The December 2023 issue of the Journal of Environmental Health (Volume 85, Number 5), published by the National Environmental Health Association.
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Volume 86, No. 5 December 2023
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JOURNAL OF Environmental Health Dedicated to the advancement of the environmental health professional -olume 8, No. ecember 2023
ADVANCEMENT OF THE SCIENCE
ABOUT THE COVER
A Framework for Assessing Exposures to Multiple Hazards and Implications for Prioritizing Risks to Human Health, Safety, and the Environment ....................................... 8 Identifying Workforce Education, Training, and Outreach Needs in Decentralized Wastewater and Distributed Water Reuse ................................................................................. 20
Alaska, with its unique geographi- cal and ecological
characteristics, is experiencing
detrimental eects of climate change at an alarming rate. The Alaska Native (AN)
Profiling Metal-Induced Genotoxic Endpoints ......................................................................... 30
ADVANCEMENT OF THE PRACTICE
population—deeply connected to the land and its resources—faces disproportionate vulner- ability to these impacts. This month’s cover story, “Impact of Climate Change on Alaska Natives,” highlights the need for environ- mental public health professionals to engage with AN and Native American communities to address health inequities and to support mitigation and adaptation eorts to tackle the environmental public health threats and consequences of climate change. See page 36. Cover photo courtesy of Gina Bare, NEHA
Feature Story: Impact of Climate Change on Alaska Natives ....................................................... 36
Direct From AAS: The Path of the Environmental Health Professional: If You Can Dream It, We Can Build It! ........................................................................................ 48 Direct From CDC/Environmental Health Services: Promoting Health Literacy With Empathetic and Inclusive Communication ........................................................................... 50 Direct From U.S. EPA/Oce of Research and Development: Elevating the Importance of Environmental Public Health and Partnership With Healthcare Professionals ........................... 52
ADVANCEMENT OF THE PRACTITIONER
Environmental Health Calendar ...............................................................................................56
ADVERTISERS INDEX
Resource Corner........................................................................................................................ 58
AEHAP Student Research Competition................59 Hedgerow Software ..............................................67 HS GovTech.......................................................... 68 Industrial Test Systems, Inc.................................... 2 JEH Advertising ....................................................56 National Onsite Wastewater Recycling Association (NOWRA)......................................... 29 NEHA Awards ................................................57, 61 NEHA Credentials ................................................ 51 NEHA Endowment Foundation........................... 19 NEHA Membership ................................................ 4 NEHA REHS/RS Credential.................................. 55 NEHA/AAS Scholarship .................................35, 59 NEHA-FDA Retail Flexible Funding Model Grant Program ............................................5
JEH Quiz #3............................................................................................................................... 60
YOUR ASSOCIATION
President’s Message: Environmental Health Is Hyperlocal—The Many Flavors of Environmental Public Health ................................................................................................................ 6
Special Listing ........................................................................................................................... 62
NEHA News .............................................................................................................................. 64
NEHA 2024 AEC....................................................................................................................... 65
NEHA Member Spotlight .......................................................................................................... 66
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December 2023 • Journal of Environmental Health
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in the next Journal of Environmental Health don’t miss Growing Seeds and Students: Therapeutic Horticulture Programs and the Involvement of University Students Rebuilding Caribbean Environ- mental Health Post-Crisis Programs: A Preliminary Study for Virtual Mentorship
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Volume 86 • Number 5
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PRESIDENT’S MESSAGE
Environmental Health Is Hyperlocal—The Many Flavors of Environmental Public Health
Tom Butts, MSc, REHS
A s I reflect on working in environ- mental health for the past 35+ years, I am regularly reminded of how good environmental health professionals are at responding to emerging issues. This responsiveness is especially evident at each National Environmental Health Association (NEHA) a liate conference I have attended. When new hot issues come to our state or community, environmental public health professionals often embrace the challenge as leaders or as contributors to a larger com- munity of public health response leaders. We are often limited not by knowledge or ability but by funding. I have proposed in the past—sometimes more seriously than others—that environmental health budgets should include 10% to 20% for new and on- going funding for sta to deal with the en- vironmental health issues of the day and to ensure there is the capacity to manage the near-constant demands on our programs. Over the years these issues have included, to just name a few: • Leaking underground storage tanks and the emergence of leaking tanks containing methyl tert-butyl ether (MTBE) in areas where oxygenated fuels were required to address ozone air pollution issues • Illegal hazardous waste dumping and the ongoing cleanup of hazardous material spills and waste sites • Household chemical waste management • Indoor air quality • Consumer product safety investigations • Radiator shop lead exposure assessments • Use of GIS to map and address a range of issues such as old landfills and vectors
living programs. We may struggle, however, to be included in this type of work. On a dierent level, environmental pub- lic health is called on to respond to natu- ral and human-made disasters—including wildfires, hurricanes, droughts, and torna- dos—as well as expected to aid in the recov- ery of these disasters. Local governmental environmental health programs face a range of challenges, often due to a combination of fiscal constraints, political pressures, technical barriers, and evolving environmental threats. Address- ing these challenges necessitates a combina- tion of innovative strategies, public–private partnerships, working with new and dier- ent partners, community engagement, and capacity building eorts. I have observed a wide range of ways envi- ronmental public health has been engaged in community planning and actions around greenhouse gas emissions and climate change. Although at times those words are not used, the work carried out around miti- gation is important and under-recognized. So, given the wide range of work we are asked to engage in, what do environmental health professionals bring to the table? Many of our skills and abilities have been built through the work done in our core environ- mental health programs that address food, water, waste, vectors, housing, schools, pools, body art, and more. One of the most impor- tant skills we have is communication. We should think of information as a social determinant of health. We should know how to engage with the local information ecosys- tem and not fear it. Unfortunately, we must
• Emergence of West Nile virus and its ran- dom resurgence in communities • Emergence of the Zika virus, E. coli O157:H7, and the range of potential caus- ative agents of foodborne illness (e.g., sea- sonal norovirus) • Cannabis (e.g., medical use, recreational use, hemp) • The Virginia Graeme Baker Pool and Spa Safety Act • Bisphenol A (BPA) in plastics • Per- and polyfluoroalkyl substances (PFAS), perfluorooctanoic acid (PFOA), and other persistent organic pollutants in water, wastewater, and many other places We often have the skills, abilities, and authority to contribute to community work to take on obesity and address the built envi- ronment to support healthy eating and active By adopting a proactive and collaborative approach, local environmental health programs can address hyperlocal and global challenges in the face of evolving environmental threats.
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accept that misinformation will travel fur- ther, faster, and deeper than truth—in fact, 6 times faster (Vosoughi et al., 2018). It is important to recognize that people’s relation- ships to information are emotional and that legitimate concerns often exist. Actively lis- tening in and of itself often addresses some of the emotions of an issue. Here are some of the challenges faced in building and supporting strong local (regional or state) environmental public health programs: • Limited Funding: Many governments face budgetary constraints that can limit their ability to adequately fund and sta envi- ronmental health programs. Programs funded solely by fees are susceptible to fluctuations in funding as the regulated industry often fluctuates, which creates the need to grow or cut programs based on lags versus needs. • Technical Expertise: Maintaining a sta with the necessary expertise to address a wide range of environmental health issues can be challenging. Hiring sta with a range of skills and knowledge bases is also a chal- lenge. Further, retaining sta , especially with salaries that are not at an adequate level, impacts maintaining a skilled workforce. • Political Pressure: Environmental pub- lic health decisions can be controversial. Locally elected or appointed ocials might make political decisions that conflict with improving long-term health outcomes. • Data Availability: Comprehensive and timely data are needed to assess environ- mental health risks. The data can, how- ever, be hard to obtain or interpret at the local level. • Changing Environmental Threats: With climate change and other evolving chal-
lenges, local governments face unpredict- able and emerging threats that can be hard to anticipate and address. • Public Awareness and Engagement: There might be a lack of understanding or even skepticism about environmental health risks among the public. • Regulatory Challenges: At times, local reg- ulations might be insucient or outdated, and it can be hard to navigate overlapping state and federal laws. Here are a few ways in which we can over- come these challenges: • Diversify Funding Streams: Local govern- ments can look to a mix of fees and federal grants, state support, public–private partner- ships, and innovative funding mechanisms to bolster environmental health programs. • Capacity Building: Assure access to con- tinuous training and workshops for fed- eral, state, and local environmental health staff and industry to ensure they are equipped with the latest knowledge and skills. (Check out the educational o erings from NEHA at www.neha.org/education.) • Public Engagement and Education: Engage the community through workshops, public meetings, and educational campaigns to increase awareness, build trust, and garner support for environmental health initia- tives. Stories that are supported by data are very important to consider. • Collaboration: Partner with universities, nonprofits, and other agencies to bring in added expertise and resources. Collabora- tive e orts can also lead to shared solutions and stronger advocacy at higher govern- mental levels. • Data Collection and Technology: Invest in monitoring equipment, data analysis tools, and technological solutions to ensure accu-
rate, timely, and actionable environmental health data. • Clear Regulatory Frameworks: Streamline and update local regulations to provide clear guidelines for businesses and the commu- nity. Collaborate with state and federal enti- ties to ensure cohesive and comprehensive regulatory approaches. Regularly review and update environmental health plans and strategies to account for new information and emerging threats. • Advocacy: Engage in active advocacy at the state and federal levels to secure the necessary support, resources, and legisla- tive changes. • Feedback Mechanisms: Establish feed- back loops with the community and other partners to regularly review the e ective- ness of interventions and recalibrate strat- egies as needed. • Inclusive Decision Making: Ensure that decisions are made with the involvement of those groups most impacted, especially mar- ginalized communities that might bear a dis- proportionate environmental health burden. By adopting a proactive and collaborative approach, local governmental environmental health programs can address hyperlocal and global challenges and ensure the well-being of communities in the face of evolving envi- ronmental threats.
tbutts@neha.org
Reference Vosoughi, S., Roy, D., & Aral, S. (2018). The spread of true and false news online. Sci- ence , 359 (6380), 1146–1151. https://doi. org/10.1126/science.aap9559
The National Environmental Public Health Internship Program (NEPHIP) is a 400-hr paid internship opportunity that links environmental health undergraduate and graduate students with funded internship placements at qualified environmental public health agencies. Dates for student applications for the summer 2024 session will be announced soon. Applications for environmental health agencies are always open and will be accepted on a rolling basis if positions are open and available. Learn more at www.neha.org/nephip.
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7
December 2023 • Journal of Environmental Health
ADVANCEMENT OF THE SCIENCE
A Framework for Assessing Exposures to Multiple Hazards and Implications for Prioritizing Risks to Human Health, Safety, and the Environment
Ephraim Massawe, PhD Southeastern Louisiana University
scientific evaluation methods. If any hazards are found to be in excess of limits relative to the established voluntary or regulatory bind- ing occupational exposure limits (OELs), then recommendations in the form of control and management are presented. Unfortunately, not all hazards have OELs. When available, OELs are not always pro- tective enough to all employees or people in the community because of the assump- tions that underlie OELs. Furthermore, some hazards can have multiple eects on human health that complicate the process of exposure assessment. The complexity of a workplace—such as metal and metallurgi- cal industries—can be a prime candidate to showcase the use of tools to characterize and prioritize multiple hazards. Creating a comprehensive exposure assess- ment strategy for all tasks and hazards for the purpose of a management plan can be overwhelming. When confronted with these challenges, it is sometimes necessary to rely on limited information to assess and make informed professional judgments about expo- sure scenarios to multiple hazards on which management can derive protective strategies. A framework to characterize and prioritize multiple hazards can support management and improve the assessment of the exposure scenarios adequately, thereby protecting work- ers and the community. Background The metal and metallurgical industries operate worldwide with the primary objec- tive of making profits from the products they manufacture and supply. The products from these industries find wide applica- tions in automobile manufacturing, gas and oil pipelines, and domestic appliances.
Abstract Exposure assessment in the workplace or community is time-consuming and a lack of resources can mischaracterize risks to hu- man health, safety, and the environment. It is even more dicult when there are multiple hazards in operations where raw materials and the release of myriad chemicals with various health, safety, and environmental eects oc- cur. The challenge to practitioners is to ensure that hazards are anticipated, recognized, and evaluated and—where exposures are above exposure lim- its—management strategies are implemented to minimize or eliminate risks. Where resources are not available, limited exposure data should support professional judgment to characterize and prioritize risks. The aim of this study is to review and apply various approaches to assess multiple hazards and provide the basis for risk characterization and priori- tization. The prior work experience, knowledge and education, and scien- tific computational tools are described to understand exposures to multiple hazards relative to occupational exposure limits and risks. Although one industrial sector is used for illustrative purposes, the results are general- izable to other sectors and the general environment. Previous knowledge and education do not underscore the importance of walk-through audits. Further, informal and formal surveys, checklists, interviews, and structured questionnaires are useful tools to assess multiple hazards and their risks.
I ntroduction Exposure assessment is the process of identifying instances of human contact with chemicals, physical hazards, biologi- cal agents, or other hazards in the environ- ment (U.S. Environmental Protection Agency [U.S. EPA], 2019). Implementing exposure assessment of multiple hazards for purposes of characterizing and prioritizing risks to human health, safety, and the environment can be time-consuming and could exceed available resources. This type of assessment
is particularly challenging due to the mul- tiple hazards that vary by processes, units, or by day and seasons—even more so for workplaces that rely on heavy equipment and machinery for their operations and processes. Some workplaces can produce and use large amounts of chemicals that are toxic and potentially lethal (International Labour Orga- nization, 2021). For public health and occu- pational safety and health practitioners, the challenge is to ensure that multiple hazards are assessed via anticipation, recognition, and
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to gather data for the identification and rec- ognition of the specific hazards (Agency for Toxic Substances and Disease Registry, 2018; Lyon & Hollcroft, 2016). Moreover, in the identification and rec- ognition step, we conducted walk-through audits in combination with extensive reviews of the literature to understand the basic operations of workplace facilities (Ameri- can Industrial Hygiene Association [AIHA], 2020). We recognize that one of the limita- tions of walk-through audits is the primary reliance on previous experience, and for this reason, persons conducting audits must be given components of education and train- ing in specific industries to accomplish these tasks (Arnold et al., 2016). The lack of suf- ficient tools to assess hazards and the extent of the exposure can lead to underestimated or overestimated exposure scenarios and mis- characterized risks to human health, safety, and the environment (Arnold et al., 2016). Some tools for improving professional judgments are available for exposure assess- ments of multiple hazards. These tools include exposure banding or the Exposure Control Category and Exposure Control Banding schemes of the American Industrial Hygiene Association (AIHA; Anna, 2011) and National Institute for Occupational Safety and Health (NIOSH, 2019), which can be used to help make professional judgments under conditions of uncertainty, particularly in environments of multiple hazards. These tools are particularly useful for interpreting exposure scenarios when there are limited sampling data for the hazard relative to OELs. Limited exposure data for single hazards can easily be analyzed and interpreted by using statistical tools such as the Bayesian decision analysis or IHSTAT frameworks. In these circumstances, the analysis can be accompanied by a tiered criterion to make it easy to interpret the results as a risk cat- egory, which are adequate for prioritization and characterization relative to OELs (Table 1). This approach is being used to optimize resources and inform management options (Mulhausen & Damiano, 2011). Surveys and informal or formalized inter- views are qualitative assessment strategies that rely on interacting with people who are being exposed to the hazards, usually work- ers and people in the community. These approaches usually are subjective—regard-
less of if they are structured, nonstructured, standardized, or nonstandardized—and can be prone to selection or recall biases (Bogner & Landrock, 2016; Salazar, 1990). One way to avoid this shortcoming is to increase the knowledge of the assessor through training and education to identify, anticipate, recog- nize, evaluate, and control individual hazards that are crucial to human safety, health, and the environment (Vadali et al., 2012). For this approach to be e£ective, it is also essential to create and ask relevant questions that collect the opinions of workers and people in the community about the hazards (Table 2). A checklist of risks from the hazards—whether perceived or real—should help with the met- rics for assessing the hazards and the risks to human health, safety, and the environment (AIHA, 2020; Campbell Institute, 2019). Another method relates to the complexity of the work environment and possibly the varying work hours of personnel, along with the confinements of the hazards. For this reason, it is necessary to create and admin- ister electronic and paper questionnaires. As appropriate, questionnaires should be validated and approved by an institutional review board and consent forms should be provided to respondents (U.S. Department of Health and Human Services, 1998). The validity of the questionnaires is as impor- tant as the structure and the reliability of the questionnaires. This questionnaire approach is helpful in capturing as many opinions as possible from workers exposed to multiple hazards via dif- ferent tasks and jobs. As the rationale for selecting questionnaire respondents relies on the people in charge of the design and implementation of exposure assessment or management who are in charge of health, safety, and the environment at a workplace, it is equally important to select people from the community to be respondents for a wider range of answers. In other instances, an occu- pational physician who frequently interacts with workers when injuries and illnesses are reported can be a good resource for inter- views and questionnaires (Plog & Quinlan, 2012; Tendai, 2021). The opinions of workers or people in the community about hazards—whether per- ceived or real—and their qualitative views can be used to assess multiple hazards to jus- tify the risk characterization that was previ-
In North America, there are at least 1,859 metal and metallurgical industrial facilities, including heavy and energy-intensive oper- ations such as blast furnaces, steel works, and rolling and finishing mills. These facili- ties are classified by the North American Industry Classification System (NAICS) or Standard Industrial Classification (SIC) as code 3315. Other classifications for metal and metallurgical industries include: elec- trometallurgical ferroalloys (NAICS or SIC 3313); steel wire drawing, steel nails, and spikes (SIC 3315); cold-soled steel sheets, strips, and bars (SIC 3316); foundries (SIC 3325); and primary smelting and refining of nonferrous metals (SIC 33339). The economic impact of the industries under these classifications is profound. This industry has a productive capacity of >90% in iron and steel products, a total annual rev- enue of $90 billion, approximately 150,000 direct employees, and a yearly payroll of $7 billion (American Iron and Steel Institute, 2018). While there are substantial economic benefits to this industry, measures are neces- sary—including conducting comprehensive exposure assessments—to protect the safety and health of workers in this industry. Methods A literature review was conducted to under- stand the intersection of workplace hazards and the risks to workers and the community. Recognizing the connection, we further eval- uated the complexity and nature of the heavy industrial operations of metal and metallur- gical facilities as a case study to show how a comprehensive framework can be crafted to assess exposures to multiple hazards. The risk assessor must characterize the risks to support the goals of the company and to pro- tect the health and safety of both workers and the community (Lyon & Hollcroft, 2016). A comprehensive framework of assess- ment was used for this study. This framework is based on the tenets and steps of indus- trial hygiene: identification and recognition, evaluation and analysis, and control or man- agement of multiple hazards. Although such frameworks target workplace facilities, our results can be generalized across many indus- tries and the general environment. Further, steps that are embedded in the fundamentals of risk assessment of initial scoping, plan- ning, and information gathering were utilized
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December 2023 • Journal of Environmental Health
ADVANCEMENT OF THE SCIENCE
ously reported in the qualitative risk assess- ments. In these situations, responses should be interpreted with caution because of reli- ability and lack of knowledge on specific haz- ards or recall bias. Guidance via training for the interviews and questionnaires for better comprehen- sion with regard to specific hazards might improve responses and subsequently lower the degree of mischaracterization, under- estimation, or overestimation of the risks (Gallizzi & Tempesti, 2014). It is equally important that the sample size of work- ers and people in the community be large enough to avoid selection biases. If field evaluation methods used to assess specific exposures to specific hazards are implemented properly, these methods can provide the opportunity to collect quality samples of the hazard that are sucient to be analyzed by traditional statistical tools. If a limited number of samples are available, how- ever, the emerging Bayesian decision models can be used to conduct risk characterization and prioritization (Hager & Johnson, 2015). It is crucial that sampling and analytical methods from agencies such as NIOSH, the Occupational Safety and Health Administra- tion (OSHA), or AIHA are used (Andrews & O’Connor, 2020). This approach is important because the number of samples to be col- lected must meet a threshold minimum of the limit of detection of the analytical laboratory to avoid censored data or non-detect results. In these circumstances, traditional statisti- cal methods might not be the best for analysis, but Bayesian decision analysis tools are find- ing useful applications in these assessments and can provide a good basis for professional judgment about exposures, profiles of expo- sures, and risk characterizations. These tools and approaches rely on the assumption or hypothesis that exposure data are log-nor- mally distributed (Hager & Johnson, 2015). This assumption, though, must be tested before the analysis of the data is carried out. The test is done through graphical methods to obtain goodness of fit as close to 1 before further analysis can be conducted to prioritize and characterize the hazards and risks. Other tools that can be used for assessing hazards include hazard assessment and risk characterization prioritization schemes from the federal government. For example, Hazus- MH (multi-hazard) is a software package of
TABLE 1
Risk Characterization of Multiple Hazards and Exposure Control Category
Exposure Control Category/Exposure Control Banding
Criteria for Characterizing Risks Based on Permissible Exposure Limit (PEL)/ Occupational Exposure Limit (OEL)
Exposure Management Option
0 1 2 3 4
95% ≤ 0.01% × PEL/OEL 95% ≤ 0.1% × PEL/OEL
No action
Highly controlled
0.1 × OEL < 95% ≤ 0.1–0.5 × PEL/OEL 0.5 × OEL < 95% ≤ 0.5–1.0 × PEL/OEL
Well controlled
Controlled
95% > 1.0 × PEL/OEL 95% > 5.0 × PEL/OEL
Poorly controlled
Other categories
Extremely poorly controlled
Adopted from Arnold et al., 2016; Logan et al., 2009.
TABLE 2
Exposure Data Interpretation and Training Questions
Primary Hazard and Risk Characterization
How Often Does Training Occur on the Following Hazards?
1
2
3
4
5
Chemical exposure Ergonomic hazards Material handling Noise exposure Repetitive lifting Sharp injuries
Note. Response numbers are based on a 5-point Likert scale (1 = infrequently and 5 = frequently).
standardized tools to prioritize and estimate risks from multiple hazards and disasters such as hurricanes, floods, tornadoes, and tsunamis (Federal Emergency Management Agency, n.d.), These tools can support pre- and post-natural disaster hazard planning to enhance or increase resilience in the work- place and communities. Similar tools have been adopted and adapted that assess mul- tiple human-made and technological hazards to characterize the risks, some of which use letter coding to indicate probability, severity, and other factors (Lyon & Hollcroft, 2016). The common theme among the tools is the extent of the impacts (i.e., low, medium, high, or significant) and the probability and sever- ity of the impacts (Stickle, 2012). The risk of
negative impacts on property—and subse- quently the bottom line of for-profit compa- nies—has been the driver for this approach. The databases of injuries from the Cen- ters for Disease Control and Prevention and OSHA are tools that can support safety and health professionals in the prioritization of hazards and the associated risk characteriza- tion process. The data sets in these databases are available by ZIP Code or by NAICS or SIC codes for acute and chronic illnesses. The databases are also searchable by the costs of injuries. If the time frame can be established, then the probability of occurrence, location, costs for medical care, and hazard type can be established. A review of the historical injury records and events, and available information
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For example, in the production of coke (a gray, hard, and porous coal-based fuel with high carbon content and few impurities), the blast furnace consumes as much as 96% of all the energy requirements in the integrated iron and steel industry to process the raw iron and steel bars into iron. Furthermore, in this process, the metallurgical coal is heated up and gases, oils, tar, and other by-products are produced that can cause lung cancer. These emissions are a concern not only to workers but also to nearby communities (Prabhu & Cilione, 1992). Other chemical hazards include zinc, hexavalent chromium, hydrochloric acid, and flux for collecting impurities from molten materials (Table 3; Fenton, 1996). Recently engineered nanoparticles have emerged and have many industrial applications. Although they are eective in many areas and economi- cally beneficial, the health, safety, and envi- ronmental impacts are largely unknown. The energy-intensive processes and opera- tions typical in the metallurgical industries are a result of processing large raw materials into smaller sizes and converting raw materi- als into finished products. It is not uncom- mon to use jaw crushers or gyratory and roll crushers in these operations, even though silica dust can be pervasive (Gupta & Yan, 2016). The operations that involve processes such as galvanizing; corrosion resistance; oxide removal; and solid and liquid separa- tion operations, filtration, and thickening units consume significant amounts of chemi- cals where aerosols can be emitted in large amounts (Table 3). The pickling units in some metal and met- allurgical facilities rely on acids to remove the oxides and scales from the incoming steel raw material slabs before they are sent to another unit for further processing (Fox et al., 1993). According to the U.S. Environmental Protec- tion Agency, the source of acid-mist emis- sions depends mainly on the configuration of the acid baths (i.e., surface area volume, tem- perature, local exhaust ventilation systems, degree of stirring or agitation). The resulting acid emissions are a health risk to workers and the environment. Additionally, oxygen deficiency hazards can be prevalent in some facilities (Stefana et al., 2018). These hazards should undergo a systematic assessment for prioritization and risk management to avoid asphyxiation
regarding chronic health eects, can be use- ful in this activity. There are multiple approaches from other federal and nonprofit agencies such as OSHA and the American Conference of Govern- mental Industrial Hygienists (ACGIH, 2023) in which multiple hazards can be assessed through exposure and OELs to determine risks in combination. Databases of injuries and illnesses are also useful tools to estimate the cost of medical care that results from acute or chronic injury and illness. One such database is the Estimated Costs of Occupa- tional Injuries and Illnesses and Estimated Impact on a Company’s Profitability Work- sheet from OSHA (n.d.) that can support exposure assessment goals. The worksheet estimates the risk of harm to employees and, with good historical records in industrial facilities, the tool can be good at character- izing risks for acute and chronic injuries. A caveat to the use of this approach is that a 3% profit margin must also be included in the characterization process. Results and Discussion The hazards identified and recognized in the literature, from walk-through audits and through previous experience in the industry, are profiled in Table 3. A basic information characterization shows that acid mists, heat stress, and ergonomic hazards are but a few of the hazards in the industry. A brief description of each hazard, task, and worker exposure is provided (Table 3). A strategy to assess, pri- oritize, and characterize risks of hazards relies on additional eort, including letter coding (Table 4). This strategy is aided by the estab- lishment of exposure assessment goals, expo- sure profiles, risk pathways, and exposure control categories for each hazard (Hager & Johnson, 2015; Reinhold & Tint, 2009). Chemical Hazards Typically, this industry can source its raw materials by importation of heavy iron bars and pellets (50–70% iron) using a basic oxy- gen furnace or by the reprocessing of scrap metal, mill scale, and steel slag that are recy- cled on-site using an electric arc furnace (Gal- laher & Depro, 2002; Supplemental Figure 1, www.neha.org/jeh-supplementals). The last two processes (i.e., forming and finishing) are energy-intensive, making the industry the 5th- largest consumer of energy in the U.S.
risk to employees, contractors, and people in nearby communities. When confronted with multiple chemical exposure scenarios, Equation 1 considers personal exposure samples and the OEL for each chemical to characterize and prioritize the hazard (ACGIH, 2023).
C1 C4 OEL1 OEL3 OEL3 OEL4 + C5 + Cn OEL5 OELn + C2 + C3 +
x =
(1)
Where Cn in the equation is the expo- sure concentration of chemical 1 and OELn is the corresponding permissible exposure limit (PEL). When x > 1, there is significant exceedance relative to OELs. When x < 1, the risks are low relative to OELs. Occupational Noise NIOSH has a recommended exposure limit for noise exposure of 85 dBA as an 8-hr time- weighted average (TWA). NIOSH estimates that a lifetime exposure of 40 working years would easily translate into an 8% excess risk of noise-induced hearing loss, with over 25% of the excess risk if exposures are ≥90 dBA of the OSHA PEL for an 8-hr TWA (Chan, 1998). A literature review concludes that >30 million people in the U.S. are exposed to excessive noise that might cause long- term noise-induced hearing loss (Chen et al., 2020; Farrell Luka & Akun, 2018; Royster, 2017). Occupational exposure to noise is not confined to the workplace and can have a spillover eect on the health impacts felt in communities. Symptoms of depression have been reported, along with paranoia, com- munication di«culties, suicide attempts, and lower quality of life in aected communities (Monazzam et al., 2019; Themann & Master- son, 2019; Yoon et al., 2014). Modernization of the workplace often includes engineered noise abatement meth- ods, but some automated systems are likely to create novel hazards that require new solu- tions to identify, characterize, and manage these hazards. In some areas of these metal and metallurgical industries, personal and area noise monitoring can range from 85 dBA to >100 dBA, respectively (Nyarubeli, 2018). Most workplace facilities that process steel coils of varying thicknesses are wrapped with several metal bands under high tension; this
11
December 2023 • Journal of Environmental Health
ADVANCEMENT OF THE SCIENCE
TABLE 3
Hazard Identification and Recognition Matrix
Hazard
Description and Work Process
Exposure and Control Activity
Reference
Acid-mist, lime, or flux material exposure
Acid pickling process involves the removal of oxides and scales on steel wires and strip steel, as well as the processing of stainless steel sheets Flux materials include lime and limestone products Prevalent in the chrome plating of steel rolls for better strip surface and cleanness Potential use includes environmental remediation in the metal and metallurgical industries Engineered nanoparticles are also found in metal fabrication, the solidification of metals, and thermomechanical processing Exposure to employees during downtime or during planned yearly maintenance Sulfur dioxide emissions; coal by- products (e.g., ashes); and other environmental pollutants such as particulates, gases, oils, and tar Potential for greenhouse gas emissions Potential for interaction with sharp steel products to operators, contractors, and customers Heat stress proximity of electric arc and blast furnaces, casting, and melting and reheat furnace areas can be indoor high- risk areas for heat stress in employees Not uncommon for areas of debanding to have noise levels of 80–110 dBA Impact noise hazards
Use of sulfuric acid, hydrofluoric acid, and nitric acid can create acid mists in carbon steel or stainless steel Impacts to communities can occur via hazardous air pollutants Exposure job tasks include pickling tanks, handling of the acid, or acid-transfer stations
Fenton, 1996; Fox et al., 1993; U.S. EPA, 2003, 2012, 2021
Exposure to hexavalent and trivalent chromium
Alvarez et al., 2021; Saha et al., 2011; Shelnutt et al., 2007; Stern et al., 1993 Arnold et al., 2016; Bagbi et al., 2018; Borodianskiy & Zinigrad, 2016; Kaviarasu & Ravichandran, 2021
Worker exposure can result in lung cancer, nasal cancer, skin sensitization, asthma, and dermal irritation
Exposure to engineered nanoparticles
Most materials do not have PELs/OELs except for titanium dioxides and carbon nanotubes Control activities include a checklist for the Rule of 10, hazard vapor ratio, and particulate hazard ratio Consider precautionary principles in situations with or without OELs and limited data Worker exposure can result in silicosis, genotoxicity, pulmonary fibrosis, and other related health effects Environmental monitoring beyond the fence lines for sulfur dioxide, dust, sludge, and other particulates (PM 2.5 ; PM 10 ) Carbonaceous materials are a cause for a major class of nanoparticles such as spherical fullerenes (e.g., carbon 60) Sharp injuries have been identified, recognized, and evaluated since the 1800s Efforts to automate job task operations are under study Cut-abrasive-puncture-resistance glove tests are planned Occurs principally during the summer months Consider controls such as large industrial fans, water stations, and planned work regimens (i.e., administrative controls) Implement a management program for heat stress
Silica exposure
Green & Vallyathan, 1995; Wallace et al., 2006 Prabhu & Cilione, 1992; U.S. DOE, n.d.; U.S. EPA, 1995, 2022
Coal processing in a furnace (e.g., open hearth furnace, electric arc furnace, basic oxygen furnace) Sharp injuries (e.g., hand safety)
Chaney & Hanna, 1918; Kossoris & Kjaer, 1936; Ong et al., 1987; Perelman, 2016; Rajak et al., 2022
Heat stress
Bardhan et al., 2021
Occupational noise
Hazard mapping to identify areas and tasks Exposure can result in noise-induced hearing loss
Nyarubeli et al., 2018
continued
process can present multiple hazards, includ- ing noise and projectile objects from deband- ing tasks. These hazards can aect not only employees but also contractors, visitors, and consumers of these products if information on proper handling is not communicated. Previously, workers would manually cut the bands that hold the coils together to spring open the coils. Because the bands are under high tension, they can release kinetic energy and cause severe or fatal injuries. These manual banding and debanding tasks for raw steel coils present ergonomic hazards, severe sharp injuries, and heat stress, particu- larly during the summer months for North
American companies. Major companies in this sector are using their resources to modernize operations through the installation of robotic equipment for these jobs and tasks (Chan, 1998; Radian Robotics, n.d.). This moderniza- tion, however, has created new hazards such as noise, which therefore requires assessment. In the workplace or community situations where multiple sources of noise hazards are being experienced, a simplified tool (Equation 2) is used to assess exposure scenarios that can be compared with OELs relative to the time of exposure (ACGIH, 2023). The results can then be used for risk characterization of occu- pational or nonoccupational noise.
C1 T1
C2 T2
C3
C4 T4
x =
+
+
+
T3
C5
Cn Tn
+
+
T5
(2)
Where Cn in the equation is the amount of time exposed to noise levels from source n and Tn is the amount of time required by the OEL for compliance purposes. An approach for occupational noise exposure assessment and rating is part of a strategy for comprehensive assessment (Hager & Johnson, 2015). This tool is available for assessing occu- pational noise and characterizing and prioritiz- ing risks for hearing impairment (Table 5).
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-olume 8 • Number
Hazard Identification and Recognition Matrix continued TABLE 3
Hazard
Description and Work Process
Exposure and Control Activity
Reference
Ergonomic hazards and material handling
No one standard fits all and in the absence of an OEL or OEB, work regimen should be assessed Work tasks—such as long hours of work on overheard cranes, band-cutting or folding, control room operators, maintenance of vehicles—can create postures that can stress worker neck and shoulder muscles and cause high levels of discomfort in legs and forearms Confined spaces include maintenance holes, crawl spaces, and tanks, which are not designed for continuous occupancy and are difficult to exit in an emergency
Repetitive and forceful movements, vibrations, temperature extremes, manual handling, and awkward postures Use the 88:10:2 Heinrich Theory of Accident–Incident Causation Focus on human acts; unsafe conditions Interaction of overhead computers and constant watch of steel metal plates on conveyor belts can potentially present back injuries, musculoskeletal disorders, and other illnesses Redesign workstations to improve comfort and productivity More deaths are reported from the hazard of the confined spaces in the iron, metal, and metallurgical industry in Italy than in any other working environments Development of a checklist and matrix to prioritize hazards in confined spaces Can result in oxygen deficiency hazards Use of metalworking fluids can result in bacterial and fungal aerosols Mold can be present in wet areas (e.g., overhead cranes in wet seasons or in administrative offices or mobile truck offices)
Brauer, 2016; Mohammed et al., 2020; NIOSH, 2019; Tendai, 2021
Confined spaces (permit or nonpermit requirement for entry)
Chinniah et al., 2017; McManus, 1999; North Carolina Department of Labor, 2014; Permit-Required Confined Spaces, 2023; Selman et al., 2018; Stefana et al., 2018 Brinksmeier et al., 2015; Foltz, 2022
Seasonal biological hazards
Prevent metal corrosion with metalworking fluids, wet areas of cranes, etc.
Note. NIOSH = National Institute for Occupational Safety and Health; OEB = occupational exposure banding; OEL = occupational exposure limit; PEL = permissible exposure limit; PM = particulate matter; U.S. DOE = U.S. Department of Energy; U.S. EPA = U.S. Environmental Protection Agency.
Equations 3 and 4 represent outdoor and indoor environments, respectively. Studies resulting in the heat stress index of 29.0 °C and 20.4 °C for furnaces (WBGT = 34.7 °C) and the casting areas (WBGT = 39.9 °C) have been common (Bardhan et al., 2021). In these situations, a heat regimen could be imple- mented or suggested in the areas prone to these hazards (ACGIH, 2023; Bardhan et al., 2021). Furthermore, it is important to evalu- ate indoor environments where furnaces emit radiant energy. In these situations, the out- door equation must be substituted.
TABLE 4
Coding and Responsibility to Characterize Risks and Management Actions
Letter Coding
Description
Risk Characterization
Remarks
Potential Management Action
A B C D
Low risk
0–2 3–5 6–8
Acceptable
Medium risk
Low
Higher risk
Medium
Identify staff to be given responsibility and authority to address the risk
Severe risk that is unacceptable Potentially serious and fatal risk
9–12
Unacceptable
E
>12
Unacceptable
WBGT out = 0.7T wnwb + 0.2T g + 0.1T db (for outdoor work environments)
(3)
Heat Stress Risks, Exposure Scenarios, and Management Options Via literature review and also safety and health walk-through audits, this study identified areas prone to high heat stress within the facili- ties that were examined. The casting opera- tions—including the billet unit operations, reheat furnaces, and melt shops—are high-risk units (Bardhan et al., 2021). As part of heat stress monitoring and evaluation, a wet-bulb
globe temperature (WBGT) device is essential (Plog & Quinlan, 2012). Temperature results are influenced by four thermal conditions: air movement (wind), air temperature, humidity, and radiant heat. The last three values are mea- sured by a dry-bulb thermometer that measures ambient temperature, a natural wet-bulb ther- mometer that measures the potential for evapo- rative cooling, and a black-globe thermometer that measures radiant heat (ACGIH, 2023).
WBGT in = 0.7T wnwb + 0.3T g (for indoor work environments)
(4)
Where in the equations, T wnwb = natural wet bulb (evaporative cooling), T g = black globe thermometer (radiant heat), and T db = dry bulb (ambient temperature). Body temperature is a measure of the heat energy present in a person (in this scenario, a worker). The average temperature of a
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December 2023 • Journal of Environmental Health
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