Research Rounds – Volume 2, Issue 8, February 2017

NIOSH Research Rounds is a monthly bulletin of selected research at the National Institute for Occupational Safety and Health.

Volume 2, Number 8 (February 2017)

NIOSH 8 Core Competencies Help Protect Young Workers

A young grocery worker scans an item in a grocery store.

The NIOSH 8 Core Competencies include eight steps that younger workers can take to help ensure their safety in any workplace. Photo from Thinkstock.

Many young workers under age 25 enter the workforce before they have had a chance to develop foundational job skills. In fact, most high schoolers—an estimated 80 percent— hold a job at some point during their school years. With work-related injury among these young workers approximately twice as high as among older workers, the need for early training in foundational job skills is critical. To address this knowledge gap, researchers at the National Institute for Occupational Safety and Health (NIOSH) developed a framework for teaching young workers fundamentals about safety and health on the job. These foundational skills include the abilities to read for information, apply mathematics, problem solve, think critically, manage social relationships, and communicate effectively. Called the NIOSH 8 Core Competencies, this framework includes eight steps that younger workers can take to help ensure their safety in any workplace, the researchers report in the Journal of Safety Research:

Recognize that all workers potentially face the risk of injury, illness, and even death on the job. Workers need to know how workplace risks can affect their lives and their families.
Recognize that work-related injuries and illnesses are predictable and preventable.
Identify hazards at work, evaluate the risks, and predict how workers can be injured or become ill.
Recognize how to prevent injury and illness. Describe the best ways to address workplace hazards and apply these concepts to specific workplace problems.
Identify emergencies at work and decide on the best ways to address them.
Recognize that employers are responsible for, and workers have the right to, safe and healthy work. Workers also have the responsibility for keeping themselves and coworkers safe.
Find resources that help keep workers safe and healthy on the job.
Demonstrate how workers can communicate with other people, including authority figures, to ask questions or report problems and concerns when they feel unsafe.

The researchers used the Health Belief Model, an established theoretical framework for effecting change in health behavior, to guide the development of the NIOSH 8 Core Competencies. In practical terms, according to the researchers, teachers and administrators can incorporate the NIOSH 8 Core Competencies into school curricula to help ensure that young workers have the skills and knowledge they need to stay safe and healthy at work.

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In This Issue

NIOSH Research Rounds is Brought to You By:

John Howard, M.D., Director
Fred Blosser, Editor in Chief
Anne Blank, Story Editor
Tanya Headley, Contributing Editor
John Lechliter, Copy Editor
Glenn Doyle, Technical Lead
Tonya White, Technical Support

Exposure to Surgical Smoke Persists, Despite Available Ventilation Controls

A recent survey of healthcare workers found that certain surgical procedures often lack ventilation that removes surgical smoke at its source. Photo courtesy of Vangie Dennis, The Emory Clinics: Ambulatory Surgery.

A recent survey of healthcare workers found that certain surgical procedures often lack ventilation that removes surgical smoke at its source, according to researchers at the National Institute for Occupational Safety and Health (NIOSH). As a result, some healthcare workers may face serious health problems from exposure to surgical smoke, as explained in an article in the American Journal of Industrial Medicine.

Thanks to medical advances in electrosurgery and laser surgery, we now have access to minimally or non-invasive procedures for everything from heart disease to glaucoma. For patients, these procedures provide clear benefits, including faster, less painful recoveries. However, the advances in technology can present new hazards to healthcare workers. As laser and electrosurgical tools heat body tissues, they generate surgical smoke that contains toxic gases, vapors, and cellular material. Exposure to these substances may cause short-term health problems, such as eye, nose, and throat irritation, and possible long-term illnesses, such as emphysema, asthma, and chronic bronchitis. The Occupational Safety and Health Administration estimates that 500,000 healthcare workers are exposed to surgical smoke each year.

To control emissions, professional, consensus, and government organizations recommend that local exhaust ventilation (LEV) be used to capture the smoke at its source. This local, as opposed to general, ventilation collects smoke at the surgical site so that it never reaches the breathing zone of healthcare workers or patients. NIOSH recommends LEV, in addition to general room ventilation, to control healthcare workers’ exposure to surgical smoke.

NIOSH researchers analyzed data from a targeted, anonymous, web-based survey to examine what precautions healthcare employers and workers take in relation to hazardous substances, including surgical smoke. The NIOSH Health and Safety Practices Survey of Healthcare Workers is the largest federally sponsored survey of healthcare workers in the United States. It addresses safety and health practices relative to the use of hazardous chemicals among more than 12,000 healthcare workers. Of the respondents, more than 4,500 reported exposure to surgical smoke during electrosurgery or laser surgery and answered specific questions about work practices that control surgical smoke. Most respondents were female, white, and between 41 and 55 years of age. In terms of occupation, over one-third were nurse anesthetists, and about one-fifth were anesthesiologists.

The results showed that only 47% of the respondents reported always using LEV during laser surgery, and even fewer, 14%, always used LEV during electrosurgery. Respondents who reported always using LEV also were more likely to report that they had received training on the hazards of surgical smoke and that their employer had procedures in place for preventing exposure. Few survey respondents reported that they wore respiratory protection; most wore surgical or laser masks, neither of which provide respiratory protection. Electrosurgery was the most common source of exposure to surgical smoke, with 4,500 respondents reporting they were present during this procedure. In contrast, 1,392 respondents reported exposure during laser surgery. These survey results can help raise awareness about the importance of local control of surgical smoke by underscoring impediments to LEV use.

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Disclaimer: Mention of company names or products does not constitute endorsement by the National Institute for Occupational Safety and Health.

Study Examines Relationship Between Lifting and Low Back Pain

In manufacturing and other industries where lifting is part of the job, disorders that affect the muscles and bones are a common problem. In fact, musculoskeletal disorders cause one-third of work-related injuries resulting in missed workdays, costing about $45 to $54 billion annually in lost productivity and treatment, according to estimates from the National Research Council and the Institute of Medicine.

At the National Institute for Occupational Safety and Health (NIOSH), scientists study the causes and prevention of these prevalent disorders, including low back pain. Unlike some exposures, however, exposures related to low back pain may be more difficult to measure. In a study published in the journal Safety and Health at Work, NIOSH scientists adapted risk assessment methods typically used in chemical risk assessment to assess workers’ accounts and the revised NIOSH Lifting Equation to identify specific factors related to low back pain among a group of manufacturing workers. This equation calculates a composite lifting index, which is the ratio of the load lifted to the recommended weight limit for multiple lifting tasks performed consecutively.

The study participants included 138 manufacturing workers. Most were male, their average age was 38 years, and all reported that they were free of low back pain at the beginning of the study. Follow-up was 1 year. Statistical analysis showed that workers in this study who reported more lifts per work shift were more likely to report instances of low back pain than other workers. Factors associated with fewer instances of self-reported low back pain in this study were non-work-related activities involving bending and twisting of the back, more overtime-work hours, and more years of overall employment. It is important to note that this study only identifies a relationship and does not prove that more lifts per work shift cause low back pain. Similarly, it does not prove that bending and twisting of the back and the other factors examined were unrelated to low back pain. Further development of these risk assessment methods and research is necessary to confirm the study’s results and their possible application to identifying the causes of other work-related musculoskeletal disorders.

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Tests Lead to Recommendations to Minimize Exposure to Alternative Dry-cleaning Chemicals

If you have ever opened a dry-cleaning bag and put on a freshly laundered garment, you know that dry-cleaning can make clothes look and smell almost new. That freshness, however, is created using chemicals that may be potentially harmful to employees who work in the dry-cleaning process. Although today’s dry-cleaners are moving away from using perchloroethylene, a toxic chemical that may cause cancer, the work-related health effects of the chemicals taking its place are unknown.

In a new evaluation from the National Institute for Occupational Safety and Health (NIOSH) and a state health department, researchers tested air samples in four dry-cleaning shops for two types of alternative chemicals to perchloroethylene. In two of the shops, they tested for butylal and the chemicals it can decompose into, formaldehyde and butanol. In the other two shops, they tested for high-flashpoint hydrocarbons, which are chemicals that require high temperatures to ignite. They found that air concentrations of the chemicals in all four shops were below occupational exposure limits set by NIOSH and other occupational health organizations, except for butylal, which does not have exposure limits. Workers had the highest airborne exposures while loading and unloading the dry-cleaning machines and pressing fabrics. In another finding, the researchers noted possible skin exposures to the chemicals. Since many of the employers and workers were not native English speakers and had limited English proficiency, the researchers used interpreters during the site visits and provided translated information back to the participants in the language they could understand best. The health hazard evaluation also recently was published in the Journal of Occupational and Environmental Hygiene.

To minimize exposures, the researchers made several recommendations to shop owners and employees:

Wear eye protection and appropriate hand protection when cleaning the waste dry-cleaning chemical container.
Use NIOSH-certified respirators, not surgical masks, to protect against dust and chemical droplets in the air.
Pour or brush the new, butylal-containing spot cleaner, rather than spraying it, which would also prevent creating a fire hazard.
Follow safety and health recommendations on products’ safety data sheets when using any spot cleaners.
Ensure the dry-cleaning shop has adequate ventilation.
Periodically monitor exposures, with help from local government agencies, in shops that use new dry-cleaning chemicals, especially after changes in work practices and conditions.

Further study of the possible health hazards of alternative dry-cleaners, especially butylal, is needed, according to the researchers.

More information is available: