Fatalities associated with confined space entry dominate the documented instances of adverse health effects that result from short-duration, high-level chemical exposures in the manufacturing industry. We still do not have an accurate measure of the probability of less acute illnesses that arise from lower-level or repeated incidents that do not result in fatality or emergency response. Anecdotal reports of employee symptoms from major and minor spills of process chemicals, emissions from process upsets, fires, and explosions are frequent but not systematically documented. For example, the chemical exposures during restoration of production after a fire, spill, or process upset can be substantial. Servicing of ventilation, air cleaning, and other environmental control equipment is a significant concern. Disturbing or removing asbestos and lead paint is an important risk in the auto industry, where the occupational groups most likely to be impacted are skilled trades workers and nonskilled maintenance and cleanup workers. Health impact can also be inferred from limited studies that reveal chronic illnesses among skilled trades workers whose chemical exposures follow this pattern due to the nature of their work assignments (Park and Mirer, 1996).
Preventive measures include job-specific chemical hazard control procedures and information for nonroutine activities (supported by 1910.1200), hazardous waste and emergency response operations programs (supported by 1910.120), and confined space entry programs (supported by 1910.146), as well as construction asbestos and construction lead programs. An industrial hygiene evaluation of nonroutine activities needs to be carried out in order to develop appropriate exposure-based protective measures and information. The limitations of an industrial hygiene exposure measurement approach, however, are the governmental exposure limits (OSHA PELs) discussed below. Without appropriate and available PELs, industrial hygiene evaluations are limited.
The fundamental prevention of these outcomes depends on eliminating or reducing sources of nonroutine exposure: Eliminate confined spaces or the need to enter those spaces; clean without solvents; and modify equipment or production processes to prevent spills, leaks, and process upsets. A canonical solution is to substitute nonhazardous or less hazardous materials; however, examples of such substitution are largely limited to exchanging water-based cleaners for volatile organic solvents.
Outcome: Illness From Long-Term Chemical Exposures
The risk of a work-related fatality caused by illness from long-term chemical exposures far exceeds that of a fatality caused by traumatic injury (Fingerhut et al., 2006). The fatality risk of United Auto Workers members generally, calculated from the database described above, is about 5 per 10 000. For the high-risk skilled trades worker group, the risk is about 2 per 1000. By contrast, the risk over the whole private workforce is 2 per 1000, and that for construction workers (comparable to UAW skilled trades) is 8.7 per 1000. Translating the rate of mortality from occupational cancer generally into the same units, based on the very limited estimate of 4% of cancers due to occupational exposures, yields an estimate of 1 per 100, between 5 and 20 times the rate of traumatic injury fatalities.
Studies in the U.S. motor vehicle manufacturing industry have reported increased mortality from cancer among foundry workers (lung), workers exposed to metalworking fluids (a variety of sites), vehicle assembly workers (lung), stamping and sheet metal fabricators (lung, stomach), and electronics workers (brain) (Mirer, 2003). These illnesses arose from exposure levels that were in compliance with current and past occupational health exposure limits (except for silica in foundries).
Respiratory conditions are the most prominent chemically related noncancer illness observed among foundry workers and workers exposed to metalworking fluids.
Prevention of these adverse outcomes is hampered by the absence of governmentally enforced or generally accepted exposure limits that sufficiently restrict exposure to prevent a significant risk of adverse effects. This problem has largely been discussed in the political arena rather than in the peer-reviewed literature. Prevention strategies revolve around best practices for ventilation, prevention of skin contact, and medical surveillance. Control of exposure is supported by the Hazard Communication standard (1910.1200).
Outcome: High-Impact Service Sector Occupations
Service sector occupations are found in virtually every industry sector. For example, health-care workers are found in most large factories. Their exposures include infectious disease and patient movement, as well as the potential for client violence. Other occupations such as personnel management and union representation have the aspect of social work, also with a potential for client violence.
The most applicable regulation is bloodborne pathogens (1910.1030), although a general infection control program is indicated in every large facility.
Outcome: Somatic And Mental Illness Arising From Work-Related Psychosocial Stress
The prominence of mental illness as a leading cause of disability among manufacturing workers suggests that work-related psychosocial stress may play some causal role. Adverse effects of work-related psychosocial stress have largely been investigated outside the manufacturing sector, in job settings with less intense exposure to physical and chemical hazards. Stressors frequently mentioned under the rubric ‘work organization’ include high-demand low-control jobs, lack of social support, and effort–reward imbalance. These same stressors may be present, with similar or greater intensity, in the manufacturing environment. The effect of stressors may be direct or indirect through an association with increased health risk behaviors such as smoking, substance abuse, or poor diet.
The association of noise exposure, prominent in the manufacturing sector, with hypertension has been observed in a number of studies, but this endpoint has not been taken into account in priority of noise abatement programs. Similarly, adverse effects of various unusual work schedules – extended duty (frequently named ‘overtime’), rotating shift, afternoon and night shift – have been observed but not taken into account. The contribution of work-related musculoskeletal pain directly to cognitive effects and indirectly to health risk behavior has not been sufficiently explored.
Preventive measures for outcomes of psychosocial stress are not generally a part of occupational health and safety programs. These measures are addressed by aspects of labor law – labor standards, hours of work, antidiscrimination legislation. To the degree that unequal treatment and lack of access to information and input on work questions contribute to stress, a labor agreement may alleviate these problems.
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