The Health Hazard Evaluation Program at NIOSH Reviews of Research Programs of the National Institute for Occupational Safety and Health (2009) / Chapter Skim
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3 Relevance of the Health Hazard Evaluation Program
3 Relevance of the Health Hazard Evaluation Program
Pages 42-81
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From page 42... ...
. One of the challenges faced by the HHE Program is weighing the need to be responsive to individual requests with the need to develop strategic approaches to identifying emerging health threats in the workplace.
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From page 43... ...
The goals are well targeted and relevant, and can be measured by the number and types of HHE requests received, the number of reports and field investigations conducted related to each of these goals, and their effects as determined through followback surveys (described in Chapter 2)
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From page 44... ...
with nonprofit organizations, community 1.1.2.2. 2007: Increase the percentage of state Occupational Safety FY development organizations, and worker and Health Administration (OSHA) websites that include a centers could be explored, and specific metrics link to the HHE Program website (obtain baseline data)
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From page 45... ...
With site visit (baseline: 36% for investigations with a last visit in FY the diminishing number of HHE requests, the 2005) a program should be able to set more timely 1.2.4. Annual goal: Produce useful reports for HHE requests addressed response goals.
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From page 46... ...
a range of workplaces about ways to reduce assistance for 1.3.2. Annual goal: Provide helpful informational letters poor IEQ. It should be possible to produce HHE requests 1.3.2.1. 2007: 65% of HHE requestors completing a followback FY similar educational materials for other areas addressed without survey report that the letter was helpful (baseline: 60% for FY of high-frequency requests in which the HHE a field visit 2001-2005)
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From page 47... ...
2.1.2. Annual goal: Transfer information regarding emerging issues to Interaction with NORA sector councils will appropriate internal and external partners increase recognition of the HHE Program 2.1.2.1. 2007: Complete and accurate information regarding new FY within these industries as well as the HHE HHE requests and closed projects is entered in the HHE Program's understanding of potential hazards database within each industry. Sectors chosen by 2.1.2.2. 2007: Prepare and disseminate annual HHE summary data FY the HHE Program are certainly relevant, to National Occupational Research Agenda (NORA)
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From page 48... ...
handling HHE requests with broader policy assistance certification, complete incident command system training, and implications. are aware of information resources regarding specific potential hazards 3.2.1.2. 2007: Assurance is received from the Office of Health and FY Safety that HHE emergency responders have appropriate medical oversight
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From page 49... ...
is ready to respond 3.3.1.1. 2007: The electronic inventory of industrial hygiene FY to requests for equipment is complete and current assistance 3.3.1.2. 2007: Calibrations are up-to-date for 100% of industrial FY hygiene equipment likely to be used in an emergency deployment, and records of current calibration dates are maintained 3.3.1.3. 2007: The Hazard Evaluations and Technical Assistance FY Branch (HETAB) emergency response vehicle is appropriately equipped and maintained, records are up-to-date, and a minimum of two drivers have commercial drivers licenses 3.3.1.4. 2007: At least three HHE Program staff members are FY currently certified to ship dangerous goods 3.3.2. Annual goal: Management systems are in place to facilitate efficient response to requests for assistance 3.3.2.1. 2007: Database of responders is current and complete with FY regards to home, work, and cellular telephone numbers for responder and emergency contact, respirator fit test results, and security clearance status 3.3.2.2. 2007: Develop standard operating procedures for FY communications and preparation for responding aBased on the three most recent years for which data are available.
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From page 50... ...
Production inputs, including budget, staff, facilities, and management, play major roles in the program. F inding 2: For the most part, the HHE Program has judiciously used its resources to meet its mission in the face of the changing economy, the changing nature of HHE requests, and increased responsibilities related to emergency response.
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From page 51... ...
Because most HHE requests are related to multiple hazards or hazard classes, the HHE Program developed the following strategy for tabulation of hazard class of requests: • Indoor environmental quality (IEQ) -- any request that included an IEQ issue, regardless of other issues also present
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From page 52... ...
The effect of the changing economy can be seen in Figure 2-3, which indicates a greater than 50 percent decline in the number of requests from the manufacturing sector since the 1990s. One might expect this change to allow the program greater flexibility to respond more efficiently to the increasing number of HHE requests in health services, trade, and transportation and to conduct unexpected emergency response activities.
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From page 53... ...
dPercentage of HHE requests resulting in a field investigation. eNumber of HHE requests.
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From page 54... ...
As noted in Table 3-1, the committee endorses the HHE Program's inter mediate goal of increasing the number of HHE requests concerning important occupational health problems (intermediate goal 1.1)
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dPercentage of HHE requests resulting in a field investigation. eThis group may include some HHE requests more appropriately assigned to the management group due to a change in coding over time.
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From page 56... ...
HHE Program staff informed the committee how necessary expertise is identified during the triage process and indicated that many areas of expertise are readily available through existing, relatively informal arrangements within and external to NIOSH. It was not made clear how certain areas of expertise, such as dermatology or clinical toxicology, are accessed, or how HHE staff acquire information in such areas as health services or intervention effectiveness research.
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From page 57... ...
. F inding 3: The HHE Program has not made sufficient use of available surveillance data to assist in targeting field investigations to recognize previously unknown hazards or to identify new or increased hazards caused by changes in the workforce and work environment.
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From page 58... ...
. Access to comprehensive surveillance data could allow the HHE Program to more effectively prioritize HHE requests, make more informed triage decisions, and identify emerging workplace health hazards.
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From page 59... ...
R ecommendation: The HHE Program should make systematic use of professional meetings, scientific conferences, scientific literature, and surveillance data, including those generated by NIOSH, to assist in pri oritizing field investigations and recognizing emerging issues. F inding 4: The extent and effectiveness of relationships between the HHE Program and federal and state agencies are variable.
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From page 60... ...
BOX 3-2 Bronchiolitis Obliterans (Popcorn Lung) and Diacetyl In 1985, the HHE Program conducted an investigation in an Indiana food processing plant where two employees were diagnosed with bronchiolitis obliterans, a severe and sometimes fatal lung disease (NIOSH, 1986)
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From page 61... ...
. A Massachusetts Occupational Health Surveillance Program industrial hygienist indicated her personal hesitancy in filing HHE requests for and communicate the risk to workers who produce or apply flavorings, their employers, and the occupational health community.
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RELEVANCE OF ACTIVITIES F inding 5: The HHE Program has responded well to HHE requests as mandated, although mechanisms for eliciting a broader array of HHE requests are needed. There is strong evidence the HHE Program has conducted relevant field investigations and has performed well in identifying emerging hazards, serious HHE Program staff indicated that currently available communication pathways within the CDC (such as Epi-X)
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From page 63... ...
All four examples included multiple field investigations and successful transfer of knowledge to the occupational health community by the HHE Program. BOX 3-3 Interstitial Pneumonitis (Flock Worker's Lung)
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From page 64... ...
. Other documents based on HHE Program outputs include several manuals to assist employers and employees in the development of effective ergonomics programs, including those intended for underserved populations such as farm workers (NIOSH, 1997a, 2001e, 2007j)
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From page 65... ...
The inclusion of the HHE Program in the investigation has facilitated the broader evaluation of the condition as an occupational illness and further demonstrates the relevance of the HHE Program. "Casting a Larger Net" Based on information submitted to the committee, it is not possible to determine whether the needs of underserved populations and small businesses are being met or whether the lack of anonymity or the fear of legal or political reprisals
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From page 66... ...
The BSC recommendation to "cast a larger net" to enable the program to "select only the evaluations that truly serve program goals" (NIOSH BSC, 2006:5) deserves attention here: while many attempts have been described to increase the overall number of HHE requests, there has been no systematic effort to ascertain either the relative success of these efforts or the reasons for any failures.
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From page 67... ...
The criteria applied during triage, apart from the straightforward assessment of request validity as determined by regulation, do not explicitly outline when field investigations are necessary, nor do they assist in distinguishing those requests that require complex investigations or that may yield future research opportunities. Classification appears to be handled informally.
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From page 68... ...
The triage program would ideally involve epidemiologists, toxicologists, engineers, and other relevant specialists, as well as HHE Program staff, to ensure that qualified personnel are handling responses. For example, the committee reviewed a close-out memo from an HHE Program file regarding a state health department request for assistance related to possible worksite metals contamination (NIOSH, 2007a)
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From page 69... ...
Responding to HHE requests with a systematic approach of defining the request, identifying the implications of potential responses, and identifying justifiable resources and necessary expertise based on the triage criteria would provide the means for the program to better communicate the outcomes of the triage process to requestors. A more transparent triage process could potentially help requestors understand why their requests may be considered invalid and help them form valid requests in the future.
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From page 70... ...
However, the committee did not find evidence that a well-defined quality assurance process is in place to ensure consistently high-quality outputs and recommendations. Review of Numbered Reports The HHE Program provided the committee with several examples of num bered HHE reports as well as less formal letter responses to HHE requests on a variety of occupational health-related issues.
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From page 71... ...
The quality and depth of interaction between HHE Program staff and stakeholders is evident in major examples described in Boxes 3-2 through 3-5, as well as for information developed by the HHE Program concerning latex exposure (NIOSH, 1997c, 1998d) , publications related to carbon monoxide as a prevalent and lethal hazard in outdoor settings (NIOSH, 1996b; U.S.
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From page 72... ...
Timeliness of reporting still needed improvement, and stakeholders sometimes raised concerns regarding the feasibility or technical accuracy of HHE recommendations. Some stakeholders said they did not understand why their HHE requests were not deemed appropriate for field investigations.
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Based on reports reviewed by this committee, HHE Program staff members are well aware of the literature regarding different hazards or potential hazards associated with the r equests they are receiving. Improvements could be made to avoid selection bias in followback program results by identifying similar facilities for which HHEs were not requested and by comparing health hazards before and after investigations.
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From page 74... ...
. Toxicologists, epidemiologists, engineers, and others from academic research institutions or from prioritized industry sectors might review reports both for quality and to identify emerging issues.
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From page 75... ...
A resource for stimulating HHE requests related to emerging hazards is the 26 state OSHA programs, all of which have enforcement and consultation resources, and all of which are members of the Occupational Safety and Health State Plan Association. To date, however, there is no evidence of interaction with this organization.
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From page 76... ...
The HHE Program is instrumental in identifying and responding to emerging issues associated with work organization. Chemical Hazards To be more proactive, the HHE Program and NIOSH might consider certain classes of chemical compounds as emerging issues.
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From page 77... ...
Known Hazards Affecting Underserved Populations and Small Businesses It is an HHE Program priority to honor HHE requests. However, if the program is to be fully relevant, it should seek out emerging issues by ensuring that workers and employers know about the HHE Program and understand the value of filing a request.
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From page 78... ...
The HHE Program could establish one or more stakeholder groups to assist in identifying exposure circumstances or types of workplaces that could be the object of HHE requests likely to have high relevance and impact. The NORA sector councils may serve this function.
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From page 79... ...
It is a model for exploring emerging issues in disaster settings. At the time of this writing, the results from this report were in press in a peer-reviewed publication, and a follow-up field investigation had been requested by the NOPD.
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From page 80... ...
However, the committee believes the pro gram could do a better job of eliciting a broader array of requests, especially from underserved populations and those exposed to new or newly recognized hazards. Rapid changes in the economy and workforce have affected the nature of HHE requests.
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From page 81... ...
In this example, the HHE Program took advantage of local resources to maximize the effectiveness of HHE recommendations. A third example of HHE Program-state occupational health collaboration was provided in comments by an industrial hygienist working at the Massachusetts Department of Public Health Occupational Health Surveillance Program (OHSP)
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