8 24 30 38

ETHICS FEATURE FEATURE BY THE NUMBERS

Comparing Codes Drug-Free Workplace Hazardous Drugs in COVID-19 at Meat
of Ethics Policies Veterinary Medicine Processing Facilities

June/July 2020

RESPIRATORY
Sensitizers
Strategies to Address
Occupational Asthma Caused
by Respirable Allergens

AIHA: Healthier Workplaces | A Healthier World

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FEATURES

18
RESPIRATORY SENSITIZERS
STRATEGIES TO ADDRESS OCCUPATIONAL ASTHMA CAUSED
BY RESPIRABLE ALLERGENS
Respiratory sensitization leading to occupational asthma
(OA) is growing in prevalence worldwide. This article
describes where sensitizers can be found, how respiratory
and dermal sensitization differ, the symptoms and
characterization of OA, and approaches to assessing
and controlling exposures to respiratory sensitizers.
BY SAMANTHA CONNELL AND SELENE ARAYA

24
THE MARIJUANA DILEMMA
DRUGS IN A DRUG-FREE WORKPLACE
Marijuana is legal for medical use in 33 states and the
District of Columbia, but the federal status of cannabis
hasn’t changed. Companies subject to the Drug-Free
Workplace Act must prohibit the use of controlled
substances in the workplace. How can employers reconcile
the legality of cannabis in many states with the need to
comply with drug-free workplace policies?
BY LAMONT BYRD, CARL W. HEINLEIN, JANET L. KEYES, JASON MCINNIS, DIANE RADNOFF,
AND SCOTT SCHNEIDER

30
HAZARDOUS DRUGS IN VETERINARY MEDICINE
USP <800> RAISES AWARENESS OF AN OBSCURE CONCERN
The recent promulgation of the United States
Pharmacopeia (USP) General Chapter 800 standard
has led to increased interest in preventing exposure to
hazardous drugs in veterinary medicine providers.
The potential for exposure to hazardous drugs, and the
challenges related to minimizing it, are quite similar in
veterinary and human healthcare settings.
BY SHELLEY R. CARRY

CONTRIBUTORS
SAMANTHA CONNELL, FEATURE AUTHOR SCOTT SCHNEIDER, FEATURE AUTHOR SHELLEY R. CARRY, FEATURE AUTHOR
Samantha Connell, MSPH, CIH, is an industrial hygienist at Scott Schneider, CIH, FAIHA, recently retired as director of Shelley R. Carry, CIH, CSP, is principal consultant at
Lonza in Visp, Switzerland. Occupational Safety and Health for the Laborers’ Health and Safety Kaiser Permanente.
Fund of North America.

| June/July 2020 4
THE FUTURE OF AIHA
HAS ARRIVED.
COME TAKE A LOOK.
Changes in our industry are inspiring changes at AIHA. We are
dedicated to being a forward-looking organization, working to advance
the Occupational Health and Safety profession—enhancing our
member services and recruiting the next generation of professionals
into our ranks.

All with a bold new look. Come see the future.

aiha.org
 JUNE/JULY 2020

Volume 31 Number 6

EDITOR IN CHIEF
Ed Rutkowski: [email protected]

COLUMNS & DEPARTMENTS MANAGING EDITOR

Kay Bechtold: [email protected]

8 ETHICS 16 ADVERTISERS’ INDEX EDITORIAL ASSISTANT

Abby Roberts: [email protected]
Comparing Codes of Ethics
BY CELIA A. BOOTH AND JOY ERDMAN 35 PRODUCT FEATURES DESIGNER
Janelle Welch, 2 Hounds Media
9 MEMBERSHIP 36 COMMUNITY
Members Making a Difference: AIHA News PRODUCTION MANAGER
Jim Myers: [email protected]
Laurence Svirchev, CIH
BY GOUHAR NAYEEM 38 BY THE NUMBERS ADVERTISING REPRESENTATIVE
COVID-19 at Meat and Poultry MCI | USA
10 NEWSWATCH Processing Facilities Holly Klarman: [email protected]
OEHS and Industry News
CHIEF EXECUTIVE OFFICER
Lawrence D. Sloan, CAE: [email protected]

The Synergist® is a copyrighted publication of the American Industrial

Hygiene Association, 3141 Fairview Park Drive, Suite 777, Falls Church,
VA 22042; (703) 849-8888; e-mail [email protected]. No part of The
Synergist may be reprinted without the express written consent of AIHA.
Submission of articles or letters to the editor are welcome, but AIHA
and The Synergist will determine what to publish and reserve the right to
edit all submissions for content, style, length and clarity.

The Synergist (USPS #009-332) is published monthly except a combined

June/July issue by the American Industrial Hygiene Association, 3141
Fairview Park Drive, Suite 777, Falls Church, VA 22042 for $50 per year
for members; nonmembers may subscribe for $315/yr. International
nonmembers may subscribe for $415/yr (U.S. funds). Periodicals
postage paid at Merrifield, Virginia, and additional mailing offices.
POSTMASTER: Send address changes to The Synergist, American
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Ü IN THE DIGITAL EDITION Ü ON AIHA.ORG Park Drive, Suite 777, Falls Church, VA 22042. ISSN 10667660.
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EDITORIAL ADVISORY BOARD MEMBERS

COMING IN AUGUST:
Jeff Behar, California Institute of Technology
Sampling and Analysis of Metals and Metalloids | Surface Sampling | Fume Hood Testing Requirements Patricia Crawford, Consultant
M. Cathy Fehrenbacher, U.S. EPA
Don Garvey, 3M Co.
The Synergist’s mission is to provide AIHA members with news and information about
Stephen Hemperly, Hitachi GST
the occupational and environmental health and safety fields and the industrial hygiene Hank Muranko, Muranko & Associates
profession. The Synergist focuses on industry trends and news, government and regulatory Derek Popp, Wisconsin Occupational Health Laboratory
activities, key issues facing the profession, appropriate technical information and news on Doris Reid, Goodrich Corporation
association events and activities. John Rekus, John F. Rekus & Associates Ltd.
The Synergist’s objective is to present information that is newsworthy and of general
interest in industrial hygiene. Opinions, claims, conclusions, and positions expressed in this
publication are the authors’ or persons’ quoted and do not necessarily reflect the opinions
of the editors, AIHA, or The Synergist.

| June/July 2020 6
 DUST MONITORING
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Connecting Talent with Opportunity

 ETHICS

CELIA A. BOOTH, CIH, CSP, MA, is a con-

Comparing Codes of Ethics
sultant with Booth McCaffery LLC in Saint
Augustine, Florida. She can be reached at BY CELIA A. BOOTH AND JOY ERDMAN
[email protected].

L
ast November, the American Public Health Association updated ethically relevant facts and uncertain-
its code of ethics. This code is of interest to occupational health ties; analyzing the meaning and impli-
JOY ERDMAN, CIH, CSP, MA, is a and safety professionals because many of us work in public cations of the action for the health
consultant with Joy Solutions, LLC in Falls health entities, including governmental, academic, and healthcare and rights of affected individuals and
Church, Virginia. She can be reached at organizations; we should be familiar with the code because we communities; and analyzing how the
[email protected]. are part of the larger, interdisciplinary field of public health. More proposed action fits with core public
importantly, the APHA code provides a detailed framework for decision-making that health values. In addition, the code
Send feedback to [email protected]. can help us weigh options when we face ethical dilemmas. lists eight considerations for public
health interventions and policies:
permissibility; respect; reciprocity;
The focus of the APHA code on service and institutions” and “is intended to effectiveness; responsible use of
to society is timely given the COVID- guide individual and collective decision scarce resources; proportionality;
19 pandemic. Ethical dilemmas are making.” However, APHA states that accountability and transparency; and
occurring nearly every day as scarce its code is not intended to be used in public participation.
resources are rationed, healthcare a disciplinary way. Instead, the code
workers go into harm’s way, and popu- serves as a “promise to society,” stat- OVERLAPPING PROFESSIONS
lations are quarantined. These actions ing, “When people become profession- There is considerable overlap between
constrict the civil rights and liberties als, they take on a second set of special public health and industrial hygiene in
of individuals, disrupt the global econ- responsibilities and obligations con- investigating health problems; inform-
omy, and obstruct the primary goal of cerning how and for what ends their ing and educating; maintaining compe-
public health, which is to allow people professional knowledge and authority tency; and evaluating and continuously
to flourish. should be used.” improving processes, programs, and
RESOURCES Further, the APHA code encom- interventions. Public health delves
American Journal of Public Health: FOCUS ON VALUES passes values that overlap with, and deeper into the population, commu-
“Public Health Code of Ethics: There are some key differences extend beyond, those of the industrial nity, and social components of these
Deliberative Decision- between the APHA code and the Board hygiene profession. In addition to pro- domains. Nonetheless, in each of
Making and Reflective Practice” for Global EHS Credentialing code, fessionalism, trust, health, and safety, these areas industrial hygiene may
(April 2020). which applies to industrial hygienists. the APHA code embraces justice and contribute to the evidence-based prac-
American Public Health Association: While both public health and OHS pro- equity; interdependence and solidar- tice of public health.
Public Health Code of Ethics, bit.ly/ tect the public, the APHA code also ity; human rights and civil liberties; The complexity of the APHA code
aphaethics. serves societies and the ecosystem. and inclusivity and engagement. reflects the multidisciplinary nature
American Public Health Association: The main difference is that the BGC These values reflect the broader mis- of public health and provides a broad
Principles of the Ethical Practice of code of ethics is connected to the sion of public health, which is influ- scope of standards for performance
Public Health, Certified Industrial Hygienist certifi- enced by governmental, academic, of duties. Against the backdrop of the
bit.ly/ethicspublichealth.
cation and includes an enforcement healthcare, and non-governmental COVID-19 coronavirus pandemic, the
Board for Global EHS Credentialing: mechanism. organizations. actions taken by U.S. public health
Code of Ethics, bit.ly/bgcunified Both codes specify standards The APHA code identifies four officials reflect the values, standards,
code (PDF, November 2019). and obligations. As explained in its components of decision-making: and obligations in their code of ethics,
introduction, the APHA code applies determining the public health goals even in the midst of a dynamic global
to “both public health practitioners of a proposed action; identifying the event.

| June/July 2020 8
 MEMBERSHIP

Members Making a
Difference:
GOUHAR NAYEEM is AIHA's
membership marketing specialist.

Laurence Svirchev, CIH

Send feedback to [email protected].

BY GOUHAR NAYEEM

P
rotecting the health and safety of people at work has never Laurence identified his key take-
been as critical as it is now during the COVID-19 pandemic. Our away: “Knowledge and human need
members have used their expertise and knowledge to collaborate cause people to pull together,” he said,
online, at work, in communities, and in households. Take Laurence and emphasized the importance of
Svirchev, CIH, an AIHA member since 2003, and AIHA’s ambassador sharing that knowledge to combat
to China. In early February, he appealed to the AIHA membership problems such as COVID-19.
through Catalyst for donations of PPE that would go directly to emergency medical
staff in Wuhan. IH CAREERS
I asked his advice for students con-
sidering careers in IH. “Young people
I reached out to Laurence to find out to need fit-tested N95 respirators. are inspired, but they may not know
how he got involved in the COVID-19 Industrial hygienists demonstrated what they want to do,” he said. “They
“Young people response and why he finds IH/OEHS that infectious aerosol particles could are always looking for direction and
to be a fulfilling profession. have long residency in air beyond the ultimately, they will find it. In IH you
can see the
3 foot mark. The IHs and their medi- can specialize in various fields; once
opportunities TWO PANDEMICS cal colleagues also had to learn how you have learned the fundamentals,
that IH offers.” Laurence has 38 years of experience to protect other healthcare workers, you can do whatever you want. Young
in the IH/OEHS field, including work- such as orderlies delivering meals to people can see the opportunities that
ing as an occupational hygiene officer patients. Laurence stressed the impor- IH offers.”
with WorkSafeBC in British Columbia. tance of closely collaborating with the In IH, students establish a general
One of his tasks was to inspect the medical and public health communities, base upon which they can build and
health and safety operations of hospi- as different professions have different specialize according to their fields of
tals at the time of the SARS outbreak knowledge bases. As a result of these interest. And when a crisis such as
in 2003. That led him and other IHs collaborations, there was no transmis- the COVID-19 pandemic occurs, they
to collaborate with the ad hoc SARS sion of SARS in British Columbia. are able to share their knowledge
Scientific Committee. They researched Starting in 2010, Laurence began and experiences to make a difference
what happens when a person coughs managing HSE departments for a Chi- beyond the confines of their job or
and sneezes. A dramatic high-velocity nese company specializing in inter- business.
photo from the 1930s of a sneeze led to national infrastructure construction. Laurence concluded our conversa-
a series of questions about the visible When COVID-19 appeared in China, tion by saying that “our organization
particles coming out of the person’s Laurence was personally concerned, and our members are mobilized and
mouth. How long do these particles as he has family and friends in China. doing really great stuff. The exchange
stay in the air before they deposit on Using his knowledge and connections, of ideas and questions on Catalyst
surfaces? What is the distribution of Laurence started encouraging his shows that we are all still learning and
particles and their deposition sites colleagues to donate PPE to vetted looking for the right things to do. Indus-
within the respiratory system? Chinese contacts, people who would trial hygienists are curious and caring
At that time, the "3 foot rule" domi- ensure healthcare workers received people, always seeking new knowledge
nated: only healthcare workers within needed equipment until China could and modifying old knowledge to fit new
three feet of a patient were thought ramp up its internal production. circumstances.”

9 www.aiha.org |
 NEWSWATCH

PERSONAL PROTECTIVE EQUIPMENT

NIOSH Creates “PAPR100”

Class of Respirator
BACTERIA AND VIRUSES
CDC RECOMMENDATIONS
COVER CLEANING, Editor’s note: Information about the COVID-19 pandemic is rapidly developing. The articles on these pages were current at time
DISINFECTION FOR of printing. Visit bit.ly/synergistcovid for the latest news and bit.ly/coronavirusresources for links to authoritative sources.
NONEMERGENCY
VEHICLES

A
Interim recommendations
published in April by CDC focus n interim final rule in industrial environments such as be worn with facial hair.
on the cleaning and disinfection published by NIOSH mining and milling operations. To The idea for a PAPR100 class
of nonemergency transport in the Federal Regis- provide enough airflow to pass the originated during a series of public
vehicles, including passenger ter April 14 creates a silica dust test, PAPRs need batteries meetings NIOSH held between 2003
vans, accessible vans, and cars, new class of powered air-purifying and fans, which increases their size and 2008 to investigate a new PAPR
following the transport of people respirator (PAPR) that may be better and weight. The new “PAPR100” class concept. Participants at the meetings
who are known or suspected suited to the needs of workers in the of respirator created by the NIOSH discussed issues related to PAPR
to have COVID-19. Commonly healthcare and public safety indus- rule replaces the silica dust test with certification requirements, the possi-
touched surfaces in these tries who require protection from aerosol tests, which allow for smaller, ble elimination of the silica dust test,
vehicles should be cleaned and COVID-19, according to an agency lighter designs. A sodium chloride and the incorporation of warnings for
disinfected at the beginning and press release. aerosol will be used to test filters for low airflow, pressure, and battery life.
end of each shift and between Because they are designed to filter the N-series PAPR100, which are not A subsequent Institute of Medicine
transporting passengers who are chemicals, bloodborne pathogens,
visibly sick. CDC recommends and aerosol-transmissible diseases,
NIOSH expects the addition of new
that individuals wear dispos- PAPRs with high-efficiency filters,
able gloves compatible with which NIOSH designates as PAPR PAPRs to the marketplace to help
the cleaning and disinfecting class HE, are often used in high-haz-
alleviate the strain on respirator supplies
products being used as well as ard procedures in healthcare settings.
any other personal protective According to NIOSH, PAPRs played in healthcare facilities.
equipment required in the a key role in respiratory protection
products’ manufacturer-provided programs during emergencies related
instructions. If possible, the to the outbreaks of Severe Acute resistant to oil. For the oil-resistant workshop held in 2014 explored the
agency also encourages the use Respiratory Syndrome (SARS) in 2002, P-series PAPR100 filters, NIOSH will unsuitability of PAPR requirements
of a disposable gown. H1N1 influenza in 2009, and Ebola use a dioctyl phthalate aerosol test. for use of the devices in healthcare.
The guidance, which includes virus in 2014. However, the size and NIOSH expects the addition of Although the NIOSH interim final
links to appropriate products weight of current PAPR HE devices new PAPRs to the marketplace to rule went into effect immediately, the
for cleaning and disinfecting is considered to be an impediment help alleviate the strain on respira- agency is accepting comments through
surfaces inside nonemergency to their wider adoption in health- tor supplies in healthcare facilities, August 12. For information on submit-
transport vehicles and recom- care. Both healthcare workers and many of which are running low on ting comments and a full discussion of
mendations for drivers who first responders would benefit from N95 particulate filtering facepiece the interim final rule, see the notice
transport passengers confirmed additional PAPRs during the COVID-19 respirators during the COVID-19 pan- in the Federal Register at bit.ly/papr
to have COVID-19, is available pandemic, the agency stated. demic. According to NIOSH, PAPRs 100rule. The NIOSH press release is
on the CDC website at bit.ly/ To achieve NIOSH approval for have several advantages over N95 available at bit.ly/papr100pr. Descrip-
cdcnonemertransport. PAPR class HE, a device must FFRs. Unlike N95 FFRs, PAPRs are tions of the standard testing proce-
pass a silica dust loading test. This reusable, and have a higher assigned dures for classes HE and PAPR100 are
requirement, established in 1972, protection factor as determined by collected on the agency website at bit.
was intended to ensure the device OSHA. Loose-fitting PAPRs do not ly/papr100hetests.
could meet the needs of workers need to be fit tested and can often

| June/July 2020 10
 NEWSWATCH

BACTERIA AND VIRUSES

CDC Publishes Strategies for Use of Elastomeric

Respirators During COVID-19 Pandemic
CDC published strategies in April that individual elastomeric respirator, filter material or render it ineffective,
facilities can use to conserve elasto- while crisis strategies apply when CDC states.
meric respirators, which are at least supplies are too low to allow each In contingency conditions, elasto-
as protective as N95 filtering facepiece worker to use a dedicated elasto- meric respirators must be cleaned as
respirators and, in some cases, have meric respirator. often as necessary to remain unsoiled PERSONAL PROTECTIVE
a higher assigned protection factor, During contingency and crisis con- and sanitary. Cleaning instructions EQUIPMENT
according to the agency. NIH VALIDATES FOUR
Unlike N95 and other FFRs, elas- DECONTAMINATION
tomeric respirators are intended to Contingency strategies apply to METHODS
be reused and therefore must be emergency situations where each A government study has vali-
maintained and inspected after each dated that four decontamination
use. Components such as valves, valve employee has exclusive use of an methods remove detectable
covers, and straps need to be cleaned individual elastomeric respirator. viable SARS-CoV-2 virus from
and disinfected. small sections of filter fabric
CDC’s guidance suggests ways to from N95 filtering facepiece
conserve elastomeric respirators ditions, filters for elastomeric respi- are provided by the respirator man- respirators, according to the
under conventional, contingency, rators may be used for an extended ufacturer. For managing respirator National Institutes of Health.
and crisis circumstances. Con- period if the filter housing is disin- supplies during a crisis, CDC recom- Investigators tested methods
ventional strategies should not be fected after each interaction with a mends sharing elastomeric respira- involving vaporized hydrogen
used during a pandemic, the agency patient and the disinfectant or clean- tors and waiving requirements for fit peroxide, 70-degree Celsius
says. Contingency strategies apply ing agent does not contact the filter testing. dry heat, ultraviolet light, and
to emergency situations where each media. Dipping filters in a cleaning or View the guidance at bit.ly/elasto 70 percent ethanol spray, then
employee has exclusive use of an disinfection solution may damage the strategies. treated fully intact respirators
with each method to determine
PERSONAL PROTECTIVE EQUIPMENT their effects on reuse durability.
Vaporized hydrogen peroxide,
or VHP, was the most effective
method. After a ten-minute
OSHA Issues Enforcement Guidance for Reuse of treatment, no viable virus
Decontaminated N95 FFRs could be detected. Respirators
treated with VHP experienced no
A temporary enforcement memo- decontamination methods that may ate precautionary measures prior to failures, which suggests they can
randum from federal OSHA outlines be effective on FFRs. The OSHA memo using a decontaminated respirator be reused up to three times.
conditions under which employers states that if these methods are not and to understand that respirators Ultraviolet light and heat
may reuse N95 filtering facepiece available, decontamination via micro- with structural or functional defects treatments caused fit and seal
respirators that have been decon- wave-generated steam or liquid hydro- should not be worn. Visual inspection problems after three decontam-
taminated. The memo, dated April gen peroxide may also be acceptable. of the respirators is also required. inations, which suggests these
24, states that reuse of respirators Despite the method chosen, OSHA will use “enforcement dis- treatments can allow respirators
that have been decontaminated via employers must be able to demon- cretion” in cases where employers to be used twice. Ethanol spray
three methods—vaporous hydro- strate its effectiveness, according to have used engineering and adminis- damaged the respirators’ fit and
gen peroxide, ultraviolet germicidal the memo. Employers must also make trative controls to protect employees; the integrity of their seal after two
irradiation, and moist heat—may be a good-faith effort to provide workers have tried to obtain alternative appro- decontamination sessions, and
acceptable provided employers meet with the most appropriate respiratory priate respiratory protection; and have therefore is not recommended.
several requirements related to train- protection; ensure that decontamina- monitored their supply of FFRs and The investigators urge anyone
ing workers and ensuring respirators tion is accomplished according to CDC prioritized their use according to CDC decontaminating a respirator to
maintain their fit and integrity. guidance; and ensure users perform guidance. test the fit and seal before each
NIOSH has identified vaporous a seal check each time they don a For complete guidance, view the reuse. For more information, visit
hydrogen peroxide, ultraviolet ger- respirator. In addition, employers OSHA memo at bit.ly/oshadeconguid bit.ly/nihvalidate.
micidal irradiation, and moist heat as must train users to follow appropri- ance.

11 www.aiha.org |
 NEWSWATCH

CHEMICAL AND MATERIAL HAZARDS

EPA Publishes Draft Scope Documents for

Formaldehyde, Other “High-Priority” Chemicals
EPA seeks public input on draft scope each chemical’s risk evaluation. EPA’s comment until June 8, 2020. Instruc-
documents for formaldehyde and scope documents also cover the “sci- tions for submitting comments can
other “high-priority” chemicals for ence approaches” that the agency be found in the Federal Register notice
GOVERNMENT upcoming risk evaluations under the plans to use during its evaluations, at bit.ly/frepascope.
AMANDA EDENS Toxic Substances Control Act. These conceptual models of potential haz- In April, EPA had published draft
APPOINTED NEW DEPUTY substances are part of a group of 20
ASSISTANT SECRETARY chemicals that EPA designated as
FOR OSHA Work related to formaldehyde completed
high priority for risk evaluation in
The U.S. Department of Labor December 2019. According to the under EPA’s Integrated Risk Information
announced April 1 that Amanda agency, work related to formaldehyde
System program was used to select the
Edens has been selected as the completed under EPA’s Integrated
new deputy assistant secretary Risk Information System (IRIS) pro- chemical as a high priority for
for OSHA. Edens was previously gram was used to select the chemical
risk evaluation.
the director of the agency’s as a high priority for risk evaluation.
Directorate of Technical Support EPA states that work done for IRIS,
and Emergency Management. which identifies and characterizes ards and exposures throughout the scope documents for the remaining
According to her biography on the health hazards of chemicals chemicals’ lifecycles, and potential 13 high-priority chemicals: p-di-
the OSHA website, Edens has found in the environment, will also plans for peer review. Collecting com- chlorobenzene, 1,2-dichloroethane,
contributed to the development be used to inform the formaldehyde ments on these scope documents rep- trans-1,2-dichloroethylene, o-dichlo-
of health standards such as risk evaluation. resents the next step in EPA’s three- robenzene, 1,1,2-trichloroethane,
asbestos, bloodborne pathogens, The draft scope documents include year risk evaluation process. 1,2-dichloropropane, 1,1-dichlo-
and hexavalent chromium; led the hazards, exposures, proposed Draft scope documents for formal- roethane, TBBPA, TCEP, TPP, eth-
emergency management efforts conditions of use, and the potentially dehyde, phthalic anhydride, and five ylene dibromide, 1,3-butadiene, and
for protecting the health and exposed or susceptible subpopula- phthalates will be available at bit.ly/ HHCB. The comment period for these
safety of response and cleanup tions EPA expects to consider during formaldehydescope for review and chemicals closed May 26.
workers following Hurricanes
CONSTRUCTION
Sandy, Harvey, Irma, and Maria;
and led emergency technical
support efforts during Ebola
events and the Zika epidemic.
Edens joined OSHA as an California Law Orders Valley Fever Training for
industrial hygienist in 1985 and
became director for the Office
Construction Workers
of Chemical Hazards-Metals in A new law recently approved by the scopic fungus Coccidioides immitis, information on what Valley Fever is,
OSHA’s Directorate of Standards governor of California mandates which is present in the soil of semi- how it is contracted, its symptoms,
and Guidance in 2002. In 2007, that construction employers with arid areas such as the Central Valley and high-risk activities and envi-
she became deputy director of worksites in counties where Valley of California. When soil is disturbed, ronments that may result in expo-
the Directorate of Standards and Fever is highly endemic provide their such as by high winds or construc- sure. Employees should be taught
Guidance. employees with awareness training tion activities, the fungus’ spores can about personal risk factors, such
on the disease. Assembly Bill No. 203 become airborne and inhaled. The as having a compromised immune
required employers to train workers disease can cause disability or death, system, that may make them partic-
on minimizing the risk of Valley Fever along with symptoms such as fatigue, ularly vulnerable, and personal and
by May 1, 2020. Training must be pro- cough, fever, shortness of breath, environmental exposure prevention
vided annually thereafter, and before headaches, body aches, joint pain, methods, including water-based dust
employees begin work that is “reason- rash, and flu-like symptoms. suppression, good personal hygiene,
ably anticipated to cause exposure to Employers in counties in Cali- and working upwind.
substantial dust disturbance.” fornia where Valley Fever is highly Assembly Bill No. 203 is available
Valley Fever is caused by the micro- endemic must provide workers with at bit.ly/cavflaw.

| June/July 2020 12
 NEWSWATCH
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SOLVENTS [email protected]

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A new draft risk evaluation published by EPA in April identifies “unreasonable Identify the Unknown
risk” to workers, consumers, bystanders, and the environment associated
with certain uses of perchloroethylene, a chemical used in dry cleaning. HCl HF HCN Acrolein Cold Sterilants
According to the agency, the primary health risk for workers is neurological
effects from short- and long-term exposure to perchloroethylene. Consumers’
PH3 Benzene CO CO2 CS2 WAGs Freons
risk is associated with skin exposure to items cleaned with the chemical, Toluene SO2 Arsine NH3
and EPA also found environmental risks to aquatic organisms. The agency
evaluated 68 uses of perchloroethylene, including in the production of fluo- Nerve Agents …
rinated compounds and as a solvent in dry cleaning and vapor degreasing.
Perchloroethylene is also known as tetrachloroethylene, PCE, and PERC.
A final toxicological profile for perchloroethylene published earlier this
year by the Agency for Toxic Substances and Disease Registry explains that
workers in the dry-cleaning industries and those who use metal-degreas-
ing products may be exposed to elevated levels of the chemical. ATSDR
states that breathing high levels of perchloroethylene for a brief period
may cause health effects such as dizziness or drowsiness, headache, and
incoordination, and higher levels of exposure may cause unconsciousness
and death. Longer-term exposure to low levels of perchloroethylene may
cause changes in mood, memory, attention, reaction time, and vision, the
agency says. In addition, some studies in humans suggest that exposure to
perchloroethylene might lead to an increased risk of bladder cancer, multiple
myeloma, or non-Hodgkin’s lymphoma.
EPA urges workers and others who use products containing perchlo-
roethylene to follow label and safety data sheet instructions, adhere to
applicable workplace regulations, and use appropriate personal protective
equipment. According to the agency, “use of perchloroethylene in dry cleaning
has decreased over time as companies shift to alternative chemicals and
new technologies.”
The agency will accept comments on its draft risk evaluation until July 6,
2020. The Science Advisory Committee on Chemicals—a federal advisory
committee charged with providing scientific advice, information, and recom-
mendations to EPA on chemicals regulated under Toxic Substances Control
Act legislation—was scheduled to review the draft risk evaluation during a
virtual public meeting May 26–29, 2020.
EPA’s new draft risk evaluation of perchloroethylene is the tenth that
EPA has published under the amended TSCA legislation. As amended by Recent webinars include:
the 2016 Frank R. Lautenberg Chemical Safety for the 21st Century Act, • Product Demo: Cority’s Industrial Hygiene Software: How to Use
TSCA requires EPA to complete risk evaluations for 10 chemicals, including Your Data to Demonstrate the Full Value of Your IH Program
perchloroethylene, within three to three-and-a-half years. EPA provides an • Democratizing Ergonomics: How to Involve Everyone in Improving
overview of its risk evaluation process for existing chemicals under TSCA the Workplace, sponsored by Humantech
at bit.ly/epariskevalprocess. • Understanding Trace Materials Analysis Investigations, sponsored
More information on EPA’s risk evaluation for perchloroethylene, including by SGS Forensic Laboratories
a PDF copy of the draft document and spreadsheets for calculating occupa-
tional risk, consumer inhalation risk, and consumer dermal risk, is available View archive at aiha.webvent.tv
on the agency’s website at bit.ly/epapercdraft.

13 www.aiha.org |
 NEWSWATCH
COMMUNICATION AND TRAINING

Trainers Gain New Features in Update

to NIOSH Software That Helps Miners
Recognize Hazards
The latest release of NIOSH’s Windows-based later or export them to share with colleagues.
EXAMiner software allows trainers to create, NIOSH explains that exported files can be emailed
save, and share safety training scenarios with or added to shared folders, then imported into
mineworkers. Using the software, workers can EXAMiner by other users.
perform a virtual workplace examination as well “EXAMiner serves to find the gaps between
as test and improve their hazard recognition skills. what mineworkers think they know about work-
According to NIOSH, EXAMiner can be adopted place hazards and the reality of what they see
into current training programs, including annual when they are in the work environment,” said
refresher training required by MSHA regulations. Jessica Kogel, NIOSH’s associate director for
The software features an interactive environ- mining. “It is a versatile tool that safety trainers
ment with more than 30 preloaded panoramic can use to increase their workers’ ability to find
photos from a real surface limestone mine. The hazards before they face those hazards on the
latest EXAMiner update gives trainers the option jobsite.”
to import their own photographs to create cus- The beta release of EXAMiner was published in
tomized site-specific scenes for use in training February 2019. The latest version of the software,
materials for any type of mine. Users are now which was updated in March 2020, is available
able to save their training scenarios to revisit from NIOSH’s website at bit.ly/nioshexaminer.

CHEMICAL AND MATERIAL HAZARDS

Professional Liability Insurance

Designed for Industrial Hygiene
& Environmental Consultants California Adds Fact Sheet on
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Full & Part-Time Rates A fact sheet released in March by the California skin notation indicating that NMP can be easily
Mold Liability Coverage Office of Environmental Health Hazard Assessment absorbed into the bloodstream through the skin.
Exclusive Member-Only Rates warns consumers about exposures to N-Meth- The fact sheet recommends that consumers
ylpyrrolidone, or NMP, a chemical component of use NMP-containing products outdoors if possi-
Contact Us Today! products that remove or strip away paint, graffiti, ble, to limit their use to no more than four hours
(855) 279-AIHA and coatings. NMP appears on California’s Prop- per day, and to use NMP-resistant gloves. Indoor
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osition 65 list due to its potential to cause birth areas where NMP is to be used should be well
[email protected]
defects or other reproductive harm. Proposition 65 ventilated.
requires businesses to warn California residents NMP is a common alternative to the solvent
about significant exposures to chemicals that cause methylene chloride, which is also present in paint
cancer or have reproductive toxicity. and coatings strippers and removers. An inves-
The most likely route of exposure to NMP for tigative report in 2015 by the Center of Public
consumers is through skin contact with paint strip- Integrity linked methylene chloride to at least 56
pers and similar products, according to the fact accidental exposure deaths—both occupational
sheet. But inhalation exposure is also a concern, and non-occupational—between 1980 and 2015. In
particularly stemming from use of aerosol products 2019, EPA banned retail distribution of methylene
that contain NMP. California OSHA’s permissible chloride in paint and coating removal products for
exposure limit for workplace exposure to NMP consumer use but did not ban commercial uses.
is 1 part per million as an 8-hour, time-weighted Read California’s NMP fact sheet at bit.ly/
average. The California exposure limit also has a canmpfact.

| June/July 2020 14
 NEWSWATCH
MINING Toxic Vapor
Monitoring Badge
“Safety Climate Constructs”
Influence Mine Worker Health,
Safety Performance
A new report published by NIOSH discusses the findings of a survey conducted
to determine significant influences on worker health and safety performance
in the mining industry. The survey considered the effects of 10 “safety climate
constructs” on health and safety performance, which was measured in the
forms of worker proactivity, compliance, and reported near misses and
other incidents. NIOSH evaluated four personal constructs, including risk
tolerance, thoroughness, sense of control, and adaptability. The other six
constructs assessed during the survey were considered to be organizational:
supervisor support, supervisor communication, coworker communication,
organizational support, worker engagement, and training. • Results will be analyzed by an AIHA-LAP, LLC
Nearly 2,700 workers at 39 mine sites in 17 states participated in NIOSH’s Accredited Laboratory
survey. The mines represented the three major mining subsectors—coal; • Results in 72 hours
stone, sand, and gravel; and industrial minerals—and nine major companies. • Chemicals such as: Formaldehyde, Xylene,
Unlike previous reports that assessed safety climate at the crew or group Nitrous Oxide and many more
level, NIOSH’s new report focuses on individual perceived safety climate.
The report identifies five areas of focus for improving the safety climates of
ACS Badge • (561) 338-3116 • http://www.acsbadge.com
mining organizations: going beyond annual refresher training; acknowledging
and addressing risk tolerance; enhancing worker engagement opportunities;
maintaining worker thoroughness and improving sense of control; and being
accountable for communication practices. Although cultural strengths and
weaknesses vary among workplaces, NIOSH anticipates that all organizations
have room for improvement in at least one of these areas.
NIOSH researchers found that while training is a strong predictor of 866-736-8347
workers’ knowledge on the job, it has a smaller effect on their health and www.RaecoRents.com
safety proactivity and decision-making. To increase workers’ sense of control
and confidence, the agency suggests that management focus on improving
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agers should consider improving the content of training, follow-up, and Respirator Fit Test Systems
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Another recommendation discussed in NIOSH’s report is for management Sound Level Meters
to focus on enhancing workers’ decision-making autonomy in addition to
building their knowledge and skills related to detecting and managing risk.
The agency stresses that “the greatest threat is usually not missing a hazard
but rather failing to mitigate the hazard due to a high tolerance for risks,” so
management must address risk tolerance and workers’ associated decisions.
NIOSH also urges management to provide more opportunities for workers
to engage with measures to improve safety climate. For example, companies
could allow workers to choose a new type of personal protective equipment Environmental Monitors
based on approved options; involve workers in health and safety commit- Portable Gas Analyzers
tees; and improve the quality and amount of communication throughout
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For further information on NIOSH’s survey, see the full report at bit.ly/
miningconstruct.

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15 www.aiha.org |
 NEWSWATCH

ASBESTOS

EPA Draft Risk Evaluation Examines

Asbestos Conditions of Use
Do you have a A new draft risk evaluation published by EPA in late March identifies “unreasonable risk” associated

safety concern? with exposure to asbestos. The draft document describes how workers, consumers, and bystanders
could be adversely affected by asbestos under certain conditions of use. EPA evaluated 33 uses
Finding an for asbestos, including processing and industrial use of asbestos diaphragms in the chlor-alkali
industrial hygienist near you industry and asbestos-containing sheet gaskets in chemical production. The agency also examined
is easy with AIHA! the commercial use and disposal of aftermarket automotive asbestos-containing brakes and lin-
ings, other vehicle friction products, and other asbestos-containing gaskets. Another occupational
condition of use evaluated by EPA was the industrial use and disposal of asbestos-containing brake
Locate a reliable safety blocks in the oil industry.
professional in your area The chlor-alkali industry uses electrolysis of sodium chloride solutions to produce chlorine and
by searching AIHA’s sodium hydroxide. The semipermeable asbestos diaphragms used in the industry prevent chlorine
Consultants Listing. generated at the anode of an electrolytic cell from reacting with sodium hydroxide generated at
the cathode, according to reports from the U.S. Geological Survey. Annual summaries from USGS
Consultants can be found
of mineral use in the United States (bit.ly/usgssummaries) indicate that the chlor-alkali industry
by company name, state, accounted for 100 percent of domestic consumption of asbestos in 2018 and 2019—681 metric tons
services provided, or country. and an estimated 100 metric tons, respectively.
EPA urges workers who use asbestos products to follow label and safety data sheet instructions,
consultantslisting.org adhere to applicable workplace regulations, and use appropriate personal protective equipment.
The Science Advisory Committee on Chemicals—a federal advisory committee charged with
providing scientific advice, information, and recommendations to EPA on chemicals regulated under
Toxic Substances Control Act legislation—was originally scheduled to review the draft risk evaluation
during a virtual public meeting April 27–30. Citing changes in the availability of committee members,
EPA rescheduled for June 8–11 and changed the format to a virtual meeting, with participation only
by phone and webcast. Registration is required at bit.ly/epaasbestosmeeting for all participants.
Those who wish to make comments during the meeting must register prior to noon ET on June 2

ADVERTISERS’ INDEX to be included on the meeting agenda. Information about the meeting, including public comments,
is available in the docket on Regulations.gov at bit.ly/asbestosmeeting.
ADVERTISER PAGE EPA’s new draft risk evaluation of asbestos is the ninth published by the agency under the
ACS Badge 15 amended TSCA legislation. As amended by the 2016 Frank R. Lautenberg Chemical Safety for the
21st Century Act, TSCA requires EPA to complete risk evaluations for 10 chemicals—1,4-dioxane;
Alliant Insurance
14 1-bromopropane; asbestos; carbon tetrachloride; cyclic aliphatic bromides cluster (HBCD); DCM
Services (methylene chloride); NMP (n-methylpyrrolidone); pigment violet 29; perc (tetrachloroethylene);
Colden Corporation 14 and TCE (trichloroethylene)—within three to three-and-a-half years. EPA issued its tenth draft risk
evaluation for tetrachloroethylene in April.
Inside Front
EMSL Analytical More information on EPA’s risk evaluation for asbestos, including a PDF copy of the draft document,
Cover is available on the agency’s website at bit.ly/epaasbestosdraft.
EMSL Analytical Back Cover
Gasmet Technologies
13
Inc.
Nanozen 7
RAECO Rents LLC 15 Correction
Inside Back The article “COVID-19 and the Industrial Hygienist” in the May issue specified an incorrect unit
SKC Inc. of measurement in its discussion of the potential of ultraviolet light to sterilize influenza virus.
Cover
The correct unit of measurement is microwatts per centimeter squared (µw/cm2). The digital
VPPPA 3 version of the article (bit.ly/covid19ih) has been corrected.
See this month’s Product Features on page 35.

| June/July 2020 16
SPONSORED BY AIHA®

Features expert, industry-specific guidance

for both businesses and consumers to safely
re-open and re-engage as they emerge from
the COVID-19 quarantines.

GetBacktoWorkSafely.org
 RESPIRATORY
Sensitizers
Strategies to Address Occupational Asthma
Caused by Respirable Allergens

A
BY SAMANTHA CONNELL AND SELENE ARAYA

respirable allergen or respiratory sensitizer is a compound that will cause respiratory

sensitization following its inhalation. Respiratory sensitization leading to occupational
asthma (OA) is an unwanted immunological reaction that represents a worrisome work-
place hazard that is growing in prevalence worldwide. An article published in European
Respiratory Review in 2017 describes an incidence of approximately two to five cases
of OA per 100,000 population each year, or roughly 15 to 20 percent of the overall adult-asthma
burden. Approximately 90 percent of OA cases are caused by inhalation exposure to respiratory sen-
sitizers and 10 percent by inhalation exposure to a very high concentration of irritants, according to a
study published in 2017 in Clinical & Experimental Allergy.

OA caused by sensitizers can be life-threatening. Symp- to deal with OA in the workplace. OA caused by a sensitizer
toms manifest very quickly, and limited toxicological and might require complete avoidance of the sensitizer because
clinical data as well as insufficient clinical experience can exposure to even extremely low quantities can exacerbate
hamper the diagnosis of cases and the identification of the asthma. Symptoms caused by exposure to a respiratory
potential respiratory sensitizers. Due to enormous individ- irritant, however, will generally not worsen with repeated
ual differences in susceptibility, rigorous health surveillance exposures.
is necessary. As sensitization does not follow a clear dose-re- The authors of a 2008 U.K. Health and Safety Laboratory
sponse relationship, it is also difficult to calculate reliable, study intended to document key clinical differences between
protective occupational exposure limits, which makes it irritation and sensitization in the workplace. They observed
challenging in practice to adequately judge and prevent that workers reporting respiratory symptoms attributable
critical exposures. Despite all the complexities associated to allergen exposure and sensitization were more likely to
with prediction, diagnostics, and assessment of exposures, report cough and chest tightness (both hallmarks of asthma),
it is feasible and important to implement a strategy to con- as well as eye irritation, than those exposed to an irritant.
trol the risk of these life-threatening reactions in specific In addition, they were more likely to have abnormal lung
individuals. function tests. Those exposed to an irritant instead typically
reported wheeze and nasal irritation.
SYMPTOMS OF EXPOSURE Respiratory sensitizer-induced OA should be suspected if
The symptoms caused by respiratory sensitizers and respi- a worker’s symptoms begin during work, are worse at work
ratory irritants differ, so they require different strategies or in the evenings after work, and diminish during weekends

| June/July 2020 18
 Editor’s note: This article is a sequel to
“Dermal Sensitizers,” which was pub-
lished in the November 2019 issue
of The Synergist (see bit.ly/dermal
sensitizers). The digital version of this
article at bit.ly/respsensitizers contains
additional information on respiratory
sensitizers that could not be included in
print due to space limitations.

yodiyim/Getty Images

19 www.aiha.org |
 or holidays. According to a 2003 paper published in the molecular weight (HMW)—usually proteinaceous—and low
Annals of Allergy, Asthma & Immunology, irritant-in- molecular weight (LMW). Some of these products have been
duced OA should be suspected if the symptoms first begin clearly labeled as respiratory sensitizers with the GHS hazard
within 24 hours after accidental inhalation of a high statement H334, “May cause allergy or asthma symptoms
concentration of an irritant. In some cases, sensitization or breathing difficulties if inhaled.” This information can be
can occur prior to the first exposure to a sensitizer due found on products’ safety data sheets or from other sources
to cross-reactive epitopes. This can happen when part such as the PubChem database and the European Chemi-
of a sensitizer is recognized by the immune system as cals Agency’s Classification and Labelling (C&L) Inventory.
another similar sensitizer that previously induced a sen- Unfortunately, some products that could lead to respiratory
sitization response. For example, an individual is exposed sensitization are not yet formally classified as sensitizers.
to Product A, which caused a sensitization response.
The person hasn’t yet been exposed to Product B, but TOXICOLOGY
the immune system mistakes Product B for Product A, There are two phases of respiratory sensitization: induction
leading to asthma symptoms after the first exposure to and elicitation. Induction is defined as the tolerance of the
Product B. The diagnosis of OA caused by a sensitizer exposure by the immune system, whereas elicitation is the
must be confirmed by a doctor. reaction from a sensitized person. As with other types of
hypersensitivity, both an induction and elicitation phase are
WHERE TO FIND RESPIRATORY SENSITIZERS needed to invoke a response. The initiation of sensitization
Respiratory sensitizers are widespread. An article published occurs as soon as specific antibodies are present in the blood
in 2012 in Clinics in Chest Medicine states that over 400 following exposure to a foreign protein. The presence of anti-
agents are known or suspected to cause respiratory sensi- bodies does not necessarily mean that a noticeably ill effect
tization and possibly OA. Table 1 provides an overview of such as asthma will occur directly. An individual becomes
these substances from several resources, which are listed sensitized following the first or repeated contact with the
below the table. respiratory antigen; however, the stronger, immediate reac-
There are two main classes of respiratory sensitizing tion will only take place once a subsequent exposure occurs.
agents that can cause sensitizer-induced asthma: high This is the elicitation phase, which can happen at a much
lower concentration. Clinical symptoms of respiratory sensi-
Table 1. Examples of High Molecular Weight and Low Molecular Weight tization occur during the elicitation phase.
Respiratory Sensitizers Found in the Workplace Figure 1 illustrates the main mechanism of immune-
High Molecular Weight Low Molecular Weight mediated respiratory sensitization, which involves two
> 5, 000 Daltons < 5,000 Daltons important elements: T helper 2 (Th2) lymphocytes and a
Animal-derived antigens and Chemicals specific type of antibody, Immunoglobulin E, or IgE (mean-
proteins Acrylics and acrylates (e.g., ing a type I hypersensitivity reaction).
Dander, urinary proteins, casein adhesives);
anhydrides (e.g., resins); ammonium It is not well understood why only certain people develop
Shellfish and fish chloride; this immunological reaction (as described in Figure 1) and
chloramines; diisocyanates; not all sensitizers will induce it, but there is some evidence
Arthropods persulfate salts;
Moths, silkworms, grasshoppers polypropylene; TBTU; triglycidyl
of a genetic component influencing the mechanism and
isocyanurate; severity. The third edition of Immunotoxicology and Immu-
Acarians (mites) aliphatic, aromatic, heterocyclic, and nopharmacology explains that other individual risk factors
quaternary amines
Plant or fungi proteins
such as smoking, obesity, and barrier abnormalities from the
Wood dust, mushroom spores, Pharmaceuticals lungs likely play a role.
pollens, vegetable gums, algae, Anesthetic agents, vitamin B1
latex, soybeans, molds (thiamine), antibiotics (e.g.,
vancomycin, colistin, penicillin,
CHALLENGES OF CALCULATING OELS
Flours cephalosporin), antineoplastic There are currently no universally accepted models appli-
agents (e.g., mitoxantrone) cable to humans that permit the determination of the
Pharmaceuticals
Ispaghula husk (psyllium, a Wood dust or bark
dose-response relationship or relative potency of HMW or
laxative agent) Oak, cedar LMW chemicals that can cause production of allergen-spe-
cific antibodies or symptoms of allergy via the inhalation
Enzymes Metals, metalworking fluids
Amylase, trypsin, lactase Cobalt, nickel, manganese
route. In fact, predictive toxicological assays (in silico, in
vitro, and in vivo) are not fully validated for the detection
Microbiologically contaminated Biocides of respiratory sensitization. Moreover, the intraspecies
aerosols Glutaraldehyde, hydroxylamine,
triclosan
differences and the complexity of their associated immune
response led to difficulty in identifying animal models for
Fungicides these type I (IgE-mediated) allergens, as noted in a 2010
Toxicology article on defining OELs for enzyme protein
Sources: Oasys and Occupational Asthma, a website that hosts a free computer program used
to help diagnose OA from serial peak flow records; CNESST, Québec’s commission on occu- respiratory allergens and in the fifth revised edition of the
pational health and safety standards; and the Association of Occupational and Environmental GHS. Specifically, in vitro (such as GARDair, a new method
Clinics (links to these resources can be found at the end of this article). These sources also
contain information regarding the professions in which these sensitizers are present. using genomics and machine learning) and in silico assays

| June/July 2020 20
 Figure 1. Schematic representation of how immune-mediated respiratory sensitization takes place.
During induction, dendritic cells are primed
in the epithelia of the lungs with an antigen
and will present it to T lymphocytes. They
will further differentiate to Th2 lympho-
cytes, which will help the maturation of the
B lymphocytes. B cells are then activated
to memory and plasma B cells that will
produce and release the antibodies (IgEs),
which can activate strong immune effector
cells in case of a second exposure to the
antigen during the elicitation phase. IgE and
the antigen can bind to immune cells as
mast cells that secrete immune media-
tors such as histamines and leukotrienes.
Histamines contained in the granules of
mast cells will lead to acute symptoms such
as sneezing and spasming of the airways,
and leukotrienes from mast cell mem-
branes will lead to prolonged symptoms
of the airways such as breathlessness and
wheeze. Symptoms such as inflamed and
constricted airways can be treated using
antihistaminic agents.

have limited applicability, while in vivo assays (for example, primarily on dose-response relationships, they are often
guinea pig intratracheal instillation test, mouse intranasal less suitable for allergic reactions, particularly respiratory
test, mouse IgE tests, and cytokine profiling) have limited IgE-mediated ones. While the risk of becoming sensitized is
predictivity for human asthmatic response potency. concentration-dependent, it is challenging to determine an
Relationships between dermal sensitization in vivo tests exposure limit that is safe for everyone. In general, OELs for
and respiratory sensitization can be used to inform risk type I allergens are derived primarily by human data, accord-
assessments. To date, with very few outliers, most LMW ing to a 2012 paper in The Annals of Occupational Hygiene.
respiratory sensitizers seem to also be dermal sensitizers, Both the 2012 paper and another published in 2015 in the
while only a small minority of LMW dermal sensitizers Journal of Occupational and Environmental Hygiene
(less than 1 percent) are also respiratory sensitizers. This explain that OELs should be selected to avoid the induction
is shown in papers published over the last several years, and not the elicitation phase of sensitization. In any case, a
including studies on phthalic anhydride in the Journal of sensitized worker must not be exposed to a sensitizer at any
Immunotoxicology, interrelationships between different level of concentration in air. Considerations for acceptable
classes of chemical allergens in the Journal of Applied daily exposure (ADE) derivations described by Gould et
Toxicology, and chemical-induced asthma in Regulatory al. in the August 2016 issue of Regulatory Toxicology and
Toxicology and Pharmacology. HMW substances—for Pharmacology also apply for OELs. Table 2 summarizes
example, pollen or enzymes such as trypsin or α-amylase— methods for the determination of OELs based on respiratory
are generally not considered effective dermal sensitizers due sensitization effects. The assumed IgE mechanism of action
to impossibility of skin penetration. is an important aspect to consider for the predictive meth-
Some products might be falsely identified as positive sen- ods, while the medical surveillance and monitoring data are
sitizers due to their corrosive or irritative properties, which key points for the retrospective methods. This information is
can cause a local immune response. Similarly, some very based on what we have experienced in industry.
fine irritating powders can cause sensitization to develop A good example of Method A in application in detergent
over time. Exposure to such products should be limited in manufacturing is the use of an existing OEL of 60 ng/m³
any case due to their strong irritative and corrosive effects. for subtilisins (serine protease enzymes), which can also be
Taking all of this into account, the primary focus in applied to other bacterial and fungal enzymes. However,
assessing potential respiratory sensitization leading to OA literature data could support the use of less stringent limits.
is the weight of evidence based on the understanding of If there is concomitant exposure to detergents/surfactants,
IgE involvement and epidemiology. Consequently, dose- the general use of exposure limits could be reduced by three
response assessment is very difficult and cannot provide a to 10 times, according to guidelines for the safe handling of
precise determination of potency, making it difficult to pro- enzymes published by AISE, the International Association
vide a reliable OEL. for Soaps, Detergents and Maintenance Products. Methods
B through F are based on the identification of a human IgE
CALCULATING AND INTERPRETING OELS type of mechanism (see Table 1 and its sources for more
Controlling occupational exposures to respiratory sensi- information). They are reliable, as they are based on data
tizers is critical to prevent OA and can be done with the supporting an IgE type of mechanism; however, the studies,
assistance of OELs, but practitioners must understand the literature information, or updated regulatory values must
associated limitations. Although OEL derivation approaches exist and be accessible. Methods G and H are considered
are well established for non-immunological endpoints based retrospective as they are based on exposure monitoring and

21 www.aiha.org |
Table 2. Methods for Determining OELs for Respiratory Sensitizers with Relative Pros and Cons

Method ID Method Description Pros Cons

Setting a general internal OEL to Extremely low levels may contribute to
Generally conservative and thus more
A prevent induction for similar potent difficulty in achieving proper containment and
reliably limits the induction.
respiratory sensitizers. unnecessary investments due to a lack of data.
Use of an NOAEL (or LOAEL with It should reliably prevent workers from
even more stringent adjustment exhibiting an OA response. Potential
If an individual is already sensitized, OELs are
B factors) from clinical studies based containment solutions should be
not reliable.
on a dose not leading to an IgE type of available on the market to achieve these
hypersensitivity in sensitized humans. levels.
Use of an NOAEL with a critical effect It should reliably prevent workers from
based on a non-sensitization endpoint, exhibiting an OA response. Potential
If an individual is already sensitized, OELs are
C including application of an adjustment containment solutions should be
not reliable.
factor of 2-3 when IgE mechanism is available on the market to achieve these
Predictive

suspected. levels.
Multiple values could be available in different
Use of regulatory and research
countries and are not always updated. Many
agency limits based on respiratory Most conservative limits are generally
D products do not have limits available. If an
sensitization (such as limits from reliable to avoid induction.
individual is already sensitized, OELs are not
ECHA, OSHA, ACGIH, HSE, or DOSH).
reliable.
Using qualitative indicators (GHS Hazard labelling allows easy recognition
Lack of a quantitative value. Might rely heavily
E statements such as H334, notations for the employee and provokes
on PPE.
such as ACGIH’s SEN, and others). protection regardless of the OEL.
Workers risk losing sight of the actual effects
of the product if they only see an exposure band
Exposure banding: including
If it is a band with low exposure limits, it in the risk communication.
F respiratory sensitizers into one
can be useful to invoke containment.
exposure band.
Uncertainty of whether additional PPE/
containment is justified.
Provides a quantitative basis for devel-
oping a reliable OEL.
Setting internal OELs to prevent Exposure monitoring data are difficult to obtain.
induction based on monitoring: OEL is
Prevents workers from becoming
G derived from exposure monitoring data Data from multiple monitoring campaigns over
sensitized.
confirming that employees have no OA an extended period of time must be available to
symptoms. ensure no adverse reactions took place.
Retrospective

Potentially available in literature/shared

databases.
Setting internal OELs to prevent
induction based on observed Reactive if coming from an internal process.
elicitation: OEL is derived from Compound could be newly characterized Workers would be already exposed and affect-
medical surveillance data (exposure as an OA sensitizer. ed.
H limits that led to allergic rhinitis and/
or asthma, positive immunological Potentially available in literature/shared Medical surveillance data might not be enough
tests, or positive spirometry tests databases. to distinguish respiratory sensitization from
following exposure to respiratory respiratory irritation.
sensitizers).

medical surveillance data (from internal data or liter- exists, it has to be applied as a ceiling exposure that must
ature). They could be needed to adapt OELs that were not be exceeded at any time. The goal is to prevent the
preventatively set due to the absence of human exposure opportunity for peak exposures and therefore avoid the
data—to make them more reliable. different thresholds for the induction of antibodies and
A study focused on the safe use of detergent enzymes in the elicitation of symptoms. As observed by AISE in the
the workplace that appeared in Applied Occupational and pharmaceutical industry, low doses with peak exposures
Environmental Hygiene in 2001 found that well controlled are enough to invoke sensitization when working with
facilities in the detergent industry would not exceed an respiratory OA sensitizers such as enzymes. With respect
incidence of three percent per year for new sensitizations. to toluene diisocyanate, one prospective epidemiology
This could be used as a reference point in other industries, study published in EXCLI Journal found that exposure to
suggesting that the OEL be revised and lowered when an high concentrations resulted in IgE antibody formation,
exceedance of cases occurs. but exposures of low concentrations (less than 0.02 ppm
or 0.14 mg/m3) for up to three years did not result in
AVOID PEAK EXPOSURES hypersensitivity or the production of specific antibodies.
When working with sensitizers, the typical notion of the A short-term exposure limit would be useful in this case,
time-weighted average (TWA) no longer applies. If an OEL but according to the European Commission’s Scientific

| June/July 2020 22
Committee on Occupational Exposure Limits, a scientifi- working population and any new cases. Both approaches aid
cally based value is impossible for many chemicals. in the confirmation of suspected cases.

REDUCING THE POTENTIAL FOR SENSITIZATION SAMANTHA CONNELL, MSPH, CIH, is an industrial hygien-
Regardless of whether an OEL is available, it is important ist at Lonza in Visp, Switzerland. She can be reached at
to take the proper precautions and minimize exposure to [email protected].
sensitizers as much as possible. The following suggestions
are usually identified in a risk assessment and imple- SELENE ARAYA, PhD, is a toxicologist at Lonza in Basel,
mented to reduce the risk and control exposures for the Switzerland. She can be reached at selene.araya@lonza.
general population. com.
Substitution. Substitute a sensitizer for a non-sen-
sitizer, if possible. Other examples include replacing fine Acknowledgement: The authors would like to thank Thomas
powders or granules with flakes or pellets, encapsulating Pfister, F. Hoffmann-La Roche, for reviewing this article.
the product (typically used for enzymes), and replacing
powders with liquids. Send feedback to [email protected].
Technical controls. High-containment solutions
help to prevent exposures. Dedicated equipment or seg-
regation of the operations helps ensure that sensitizers
do not contaminate other areas. In the pharmaceutical
industry, for example, this solution is applied for beta RESOURCES
lactams and antibiotics. AISE: “Enzyme Safety Management: A Series of Web-Based Training and Information Sessions Developed and
Presented by the AISE Enzyme Safety Task Force,” bit.ly/aisetraining (PDF, November 2015).
Consider non-routine operations. Workers may
not be exposed during “normal” operations, but sensi- AISE: Guidelines for the Safe Handling of Enzymes in Detergent Manufacturing, bit.ly/aiseguidelines (PDF, 2018).
tization (induction) may occur during tasks that could Annals of Allergy, Asthma & Immunology: “Workplace Irritant Exposures: Do They Produce True Occupational
potentially be overlooked during the risk assessment Asthma?” bit.ly/irritantoa (May 2003).
(for example, a filter change or when a worker opens a Applied Occupational and Environmental Hygiene: “Safe Use of Detergent Enzymes in the Workplace” (2001).
centrifuge to manually remove the product). They may Association of Occupational and Environmental Clinics: “Exposure Code Lookup,” bit.ly/expcodelookup.
experience symptoms when exposed to a minimal amount
Clinical & Experimental Allergy: “Diagnosing Occupational Asthma,” bit.ly/diagnosingoa (January 2017).
of product later on.
Clinics in Chest Medicine: “Occupational Asthma: New Deleterious Agents at the Workplace,” bit.ly/chestmedoa
Training. It is critical to perform work practices in
(2012).
a certain manner, especially those that might provoke
a peak exposure (docking or undocking packaging and CNESST: “Occupational Asthma,” bit.ly/cnesstoa.
then disposing of it, for example). Limiting the number of CRC Press: Immunotoxicology and Immunopharmacology, 3rd Edition, Chapter 33, “Respiratory Allergy and
workers who perform these tasks helps prevent differing Occupational Asthma” (2006).
work practices. Informing employees that a history of European Respiratory Review: “Current and New Challenges in Occupational Lung Diseases,” bit.ly/errlung
asthma and smoking habits lead to a higher risk of OA disease (December 2017).
increases awareness. EXCLI Journal: “Toluene Diisocyanate (TDI) Airway Effects and Dose-Responses in Different Animal Models”
Personal protective equipment. If PPE is the (2012).
control method of choice, practitioners should thoroughly Health and Safety Laboratory for the Health and Safety Executive: “Irritancy and Sensitization,” bit.ly/rr601
review proper donning and doffing of PPE and decontam- (PDF, 2008).
ination of the work zone. Limiting the work zone will help Journal of Applied Toxicology: “Inter-Relationships Between Different Classes of Chemical Allergens” (July 2013).
reduce contaminated areas. Respiratory protection may
Journal of Immunotoxicology: “Phthalic Anhydride: Illustrating a Conundrum in Chemical Allergy” (2016).
be considered as a safety net, even when technical con-
trols are in place. Journal of Occupational and Environmental Hygiene: “Setting Occupational Exposure Limits for Chemical
Allergens—Understanding the Challenges” (2015).
Medical surveillance. Medical surveillance pro-
grams for sensitizers can include lung function testing, in Oasys and Occupational Asthma: occupationalasthma.com.
vitro testing for specific IgE (if available), and blood tests. Regulatory Toxicology and Pharmacology: “Chemical-Induced Asthma and the Role of Clinical, Toxicological,
In some cases, medical surveillance may include specific Exposure and Epidemiological Research in Regulatory and Hazard Characterization Approaches” (November
allergy testing, a respiratory questionnaire, or spirometry. 2017).
Prick testing is rarely conducted. Regulatory Toxicology and Pharmacology: “Special Endpoint and Product Specific Considerations in Pharmaceuti-
Challenges remain for individuals who present cal Acceptable Daily Exposure Derivation” (August 2016).
increased sensitivity due to pre-existing asthma or The Annals of Occupational Hygiene: “Experiences from Occupational Exposure Limits Set on Aerosols Containing
genetic predisposition. Exposure and medical sur- Allergenic Proteins,” bit.ly/annhygaerosols (October 2012).
veillance are two key elements in ensuring early Toxicology: “Defining Occupational and Consumer Exposure Limits for Enzyme Protein Respiratory Allergens
identification of potential new OA cases. Exposure moni- Under REACH,” bit.ly/toxicologyoels (February 2010).
toring helps to validate the controls in place and indicates United Nations: “Globally Harmonized System of Classification and Labelling of Chemicals (GHS),” 5th Revised
whether improvements should be made. Medical sur- Edition (2013).
veillance allows for the identification of the predisposed

23 www.aiha.org |
 The Marijuana
Dilemma
Drugs in a Drug-
Free Workplace

W
hile marijuana is legal for medical use in
33 states and the District of Columbia, the
federal status of cannabis hasn’t changed.
The Drug Enforcement Agency still classi-
fies it as a Schedule 1 drug, or one that has
“no currently accepted medical use and a
high potential for abuse.” Any use of cannabis is prohibited
by anyone subject to the 1988 Drug-Free Workplace Act
(DFWA) and by laws regulating those in safety-sensitive
positions (such as transportation and commercial nuclear
power). Companies required to comply with the DFWA
BY LAMONT BYRD,
must establish drug-free workplace policies—specifically,
they must prohibit the use of controlled substances in the CARL W. HEINLEIN,
workplace. Companies with safety-sensitive jobs need to JANET L. KEYES,
follow similar requirements. But how can we reconcile the JASON MCINNIS,
legality of cannabis in many states with the need to comply
DIANE RADNOFF, AND
with drug-free workplace policies?
SCOTT SCHNEIDER

| June/July 2020 24
WangAnQi/Getty Images; viennetta/Getty Images
 MARIJUANA AND IMPAIRMENT carboxy-THC may be high, but because of that substance’s
Marijuana impairs cognitive function. According to the lipophilicity, it does not correlate well with THC’s effects.
World Health Organization, cannabis affects memory, Long-term use of cannabis is correlated with reduced
decision-making, response speed, accuracy, and motor cognitive performance, particularly when use starts at a
coordination. It can impair performance for as long as 24 young age. But as explained in a report from the World
hours after smoking a moderate dose. Health Organization, cause and effect hasn’t been clear:
The most common effect of marijuana is psychoac- does cannabis cause poorer cognitive performance, or are
tive. Smoking or vaping produces effects within minutes. young people with poor cognitive performance likely to
Ingesting it can delay the effects several hours. This become habitual cannabis users?
psychoactive effect results from a release of dopamine, Other long-term effects from smoking marijuana
providing a euphoric feeling. According to the govern- include chronic bronchitis, chronic obstructive pulmonary
ment of Canada, marijuana can heighten the senses, disease, cardiovascular disease, and possibly cancer. But
distort the sense of time, impair motor skills, and lower these are similar to the effects seen in tobacco smokers,
inhibitions, which might lead to risky behavior. Some and drug-free workplaces do not screen for tobacco use.
people can experience anxiety, hallucinations, or para-
noid feelings, particularly with high doses, although that DEFINING “DRUG-FREE WORKPLACE”
appears to be rare. According to the DFWA, any U.S. employer that receives
federal contracts worth over $100,000 or federal grants
of any amount must develop and implement a drug-free
workplace policy. Some federal agencies, including the
Nuclear Regulatory Commission, as well as the depart-
ments of transportation and defense, require employers of
workers in safety-sensitive jobs to have drug-free policies.
Some private businesses that aren’t required to follow the
law’s requirements may nevertheless choose to do so.
The DFWA doesn’t mandate drug testing, although
testing is part of the model plan for compliance published
by the U.S. Substance Abuse and Mental Health Services
Administration (SAMHSA), part of the Department of
Health and Human Services (DHHS). In contrast, drug
testing is mandatory under laws that address safety-
sensitive jobs.
LindaParton/Getty Images
In workplaces regulated under DFWA, employers are
required to have a formal drug-free workplace policy that

The blanket prohibition clearly prohibits the manufacture, distribution, and use
of drugs in the workplace. This policy must also include

against medical marijuana language detailing the consequences of violations. If

employers have a testing program, it must comply with
leaves many employers with mandatory guidelines developed by DHHS and regulated

conflicting obligations.
by SAMHSA. But testing won’t catch all drug use. The
most common type of screening, immunoassay-based
drug screening, may miss synthetic opioids such as fen-
tanyl or oxycodone, according to research published in the
Studies have found that cannabis users who drive journal American Family Physician.
while intoxicated have much higher risks of motor vehicle
accidents. Frequent marijuana users showed less impair- MARIJUANA TESTING
ment than infrequent users at the same dose. The greatest According to the Department of Transportation’s reg-
impairment was seen twenty to forty minutes after ulation on Controlled Substances and Alcohol Use and
smoking. No impairment was observed 2.5 hours after Testing (49 Code of Federal Regulations 382.101), the
smoking 18 milligrams (reportedly one joint) or less of purpose of testing for marijuana is “to help prevent acci-
tetrahydrocannabinol (THC, the active ingredient in mar- dents and injuries resulting from the misuse of alcohol
ijuana), according to research published in The American or use of controlled substances.” We don’t want impaired
Journal on Addictions. workers trying to do jobs that require skill and attention.
When marijuana is smoked, THC levels in the blood According to the National Safety Council, employees with
peak rapidly, then fall rapidly. Measuring a driver’s substance use disorders miss nearly 50 percent more days of
impairment immediately after a crash is difficult: if work than their peers; are less likely to stay on the job, lead-
a sample is delayed an hour, blood THC levels will ing to more job turnover; and are less productive. Testing
have dropped significantly. Levels of the metabolite seems like a logical way to prevent having impaired workers.

| June/July 2020 26
Table 1. Drug Use, Impairment, and Test Results

Situation Potential Impairment Result of Drug Test

J is a skilled carpenter, working for a large construction J isn’t likely to show any psychoactive or Probably positive at first but reported as negative. Marijuana testing usually is based on
company. He’s feeling his age. His chiropractor suggested he cognitive effects from the CBD oil, if its THC detection of the THC metabolite carboxy-THC, but it will also detect other cannabinoids (bit.ly/
try CBD oil. content is as low as it should be. redwoodmarijuana). CBD oil should have very little THC, but because CBD is not a legal drug or
food additive, there is little regulatory oversight. Research published in JAMA found detectable levels
of THC, up to 6.43 mg/ml, in 18 of 84 CBD products purchased online. Even if cannabinoids were
detected in the initial screening, confirmatory testing should have been specific for carboxy-THC (bit.
ly/redwoodmarijuana). Confirmation is usually done with GC/MS or LC/MS/MS, which can create
its own problems: with one method of sample derivatization, GC/MS will not be able to distinguish
between cannabidiol and THC (bit.ly/joatspectra).
M is a roofer, who fell off a roof many years ago. He’s been M might be impaired. Negative. Although the lab would probably detect opioids in his urine, the Medical Review Officer
able to keep working but has chronic pain. He’s on prescrip- would report the results as negative, because the drug is prescribed.
tion opioid pain medications.
K has worked construction for years. He also has Crohn’s K probably won’t show any signs of impair- Positive. Depending on his employer’s policy, he could be terminated or could be required to go
Disease. His doctor prescribed medical cannabis for that. He ment, as long as he only takes marijuana at through drug rehabilitation.
takes it when he gets home each night. the end of his workday.
E is a crane operator. He doesn’t drink. His only drug use: E won’t be impaired by the time he’s back at Potentially positive, depending on how heavily he smoked and how long ago the trip was. If he
now that marijuana is legal in Canada, he’ll smoke it when work. smoked on Saturday and was tested Monday morning, he probably would have a positive test. The
he’s there with his buddies for his annual fishing trip. psychotropic effects would have worn off within three hours and any adverse effects on performance
probably would have passed (bit.ly/joemmarijuana). But infrequent users will generally show
carboxy-THC levels above the usual threshold of 50 ng/ml for one to three days past exposure (bit.
ly/redwoodmarijuana).
L has three kids under the age of five, including one with L might be impaired. Negative.
special needs. As an only child, he’s helping his parents move
to assisted living. His wife was just diagnosed with breast
cancer. He doesn’t use drugs or alcohol. The stress and
family demands mean he hasn’t had more than four hours of
sleep a night for the last few months.
T is applying for a job with a builder with a large government T probably is impaired. Negative. Synthetic cannabinoids are not detected in the required drug screen (bit.ly/redwood
contract. She’s a heavy user of K2, a synthetic cannabinoid. marijuana).
Q, a heavy-set woman, used to smoke marijuana every day. Q won’t show any signs of impairment from Possibly positive, even though she hasn’t used marijuana in three weeks. THC is stored in the fat
She stopped completely three weeks ago. She is now applying marijuana. tissues and released into the blood at highly variable rates. Heavy users, particularly those with high
for a job driving a dump truck. body mass indices, can have elevated carboxy-THC levels in urine even thirty days post-exposure
(bit.ly/joatcannabis).

But testing for marijuana presents several problems. outcomes for the worker range from immediate termina-
Employees legally prescribed marijuana for medical condi- tion to an opportunity for education, rehabilitation, and
tions could be at risk of losing their jobs if they take those ultimately a return to work.
prescriptions. Marijuana is legal in many places, but tests In the U.S., a medical prescription for marijuana is not
that are positive could result in lost jobs or missed job accepted as a negative test. Neither DOT nor the mandatory
opportunities. The testing method for marijuana will miss guidelines allow any medically prescribed use of marijuana.
drugs with similar effects (such as synthetic marijuana) That blanket prohibition against medical marijuana
but could result in positive tests for users of cannabidiol leaves many employers with conflicting obligations. The
(CBD). See Table 1 for examples of workers whose poten- 1990 Americans with Disabilities Act prohibits discrimina-
tial impairment appears to be inconsistent with the likely tion on the grounds of disability. Because cannabis is illegal
results of drug testing. under federal law, federal courts have ruled that the ADA
If an employee tests positive for marijuana, the provides no protection even for prescribed use. But some
employer isn’t immediately informed. Instead, under DOT state laws specifically forbid any discrimination for medical
regulations and SAHMSA’s mandatory guidelines, the marijuana use. For example, in Barbuto v. Advantage Sales
results are reviewed by a Medical Review Officer (MRO), a and Marketing, LLC, the Supreme Court of Massachusetts
licensed physician responsible for evaluating drug testing allowed an employee to sue for disability discrimination
results. Workers who test positive are contacted by the when she was fired for a positive marijuana test. If the
MRO and queried about the result. Positive results that company has a policy of firing or refusing to hire because of
are a consequence of a legitimate prescription for anything positive drug tests, but the positive test results from med-
other than marijuana are reported as negative. Employees ically prescribed marijuana, the worker might prevail in a
who test positive but don’t have a prescription can opt to lawsuit.
have the specimen tested at another approved laboratory Even the most lenient state laws don’t require employ-
to confirm the results of the initial testing. ers to allow employees to use marijuana at work or to work
If the MRO validates the test result as positive, the under the influence of marijuana.

27 www.aiha.org |
 THE EMPLOYER’S DUTY from peak. Tests of a worker for THC levels in blood,
Drug testing was instituted because impaired workers are saliva, or urine could very well be negative even when the
dangerous workers. With many drugs, a clear correlation worker is obviously impaired.
exists between drug levels measured in the body and For marijuana, impairment tests would need to be
impairment. That correlation isn’t present with mari- based solely on the ability to perform certain tasks. If
juana. Employers need to look for alternatives: refusing the tasks aren’t correlated specifically with marijuana’s
to tolerate impaired performance, training supervisors effects, there is a risk of considering people “guilty” not
on how to recognize and handle perceived impairment, because of marijuana, but because of some other factor.
and developing clear policies that communicate to their Consider an employee under an incredible amount of
workers that impaired performance, for whatever reason, stress. Would it be fair for an employer to discipline him
cannot be tolerated in the workplace. The policies need to because of the stress-caused impairment? The use of
be clear, communicated, and not punitive. illegal drugs is not protected under the Americans with
Measuring impairment also presents difficulties. Disabilities Act, but disabilities are protected. Could using
According to a 2017 report from the National Highway a test of impairment as a test of employment put employ-
Traffic Safety Administration, peak impairment occurs ers in legal jeopardy? Blood and saliva testing would
90 minutes after smoking marijuana. By that time, THC detect THC instead of the metabolite and would reflect
levels in blood and saliva have dropped over 80 percent very recent use of marijuana, but positive tests don’t nec-
essarily indicate impairment.
The Canadian Centre for Occupational Health and
RESOURCES Safety (CCOHS) has developed a strategy for addressing
American Family Physician: “Urine Drug Screening: A Valuable Office Procedure,” bit.ly/afpscreening workplace impairment from marijuana. CCOHS notes
(March 2010). that impairment can result from fatigue, life stresses,
The American Journal on Addictions: “The Effect of Cannabis Compared with Alcohol on Driving,” bit.ly/ prescription drugs, and so on. CCOHS makes it clear that
ajoacannabis (May-June 2009). Canadian employers have a duty to provide a safe work
Barbuto v. Advantage Sales and Marketing, LLC, bit.ly/barbutocase. environment, as well as a duty to accommodate employ-
Canadian Center for Occupational Health and Safety: “What You Need to Know about Marijuana Use ees with diagnosed medical conditions or disabilities.
and Driving,” bit.ly/ccohsmarijuana (PDF, 2017). Employers in the U.S. should embrace this duty, too.
Canadian Centre for Occupational Health and Safety: Workplace Strategies: Risk of Impairment from
Cannabis, 3rd Edition (2018).
LAMONT BYRD is director of Safety and Health for the
International Brotherhood of Teamsters. He can be reached
Department of Transportation: Title 49 Part 382, Controlled Substances and Alcohol Use and Testing, at [email protected].
Subpart A, Section 382.101.
Drug Enforcement Agency: Drug Scheduling, bit.ly/deaschedule. CARL W. HEINLEIN, ARM, CIT, CPEA, CRIS, CSHM, CSP,
EveryCRSReport.com: “Defining Hemp: A Fact Sheet,” bit.ly/crshemp (March 2019). FAIHA, OHST, STSC, is senior safety consultant at the
American Contractors Insurance Group. He can be reached
Food and Drug Administration: “What You Need to Know (And What We’re Working to Find Out) About
at [email protected].
Products Containing Cannabis or Cannabis-Derived Compounds, Including CBD,” bit.ly/fdacanna
biscbd.
JANET L. KEYES, CIH, FAIHA, is a founder and principal
Government of Canada: “Cannabis and Your Health,” bit.ly/cannabishealthcanada. of CHESS, a safety and health consulting firm. She can be
JAMA: “Labeling Accuracy of Cannabidiol Extracts Sold Online,” bit.ly/jamacbd (November 2017). reached at [email protected].
Journal of Analytical Toxicology: “Production of Identical Retention Times and Mass Spectra for
JASON MCINNIS is the Canadian Director of OH&S for the
Δ9-Tetrahydrocannabinol and Cannabidiol Following Derivatization with Trifluoracetic Anhydride
Boilermakers International union. He can be reached at
with 1,1,1,3,3,3-Hexafluoroisopropanol,” bit.ly/joatspectra (January 2012).
[email protected].
Journal of Analytical Toxicology: “Urinary Elimination of 11-Nor-9-carboxy- 9-tetrahydrocannnabinolin
Cannabis Users During Continuously Monitored Abstinence,” bit.ly/joatcannabis (October 2008). DIANE RADNOFF, P.Eng., M.Eng., CIH, is senior occupa-
Journal of Occupational and Environmental Medicine: “Medical Marijuana in the Workplace: Challenges tional hygienist with Alberta Ministry of Labour and Immi-
and Management Options for Occupational Physicians,” bit.ly/joemmarijuana (May 2015). gration. She can be reached at [email protected].
National Highway Traffic Safety Administration: “Marijuana-Impaired Driving: A Report to Congress,”
bit.ly/nhtsamarijuana (July 2017). SCOTT SCHNEIDER, CIH, FAIHA, recently retired as
director of Occupational Safety and Health for the Labor-
National Safety Council: “Implications of Drug Use for Employers,” bit.ly/nscemployersdrug.
ers’ Health and Safety Fund of North America. He can be
The New York Times: “CBD or THC? Common Drug Test Can’t Tell the Difference,” bit.ly/cbdthctest reached at [email protected].
(October 2019).
Redwood Toxicology Laboratory: “Marijuana Drug Information,” bit.ly/redwoodmarijuana. The authors are members of a project team for the AIHA
Substance Abuse and Mental Health Services Administration: Federal Laws and Regulations, bit.ly/ Construction Committee.
samhsalaws.
World Health Organization: “The Health and Social Effects of Nonmedical Cannabis Use,” bit.ly/ Send feedback to [email protected].
whocannabis (PDF, 2016).

| June/July 2020 28
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HAZARDOUS DRUGS
in Veterinary Medicine

BY SHELLEY R. CARRY
USP <800> Raises Awareness of
an Obscure Concern

V
eterinary care workers encounter a plethora of hazards in their
daily work. In addition to the animals themselves, which need
to be restrained so they don’t inflict injuries, veterinary care
workers can be exposed to infectious organisms, bloodborne
pathogens, hazardous chemicals, musculoskeletal disorders,
workplace violence, fire, radiation, waste anesthetic gases, and noise.
Recently, the promulgation of the United States Pharmacopeia (USP)
General Chapter 800 standard has led to increased interest in preventing
exposure to hazardous drugs in veterinary medicine providers.

antoine-photographe/stock.adobe.com.
| June/July 2020 30
 When most people hear the term “hazardous drug,” of Veterinary Medicine and president-elect of the Society of
they usually think of chemotherapy drugs administered Veterinary Hospital Pharmacists, “this would be rare and
to patients within a human healthcare setting. Veterinary likely to occur only in a university setting.”
care workers also administer a fair number of hazardous Another avenue of enforcement of USP standards would
drugs, albeit to furrier patients with two (or more) legs in be through the Board of Veterinary Medicine, but accord-
some rather unorthodox environments. The potential for ing to an article from the Veterinary Information Network
exposure to hazardous drugs, and the challenges related to Services, as of February 2018 only four states—Delaware,
minimizing it, are quite similar in veterinary and human Georgia, New Mexico, and Washington—had confirmed
healthcare settings. that they will either be amending or have already incor-
USP is a nonprofit organization that develops stan- porated USP <800> language into their state’s veterinary
dards for the uniform preparation of drugs to ensure their practice act. In Alaska, Missouri, Nevada, New Hampshire,
quality, potency, and purity. USP <800> was developed and Virginia, USP <800> was “under review.”
with the goal of protecting the health and safety of all Many states have adopted or are in the process of
healthcare workers and patients who may be exposed adopting their own OSHA standards related to hazard-
to hazardous drugs. On December 1, 2019, USP <800> ous drugs—for example, North Carolina and Washington
became official, yet informational only until updates to have adopted OSHA standards, while California has a rule
USP chapters <795> and <797> become official. The effec- pending—which would impact veterinary care workers. If
tive dates for those chapters have yet to be determined. your state does not have a local OSHA standard specific
The unique aspect of USP <800> is that its scope is not to hazardous drugs, there is always the OSHA Hazard
limited to the pharmacy space: USP <800> is applicable Communication standard (29 Code of Federal Regulations
to personnel handling hazardous drugs in all healthcare 1910.1200), which requires employers to provide informa-
settings, including pharmacists, nurses, veterinarians, and tion about the hazards of each chemical in the workplace;
technicians. USP <800> provides an 18-section framework and the OSHA General Duty Clause, which stipulates that
to help veterinarians protect their staff from exposure each employer furnish to each of its employees a workplace
to hazardous drugs from the moment the drug enters an that is free from recognized hazards that are causing or
organization to the time it leaves, encompassing prepara- likely to cause death or serious physical harm.
tion, administration, use of engineering controls, personal
protective equipment, training, and disposal. DEFINING “HAZARDOUS DRUG”
The foundation for a successful and comprehensive pro-
ENFORCEMENT OF USP <800> gram for safe handling of hazardous drugs is a complete
The enforcement of USP standards is unclear and varies and accurate inventory of hazardous drugs used within the
across local, state, and federal agencies as well as veteri- veterinary setting. According to USP <800>, “an entity
nary medicine and pharmacy licensing boards. Veterinary must maintain a list of hazardous drugs, which must
medicine may be practiced by veterinarians licensed by the include any items on the current National Institute for
Board of Veterinary Medicine at private clinics within the Occupational Safety and Health (NIOSH) list that the entity
local community; veterinary hospitals that offer more spe- handles.” NIOSH defines a drug as hazardous if it causes
cialized services such as oncology, orthopedics, cardiology, cancer or embryonic malformations, interferes with the
and dermatology; and research facilities at universities development of the fetus, impairs reproduction, damages
and specialty schools of medicine, which may employ organs at low doses, or mutates genetic information within
pharmacists licensed by a separate Board of Pharmacy. If cells. NIOSH regularly reviews drugs approved by the Food
the state Board of Pharmacy has adopted USP standards, and Drug Administration and publishes a list of hazardous
the pharmacy licensure process offers opportunities for drugs that meet the agency’s criteria. The list released in
enforcement, but according to Emily Sorah, director of 2016 contains 266 hazardous drugs grouped into antineo-
clinical pharmacy services at North Carolina State College plastics; non-antineoplastics that meet one or more of the

In April, CDC issued interim guidance to protect veterinary providers from COVID-19.
Veterinarians and Although CDC is aware of a small number of animals reported to be infected with
SARS-CoV-2 after close contact with people who have COVID-19, at this time there
is no evidence that animals play a significant role in spreading the virus. Review the
interim guidelines at bit.ly/cdcvetcovid.

31 www.aiha.org |
 manage hazardous drugs, the requirements surrounding
implementation can be quite overwhelming, especially
for small veterinary practices that have limited safety
resources. No doubt, Section 5 on facilities and engineering
controls is the most challenging section to implement. Sec-
tion 5 requires substantial capital investment to renovate
existing spaces to meet USP <800> containment primary
engineering control (C-PEC) requirements such as the
installation of appropriate biological safety cabinets within
an appropriate containment secondary engineering control
(C-SEC). (An example of a C-SEC is a negative-pressure
room to protect the worker from exposure to hazard-
ous drugs and protect the preparation from microbial
contamination.)
Overcoming the renovation hurdle to achieve protec-
tion for workers and drug preparation is enough to give
even the most experienced design consultant pause. Sorah
monkeybusinessimages/Getty Images recommends focusing on low-hanging fruit to minimize
exposure to hazardous drugs and consider outsourcing
The enforcement of USP standards areas or processes where you may not be able to achieve

varies across local, state, and

compliance. Many online tools are available to assist in
the identification of program gaps; some are listed in the

federal agencies as well as

Resources section at the end of this article.

veterinary medicine and pharmacy CLOSED SYSTEM DRUG-TRANSFER DEVICES

Closed system drug-transfer devices, or CSTDs, are readily

licensing boards. available supplemental engineering controls that offer an

additional level of protection by limiting the aerosolization
of hazardous drugs during compounding and adminis-
NIOSH criteria for a hazardous drug; and non-antineo- tration. Cassibry Fisher recommends “checking with the
plastic drugs that primarily have adverse reproductive CSTD distributor to determine if they offer education and
effects. (Ed. note: NIOSH released its most current hazard- training services as part of the product roll-out.”
ous drug list for public comment on May 1, 2020, too late
to be considered for this article.) PERSONAL PROTECTIVE EQUIPMENT
However, as Sorah noted, “The [2016] NIOSH haz- PPE such as chemotherapy-tested gloves, impermeable
ardous drug list focuses on human drugs and does not gowns, head/hair/shoe/sleeve covers, goggles, face shields,
list veterinary-specific drugs.” Jenny Cassibry Fisher, and respirators protect workers from surface residues and
director of education at Practivet, a provider of veterinary aerosols generated from handling hazardous drugs during
equipment, agreed that “the lack of a veterinary-specific receipt, storage, transport, compounding, administration,
hazardous drug list makes it challenging for veterinary deactivation/decontamination/cleaning/disinfection, spill
providers to identify all the hazardous drugs used within management, and waste disposal. PPE varies by risk of
veterinary medicine and that smaller practices do not have exposure and activity performed. To determine the appro-
the bandwidth to evaluate new drugs to determine if they priate PPE, conduct an exposure assessment that reviews
meet the NIOSH criteria.” dosage, formulation, route of exposure, and frequency
Jerald Ovesen, a NIOSH pharmacologist who coor- and duration of exposure. USP <800> stipulates that “dis-
dinates the agency’s hazardous drug list, indicated that posable PPE must not be re-used. Reusable PPE must be
“although the [2016] NIOSH hazardous drug list is under- decontaminated and cleaned after use.”
going revisions, it will not contain veterinary-specific drugs Gloves. Gloves used for compounding and admin-
at this time, but NIOSH does consider input from the istration of chemotherapy drugs must meet the ASTM
public concerning potential changes to the list.” In lieu of International D6978 standard, which tests the permeation
a NIOSH veterinary hazardous drug list, Cassibry Fisher (breakthrough) of nine chemotherapy drugs through the
recommends “using the current NIOSH hazardous drug glove material over a certain period of time. Although ASTM
list as the foundation of the facility-specific list and add D6978 gloves are not required when handling non-chemo-
veterinary-specific drugs that have similar toxicological therapy drugs, it is a best practice to use the ASTM D6978
profiles to the human drugs” on the NIOSH list. gloves. If you are uncertain whether your current gloves
meet the ASTM D6978 requirements, look on the glove box
BRIDGING THE IMPLEMENTATION GAP for the symbol indicating ASTM D6978 testing or contact
Although USP <800> provides an 18-section framework to your distributor or manufacturer for the glove specifications.

| June/July 2020 32
Users should change gloves every 30 minutes or when torn, exposed to hazardous chemicals must be trained prior to
punctured, or contaminated, and wash their hands with their initial assignment on how to work safely with the
soap and water after removing gloves. hazard. USP <800> essentially reinforces this require-
Gowns. Compounding and administration (via injec- ment, but it is specific to working with hazardous drugs
tion) of chemotherapy drugs requires the use of a gown and requires reassessment at least every 12 months.
that resists the drugs’ permeability. Unfortunately, there is Sorah tackled the training dilemma by developing online
no current test for permeability of chemotherapy drugs on learning modules to provide quick and efficient training
gowns, so manufacturers tend to use chemotherapy drugs with standardized content for many staff who handle
as surrogates for ASTM F739, Test Method for Permeation hazardous drugs. “Boards of pharmacy typically also
of Liquids and Gases Through Protective Clothing Materi- prefer an observational checklist demonstrating under-
als Under Conditions of Continuous Contact. USP <800> standing and skills,” Sorah said, adding that, at North
recommends using “disposable gowns made of polyeth- Carolina State, the observational checklist is indepen-
ylene-coated polypropylene or other laminate materials dent of online training. But she cautioned that “training
[that] offer better protection than those made of uncoated through staff meetings is likely more efficient in small
materials.” When in doubt, review the manufacturer speci- clinic settings.”
fications, especially for isolation gowns, which typically are Quick wins with low-hanging fruit can also be achieved
not made with polyethylene-coated polypropylene or other through labeling of hazardous drugs, obtaining safety
laminate materials. As with gloves, gowns are required data sheets, and procuring spill kits. Sorah recommends
when handling non-chemotherapy hazardous drugs. The “focusing on the ‘must’ versus the ‘should’ language of
use of gowns made with polyethylene-coated polypropyl- USP <800>, and remember that the implementation of
ene or other laminate materials, though not required, is USP <800> is a learning process and to remain flexible in
a best practice. Change gowns per manufacturer recom- workflows to achieve proper compliance.”
mendations or every two to three hours in the absence of
manufacturer recommendations. SHELLEY R. CARRY, CIH, CSP, is principal consultant at
Eye and face protection. USP <800> states that Kaiser Permanente. She can be reached at shelley.rae.
“appropriate eye and face protection must be worn when [email protected].
there is a risk for spills or splashes of hazardous drugs or Acknowledgments: The author thanks Jerald L. Ovesen,
hazardous drug waste materials when working outside of PhD; Jenny Cassibry Fisher, RVT, VTS-Oncology; and
a C-PEC (e.g., administration in surgical suite, working Emily Sorah, PharmD, RPh, DICVP, FACVP, FSVHP, for
at or above eye level, or cleaning a spill).” Use of eye and their contributions to this article.
face protection is especially important when veterinarians
administer electrochemotherapy (delivery of chemother- Send feedback to [email protected].
apy drugs through electric pulses to tumors) on large
animals, as this work tends to be above eye level.
A common misconception when working with hazard- RESOURCES
ous drugs that present a potential splash hazard to the ASTM International: ASTM D6978 - 05(2019), Standard Practice for Assessment of Resistance of Medical Gloves to
eyes and face is that the use of safety glasses is adequate. Permeation by Chemotherapy Drugs (2019).
Safety glasses are similar in shape to prescription glasses ASTM International: F739-12e1, Standard Test Method for Permeation of Liquids and Gases through Protective
and sunglasses—they have open sides that allow a splash to Clothing Materials under Conditions of Continuous Contact (2012).
reach the eyes above, under, or around the lenses. Chem- California OSHA: Occupational Exposure to Antineoplastic Drugs, bit.ly/caloshahazdrugs.
ical safety goggles that seal to the face on all sides are the
CriticalPoint: 2020 USP <797> & <800> Compliance Study and Gap Tool, www.800gaptool.com.
appropriate type of protection from splash hazards coupled
HazMedSafety.com: “Self-Assessment of Safe Handling Practices for Hazardous Drugs,” www.hazmedsafety.
with a face shield to prevent splashes to the face. Another
com.
misconception is that a face shield is adequate protection
in lieu of eye protection. As with safety glasses, a splash NIOSH: NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2016, bit.ly/hazardous
drugs2016 (2016).
can enter the eyes and face through the openings above,
under, and around the face shield. North Carolina OSHA: 13 NCAC 07G.0101, Handling of Antineoplastic Agents.
Respiratory protection. An exposure assessment OSHA: Occupational Safety and Health Standards, Personal Protective Equipment, Respiratory Protection,
should be conducted to determine which tasks require bit.ly/osharespprotection.
respiratory protection and which type is appropriate. In OSHA: Occupational Safety and Health Standards, Toxic and Hazardous Substances, Hazard Communication,
addition, ensure that you follow the OSHA respiratory bit.ly/hazcomstandard.
protection standard (29 CFR 1910.134), which requires USP: United States Pharmacopeia General Chapter 800, Hazardous Drugs — Handling in Healthcare Settings,
medical clearance, fit testing, and training for those tasks bit.ly/usp8002017 (PDF, 2016).
that require respiratory protection. VIN News Service: “Veterinary Profession Mulls Implementing USP 800,” bit.ly/vetsusp800 (February 2018).
Washington OSHA: WAC 296-62-500 Hazardous Drugs, bit.ly/washoshahazdrugs (PDF).
EDUCATION AND TRAINING
The OSHA hazard communication standard (29 CFR
1910.1200) requires that all employees who may be

33 www.aiha.org |
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 COMMUNITY

AIHA INTRODUCES “BACK TO

WORK SAFELY” INITIATIVE

A
IHA announced the tion, general office settings, gyms sectors, including government, the
Register for AIHA’s “Back to Work Safely” and workout facilities, hair and nail private sector, higher education, and
Annual Business initiative in early May salons, retail, restaurants, and ride- consulting.
Meeting as the United States share, taxi, limo, and other passenger AIHA’s initiative was launched in
economy began to reopen follow- driver-for-hire companies. conjunction with Mark Cuban, entre-
AIHA’s Annual Business Meeting
ing the shutdown of businesses in “Owners must not assume that preneur, investor, and owner of the
will be held virtually on Thurs-
most industries due to the COVID-19 they can walk back into a building National Basketball Association's
day, June 11, from 12 to 1 p.m.
pandemic. As part of the initiative, that has sat unused or with low occu- Dallas Mavericks. Cuban is one of
ET, to introduce incoming offi-
AIHA published free industry-specific pancy for weeks or months,” said several sports executives serving on
cers and directors and address
guidelines for the safe reopening of AIHA President Kathleen S. Murphy, the White House’s council to reopen
other association business. All
businesses as restrictions are lifted. CIH. “As professionals committed to the economy.
members who wish to attend
The new guidelines are intended to preserving and ensuring health and All resources are available to
the meeting must register
help business owners, employers, safety in the workplace and commu- download from backtoworksafely.
in advance.
employees, and consumers imple- nity, it is our ethical responsibility to org. A link to the guidance documents
To ensure a quorum for the ment science-based procedures for develop science-based recommen- will also be featured on CDC’s web-
meeting, a call for proxy votes limiting the spread of SARS-CoV-2, dations for limiting the transmission site.
was issued electronically. the virus that causes COVID-19. of COVID-19 as employers begin to AIHA continues to provide accurate
Through the proxy vote form, The guidance includes recom- reopen their workplaces.” and timely resources to members
members who cannot attend the mendations related to ventilation, The “Back to Work Safely” doc- and the public about the current
meeting may designate another personal hygiene, physical distanc- uments were developed by AIHA’s COVID-19 pandemic via its Coronavi-
AIHA member to vote in their ing, and enhanced cleaning in the COVID-19 Re-Open America Guide- rus Outbreak Resource Center at bit.
place. Members who plan to workplace. Smaller businesses that lines Task Force, which comprises ly/coronavirusresources. The asso-
attend the meeting do not need don't have readily available resources more than a dozen OHS experts ciation is also doing its part through
to designate a proxy. for occupational health and safety who worked quickly with the goal of partnerships, government relations,
AIHA members who wish to may find AIHA’s guidance particularly helping people stay healthy as the and member outreach to the public
register to attend the meeting helpful. Guidelines are available for economy reopens. Members of the health sector. Learn more about
or access the proxy vote form at-home service providers, construc- group represent a variety of business AIHA’s efforts at bit.ly/covidefforts.
can access those links via
AIHA’s website at bit.ly/
aihameeting2020. Call for New AIHA-LAP, LLC Volunteers
AIHA Laboratory Accreditation Programs, LLC is seek- environmental lead, environmental microbiology, food,
ing qualified volunteers to fill positions on the Analytical and unique scopes.
Accreditation Board and the Technical Advisory Panel to Newly appointed volunteers will be required to attend
serve terms beginning in March 2021. the LLC’s annual training and orientation meeting in the
The AAB is responsible for approving laboratories for first quarter of 2021.
accreditation and reaccreditation once site assessments AAB and TAP applications are available from the AIHA
are conducted. AAB members are also responsible for LAP website at bit.ly/lapleadership. Applications will be
approving policy changes and participating on ad hoc accepted until July 30, 2020. For additional information,
task forces formed to address certain policy matters please email AIHA LAP Managing Director Cheryl O.
that may arise. TAP members advise the staff and AAB Morton at [email protected].
on technical laboratory matters and review accreditation More information about AIHA LAP is available at aiha
packages for the major programs: industrial hygiene, accreditedlabs.org.

| June/July 2020 36
 COMMUNITY

AIHA Joins SAFER Task Force to Ensure Employee Safety In Memoriam

Through the Pandemic Finis Cavender, PhD, DABT, FAIHA,
passed away April 5 from complications
AIHA has joined the National Safety "With SAFER, we are bringing for complicated and challenging
resulting from a bicycle accident. A
Council task force to support the the best minds together to ensure times, with practical implementa-
member for more than 20 years, Mr.
"SAFER: Safe Actions for Employee Americans have the safest transition tion resources.
Cavender was named an AIHA Fellow
Returns" initiative, a comprehensive back to work possible," said Lor- "Worker health and safety is
in 2019. He was heavily involved with
plan to guide employers through the raine M. Martin, president and CEO the center of everything we do at
the Emergency Response Planning
process of safely resuming tradi- of NSC. "We are thrilled to have the AIHA," said AIHA President Kath-
Guidelines Committee, and also served
tional work and operations now and partnership of AIHA to help us on our leen S. Murphy, CIH. "We are look-
on the Toxicology and Workplace Envi-
after the pandemic. In partnership mission to make workplaces safer." ing forward to providing NSC with
ronmental Exposure Levels Committees.
with NSC, AIHA joins Fortune 500 Led by NSC, SAFER will issue our best practices, expertise, tools,
He spent his professional career as an
companies in leading safety orga- recommendations and guidance and solutions so that worker safety
inhalation toxicologist and participated
nizations, public health profession- for employers, including small and continues to be an employer priority
on committees of the Society of Toxicol-
als, and experts to prioritize worker mid-size companies, across a vari- in a post-pandemic world."
ogy and the Science Review Panel of the
safety and navigate the changed ety of industries. SAFER will pro- For more information about the
National Library of Medicine.
work environment. vide employers tools and solutions task force, visit nsc.org/safer.

AIHA Launches New Job Board Guidance on Workplace

Cleaning for COVID-19
In April, AIHA announced a new job Job seekers can use the new Barbour, AIHA's senior manager of
A guidance document developed by
board as part of its CareerAdvan- board to search for openings in member and customer relations.
AIHA's Indoor Environmental Quality
tage Center. AIHA collaborated with the U.S. and abroad, make their “We strongly believe that it will set
Committee focuses on workplace clean-
YM Careers, a leader in association resumes more accessible, and pre- a new standard for the way people
ing, disinfecting, and safety related to
career resources and events, to pare for job interviews with coach- and companies find jobs and talents
COVID-19 in non-healthcare settings.
create a job board intended to make ing sessions. Employers can use in our industry.”
According to the guidance (PDF, bit.ly/
it easier for industrial hygiene and the board to post jobs online, find Access the new job board at aiha.
cleaningcovid), industrial hygienists
occupational health professionals qualified resumes through data- careerwebsite.com.
can help employers reduce the risk of
to advance their careers and for base search, manage applications, Sponsored by AIHA’s Career and
infection in non-healthcare workplaces
companies to attract the top appli- and access reporting information Employment Services Committee,
by borrowing from the principles, proce-
cants from the IH/OH field. The in one place. CareerAdvantage connects IH/OH
dures, and practices used to proactively
new platform provides a variety of “The new CareerAdvantage job job seekers with employers across
prevent the spread of infectious agents
employment resources, tools, and board will be a powerful recruit- all industries. Visit the CareerAd-
in hospitals.
services for IH/OH job seekers and ing tool for our members and our vantage Center on AIHA’s website
employers. partner companies,” said Wanda at bit.ly/AIHA_Career.
Access Free Webinars from

Dates and Deadlines The Synergist

The Synergist hosts free webinars
JUNE 11 SEPT. 21–24 AUG. 21–26, 2021
throughout the year, and members and
AIHA’s Annual Business Meeting. AIHA’s “Fundamentals of Industrial New dates for IOHA 2021, the 12th
other interested individuals can access
Visit bit.ly/aihameeting2020 to learn Hygiene” course in Westerville, Ohio. IOHA International Scientific Con-
past recordings at any time. Synergist
how to attend virtually. Visit bit.ly/aihafihcourse. ference, in Daegu, South Korea. Visit
Webinars cover important topics that
ioha2020.org.
impact industrial hygiene and occupa-
SEPT. 15–16 OCT. 19–21
tional health and safety professionals.
2020 AIHA-Rocky Mountain Section AIHA’s “Exposure and Chemical
Delivered by experts from sponsoring
Fall Technical Conference in Arvada, Monitoring - Beyond IH Fundamen-
companies in three distinct formats,
Colorado. Visit aiha-rms.org/events. tals” course in Westerville, Ohio. Visit
these webinars can help you learn about
bit.ly/aihamonitoring.
best practices and emerging technol-
SEPT. 15–17
ogies relevant to your work. View the
PSX 2020 (formerly the Product
archived webinars at aiha.webvent.tv.
Stewardship Conference) in Hous- For a complete list of events, visit
ton, Texas. Visit bit.ly/psx2020. www.aiha.org/calendar.

37 www.aiha.org |
 BY THE NUMBERS

COVID-19 AT MEAT AND POULTRY

From “COVID-19 Among Workers
in Meat and Poultry Processing
PROCESSING FACILITIES
Facilities—19 States, April 2020”:
“Facility challenges included In late April, OSHA and CDC published joint interim guidance intended to protect workers at
structural and operational practices meat and poultry processing facilities from exposure to COVID-19. A subsequent CDC report
that made it difficult to maintain of facilities across 19 states quantified the extent of disease spread at these workplaces be-
a 6-foot distance while working, tween April 9 and April 27. The report identified several challenges to effective prevention and
especially on production lines…. control of COVID-19 at the facilities, such as difficulty imposing distance between workers and
The pace and physical demands of implementing disinfection guidelines for the disease. Information from the report is presented
processing work made adherence below.
to face covering recommendations
difficult, with some workers observed
covering only their mouths and
frequently readjusting their face

115
coverings while working.”

Number of meat and poultry

processing facilities that reported
cases of COVID-19 among workers
between April 9 and April 27.

130,578 Total number of workers at the

affected facilities.

4,913 Number of workers who contracted

COVID-19.

SOURCE 20 Number of workers who died

from the disease.
CDC: Morbidity and Mortality Weekly
Report, “COVID-19 Among Workers
in Meat and Poultry Processing
Facilities—19 States, April 2020,” bit.ly/
mmwrmeatprocess (May 2020).

Percentage of meat and poultry processing

18.2
workers (377 of 2,075) diagnosed with
COVID-19 in Iowa, highest among the 19
states that submitted data.

| June/July 2020 38
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