Update from the California Department of Public Health s Occupational Health Branch
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1 Update from the California Department of Public Health s Occupational Health Branch Barbara Materna, PhD, CIH Chief, Occupational Health Branch California Department of Public Health CIHC Prof. Dev. Seminar December 10, 2018
2 Overview Intro to the CDPH Occupational Health Branch Focus on work-related asthma Highlights from a few other projects Wildfire response Valley fever prevention New injury prevention activities How to stay in touch & use our resources
3 Promoting safe and healthy workplaces across California Occupational Health Branch Env/Occ Emergency Preparedness Team Hazard Evaluation System & Information Service (HESIS) Occupational Health Surveillance & Evaluation Program Occupational Lead Poisoning Prevention Program California Safe Cosmetics Program
4 OHB Health & Safety Code mandates Sections Determine causes of work-related disease & injury Collect/summarize/analyze data Develop prevention recommendations Provide technical assistance Know how hazards and work processes impact health
5 OHB mandates added in 1978 Evaluate scientific & other info to identify hazards Provide practical early warning on hazards & how to protect workers Recommend new/revised standards
6 Since 1978: CA gov t infrastructure for OH Regulations, enforcement, workers compensation Dept. of Industrial Relations Dept. of Public Health University of Calif. (was DHS) Surveillance, investigation, intervention Research & training professionals
7 26 states funded by NIOSH for occupational public health
8 Health topics with specific funding Lead poisoning Asthma Acute pesticide-related illness Fatal/nonfatal injury Chemical emergencies & natural disasters Cosmetics safety
9 Meet OHB s industrial hygienists Justine Weinberg Jennifer McNary Nina Townsend Jackie Chan This could This be you!
10 Focus on work-related asthma (WRA) 23 YEARS OF SURVEILLANCE AND PREVENTION
11 Case report: High school custodian 41-year-old custodian, worked at a high school 4 years, no asthma history Cleaned bathrooms, performed graffiti removal No safety training Developed difficulty breathing and coughing, >12 ER visits, diagnosed with bronchitis Symptoms improved when off work Transferred to elementary school
12 Case-based public health surveillance Case identification Investigation Prevention recommendations
13 California s WRA surveillance Case data from 4 sources Physician diagnosis + temporal association with work Conduct worker interviews & review medical records Selected worksite visits Identify risk factors who s getting it and how Calculate rates by industry and occupation Case reports
14 State-based WRA surveillance NIOSH funding for 5 states: CA, WA, MI, MA, NJ
15 Clinical classification of WRA
16 Classification of confirmed cases California Work-related Asthma Prevention Program (WRAPP) Surveillance Data, (n=3,740 classified cases*) New Onset (52%) Work Aggravated, 48% New Onset, Unknown Inducer, 35% RADS, 9% New Onset, Known Inducer, 8% *Note: 5,335 (59%) additional cases were confirmed, but could not be classified
17 Industries with highest WRA rates California Work-related Asthma Prevention Program (WRAPP) Surveillance Data, Transit and Ground Passenger Transit 18.0 Hospitals 14.3 Utilities Parks, Zoos, Museums Wood Product Manufacturing Heavy & Civil Engineering Construction Waste Management and Remediation Government Chemical Manufacturing Electrical Equipment Manufacturing Food Manufacturing Nonmetallic Mineral Product Manufacturing Telecommunications Transportation Equipment Manufacturing Beverage and Tobacco Manufacturing Top 3: Transit Hospitals Utilities N=9,075 Rate per 100,000 workers
18 Bus cleaner removing graffiti
19 Occupations with highest WRA rates California Work-related Asthma Prevention Program (WRAPP) Surveillance Data, Firefighting Occupations 30.0 Chemical Processing Machine Operators 17.1 Correctional Officers and Bailiffs Chemical Technicians Miscellaneous Science Technicians Eligibility Interviewers, Government Programs Ushers, Lobby Attendants, and Ticket Takers Graders and Sorters, Agricultural Products Telephone Operators Water Wastewater Treatment Plant and System Operators Food Batchmakers Medical Assistants and Other Healthcare Support Biological Technicians Respiratory Therapists Police Officers and Detectives Office and administrative support workers Top 3: Firefighting Chemical processing Correctional officers N=9,075 Rate per 100,000 workers
20 Exposures reported by top 10 occupations with highest rates Occupation Firefighting Occupations Chemical Processing Machine Operators Correctional Officers and Bailiffs Chemical Technicians Miscellaneous Science Technicians Eligibility Interviewers, Government Programs Ushers, Lobby Attendants, and Ticket Takers Most Common Exposures Smoke, chemicals Chemicals, bleach, acids, solvents, sulfur dioxide Pepper spray/mace, smoke, mold, cleaning chemicals Chemicals, solvents, acids Animal antigens, dust, acids, chemicals Indoor air pollutants, smoke, paint Smoke, indoor air pollutants Graders and Sorters, Agricultural Products Chlorine, pesticides, cleaning materials, bleach Telephone Operators Wastewater Treatment Plant and System Operators Dust, chemicals, perfume Chemicals, dust, indoor air pollutants from building renovation
21 Most common exposures reported by cases Dust Unspecified Chemicals Smoke Mold Indoor Air Pollutants Cleaning Agents Paint Indoor Air Pollutants from Building Renovation Perfume Pesticides Bleach Cigarette Smoke Glues Plant Materials Asphalt
22 Most common asthmagens reported by cases Bleach Chlorine Ammonia Latex Formaldehyde Sulfuric Acid Glutaraldehyde Diisocyanates Rat Antigens Quaternary Ammonium Compounds Flour Epoxies Hydrochloric Acid Cat Mice
23 List of 346 recognized occupational asthmagens Compiled by the Association of Occupational and Environmental Clinics (AOEC)
24 Limitations of WRA surveillance Known undercount many affected workers don t get into the system Workers Don t make the connection to work Don t know hazards of chemicals they re working with Afraid to report symptoms to employer Health care providers Don t think or ask about work Don t know about health effects of chemicals
25 Population data on WRA in California Population-based survey data show an estimated 1,210,487 CA adults have asthma that has been caused or made worse by work This represents nearly half of all adults with current asthma WRA is not rare 2012 Behavioral Risk Factor Surveillance System Asthma Call Back Survey
26 WRA and disability High rates of job loss/job change determined by working conditions Substantial income reduction after 3 years in >50% affected Impaired quality of life: increased symptoms activity limitation emotional dysfunction
27 Primary prevention Preventing WRA Identify hazards, follow hierarchy of controls PELs less relevant Secondary prevention Detect early to minimize severity and duration Tertiary prevention Provide appropriate health care: follow asthma management guidelines for adults Workers compensation claims & required reporting Early removal from exposure & long-term follow-up
28 Fragrance related WRA A real issue for many workers more needs to be done to prevent exposures
29 Workplace resources Employer & worker fact sheets Workplace fragrance-free policy template
30 Case report: Teacher 54-year-old special ed teacher, history of mild asthma Returned from spring break, carpets cleaned, lingering strong chemical odor Immediate breathing problems, left work, out 1 week 2 years later, still many meds, reacts to many triggers daily Now carpets cleaned with water
31 Resources for asthma-safe schools
32 Case Report: Teen lifeguard 17-year-old lifeguard with preexisting asthma, worked at indoor pool Sometimes added pool chemicals, mostly lifeguarded One day pool s retractable roof was closed, led to attack From then on symptoms much worse Now uses daily medications (previously intermittently)
33 Case Report: Carpenter 37-year-old carpenter, built houses and buildings. No asthma history. Visited MD for nail gun injury. Doctor heard wheezing, asked about work. Only used painter s dust mask, bought on his own. Wood dust in air at work, couldn t breathe. Diagnosed with asthma, reported 5/20 co-workers had similar breathing problems. Changes made at work.
34 Resources on pool chemicals, wood dust
35 Disinfectants & asthma Focus of OHB programs on asthma & pesticides Messages: Avoid disinfectant use where unnecessary Choose safer products Fact sheets for employers & workers (5 languages)
36 Policy efforts: Safer cleaning products & processes Third party certification programs now consider asthmagens under health criteria Promoting safer school policies
37 Efforts toward a sensitizer standard Julia Quint review of how asthmagens are regulated Cal/OSHA Sensitizer Advisory Committee process around 2005 was discontinued
38 Conclusions about WRA A significant public health problem in California, affecting >1 million adults Largely under-recognized and diagnosed Clinicians should always ask adults about work Ask if asthma symptoms are worse at work and better during time off Opportunities for prevention are frequent and achievable
39 WRAPP website
40 A few more highlights of OHB work in 2018
41 Wildfire response SF Chronicle, 11/16/2018
42 Occupational Valley fever prevention
43 New injury prevention project Targeting 5 topics Landscaping/tree work Residential construction Warehousing Violence in healthcare Young workers in career technical training programs Investigating serious traumatic injuries Partnering to promote safety
44 Stay in touch with OHB E-newsletter: Occupational Health Watch Subscribe:
45 YouTube Digital stories about death, injury, illness on the job
46 Use OHB s resources & services OHB website Workplace hazard helpline (toll-free in CA) Barbara Materna, PhD, CIH Chief, Occupational Health Branch California Department of Public Health 850 Marina Bay Pkwy, P-3 Richmond CA barbara.materna@cdph.ca.gov or
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