Case Study Session II (Papers 100-109)

100. Moving Beyond Safety Plateau with Behavior-Based Observation and Feedback.

M. McClintock, Safety Performance Solutions, Blacksburg, VA

Case Study Description: Through the combined efforts of management and union, an observation and feedback process was introduced and evaluated in a chemical processing facility. Situation: The organization's safety performance had plateaued and employees were reluctant to get involved in safety efforts.

Problems: (1) Stagnant safety improvement process, (2) lack of input and participation of employees in safety improvement process, and (3) adversarial relationship in safety between company management and the union workforce.

Resolution: Involving employees in a behavior-focused peer observation and feedback process energized the safety improvement process. Safe work practice increased. Facility and equipment deficiencies were identified, prioritized, and resolved.

Benefit to Other Practitioners: This case study suggests methods for involving employees in safety improvement efforts to reinvigorate the process and move organizations past a safety performance plateau.

101. Pigeon Infestation Abatement.

T. Horan, Social Security Administration, Baltimore, MD

Case Study Description: Following an extremely rainy Memorial Holiday weekend, complaints of a mildew-type odor were expressed. The complaints were confined to a small section of a four-story building, consisting of 285,000 square feet per floor. Upon investigation, it was determined that the source of the odor was an old, abandoned cooling tower which contained a significant amount of pigeon fecal material/debris (approximately two inches thick). There was a 6' X 4' grille above the unit which had been placed some time back by facilities management to "prevent pigeon access;" however, the unit was still exposed to the elements (rain, snow, etc.). The cooling tower area was in close proximity to the room housing the air-handling equipment which serviced the complaint area. The fresh air intakes were located on the roof, above these mechanical spaces. Smoke testing revealed the cooling tower to be under positive pressure (to the roof) and, consequently, the odor was being drawn up to the roof and pulled into the air intakes.

Problems: The cooling tower was not scheduled to be removed until four months later and routine inspections revealed the odor to be "spreading" to other floors. The employees and the union also needed to be notified of the situation and an action plan developed.

Resolution: The abatement was coordinated with appropriate staff involvement (building engineers, industrial hygienists, building manager). The employees were notified of the situation and remediation efforts via memorandum. A barrier for the roof was constructed in an attempt to prevent additional moisture from entering the tower until the abatement could be conducted. A detailed statement of work was developed, and the tower was abated, under full containment, by an asbestos abatement contractor. Appropriate personal protective equipment was worn and confined space issues were also considered. The work was conducted over a weekend period in order to minimize any impact to building occupants and to consider occupants who may be immunocompromised.

How sharing this work will benefit other practitioners of industrial hygiene: In addition to being a nuisance, pigeons may also present risks of disease. This work experience will not only demonstrate how to effectively communicate findings to building occupants but also the importance of appropriately communicating findings or following up on an issue before it causes alarm or becomes a potential health risk. For example, if the issue of pigeons gaining access to the mechanical spaces had been addressed earlier, the time and resources necessary to abate the situation could have been minimized. This experience will also be of value to industrial hygiene practitioners because it will demonstrate the importance of cooperating with all pertinent disciplines to develop a practical plan of action for resolving similar problems.

102. Exposure to Ethylene Oxide During Bee Hive Fumigation.

J. Lambeth, North Carolina Department of Labor, Raleigh, NC

Description: This study was conducted in an effort to reduce employee exposure to ethylene oxide during the fumigation of bee hives.

Situation: Bee hives thought by honey producers to be contaminated with bacteria are brought to the North Carolina Department of Agriculture's Biological Control Laboratory for fumigation. Empty hives are placed in a pressure chamber which is filled with ethylene oxide (EtO) to a pressure of 20 psi. The EtO is heated using hot water circulated through the bottom of the chamber. The hives are maintained in the chamber for a minimum of 24 hours. When the cycle is completed, the EtO is emptied from the chamber, which is then purged using fresh air. The doors of the chamber are then opened and the hives are allowed to remain in the chamber for another 30 minutes. They are then removed from the chamber for return to the producer.

Problems: DOA employees were being exposed to levels of EtO of 100 to 2500 ppm at various stages of purging, opening and emptying the chamber. Bystanders or employees working in areas adjacent to the chamber are also exposed to waste EtO.

Resolution: The waste EtO was exhausted to the atmosphere above the building instead of below as was being done originally. The chamber was purged with fresh air three times instead of once. Employees were trained to open the chamber door so as to reduce their potential for exposure, and the hives were left in the open chamber for at least two hours prior to removal.

Benefit to Other Practitioners: Other departments of agriculture or agencies using this method of fumigation will benefit by using the techniques and practices developed in this study to significantly reduce their employees' risk of exposure of EtO.

103. Investigation of Bites and Itching in Word Processing Department.

R. Lewis, St. Louis University, St. Louis, MO

Description: Investigate a series of employee complaints of bites and itching.

Situation: Employees at a word processing center of a large city office had experienced intermittent bites from a suspected arthropod source but no arthropods were ever found on employee's skin.

Problems: Previous investigators diagnosed bird mites and fleas as the culprits in the biting. Both bird and rodent mites were suspected as causes because of the relatively large population of pigeons around window ledges and sighting of mice by employees. Upon investigation of the workplace, no signs of bird mite infestation were observed. Nesting material consistent with the presence of rodents was found, bu no rodents were trapped and no rodent mites were identified on nesting material. Air monitoring and surface sampling were conducted to determine if fiberglass or insect parts were present in the workplace. No insect parts, indicative of mites, were seen on our samples. Air samples were all negative for fiber glass, but one sample revealed moderately high dust levels compared to EPA's outdoor yearly average for exposure to total dust. Surface-vacuum samples collected around employees desks contained small amounts of fiber glass or mineral wool, known to cause itching or bite-like sensations in office workers. Humidity in the occupied space was low, less than 35% RH measured during the summer months. Air was recirculated 100% with carbon dioxide measurements exceeding 1000 ppm. The workplace air handler was found to contain mineral wool insulation, and this insulation along with loose fibers from the fiber glass ducting which supplied air to the space was suspected as the cause of most "bites."

Resolution: Removal of the mineral wool insulation from the air handler and improved housekeeping to remove dust containing fibers from the work area appeared to have resolved the bites and itching complaints.

Benefit to Other Practitioners: Industrial hygienists rarely encounter concerns due to insect bites. This study demonstrated how "bite" investigations can be done examining both arthropod and nonarthropod sources.

104. An Investigation of Sickening Odors on a Construction Site.

G.S. Young, Arthur D. Little, Inc., Cambridge, MA

Description: Construction Site

Situation: Construction workers were getting sick because of intensely foul odors in a large cut and cover tunnel excavation.

Problems: The odors and symptoms are intermittent. Exposure monitoring identified low level aldehydes and suffer containing chemicals, but none had the characteristic foul odor. Workers were concerned about their health.

Resolution: A team of industrial hygienists, odor experts, and environmental engineers conducted a comprehensive field and laboratory investigation which identified the likely causes, sources, health effects, and remedial actions.

Benefit to Other Practitioners: Industrial hygienists will gain a better appreciation for construction health hazards. They will also learn about odor evaluation techniques and how they compliment traditional exposure monitoring.

105. Mercury Spills in Residential Settings.

T.M. O'Brien, New York State Electric & Gas Corp., Lansing, NY

Description: Preventing and responding to residential mercury spills.

Situation: Mercury spilled from a natural gas regulator, in a residential basement, results in mercury vapor contamination of the entire home.

Problems: Mercury sequestered in a basement wall resists decontamination efforts, making the home uninhabitable and causing high exposure to cleanup workers. Regulatory agencies demand prompt remediation.

Resolution: Relocation of occupants, remove and reconstruct block wall, chemical decontamination of the spill area, worker medical surveillance, liaison with regulatory agencies to establish cleanup criteria, air monitoring.

Benefit to Other Practitioners: The value of prevention and rapid response to spills is illustrated, also the importance of selecting and adopting effective cleanup procedures for spill events.

106. An Ergonomic Assessment of a Dredging Operation.

C. Wen, U.S. Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, MD

Description: This case study examines work-related musculoskeletal hazards in a dredging operation at the mouth of the Columbia River.

Situation: In order to maintain waterways for commercial vessels, the United States Army Corp of Engineers operates seagoing vessels which dredge and transport dredged material to safe disposal areas. Data compiled from safety records of the Dredge Essayons show a high number of muscle strains and sprains.

Problems: Many ergonomic problems exist on the Dredge Essayons, and their combination puts crew members at risk of developing muscle strains and sprains. First, the crew must handle and fasten heavy mooring lines to piers. There are six 600-foot lines, weighing 3 pounds/foot. Handling these lines stresses the upper extremities of the body. Second, the crew must use heavy tools, such as impact wrenches, in awkward postures in order to perform normal job duties. These tools leave the crew vulnerable to development of musculoskeletal disorders because of their weight and design. Next, the loading of stores requires frequent bending and lifting. Materials vary in weight with the heaviest items weighing up to 70 pounds. Finally, maintaining balance on the ship requires constant muscular contraction. Besides the physical demands of the job, the rocking motion of the ship enhances the musculoskeletal hazards already present.

Resolution: First, we recommend replacing the mooring ropes with a lighter material called Kevlar. This material is strong enough to fulfill the intended purpose, yet it is easier for crew members to handle. Second, the feasibility of a tool balancer was discussed in order to eliminate the weight of the tools on the operator. Administrative practices should encourage job rotation and limit exposure to problematic equipment. Next, modifications in loading practices and provision of spring carts will reduce lifting requirements and eliminate frequent bending. Finally, workers should take frequent stretching breaks to loosen muscles, and those not already engaged in a fitness program should begin a program.

Benefit to Other Practitioners: Practitioners of industrial hygiene will see that the dredging operation is performed in an interesting and unique work environment. Ergonomic risk factors are ubiquitous, and recommended solutions in this task can be applied in any typical industrial environment.

107. Practical Guidelines for Improving Environmental Health and Safety Performance -- Program Content.

J. Messelbeck, Allergan, Inc., Irvine, CA

Description: This study is intended to provide a practical approach to the challenge of implementing a continuously improving EHS program in a multinational environment. "Program Content" is the second of a three-part review: Introduction, Program Content, Program Evaluation. It describes the tools which were implemented to move along the continuous improvement cycle.

Situation: Achievement of a continuous improvement process for EHS management. The environment is a multinational business environment with varied EHS compliance standards. Facility management needs clear guidance about EHS goals and priorities.

Problem: How to assure EHS compliance and continuous improvement through providing management tools to move beyond compliance. Facility management understands the corporate intentions of improving EHS performance but lack the tools to move forward.

Resolution: An approach is to develop uniform EHS requirements worldwide. Allergan developed the EHS Achievement program as a road map for facility management to understand their compliance responsibilities. The program describes three levels of EHS achievement: compliance, prevention, and leadership. These levels encourage continuous improvement through a formal goal-setting practice. The facilities are audited against achievement level requirements on a regular basis. This second part of the case study describes the content of the EHS Achievement Program.

108. When Sampling Data Don't Settle the Issue?

L. Blade, K. Worthington, NIOSH, Cincinnati, OH

Description: Numerous factors, including organizational, psychosocial, and health-risk communications issues, affected the complexity of a recent National Institute for Occupational Safety and Health (NIOSH) health hazard evaluation (HHE). This presentation will discuss these factors and their apparent affects on the completion of the HHE.

Situation: Some employees at a US Department of Energy (DoE) facility that formerly produced nuclear-weapons materials reported a variety of health problems, often persistent and unresolved despite interactions with medical-care providers. An occupational physician in the employer's medical department suspected these workers were experiencing "chronic, low-level cyanide intoxication." The employee requestors of the HHE as well as several individuals in the medical department supported this. A larger number of medical practitioners did not attribute this to an occupational exposure. Blood and urine tests for cyanide were inconclusive and controversial.

Problems: Organizational: Workers reportedly received inconsistent information about the suspected agent and potential health effects and felt that their concerns were not taken seriously. The complex organizational structure made health and safety communication within the company difficult. Health-risk communications: A group of concerned employees had extensively researched cyanide toxicity. By the time the HHE was conducted, the NIOSH investigators found that strong opinions seemed to have formed. A medical and environmental evaluation was performed to address the cyanide concerns, and concluded that the employees were not occupationally exposed to a broad range of cyanide-containing compounds, and that the available information did not support a relationship between the reported health problems and chronic cyanide intoxication. Unfortunately, despite the strength of these conclusions, some employees seemed unwilling to accept them. Psychosocial: The involved parties (workers, local management, and DoE officials) generally acknowledged a lack of trust dating back to the days of weapons-material production. At the time of this evaluation, the NIOSH investigators found that an atmosphere of mistrust seemed to have formed regarding the cyanide issue. A group of concerned employees strongly vocalized their concerns to management, DoE, elected officials, media organizations, and independent advocacy groups.

Resolution: Numerous attempts were made to incorporate employees' meetings, plans and sampling activities. NIOSH personnel consulted with employees and management representatives about air-sampling locations. Individual medical interviews were conducted to allow for individuals' expressions of concerns. NIOSH personnel communicated with other government agencies with involvement at the site. Findings were presented to employees and management in a written report and at an open meeting with ample opportunities for questions. Employees still have concerns about the safety of the workplace and continue to communicate these concerns to NIOSH, CDC, and elected officials.

109. Developing a Risk Assessment Protocol for Electrical Substations.

G. Boothe, Gobbell Hays Partners, Nashville, TN

Case Study Description: A risk assessment protocol was necessary for electrical substations.

Situation: A metropolitan area electrical utility company needed to develop a spill program for its electrical substations. The preliminary step was to rank assess the substations to determine an order for developing individual spill plans.

Problems: There were very little existing data concerning the substations. No protocol existed for a rank assessment.

Resolution: A protocol was developed to rank the substations based on the impact that a release of oil would have on surrounding populations and environment. The protocol included an algorithm which allowed a numerical scoring of each site.

Benefit to Other Practitioners: This information would help other IHs in developing risk assessment protocols not only for electrical substations, but any application where the environment or surrounding population may be affected by the release of a hazardous chemical.

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