Engineering controls as an intervention to reduce worker exposure

The implementation of controls to reduce worker exposure should be considered the ultimate goal of any successful industrial hygiene program. The industrial hygiene literature has consistently described a hierarchy of controls, consisting first of the engineering controls (substitution, isolation, ventilation), and followed by administrative controls (personal protective equipment, worker education, scheduling, etc.). Recently, exhaust ventilation has been the most popular form of engineering control technology for controlling exposure to airborne contaminants. The use of ventilation to control exposures is not without its problems, however, and many of these problems potentially are more severe in smaller companies. This paper proposes a new emphasis on the first control in the hierarchy, substitution. Historically, substitution has meant the substitution of a hazardous chemical or process by one that is less so. This definition is too restrictive; because of this, it is proposed instead to use the term process change, defined as the use of any process modifications that serve to reduce worker exposure. The advantages and disadvantages of the process change approach are discussed and are illustrated with case studies. © 1996 Wiley-Liss, Inc.     

Cause and control: education and training of professional industrial hygienists for 2020.

By the year 2020, the environmental movement will have established a recognized profession, expert at studying deleterious effects in the working and public domains. Environmental science practitioners will be better able to identify and relate ill effects to the presence of adverse agents in the environment; they will not, however, necessarily be skilled at developing systems for control. Industrial hygienists should provide the unique and special skills required to establish economically optimum control systems. Industrial hygiene should by then have been redefined to emphasize this critical role of its professional members. A new orientation for education is therefore proposed to provide a sound basis for the professional needs of industrial hygienists who should be at the peak of their careers in 2020. Members of the profession should then be the leaders in research on, and practice of, the science and engineering of design, installation, and monitoring of control systems for occupational and environmental hazards. The preferred educational background for entry to the profession should be some branch of engineering, which by then must have recovered its lost status and be divided into fewer specialized compartments than it is today. Engineering should provide a broader base for students entering professional education in this field, who will be more concerned with prevention and engineering control of both occupational and environmental hazards, rather than with measurement and epidemiology of the biological and toxicologic sciences. Preparation for professional work in industrial hygiene will call for the specialized education of engineers required to design and maintain processes that minimize the use, production, or generation of hazardous substances.(ABSTRACT TRUNCATED AT 250 WORDS)     

How much should a certified industrial hygienist know about health physics?

Based on the classical definition of an industrial hygienist, it is obvious that a certain level of competence in health physics aspects is required. The converse may also be true. Individuals in both professional organizations are urging more interfacing between the two groups. In light of this, the author presents a matrix which illustrates the progressive steps involved in ionizing radiation hazard judgment, based on the classical industrial hygiene definition. The author then presents his opinion (using examples from literature and his own experience) as to the delineation of areas in which a certified hygienist should be able to handle potential ionizing radiation hazards successfully. It is stressed that the hygienist must, in addition, be able to know when to consult a qualified health physicist in situations which require a more advanced level of expertise.     

Hero or has-been: Is there a future for altruism in medical education?

The term ‘altruism’ is often used without definition, leading to contradictions in what we expect from medical students. In this reflection paper, we critique the concept of ‘altruism’ from the perspective of moral philosophy and social psychology and challenge its unquestioned usage within the medical education literature, especially that emerging from the USA. We will argue that ‘altruism’ is a social construction with a particular history, stemming from Kantian philosophy and perpetuated within newer disciplines such as social psychology. As it currently stands, ‘altruism’ seems to mean utter self-sacrifice—a position contradictory to recent recommendations by regulatory bodies in the UK, which suggest that graduates should look after the ‘self’ and achieve a work-life balance. In this article, we argue that it is undesirable to have ‘altruism’ as a learning outcome for medical students and we also argue that ‘altruism’ is not an observable behavior that can be measured. Instead, we suggest that medical educators should employ a more balanced term, borrowed from the social psychology literature i.e. pro-social behavior. We argue that whilst ‘pro-social behavior’ focuses on actions that benefit others, it does not do so at the expense of the self. In addition, it focuses on students’ observable behaviors rather than their inner motivations, so is measurable. We conclude our article by discussing the formation of physicians based upon a virtue ethics, where society and the profession are in dialogue about the telos of medicine and its virtues, and where the character of the young physician is formed within the crucible of that dialogue. Thus, central to this pro-social behavior is the concept of phronesis or prudence, including the balancing of self-interest such as self-care, and the interests of the other.     

British occupational hygiene practice 1720-1920

The first recognition of the profession of occupational hygienist was preceded by at least 200 years of developments in disease prevention practices in the workplace, many of which could readily be characterized as occupational hygiene. The nature and pace of adoption of these practices depended on the contemporary state of technology, science, medicine and social concern. At first it was a matter of individual initiative and did not depend on quantitative data, but by the second half of the 19th century techniques of measurement for both harmful effects and for exposure were being introduced and official bodies at both national and local level were active. People from a wide range of backgrounds made contributions to disease prevention at work and by 1920 most of the major concepts and practices of current occupational hygiene practice were in place, if only in rather limited settings.     

A conceptual framework for dietetics

The model for the practice of dietetics recently adopted by the CDA board of directors clarifies how the different facets of dietetics are interrelated and part of a common definition of dietetics. It is our hope that this discussion will help us to move beyond the question of identity we often feel in our profession and will stimulate debate and the development and testing of alternate models; this should further clarify the essence of dietetic practice and enable us to continue to improve our unique and common contribution towards the provision of quality nutritional care to the population.     

Spot-checks to measure general hygiene practice

A variety of hygiene behaviors are fundamental to the prevention of diarrhea. We used spot-checks in a survey of 761 households in Burundi to examine whether something we could call general hygiene practice is responsible for more specific hygiene behaviors, ranging from handwashing to sweeping the floor. Using structural equation modeling, we showed that clusters of hygiene behavior, such as primary caregivers’ cleanliness and household cleanliness, explained the spot-check findings well. Within our model, general hygiene practice as overall concept explained the more specific clusters of hygiene behavior well. Furthermore, the higher general hygiene practice, the more likely children were to be categorized healthy (r = 0.46). General hygiene practice was correlated with commitment to hygiene (r = 0.52), indicating a strong association to psychosocial determinants. The results show that different hygiene behaviors co-occur regularly. Using spot-checks, the general hygiene practice of a household can be rated quickly and easily.     

2004 Donald E. Cummings Memorial Award Lecture. Industrial hygiene in decline--what can we do?

The Donald E. Cummings Memorial Award was established in 1943 as a tribute to Donald E. Cummings, AIHA's third president. It is given for outstanding contributions to the knowledge and practice of the profession of industrial hygiene. This year's Cummings Award recipient is D. Jeff Burton for his many publications and training courses, as well as his involvement in many IH/OH organizations.     

Using Ockham’s razor to redefine “nursing science”

Confusion remains about the concept “nursing science.” Definitions vary, depending on country, context and setting. Even among nurse scholars and scientists there is disagreement about the content and boundaries of nursing science. There is an urgent need for an acceptable definition that can guide nursing knowledge development, education, and practice. In this article, we highlight the problems for the profession of this sort of conceptual ambiguity, arguing that it is an ethical responsibility for the profession to gain clarity about the meaning and apt focus of our knowledge development initiatives. We parse out nursing and science as separate concepts and synthesize from this analysis a simple yet comprehensive definition of nursing science. We propose that this definition is capable of unifying ongoing nursing endeavors and should serve as the basis for evaluating nursing's knowledge development and educational initiatives.     

Industrial hygiene and national health objectives for the year 2000.

Industrial hygiene can have a powerful effect on family, community, and environmental health in addition to its effect on occupational health. Contemporary industrial hygiene begins in the workplace, but its impact can spread and improve the health status of the nation in several ways. Thirteen objectives for industrial hygiene are presented in this report. Industrial hygienists should know what the objectives are, how the objectives are useful to their practice, and how they can help to achieve them to improve the health of Americans.     

Use of expert assessments in the determination of priority trends in social hygiene and public health organization

The study data on the evaluation of future trends in research on social hygiene and public health organization are provided. It was an expert method that was used to study the opinion of leading scientists in social hygiene and of a large number of experts-managers of public health bodies and institutions. The computerised data permitted to determine the present and future priority problems in the field of social hygiene which could be used by research workers as a social goal for practical application.     

Routine hand hygiene audit by direct observation: has nemesis arrived?

Infection prevention and control experts have expended valuable health service time developing and implementing tools to audit health workers' hand hygiene compliance by direct observation. Although described as the 'gold standard' approach to hand hygiene audit, this method is labour intensive and may be inaccurate unless performed by trained personnel who are regularly monitored to ensure quality control. New technological devices have been developed to generate 'real time' data, but the cost of installing them and using them during routine patient care has not been evaluated. Moreover, they do not provide as much information about the hand hygiene episode or the context in which hand hygiene has been performed as direct observation. Uptake of hand hygiene products offers an inexpensive alternative to direct observation. Although product uptake would not provide detailed information about the hand hygiene episode or local barriers to compliance, it could be used as a continuous monitoring tool. Regular inspection of the data by infection prevention and control teams and clinical staff would indicate when and where direct investigation of practice by direct observation and questioning of staff should be targeted by highly trained personnel to identify local problems and improve practice.     

The industrial hygiene audit: purposes and implementation

The increased implementation of industrial hygiene programs in industry, with the associated increase in funds allocated to safety and health programs, has introduced the concept of evaluative measures for program performance. The audit is a frequently used and valuable tool for the safety specialist, but it has been infrequently used by the hygienist. We differentiate the audit from 1) program guidelines and 2) program evaluation. The latter implies relating program activities to articulated measures of effectiveness. The audit, in contrast, utilizes widely accepted industrial hygiene program structural elements. In an audit a qualitative or numerical rating scale is assigned each audit program element to indicate the extent to which the element is present. The audit is an essential tool for the manager of an industrial hygiene program. Audits are not a substitute for program evaluation, but program evaluation is a very uncertain matter because the industrial hygiene profession has yet to focus on measures of program progress in terms similar to those of the safety field, i.e. accident frequencies and severities. Program elements and qualitative and quantitative rating scales are described. Preparation, conduct and reporting of the audit are discussed.     

Medicalisation by Whom? Accounts of Menstruation Conveyed by Young Women and Medical Experts in Medical Advisory Columns

The term medicalisation is considered in the light of an empirical study on menstruation as discussed in medical advisory columns. The focus is on how the medical profession responds to young women's questions about their maturing bodies. The questions are seldom of a medical nature; rather, they are concerned with normality and coping with menstruation in everyday life. The doctors' response is clear: the patient need not worry, the medical profession is both willing and able to take over the responsibility for, and control over, the body. The medicalisation of menstruation that can be found in advisory columns strengthens the position of the medical establishment as the legitimate authority on the body. Nevertheless, the letters sent to the magazines do not lend support to the idea of medicalisation as an endeavor pursued by the medical profession alone. The letters are also a means whereby young women try to establish standards for proper female gender behaviour in an areas where lay society remains silent.     

深圳市工业区食堂整顿与建设工程的现状与对策

为了建立适合劳务工安全就餐的保障体系，着力解决劳务工就餐难、就餐贵、就餐不安全的问题，深圳市于2005年7月1日启动了深圳市工业区食堂整顿与建设工程试点。试点以来，到2007年6月已领取卫生许可证的工业食堂这7179家（可供2662487人就餐），规范的餐饮门店有9857家（可供610128人就餐），劳务工安全就餐总人数为3272615人，占工业区劳务工总人数的83％。在试点过程中，存在工业区集体食堂数量严重不足；工业区食堂建设用地困难；政府财政投入力度不足，部分食堂经营状况不容乐观；政府主导作用不明显等问题。因此，必须增加财政投入，合理布局工业区食堂；合理规划，解决工业区食堂建设用地困难；政府相关部门要密切配合，充分发挥市场机制作用。     

To be or not to be: Future lives in economic evaluation

Sometimes healthcare will affect the health of people living in the future, or their chance of coming into existence. Should such outcomes be valued in health-economic evaluation? Guidelines implicitly recommend their inclusion but this rule has counterintuitive implications and is not consistently applied in practice. We suggest making a distinction between “necessary” and “potential” future lives in Health Technology Assessment. Necessary lives will exist independent of our healthcare choices and should be included. Potential lives are choice-dependent and should be excluded. This rule offers intuitive solutions within the HTA framework, and it changes the cost-effectiveness of several interventions where necessary future lives are affected.     

Environmental epidemiologic research as the basis for organizing health inspection

In the practical work of hygiene guideline and limitation values derived from animal experiments are used. The necessity to verify their validity and applicability by environmental epidemiologic research is pointed out. The close relationship between epidemiological research and practice of hygiene in the GDR is demonstrated by examples. In conclusion the problems are listed which should be treated by environmental epidemiologic research with priority.     

From good medical practice to best medical practice.

Medical and other professionals know what good practice is. It is in accordance with ideal procedures and standards of one's own practice. As actors we assess our practices from inside. If questions of quality assessment or quality assurance are raised at all, they are to be raised and answered by the professionals themselves. From that internal perspective, the idea of better or best medical practice is rejected as superfluous; or, perhaps, even nonsensical. This article suggests that concepts of best medical practice, as expressed from outside the profession e.g. economic efficiency, are not adequate in themselves if our interest lies in changing existing practice. Defined from outside, such concepts would be alien to the medical profession. Going from good practice to best practice, the article proposes, can be done on the basis of expanding the metaphor of self-transcendence. In self-transcendence the individual or profession changes or develops strategies and activities by adopting the standpoint of some perspective outside its own practice, and then integrating this perspective into practice. Self-transcendence by the medical profession can be carried out by their integrating a moral ideal from normal life into professional practice-essentially the notion of prescribing support of the weak. Such integration implies, inter alia, that the profession must take account of the scarcity of resources when assessing their practice.     

An industrial hygiene methodology developed in support of a retrospective morbidity case-control study.

An industrial hygiene methodology that was developed in support of an epidemiologic case-control study is described. This study was conducted to investigate a potentially increased incidence of colorectal cancer among employees who worked at a unit that manufactured polypropylene by a heavy diluent process. Retrospective epidemiologic case-control studies typically have exposure assessment problems because industrial hygiene monitoring data are often not available. Misleading job titles are another problem that can provide a poor framework for estimating exposures. In addition, a job title-based exposure assessment assumes individual work patterns are not important in assessing worker exposures, although this is contradictory to industrial hygiene experience. The design of the case-control study provided an innovative industrial hygiene approach to circumvent these typical exposure estimating problems. The industrial hygiene methodology of the case-control study included assessing historical exposures, developing an exposure estimating matrix, selecting candidate etiologic agents based on a joint toxicologic and industrial hygiene review, administering a work activity questionnaire, calculating exposure scores, and conducting a statistical analysis. The study design also provided an additional exposure measurement independent of the toxicologic and industrial hygiene review. This provided an opportunity to compare the likelihood of exposure misclassification and, as expected, showed that a more detailed exposure estimate resulted in less misclassification.