in Korean and Spanish.
The new compliance guide for the continued use of PCE in energized electrical cleaning outlines workplace requirements, including a new inhalation exposure concentration limit, direct dermal contact controls, and other exposure controls. Additional topics discussed in the guide for energized electrical cleaning include requirements for downstream notification and labeling and self-certification requirements for owners and operators to attest that they are complying with the relevant provisions of the rule.
The PCE rule was published in the Federal Register in December. For more information, or to download the compliance guides, visit EPA’s risk management webpage on PCE.
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NIOSH Recommends Quantitative Fit Testing for Hearing Protection Devices
An update published by NIOSH in January clarifies the agency’s policy for determining the noise or sound attenuation provided by hearing protection devices for users. NIOSH now “recommends employers use individual, quantitative fit testing to evaluate the attenuation received by workers from their hearing protection devices,” the update states.
The new recommendations supersede the guidance regarding hearing protector derating from chapters 1 and 6 of NIOSH’s 1998 Criteria for a Recommended Standard—Occupational Noise Exposure. Because commercially available fit-test systems were not available when the criteria document was published, NIOSH’s previous guidance “recommended derating the manufacturer’s labeled noise reduction rating to estimate a worker’s ‘as worn’ hearing protector attenuation.” The agency’s update is based in part on technological advancements and on research findings published in recent years that show that derating schemes cannot assess “proper fit” for hearing protectors.
Now that it is possible to check workers’ hearing protector attenuation at work sites, NIOSH recommends fit testing “as an essential practice to ensure that hearing protection devices are properly fit to each worker.” The agency’s science policy update does not favor a specific fit-testing method.
“Systems that compute a [personal attenuation rating] by the most current [Acoustical Society of America/American National Standards Institute] standards meet this NIOSH recommendation,” the agency’s new document explains. “In addition, any technology that directly measures and documents a worker’s protected exposure level (e.g., real-time protected exposure level monitoring) is consistent with this recommendation.”
For further details, see the full science policy update on the NIOSH website.
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CSB Releases First Volume of Chemical Incident Reports
The U.S. Chemical Safety and Hazard Investigation Board has released a compilation of summaries of chemical accidents that have occurred since the agency’s accidental release reporting rule went into effect in March 2020. The compilation presents summaries and probable causes of 26 incidents from April 2020 through September 2023.
Together, the incidents resulted in five fatalities, 17 serious injuries, and approximately $700 million in property damage, according to CSB. While data about some of these incidents was available on the CSB website, information about their probable causes has not previously been released, and none of the incidents were the subject of CSB investigations. The statements of probable cause reflect CSB’s determinations based on investigations conducted by the companies and, in some cases, on OSHA reports.
CSB designated the compilation as “volume 1,” indicating that it plans to publish additional reports. The compilation is available as a PDF. For more information, refer to the CSB news release.
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Study Characterizes Ergonomic Hazards, Peracetic Acid Exposures in Poultry Processing
A study funded by the United States Department of Agriculture Food Safety and Inspection Service (FSIS) found that 81 percent of workers at poultry processing establishments were at increased risk of developing musculoskeletal disorders (MSDs). The study included more than 1,000 workers at 11 establishments whose evisceration lines, where workers remove organs and clean carcasses, operated at speeds between 140 and 175 birds per minute.
The study did not find an association between line speed and MSD risk. Instead, MSD risk was greater among workers who worked at a higher piece rate, regardless of line speed. Piece rate, a measure of the number of chicken parts handled per minute by a worker, can be lowered by increasing staffing levels, for example.
The study also assessed exposures to peracetic acid, or PAA, a chemical used as an antimicrobial processing aid in poultry establishments. Twenty-one percent of the 61 establishment-specific jobs for which PAA sampling was conducted had exposures that exceeded the ACGIH short-term exposure limit (STEL) of 0.4 ppm for 15 minutes.
PAA exposure has been associated with lacrimation, irritation of mucous and nasal membranes, and respiratory tract symptoms including wheezing, coughing, shortness of breath, and chest tightness. Research also suggests that workers exposed to PAA may develop occupational asthma.
The study is available from the FSIS website.
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OSHA Terminates COVID-19 Rulemaking
OSHA has terminated its rulemaking on occupational exposure to COVID-19 in healthcare, effective Jan. 15. The agency stated that it would instead focus on completing its rulemaking on infectious diseases.
The Federal Register notice outlining the termination states that “OSHA always intended for an infectious diseases standard for healthcare workers to supplant any COVID-19 healthcare standard.” OSHA is considering long-standing infectious disease hazards like tuberculosis and measles as well as new and emerging infectious diseases such as COVID-19 and pandemic influenza for its infectious diseases rulemaking. According to the agency, control measures for infectious diseases might be necessary in healthcare as well as “other occupational settings where employees can be at increased risk of exposure to potentially infectious people,” like correctional facilities.
The standard could also apply to settings such as laboratories, which handle materials that may be sources of pathogens, and funeral homes and other settings where workers handle human remains. But President Donald Trump’s return to the White House could affect the infectious diseases rulemaking.
To learn more about OSHA’s decision to terminate its COVID-19 rulemaking, refer to the Federal Register notice and OSHA’s news release.
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Video Depicts Toxic Gas Release at Hurricane-Damaged Chemical Facility
In January, the U.S. Chemical Safety and Hazard Investigation Board released an animated video about the fire and toxic gas release at the Bio-Lab Lake Charles chemical facility in Westlake, Louisiana. The incident occurred when the facility, which manufactures chemical cleaning products for pools and spas, was damaged by Hurricane Laura.
As the hurricane approached, Bio-Lab attempted to remove products from the facility, but some of the vehicles intended to transport the chemicals never arrived. When the storm reached Lake Charles, more than 1 million pounds of a product containing trichloroisocyanuric acid (TCCA) remained on site. In large bodies of water such as swimming pools, TCCA breaks down slowly, resulting in a controlled release of the sanitizing agent chlorine into the water. But when TCCA contacts small amounts of water and does not dissolve, a chemical reaction can occur that generates heat and releases chlorine gas.
Winds from Hurricane Laura, a category 4 storm, damaged buildings at the facility, allowing rainwater to reach the chemicals inside. A fire resulted, and a toxic plume containing chlorine gas traveled over the neighboring community. Local officials issued a shelter-in-place order and closed a section of Interstate 10.
The video discusses safety issues that contributed to the incident and highlights recommendations made by CSB to the state of Louisiana, EPA, and OSHA. The video is posted to YouTube. For more information, refer to the CSB press release.
Since the Lake Charles incident, two more releases involving TCCA have occurred at another Bio-Lab facility in Conyers, Georgia.
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Vinyl Chloride Among Chemicals Designated for TSCA Risk Evaluation
In December, EPA announced that it had designated five more chemicals as high-priority substances that will undergo risk evaluations under the Toxic Substances Control Act. The five chemicals in question are acetaldehyde, acrylonitrile, benzenamine, 4,4’-methylene bis(2-chloroaniline) or MBOCA, and vinyl chloride.
Vinyl chloride made headlines in February 2023 as one of several hazardous substances that first responders vented from derailed train cars near East Palestine, Ohio. The chemical, a known carcinogen, is primarily used in the manufacturing of plastics such as polyvinyl chloride. According to EPA, concerns over the health effects of vinyl chloride prompted Congress to enact the original TSCA in 1974.
Acetaldehyde is mainly used in manufacturing and processing adhesives, petrochemicals, and other chemicals, and in intermediates for products like packaging and construction materials. Acetaldehyde exposure may cause respiratory irritation. Exposure to acrylonitrile, which is used to process plastics, paints, petrochemicals, and other chemicals, is also associated with respiratory irritation. Benzenamine exposure may affect the blood, fetal development, and reproduction, and the chemical is used to manufacture and process dyes and pigments, petrochemicals, plastics, resins, and other chemicals. The substance MBOCA is used in the manufacturing and processing of rubbers, plastics, resins, and other chemicals. EPA states that there is “extensive evidence” showing that exposure to MBOCA may damage genetic material in cells and lead to other adverse health effects, especially in infants and children.
More information about the chemicals recently selected for risk assessment, as well as those undergoing prioritization, may be found in EPA’s press release.
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OSHA Outlines Hazards in Semiconductor Manufacturing
Workers in the semiconductor manufacturing industry may be exposed to solvents, toxic metals, and radiation, according to a new OSHA fact sheet. The industry produces materials used in devices such as personal computers, smartphones, and cars, and chemicals used in the industry may be carcinogenic, reproductive toxins, or sensitizers. They also may present physical hazards, including flammability, corrosivity, reactivity, and pyrophoricity.
Rapid changes in the industry require more frequent hazard assessments and up-to-date workplace controls, OSHA explains. Many chemicals currently used in the industry have been introduced relatively recently, many lack established permissible exposure limits or adequate toxicological information, and PELs already established for some chemicals “may be outdated and inadequate for ensuring protection of worker health,” OSHA states. For such chemicals, the agency encourages employers to adhere to more protective occupational exposure limits from technical, professional, industrial, and government organizations.
Read the fact sheet in PDF format. Further information about semiconductors is available on the OSHA website.