Qualified Safety and Industrial Hygiene Professionals in Healthcare

Note: A version of this post was originally published in in The Monitor, a technical publication of the American Society of Safety Engineers' Industrial Hygiene Practice Specialty, in August 2015.

Healthcare workers have the potential to experience a wide variety of occupational injuries. Under the Occupational Safety and Health Administration (OSHA) Healthcare Safety and Health Topics webpage, OSHA lists the following as potential hazards: blood-borne pathogens (BBP) and other biological hazards, chemical and hazardous drug exposures, waste anesthetic gas exposures, respiratory hazards, ergonomic hazards, laser, hazards, workplace violence, and radioactive and x-ray hazards.

Chemicals such as formaldehyde, glutaraldehyde, ethylene oxide, peracetic acid, ortho-phthalaldehyde (OPA), and environmental disinfectants are sources of potential hazardous exposure for healthcare workers (OSHA, 2015). There is insufficient guidance for healthcare safety personnel to evaluate the risks associated with the use of these chemicals. Research evaluating the potential for synergism among chemicals used in healthcare that may adversely affect healthcare workers is scarce. The heightened awareness of infectious diseases such as Ebola and Middle East Respiratory Syndrome (MERS) has led to increased use of environmental disinfectants throughout healthcare and other workplaces. More research and expertise is needed by qualified industrial hygienists and safety experts to properly recognize, evaluate, and control the hazards present in healthcare.

Despite the improved focus on patient safety, quality control and regulatory compliance, the injury and illness rate from healthcare workers are almost twice as high as the private industry rate. A news release from OSHA on June 25, 2015 explained that OSHA will be expanding enforcement activity in healthcare facilities. OSHA�s enforcement focus will be on preventable injuries, such as those from patient handling, BBP, workplace violence, tuberculosis, and slips, trips, and falls (OSHA, 2015).

OSHA has developed resources, checklists, and guidance for healthcare safety relating to building a culture of safety, injury and illness prevention programs and/or safety and health management systems, infectious diseases, safe patient handling, and workplace violence. The National Institute for Occupational Safety and Health (NIOSH) has also developed resources for healthcare safety relating to hazardous drug exposures, waste anesthetic gases, and latex allergies. Additional guidance is available from accrediting organizations such as The Joint Commission, DNV Healthcare, and Center for Improvement in Healthcare Quality(CIHQ), among others.

So, with all the resources and guidance available, why are the injury and illness rates so high among healthcare workers?

Some safety and health professionals might argue that the healthcare organizations are too focused on patient safety as opposed to employee safety, in order to improve their ratings and popularity. To combat this belief, The Joint Commission developed a monograph entitled �Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation� that explains the methods of coordinating quality improvement activities that will benefit both the patients and the workers. In the Foreword of the monograph, The Joint Commission explains that: �The organizational culture, principles, methods, and tools for creating safety are the same, regardless of the population whose safety is the focus. In fact, the same principles, methods, and tools may be separately used by different groups (clinical, human resource, and general liability personnel) within an organization� (The Joint Commission, 2012). This is not a surprise to healthcare safety personnel who came to the healthcare industry after training in other industries, but may be a pleasant discovery for healthcare safety personnel who were promoted into their position from other clinical or non-clinical jobs.

There is variability in the tasks performed by healthcare safety personnel. Depending on the size of the campus or healthcare organization, healthcare safety personnel may have many other responsibilities beyond occupational and patient safety. Some healthcare safety personnel serve as the Director of Materials Management, Director of Facilities, Risk Manager, or Director of Infection Prevention, and the safety management aspect of their job is only a small portion of their daily responsibilities. Others may also serve as the Compliance and Privacy Officer, Radiation Safety Officer, Laser Safety Officer, and other technical and regulatory required positions.

In a quick internet search of posted jobs for �healthcare safety officer� or �EOC safety officer,� the following job tasks and requirements were listed (not a comprehensive list):

�  Conduct training of staff	�  Know OSHA and EPA regulations	�  Radiation and laser safety knowledge	�  Chemical safety and proper disposal
�  Develop education modules	�  Know NFPA Life Safety Code	�  Emergency management	�  Chair the EOC Committee
�  Conduct fire drills	�  Process improvement	�  Work independently	�  Risk assessment
�  Consultation and assessment	�  Understand project management	�  HICS and HSEEP Exercises	�  5 to 7 years� experience in safety
�  Manage hazmat program	�  Familiar with ADA compliance	�  Act as community liaison	�  B.S. or M.S. in health sciences or safety
�  Conduct emergency spill response	�  Assist with laboratory safety	�  Provide regulatory oversight	�  Professional certification(s)

Healthcare safety personnel usually serve on a facility�s Environment of Care (EOC) Committee, which is an interdisciplinary team tasked with managing a facility�s physical environment in six functional areas: safety, security, hazardous materials and waste, fire safety, medical equipment, and utilities. The EOC Committee should have representation from clinical staff, security, healthcare administration, biomedical engineering, facilities engineering, infection prevention, employee health, laboratory, and other areas such as research administration that may be applicable to the facility.

Aspects of the Environment of Care are an integral part of the survey instruments used to score hospitals on sites such as Hospital Safety Scoreor the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS). The results of these surveys are supposed to be used by patients to select hospitals and health systems based on patient safety and outcomes. The HCAPHS survey asks two questions related to the physical environment of the hospital and patient safety (Centers for Medicare & Medicaid Services, 2015):

• During this hospital stay, how often were your room and bathroom kept clean?
• During this hospital stay, how often was the area around your room quiet at night?

The Hospital Safety Score provides patients with a score for each hospital in the U.S. on an A through F scale, measuring safe practices such as (The Leapfrog Group, 2015):

• Leadership structures and skills
• Culture measurement, feedback, and intervention
• Teamwork training and skill building
• Identification and mitigation of risks and hazards
• Hand hygiene
• Falls and trauma

In reviewing the job tasks and requirements listed previously for healthcare safety personnel, it quickly becomes apparent that individuals holding a Certified Industrial Hygienist (CIH) or Certified Safety Professional (CSP) designation already have much of the required knowledge, skills, and abilities. Individuals with CIH/CSP designation who have not worked in healthcare before may need to learn more about BBP and infectious diseases, hazardous drugs, medical terminology, ionizing radiation, patient safety, laboratory safety, and the accreditation process.

Having a qualified, certified, and well-trained person at the helm of health, safety, and environmental compliance activities may help healthcare facilities to improve their overall culture of safety � both for patients and employees. In an informal survey of hospitals located within Arizona, 23 hospitals were awarded an �A� or �B� designation by the Hospital Safety Score method in June 2015. After those hospitals were identified, a search of LinkedInprofiles was conducted to evaluate whether the hospital had a qualified and trained safety and health professional serving in a healthcare safety role at the facility.

If the individual held a professional certification such as CIH, CSP, Certified Healthcare Safety Professional (CHSP), Certified Professional in Patient Safety (CPPS), orCertified Healthcare Protection Administrator (CHPA), it was noted in the survey. If the individual had also completed a master�s degree in safety, environmental management, business administration, healthcare administration, or other applicable degree, it was noted in the survey. The size of the hospital � and associated complexity of environmental health and safety management � is indicated by the number of licensed patient beds.

Table 1 details the results of the informal survey of Arizona hospitals with a Hospital Safety Score of �A� or �B� � identifying details such as the hospital name and actual number of licensed beds have been replaced with an identification number and a size range. Hospitals included in this survey range from small hospitals with less than 100 licensed beds, to large hospitals with 700 to 750 licensed beds. If the individual serving as the �safety officer� did so in an ancillary capacity (i.e., job title was Director of Facilities), and did not have any formal safety training documented in their LinkedIn profile, the �Safety Professional� selection was �No.� If the individual performed safety functions as the primary role, the �Safety Professional� selection was �Yes.� An �X� indicates that the individual held the professional designation and/or had a relevant master�s degree. 

Table 1: Informal Survey of Arizona Hospitals with a Hospital Safety Score of A or B (June 2015)

The data from this informal survey has been summarized into Tables 2 and 3 below. Table 2 shows the number of Arizona hospitals with a �Safety Professional� (e.g., a �Yes� answer) as compared with the number of Arizona hospitals with a person who acts as safety officer in addition to their other job duties (e.g., a �No� answer). Table 3 shows the number of Arizona hospitals with a �Safety Professional� holding a CIH/CSP, CHSP/CPPS/CHPA, or relevant master�s degree. The hospital size ranges associated with these trained professionals is also provided in Table 3.

Table 2: Arizona Hospitals with  Dedicated Safety Professional (June 2015)

Table 3: Arizona Hospitals with a Qualified and Certified Safety Professional (June 2015)

Of the 23 Arizona hospitals with an �A� or �B� rating on the Hospital Safety Score site in June 2015, 13 (56.5%) had a dedicated safety professional. One of the smaller hospitals (AZ002) was not able to be included in the survey results due to the lack of information about the hospital�s safety officer responsibilities and lack of presence on LinkedIn. Of the 13 dedicated safety professionals, 10 (76.9%) had obtained a professional level certification or relevant master�s degree. Hospitals employing these trained and qualified safety professionals ranged from small (<100 beds) to large (600 beds). Only 3 (30%) of the trained and qualified safety professionals held a CIH or CSP designation. The remainder of the certifications (70%) were from organizations such as the International Board for the Certification of Safety Managers, the Certification Board for Professionals in Patient Safety, and the International Association for Healthcare Security and Safety.

                Although only 10 (43.5%) of the 23 Arizona hospitals earning an �A� or �B� rating on the Hospital Safety Score site had safety and EOC responsibilities performed ancillary to the individual�s other job responsibilities, many of the hospitals represented in this informal survey are part of regional health systems spanning multiple states. These health systems may have regional or corporate level occupational health and safety personnel who serve multiple healthcare campuses and provide technical support to the facility-specific staff.

                As part of the �Improving Patient and Worker Safety� monograph, The Joint Commission listed several topic areas for targeted interventions with the goal of improving safety. Individuals with CIH/CSP designation that are looking to foray into the world of healthcare safety should research strategies, solutions, and benefits associated with this list. Healthcare systems looking to hire safety officers, safety managers, and directors of safety are looking for healthcare-specific knowledge that is difficult to obtain if you have never worked in healthcare before. An abbreviated and modified list of these topics is included below (The Joint Commission, 2012).

• Safe patient handling (including use of lifts and slings)
• Fall prevention (both patient and staff)
• Sharps injury prevention
• Infection prevention (including hand hygiene and personal protective equipment)
• Assault and violence prevention and management
• Security management
• Emergency management (including the Healthcare Incident Command System)
• Exposure to hazardous drugs
• Surveillance and exposure assessment
• Environmental hazards
• Ergonomics and human factors engineering
• Improving safety culture throughout an organization
• Safer design of practices and the built environment

Qualified industrial hygienists and safety professionals are needed to take healthcare safety to the next level. With OSHA promising to increase enforcement action, and accreditation agencies like The Joint Commission requiring documented improvements in safety and quality measures, opportunities for solution-oriented and collaborative safety professionals are becoming available. Industrial hygienists are needed to evaluate acute and chronic exposures to workers that may be inadvertently passed on to patients. Safety experts are needed to bring the industry knowledge from manufacturing, aviation, power generation, and other high-risk industries into the healthcare arena.

As Dr. David Michaels, Assistant Secretary of Labor for Occupational Safety and Health, said in the news release from June 25, 2015: �[�] it�s time for hospitals and the health care industry to make the changes necessary to protect their workers� (OSHA, 2015). Let�s accept this exciting challenge and improve safety for all of the people that enter into, or are employed by, healthcare facilities. 

References

Centers for Medicare & Medicaid Services. (2015, March 20). HCAPHS Online. Retrieved from HCAPHS Survey: http://www.hcahpsonline.org/files/HCAHPS%20V10.0%20Appendix%20A%20-%20HCAHPS%20Mail%20Survey%20Materials%20(English)%20March%202015.pdf

OSHA. (2015, June 27). Healthcare. Retrieved from Safety and Health Topics: https://www.osha.gov/SLTC/healthcarefacilities/

OSHA. (2015, June 25). OSHA adds key hazards for investigators' focus in healthcare inspections. Retrieved from News Release: https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=NEWS_RELEASES&p_id=28197

The Joint Commission. (2012). Retrieved from The Joint Commission: http://www.jointcommission.org/assets/1/18/TJC-ImprovingPatientAndWorkerSafety-Monograph.pdf

The Leapfrog Group. (2015, April). Scoring Methodology. Retrieved from Hospital Safety Score: http://www.hospitalsafetyscore.org/media/file/HospitalSafetyScore_ScoringMethodology_Spring2015_Final.pdf

What's an Exposome? Recent Research on Occupational Exposure Limits

The Journal of Occupational and Environmental Hygiene (JOEH) is the official publication of the American Industrial Hygiene Association (AIHA) and the American Conference of Governmental Industrial Hygienists (ACGIH). JOEH released a supplemental journal issue for 2015 entitled: �Special Issue: State of the Science of Occupational Exposure Limit Methods and Guidance.� 

This supplemental issue contains nine research articles and two introductory/summary articles detailing recent research in occupational exposure limits (OELs). Members of AIHA and/or ACGIH can log in to their respective member portals to view the research articles referenced below. This blog post is a high-level summary of each of the articles, including best practices that can be used by practicing industrial hygiene and safety professionals.

The Past and Future of Occupational Exposure Limits

This introductory article by Jonathan Borak and Lisa M. Brosseau about �The Past and Future of Occupational Exposure Limits� is a quick history of OELs and analysis of the barriers present in developing new OELs. The authors note that the ten articles �present a systematic approach that begins with an understanding of systems biology, mechanisms of action and the early (i.e., �pre-clinical�) effects of toxic exposures including genetic and epigenetic phenomena.� 

The most obvious barrier to developing OELs is the lack of data available that is relevant to human occupational exposure. Another barrier is the difficulty in establishing global exposure limits � since countries are at different stages of industrialization and the necessary controls may be infeasible. The third barrier mentioned by the authors is the lack of a formal, systematic approach to develop, establish, and update OELs.

Occupational Exposure Limit Derivation and Application

In a summary article titled �State-of-the-Science: The Evolution of Occupational Exposure Limit Derivation and Application� authors A. Maier, T. J. Lentz, K. L. MacMahon, L. T. McKernan, C. Whittaker, and  P. A. Schulte provide a review of the research articles provided in the JOEH supplement. The four-page summary article explains that the research articles in the JOEH supplement are not an exhaustive assessment of OELs, but they explain scientific advances to be considered for risk assessment and management of occupational hazards.

Historical Context for OELs

The first research article in this JOEH supplement is �Historical Context and Recent Advances in Exposure-Response Estimation for Deriving Occupational Exposure Limits� by M.W. Wheeler, R. M. Park, A. J. Bailer, and C. Whittaker. In the abstract of the article, the authors explain that most occupational exposure limits are not based on quantitative risk assessment (QRA), and provide examples of exposure-response modeling methods available for QRA. �The key step in QRA is estimation of the exposure-response relationship,� the authors state, recommending the use of statistical tools to properly characterize the risk.

One of the best takeaways of the article is found in Table 1: �Common Impediments to Inference When Developing an Exposure-Response Relationship from Epidemiological Studies.� This table presents issues such as confounding bias, selection bias, the healthy worker effect, reverse causation, and variable susceptibility, and provides the consequences and fixes for these issues when working on exposure-response relationships. Table 1 is a helpful summary for industrial hygienists or safety professionals who are just starting their education into epidemiology.

Another helpful element of the article is found in Table 7: �OEL Estimation Methods,� which sets forth the data requirements, considerations for use, epidemiological considerations, and caveats for estimation methods such as the no observed adverse effect level (NOAEL), traditional benchmark dose (BMD), and biologically-based methods. In the conclusion of the article, the authors recommend that risk managers select the proper �statistical methodology to estimate risks and quantify relevant uncertainties� in occupational risks.

Dosimetry Modeling for Occupational Risk Assessment

An article by Eileen D. Kuempel, Lisa M. Sweeney, John B. Morris, and Annie M. Jarabek explains the �Advances in Inhalation Dosimetry Models and Methods for Occupational Risk Assessment and Exposure Limit Derivation.� This article introduces the basic concepts of dosimetry, explains the hierarchical model selection criteria, considers agent-specific dosimetry and model selection with agent-specific examples, and discusses challenges to implementing dosimetry models and methods in risk assessment and OEL derivation.

When introducing the basic concepts of dosimetry, the authors explain that dosimetry involves determining the amount, rate, and distribution of a substance in the body. They also introduce the development and use of risk-based exposure estimates including the NOAEL, the lowest observed adverse effect level (LOAEL), and the benchmark dose (BMD), which is �the dose associated with a specified risk (e.g., 10%) of an adverse health effect (or benchmark response) as estimated from modeling the dose-response relationship.�

The authors explain that dosimetry is essential for understanding the relationship between exposure and the body�s response. Dosimetry can improve the accuracy of risk assessment by reducing the level of uncertainty in the calculated estimates. Reliable estimates of the internal dose at the target organ or tissue are accomplished by specific measurements or predictive models. 

The article focuses on inhalation dosimetry since it is a significant route of occupational exposure. Detailed mechanisms and models are provided for the respiratory tract, deposition of particles of fibers, clearance and retention of inhaled particles and fibers (including an interspecies comparison), and gas uptake factors. The interspecies comparisons discuss that similar clearance pathways are used by both humans and laboratory animals, but that extrapolation of animal data for human exposure estimates has changed due to an improved understanding of the differences between animal and human respiration.

Using Systems Biology and Biomarkers

The third research article in this JOEH supplement presents the use of �Systems Biology and Biomarkers of Early Effects for Occupational Exposure Limit Setting� as written by D. Gayle DeBord, Lyle Burgoon, Stephen W. Edwards, Lynne T. Haber, M. Helen Kanitz, Eileen Kuempel, Russell S. Thomas, and Berran Yucesoy. As provided in the abstract of the article, this article discusses �systems biology, biomarkers of effect, and computational toxicology approaches and their relevance to the occupational exposure limit setting process.� In the introduction, the authors mention the dearth of toxicity information known at present about tens of thousands of chemicals in use in industry today.

The authors note that complex exposure scenarios, where workers are �exposed to complex mixtures that may have additive, synergistic, or antagonistic actions� makes it difficult to conduct thorough risk assessments. Useful portions of this article include Table 1: �Glossary of Key Terms.� Table 1 provides definitions for key terms used in the article, including: benchmark dose (BMD), benchmark response (BMR), biomarkers, computational toxicology, metabolomics, proteomics, systems biology, and uncertainty factors.

A biomarker is an �[i]nternal [measure] or [marker] of exposures or effects for a chemical or agent in the body.� Research into biomarkers involves an assessment of which biomarkers can be quantitatively linked to human adverse outcomes from occupational exposure. The authors explain that �[e]nvironmental exposures can directly or indirectly cause alterations in gene expression at either the transcriptional (gene expression) or the translational level (proteomics).� Table 4: �Different Types of Biomarkers� shows the type of biomarker (exposure, effect, or susceptibility), its characteristics, and examples.

In the conclusion, the authors explain the advantages of using biomarkers, since they can be used to �establish more appropriate OELs to protect individuals who are at high risk.� They caution that the �whole field of computational toxicology and systems biology is still evolving and results have not been validated in human populations� and that interpretation of biomarker results is not yet available. These challenges need to be overcome before biomarkers can be used routinely in human occupational risk assessment.

Scientific Basis of Uncertainty Factors

An article by D. A. Dankovic, B. D. Naumann, A. Maier, M. L. Dourson, and L. S. Levy discusses �The Scientific Basis of Uncertainty Factors Used in Setting Occupational Exposure Limits.� The abstract of the research article explains that �[t]he use of uncertainty factors is predicated on the assumption that a sufficient reduction in exposure from those at the boundary for the onset of adverse effects will yield a safe exposure level for at least the great majority of the exposed population, including vulnerable subgroups.�

Of interest to practicing industrial hygienists and safety professionals, Table 1: �UFs Used in OEL-setting, and the Rationale for Their Use� explains the types of uncertainty factors, which area of uncertainty they are used for, and the basic principles when rationalizing their use in risk assessment and OEL setting. For example, UF_A is used for animal to human uncertainty, and is used to adjust for differences in sensitivity between animals and the average human (not the occupationally exposed human). Figure 5 shows the hierarchy of approaches that are available when incorporating chemical exposure data into the risk assessment process, in order to improve scientific certainty.

Using Genetic and Epigenetic Information

The fifth article in the JOEH supplement by P. A. Schulte, C. Whittaker, and C. P. Curra is an introductory evaluation of �Considerations for Using Genetic and Epigenetic Information in Occupational Health Risk Assessment and Standard Setting.� The authors note that genetic and epigenetic data have not been widely used in risk assessment for occupational health. However, the authors envision that �genetic and epigenetic data might be used as endpoints in hazard identification, as indicators of exposure, as effect modifiers in exposure assessment and dose-response modeling, as descriptors of mode of action, and to characterize toxicity pathways.�

When evaluating the use of epigenetics in occupational health, the authors mention that using �epigenetics in epidemiologic studies of occupational disease may help explain the relationship between the genome and the work environment; however, other environmental exposures outside of work� also will need to be controlled for. Practicing industrial hygiene and safety professionals may be interested in Table 1: �Guide to Assessing Genetic and Epigenetic Data for Risk Assessment,� which is a 4 � 4 matrix showing the types of risk assessment functions (hazard identification, dose-response modeling, exposure assessment, and risk characterization) and the questions associated with using genetic or epigenetic data (both inherited and acquired) that may be asked.

Table 2: �Framework for use of genetic and epigenetic data in occupational and environmental risk assessment� is also interesting, since it uses the same 4 x 4 matrix and risk assessment functions with the recommended or estimated use of genetic and epigenetic data. For example, for the exposure assessment function, acquired genetic data can show deviations from normal pattern of gene expression, whereas inherited epigenetic data can be used as an indicator of exposure.

In the conclusion, the authors state that: �It is not far-fetched that a worker�s �Right to Know� might someday extend to the worker�s right to know their genetic susceptibility to workplace toxicants.� This is an intriguing idea for future research.

Setting OELs for Chemical Allergens

In an interesting article about �Setting Occupational Exposure Limits for Chemical Allergens�Understanding the Challenges� by G. S. Dotson, A. Maier, P. D. Siegel, S. E. Anderson, B. J. Green, A. B. Stefaniak, C. D. Codispoti, and I. Kimber, the authors discuss establishing exposure limits for low molecular weight (LMW) chemical allergens. The definition of chemical allergy is explained as �immune-mediated adverse health effects, including allergic sensitization and diseases, caused by exposures to chemicals.�

LMW allergens that are recognized occupational hazards include: diisocyanates, organic anhydrides (i.e., maleic anhydride) and some metals (i.e., beryllium and nickel). Table 1: �ACGIH Threshold Limit Values (TLVs) Based on Immune-mediated Health Endpoints� provides a list of chemical allergens with OELs already developed. These chemical allergens include beryllium, flour dust, natural rubber latex, various diisocyanates, and piperazine.

The article also provides an explanation of the biology of chemical allergens, including the difference between sensitization and elicitation, and forms of chemical allergy. The authors note that the two forms of chemical allergy of most interest to occupational health professionals are skin sensitization (resulting in allergic eczema and contact dermatitis) and respiratory tract sensitization (resulting in asthma and rhinitis). Specific challenges associated with development of OELs for chemical allergens are also discussed.

Exposure Estimation and Interpretation of Occupational Risk

The seventh article in the JOEH supplement provides a detailed analysis of �Exposure Estimation and Interpretation of Occupational Risk: Enhanced Information for the Occupational Risk Manager� by Martha Waters, Lauralynn McKernan, Andrew Maier, Michael Jayjock, Val Schaeffer, and Lisa Brosseau. The authors explain the risk characterization process for occupational exposures, including the regulatory basis for OELs, describing exposures and the exposed population(s), intrinsic variability and how to reduce uncertainty in exposure estimation, and methods for estimating exposures.

Table 1: �Occupational Exposure Limits (OELs) Developed by Various Organizations� shows the various OELs, which organization has set them, and whether they were developed based on a health basis, analytical feasibility, economic feasibility, and engineering feasibility. The authors provide an example of the compliance approaches used by the Occupational Safety and Health Administration (OSHA) and National Institute for Occupational Safety and Health (NIOSH). OSHA and NIOSH�s �[approach] include[s] collecting samples from the worst case exposure scenario or randomly from a defined similar exposure group of interest. The measurement is compared to the OEL and is classified into one of three decision categories: clearly below the limit, clearly above the limit, or too close to the limit for an immediate decision.�

The authors also provide an explanation of the AIHA exposure assessment strategy, which �recommended that [time-weighted average (TWA)] OELs be interpreted as upper limits of exposure (e.g., 95th percentile) for each similar exposure group (SEG) and that the exposure distribution profile of each SEG should be controlled so that the 95th percentile exposure is less than the OEL over time.� Following the discussion of SEGs, a short section on Bayesian methods is provided.

Aggregate Exposure and Cumulative Risk Assessment

In this research article about �Aggregate Exposure and Cumulative Risk Assessment�Integrating Occupational and Non-occupational Risk Factors,� T. J. Lentz, G. S. Dotson, P. R.D. Williams, A. Maier, B. Gadagbui, S. P. Pandalai, A. Lamba, F. Hearl, and M. Mumtaz evaluate the benefits of considering non-occupational exposures as part of the occupational risk assessment. The authors debate using a �combined risk from exposure to both chemical and non-chemical stressors, within and beyond the workplace,� with the understanding that �such exposures may cause interactions or modify the toxic effects observed (cumulative risk).�

Like previous articles in this OEL series, the authors provide a glossary of key terms in Table 1, including aggregate risk, exposome, and total worker health. Exposome is defined as �the measure of all the exposures of an individual in a lifetime and how those exposures relate to health.� Exposomics is defined as �the study of the exposome, which relies on the application of internal and external exposure assessment methods.�

Figure 2 of this article will be of special interest to practicing industrial hygienists and safety professionals. It is an illustration of the relationship between the key factors that must be considered in a cumulative risk assessment. The primary factors are divided into three categories: occupational factors, non-occupational factors, and individual factors. The occupational and non-occupational factors are further divided into settings, sources, pathways, dominant exposure routes, key stressors, and effects. Using the illustration in Figure 2, the authors provide an illustrative case study in Figure 3 to assess the cumulative risk for hearing loss.

The Global Landscape of OELs

In this ninth and final research article from the JOEH supplement, �The Global Landscape of Occupational Exposure Limits�Implementation of Harmonization Principles to Guide Limit Selection� is discussed by M. Deveau, C-P Chen, G. Johanson, D. Krewski, A. Maier, K. J. Niven, S. Ripple, P. A. Schulte, J. Silk, J. H. Urbanus, D. M. Zalk, and R. W. Niemeier. The article�s abstract notes that an occupational hygienist seeking to determine the proper OEL to apply in an international setting will encounter a �confusing international landscape for identifying and applying such limits in workplaces.�

Practicing industrial hygienists and safety professionals may be interested in Figure 1, which is a reprint of the hierarchy of risk-based occupational exposure benchmarks as developed by AIHA in their publications on control banding and SEGs. The authors note that the goal of international harmonization for OEL derivation and development has been under much debate and discussion, and explains the existing harmonization initiatives in place.

Conclusion

As occupational health and safety professionals, industrial hygienists can have access to new and exciting research by academic, governmental, and other groups through journals such as JOEH. In their supplemental issue about OELs, JOEH has selected nine research articles that provide the current state of occupational exposure science. This blog post has summarized the contents of each article and provided takeaways and interesting quotes from the articles, to allow practicing industrial hygiene and safety professionals to focus their continuing safety education on the articles that will most interest them.

Article on Weird Workplace Safety Videos

On July 2, 2015, The Atlantic published an interesting article entitled "In Praise of the Humble Workplace Safety Video" by Sophie Gilbert.

The full article can be accessed here. 

Ms. Gilbert stated in the article: "There are no statistics relating to whether safety videos actually decrease occurrences of injuries and fatalities in the workplace, but they definitely offer a healthy defense against one serious threat: lawsuits."

A 2006 study in the American Journal of Public Health entitled "Relative Effectiveness of Worker Safety and Health Training Methods" explained that video-based training is one of the least effective intervention methods to improve workers' knowledge of safety and health. Lectures and videos are passive methods that are commonly used in industry to present safety and health information, but were shown in this study to be the least engaging and least effective methods. More engaging methods, such as hands-on demonstrations and participatory discussions, were recommended.

NIOSH also discussed the effectiveness of safety training for workers in a blog post from January 29, 2010. The blog post explained: "In many cases, it was difficult or impossible to draw firm conclusions about the areas we examined due to the lack of quality research. There is a critical need for high quality, controlled studies of workplace health and safety training. That said, given that workplace education and training programs have a positive impact on health and safety behaviors, as we noted earlier in our discussion, and that training and education is a fundamental component of workplace safety and health protections, we recommend that workplaces continue to conduct education and training programs."

In 1999, NIOSH also released a document providing "A Model for Research on Training Effectiveness" that discusses what makes training effective, and explains the Training Intervention Effectiveness Research (TIER) model. The NIOSH document explains that:     

"[...] the most important goal of occupational safety and health training is the long-term reduction of injury and illness among workers. However, a longitudinal study does not meet the immediate evaluation needs of training interventions, and resources for such studies are not readily available. Therefore, occupational safety and health training research usually focuses on representative outcomes (e.g., workers� statements of behavioral intent) that are believed to accurately project unrealized impacts. Representative outcomes include direct results (such as improved attitudes toward risk reduction and hazard control) and intermediate variables (such as changes in work practices among workers who have received training)."

More on safety training and videos later. Happy 4th of July weekend!

Thoughts on OSHA's proposed new rule for improved tracking of workplace injuries and illnesses

See the full news release from OSHA here.

After the release of the 2012 Occupational Injuries and Illnesses report was released earlier this month, OSHA posted a news release about a proposed new rule relating to record keeping.

The 2012 Occupational Injuries and Illnesses report estimated that 3 million workers were injured on the job during 2012. 

In the proposed rule, OSHA wants to add a requirement for businesses with more than 250 employees, who already keep records of workplace injuries and illnesses, to electronically submit their injury and illness records to OSHA each quarter.  OSHA also wants to add a requirement for businesses with 20 or more employees in high-hazard industries to submit their summary of work-related injuries and illnesses (OSHA Form 300A) electronically every year.

These efforts to improve the transparency of government are interesting.

From a faculty/educator perspective, if the government is able to publish the injury and illness data more than once per year, it will allow safety and industrial hygiene students and educators to focus their attention and perhaps lead to some interesting research or meta-analyses.