thesynergist | NEWSWATCH
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NIOSH Finds Elevated PFAS Concentrations in Blood of Maui Firefighters
NIOSH has assessed exposures to per- and polyfluoroalkyl substances among firefighters and other Maui County employees involved in the first five days of response to the 2023 wildfires in Maui, Hawaii. Higher concentrations of PFAS were found in blood samples submitted by firefighters compared to other first responders, according to a Morbidity and Mortality Weekly Report published by CDC on Feb. 6.
Thousands of structures were destroyed and 102 people lost their lives in the wildfires that burned throughout August 2023 in Maui, the MMWR states. Maui County firefighters, police officers, public works employees, and lifeguards participated in fire suppression, structure protection, water rescue, evacuation, and urban search and rescue. In September 2023, NIOSH medical and exposure assessment staff and a CDC logistician traveled to Maui County at the request of local officials. The team analyzed blood samples provided by 258 Maui County employees who participated in the initial wildfire response, including 178 firefighters.
Agency staff evaluated the summed concentrations of seven PFAS, as well as concentrations of perfluorohexane sulfonic acid, or PFHxS, in first responders’ blood serum. PFHxS is one of the most biologically persistent PFAS, the report states. Among firefighters, the median summed concentration of seven PFAS was 7.0 μg/L, whereas the median summed concentration for other occupations ranged from 5.7 to 6.9 μg/L. The highest concentrations of PFHxS were also detected among firefighters, with a median concentration of 1.2 μg/L.
One firefighter was found with a PFHxS serum concentration of 9.3 μg/L, about twice the 95th percentile concentration for PFHxS in data collected by CDC’s National Health and Nutrition Examination Survey during the 2017 and 2018 survey years. This firefighter also had a summed PFAS concentration above 20 μg/L, the clinical threshold set by the National Academies of Sciences, Engineering, and Medicine. As NASEM recommends that clinicians screen individuals with PFAS concentrations above this threshold for cancer and other health effects, this firefighter was advised to consult a healthcare provider.
In general, firefighters with job tenures of 30 years or longer had higher summed PFAS concentrations, the MMWR states. A few outliers occurred among firefighters who had been on the job for less than five years.
According to CDC’s report, firefighters may be exposed to PFAS in fire effluents and dust, contaminated gear or equipment, protective clothing, and firefighting foams. Studies have found that firefighters have higher blood serum concentrations of PFHxS and other PFAS compared to the general and other working populations. PFAS exposure is associated with cancer, changes in cholesterol levels, and other adverse outcomes.
The report notes that although firefighters in this assessment had higher concentrations of some PFAS in their blood than employees in other occupations, most firefighters’ PFAS concentrations were below relevant clinical thresholds. Although inconsistent use of personal protective equipment may increase firefighters’ risk of exposure to PFAS, it is unclear how much the 2023 Maui wildfires contributed to PFAS concentrations in firefighters’ blood. Samples were collected about one month after the initial response and no baseline samples were provided. However, the findings of this MMWR are “useful to advancing understanding of health implications and guiding public health decision-making for ongoing and future fires,” the report states.
More information is available in CDC’s MMWR.
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Trump Selects Nominees for OSHA and MSHA
In February, President Trump nominated David Keeling and Wayne Palmer to lead OSHA and MSHA, respectively.
Keeling was vice president of global health and safety at UPS from 2018 to June 2021 and then director of global road and transportation safety at Amazon until May 2023.
Palmer served in the first Trump administration as acting head of MSHA until November 2017 and then as principal deputy assistant secretary . He has since been executive vice president of the Essential Minerals Association, an advisor to the Department of Commerce Industry Trade Advisory Committee on Critical Minerals and Nonferrous Metals, and a senior advisor in the Department of Labor Office of Congressional and Intergovernmental Affairs.
As this issue of The Synergist went to press, nomination hearings for Keeling and Palmer had not yet been scheduled by the Senate Health, Education, Labor, and Pensions Committee.
Background information on Keeling and Palmer appears in JD Supra.
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CDC: Mercury Exposure a Concern in Electronic Waste Recycling
Workers in the electronic waste recycling industry can be exposed to mercury through the inhalation of mercury vapor and mercury-containing dust, according to a report published by CDC in January. The report focuses on the results of a NIOSH health hazard evaluation of an electronics waste and lamp recycling facility in Ohio that found levels exceeding the ACGIH Biological Exposure Index (BEI) of inorganic mercury in urine among six of 14 workers, one of whom worked outside the lamp recycling area. The ACGIH BEI is 20 μg/g creatinine.
Environmental air sampling found mercury in all direct area air samples, including those from a conference room and a material storage area. Some samples exceeded the ACGIH Threshold Limit Value of 25 μg/m3 and the NIOSH recommended exposure limit of 50 μg/m3. One sample from a production area exceeded OSHA’s permissible exposure limit of 100 μg/m3.
The health hazard evaluation also noted that four of the six workers whose spot urine mercury samples exceeded the ACGIH BEI primarily spoke Spanish, and the median job tenure of workers with elevated mercury levels was eight months. According to the report, the eight workers with mercury levels below the ACGIH BEI primarily spoke English and had a median job tenure of 23 months. As these findings “[suggest] potential barriers to effective communication and training,” the report urges employers to provide training in workers’ preferred languages. The report also recommends enclosing spaces with high potential for mercury exposure, improved ventilation, personal protective equipment, and training programs.
The full report is available from the CDC website.
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CDC: Three Veterinary Practitioners Infected with Avian Influenza
The results of a serosurvey conducted among 150 bovine veterinary practitioners in mid-September found evidence that three had been recently infected with highly pathogenic avian influenza (HPAI) A(H5), according to a report published in the Feb. 13 issue of CDC’s Morbidity and Mortality Weekly Report (MMWR). None of the practitioners with positive serology results worked with dairy cattle with known or suspected HPAI A(H5) virus infection, though one practitioner reported working with poultry confirmed to be infected with the virus.
Two of the seropositive practitioners cared for cattle in multiple states, including states with known HPAI A(H5) infection among dairy cattle as of September 2024. However, one practitioner with a positive serologic test result reported caring for cattle only in Georgia and South Carolina, two states that had not reported HPAI A(H5) infection in dairy cattle.
All three affected practitioners reported wearing gloves or a clothing cover while caring for cattle, but none reported the use of respiratory or eye protection. The three seropositive practitioners did not report any respiratory or influenza-like symptoms.
“Detection of HPAI A(H5) antibodies in persons without reported symptoms suggests that surveillance of symptomatic exposed workers might underestimate human infection,” the MMWR states. For further details, read the report.
As of Feb. 19, CDC had confirmed 69 human cases of avian influenza A(H5) and one death. The virus is responsible for outbreaks in poultry flocks and an ongoing multi-state outbreak among dairy cattle. As of early March, CDC characterized public health risk as low and stated that there was no evidence for person-to-person H5N1 transmission.
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Canadian Occupational Health Center Launches Plain Language Toolkit
The Canadian Center for Occupational Health and Safety (CCOHS) has released “Spell It Out,” a new toolkit intended to help create safer workplaces through plain language. The toolkit stresses the need for clear, simple, inclusive communication related to occupational health and safety. CCOHS recommends health and safety professionals, employers, and others avoid unnecessary jargon, spell out acronyms, use active voice, and organize information logically when sharing information with workers. Complex language and technical terms can cause workers to feel excluded, CCOHS cautions, but plain language helps foster a welcoming work environment.
“In today’s diverse work environments, using acronyms, jargon, and complex words can create barriers and make it hard for everyone to understand important health and safety guidance, including people who are new to the workforce or those who speak a different first language,” CCOHS stated in a news release.
The “Spell It Out” resources, which include videos, posters, and infographics, are available for free from the CCOHS website.
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Guidance Addresses Nitrous Oxide Exposure Among Maternity Ward Workers
New guidance published by Britain’s Health and Safety Executive (HSE) is intended to help protect workers on maternity wards from exposure to nitrous oxide, a colorless anesthetic gas used in healthcare. Nitrous oxide is commonly mixed with oxygen to help control pain during childbirth, presenting an exposure risk to workers who spend extensive time in labor rooms. Workers’ risk of exposure to higher levels of nitrous oxide depends on how well exhaled gas from women in labor is controlled, according to HSE. Symptoms of exposure to nitrous oxide include difficulty breathing, drowsiness, and headache, notes the NIOSH Pocket Guide to Chemical Hazards, while HSE stresses that exposure to high levels of the gas over time can cause health effects like neurological problems and anemia. HSE’s long-term workplace exposure limit for nitrous oxide is 100 ppm or 183 mg/m3 as an eight-hour time-weighted average. For comparison, the NIOSH recommended exposure limit for exposure to waste anesthetic gas is 25 ppm or 46 mg/m3 as a time-weighted average over the time exposed. There is no OSHA permissible exposure limit for nitrous oxide.
HSE’s guidance describes three types of control in order from most to least effective: a demand valve and mouthpiece or facemask used to capture patients’ exhaled breath, an extraction or scavenging system with an extraction unit located close to patients’ breathing zones, and general ventilation. Other topics covered in the guidance include exposure monitoring and the role of effective management systems in controlling the risk of exposure to nitrous oxide.
The new guidance can be found on the HSE website.
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GAO: Data Analysis Skills Needed Among Public Health Workforce
A report published on Jan. 29 by the Government Accountability Office (GAO) describes gaps in the public health workforce in the United States that exist across multiple occupations, including nursing and epidemiology. According to GAO, the gaps vary by location, with more pronounced gaps in some regions, especially rural areas. GAO also found that gaps in the workforce “may be exacerbated during public health emergencies as needs increase, especially when accompanied by staff departures” like those that occurred because of the COVID-19 pandemic, in part due to increased workplace stress and public mistrust and criticism of public health workers.
The report concludes that gaps in the public health workforce “limit the ability of jurisdictions to conduct key public health functions, such as disease investigation and control, identification of hazards, and readiness to respond to emergencies.” Regarding hazard identification and control and emergency preparedness and response—both areas in which occupational and environmental health and safety professionals often work—GAO identified gaps in staff with skills in data analysis, a key competency for responding to public health emergencies.
Officials in five of 11 jurisdictions in which GAO conducted interviews indicated a need for staff with skills in informatics, which the Public Health Informatics Institute defines as “the science of how to use data, information and knowledge to improve human health and the delivery of health care services.” According to GAO, knowledge of informatics can help the public health workforce address public health needs and disparities and improve disease surveillance.
The GAO report can be found on the agency's website.
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California Issues Wildfire Cleanup Safety Guidance for Workers
In early February, California’s Department of Industrial Relations (DIR) posted guidance for protecting workers involved in fire debris removal and cleanup. The guidance was published after fires in the Los Angeles area destroyed an estimated 16,000 structures and took the lives of 29 people.
“Even after fires are extinguished, hazardous conditions persist,” notes the agency’s news release. “Employers involved in recovery operations within fire-damaged areas must assess these risks, address unsafe conditions, and ensure proper training is provided to all workers.”
This guidance includes DIR’s wildfire cleanup training tool (PDF). The tool advises cleanup workers to protect their health by coordinating with hazmat crews, wetting work areas to control dust, wearing personal protective equipment and long-sleeved clothing, avoiding heat stress, and taking steps to avoid bringing dust into their homes.
Further information is available from DIR’s news release.
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Final Risk Evaluations Available for Two Plasticizers Used in PVC
EPA recently released final risk evaluations for the chemicals diisononyl phthalate (DINP) and diisodecyl phthalate (DIDP). Both DINP and DIDP are plasticizers used to make flexible polyvinyl chloride (PVC). They are also used to make building and construction materials, car parts, adhesives, sealants, paints, coatings, and electrical and electronic products.
EPA found that spray application of adhesives, sealants, paints, and coatings that contain DINP presents an “unreasonable risk of injury to human health” for unprotected workers. According to the agency, DINP exposure can result in developmental toxicity, harm to the liver, and, at high concentrations, cancer. “Phthalate syndrome,” the name given to a range of effects that harm the male reproductive system, is also associated with DINP exposure. DINP was one of six phthalates included in a draft cumulative risk analysis that EPA released in January 2024.
For DIDP, the main concern is for unprotected female workers of reproductive age who are exposed through application of spray adhesives, sealants, paints, and coatings as well as lacquers, stains, varnishes, and floor finishers. The final risk evaluation for DIDP includes several changes from a draft released in May 2024, which based its findings only on high-pressure spray application.
For more information on chemical risk evaluations, visit EPA's website.
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California Adds Vinyl Acetate to Proposition 65 List
California’s Office of Environmental Health Hazard Assessment (OEHHA) has added vinyl acetate to its list of chemicals regulated under Proposition 65, the state law protecting residents from substances that cause cancer, birth defects, or reproductive harm. Vinyl acetate is used mainly in polymer and copolymer production and as a food additive.
According to an OEHHA notice, California’s Carcinogen Identification Committee (CIC) voted unanimously to add vinyl acetate to the Proposition 65 list in December 2024. OEHHA’s hazard identification document on vinyl acetate (PDF) lays out the findings of studies that provide evidence for the chemical’s carcinogenicity. The document notes that vinyl acetate was classified as “possibly carcinogenic to humans” by the International Agency for Research on Cancer in 1995 and as “suspected of causing cancer” by the European Chemicals Agency in 2011.
During the same meeting, CIC voted to add 2,2,3-trifluoro-3-(trifluoromethyl)oxirane, also known as hexafluoropropylene oxide or HFPO, to California’s list of chemicals “for which testing is required but has been inadequate,” OEHHA states.
Proposition 65 requires businesses to warn people in California about toxic chemicals in their products, homes, and workplaces or that are released into the environment.
For more information about the OEHHA determination on vinyl acetate, see the agency’s notice.