NIOSH HEALTH HAZARD EVALUATION REPORT:

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

HETA #2002-0257-2916

Bil-Mar Foods, Inc.

Storm Lake, Iowa

October, 2003

This Health Hazard Evaluation (HHE) report and any recommendations made herein are for the specific facility evaluated and may not be universally

applicable. Any recommendations made are not to be considered as final statements of NIOSH policy or of any agency or individual involved.

Additional HHE reports are available at http://www.cdc.gov/niosh/hhe/reports

This Health Hazard Evaluation (HHE) report and any recommendations made herein are for the specific facility evaluated and may not be universally

applicable. Any recommendations made are not to be considered as final statements of NIOSH policy or of any agency or individual involved.

Additional HHE reports are available at http://www.cdc.gov/niosh/hhe/reports

applicable. Any recommendations made are not to be considered as final statements of NIOSH policy or of any agency or individual involved.

Additional HHE reports are available at http://www.cdc.gov/niosh/hhe/reports
ii

PREFACE

The Hazard Evaluations and Technical Assistance Branch (HETAB) of the National Institute for

Occupational Safety and Health (NIOSH) conducts field investigations of possible health hazards in the

workplace. These investigations are conducted under the authority of Section 20(a)(6) of the Occupational

Safety and Health (OSHA) Act of 1970, 29 U.S.C. 669(a)(6) which authorizes the Secretary of Health and

Human Services, following a written request from any employer or authorized representative of employees,

to determine whether any substance normally found in the place of employment has potentially toxic effects

in such concentrations as used or found.

HETAB also provides, upon request, technical and consultative assistance to federal, state, and local agencies;

labor; industry; and other groups or individuals to control occupational health hazards and to prevent related

trauma and disease. Mention of company names or products does not constitute endorsement by NIOSH.

ACKNOWLEDGMENTS AND AVAILABILITY OF REPORT

This report was prepared by Bradley King and Elena Page of HETAB, Division of Surveillance, Hazard

Evaluations and Field Studies (DSHEFS). Statistical analysis was performed by Charles Mueller of HETAB,

DSHEFS. Field assistance was provided by Erin Snyder, Angela Warren, Julia Maldonado, Chad Dowell,

Manny Rodriguez of HETAB, DSHEFS; Walter Alarcon of Surveillance Branch, DSHEFS; James Taylor,

David Spainhour, Diana Freeland, and Susan Englehart of Field Studies Branch (FSB), Division of

Respiratory Disease Studies (DRDS). Analytical support was provided by Don Dollberg, Katherine Gomez,

Mark Millson, and Larry Jaycox of the Chemical Exposure and Monitoring Branch (CEMB) of the Division

of Applied Research and Technology (DART) and DataChem Laboratories. Desktop publishing was

performed by Robin Smith. Review and preparation for printing were performed by Penny Arthur.

Copies of this report have been sent to employee and management representatives at Bil-Mar Foods and the

OSHA Regional Office. This report is not copyrighted and may be freely reproduced. Single copies of this

report will be available for a period of three years from the date of this report. To expedite your request,

include a self-addressed mailing label along with your written request to:

NIOSH Publications Office

4676 Columbia Parkway

Cincinnati, Ohio 45226

800-356-4674

After this time, copies may be purchased from the National Technical Information Service (NTIS) at

5825 Port Royal Road, Springfield, Virginia 22161. Information regarding the NTIS stock number may be

obtained from the NIOSH Publications Office at the Cincinnati address.

For the purpose of informing affected employees, copies of this report shall be posted by

the employer in a prominent place accessible to the employees for a period of 30 calendar

days.
iii

Highlights of the NIOSH Health Hazard Evaluation

Evaluation of Chloramine and Endotoxin Exposures at a 

Turkey Processing Plant

NIOSH received a request for a health hazard evaluation (HHE) at Bil-Mar Foods in Storm Lake, Iowa. This

request noted that employees in the evisceration department were experiencing symptoms such as eye and

respiratory irritation. NIOSH investigators performed an evaluation to assess the possible causes of such

symptoms.

What NIOSH Did

# We tested the air for chlorine, chlorine-related

compounds called chloramines, and for

endotoxins, a bacterial component.

# We asked employees to perform breathing tests

to record any changes over the work shift.

# We asked workers about eye and respiratory

symptoms they had at work.

What NIOSH Found

# Chlorine was not detected in any areas.

# Levels of the chlorine-related compounds were

higher in the evisceration line than in the dark

meat area.

# More people in evisceration reported respiratory

and eye irritation symptoms than in dark meat.

# Those that reported these symptoms had higher

exposure to some chlorine-related compound

than those workers who did not report the

symptoms.

# Endotoxin levels were higher in evisceration

than in dark meat, but were not significantly

related to employee symptoms.

What Bil-Mar Foods Managers Can Do

# Further assess the ability of the ventilation

system to exhaust and dilute air contaminants.

# Continue collaborating with NIOSH to further

explore possible engineering controls that can

be used at this facility.

# Monitor reported health problems.

What the Bil-Mar Foods Employees Can Do

# Tell health personnel at work if you have health

problems that may be associated with the work

environment.

What To Do For More Information:

We encourage you to read the full report. If you

would like a copy, either ask your health and

safety representative to make you a copy or call

1-513-841-4252 and ask for

 HETA Report # 2002-0257-2916

Highlights of the HHE Report
iv

Health Hazard Evaluation Report 2002-0257-2916

Bil-Mar Foods, Inc.

Storm Lake, Iowa

October, 2003

Bradley S. King, MPH

Elena Page, MD, MPH

SUMMARY

On May 16, 2002, the National Institute for Occupational Safety and Health (NIOSH) received a request for

a health hazard evaluation (HHE) at Bil-Mar Foods in Storm Lake, Iowa, from the Occupational Safety and

Health Bureau of the Iowa Division of Labor. This request for technical assistance noted that employees in

the evisceration department were experiencing symptoms such as eye and respiratory irritation.

On June 26-27, 2002, NIOSH medical and industrial hygiene representatives visited the facility. On June 26th,

an opening conference was held and attended by NIOSH investigators, representatives of Bil Mar Foods, and

employee representatives. After the opening conference, a walk-through survey of the facility was conducted

to observe operational procedures and work practices. Following the walk-through, air flow patterns were

evaluated in the evisceration department. On June 26th and 27th, employees on the first shift in the

evisceration and dark meat departments were administered questionnaires regarding medical, job, and personal

history, and work-related symptoms. Air samples and readings for chlorine, ammonia, carbon dioxide,

temperature, and relative humidity were taken in the same departments during the first shift on the 27th. No

chlorine or ammonia was detected at any station. 

On June 2-6, 2003, NIOSH investigators returned to the facility. Personal breathing zone (PBZ) and area air

samples were collected for chloramines and endotoxins in the evisceration and dark meat areas of the facility

during the 6 a.m. to 2 p.m shift on each of these five days. Dräger® tubes were used to sample for chlorine,

and carbon dioxide, temperature, and relative humidity were measured throughout the week. Every individual

who wore sampling equipment was also asked to perform spirometry immediately prior to, and directly after,

their work shift as part of the medical monitoring aspect of the evaluation. Additionally, they were questioned

about mucous membrane and respiratory symptoms experienced during that shift. 

The concentrations of chloramine compounds (trichloramine and soluble chlorine [monochloramine,

dichloramine, hypochlorite, and hypochlorous acid]) were significantly higher in the evisceration area than

the dark meat area. Additionally, upper respiratory irritation symptoms, such as stuffy or itchy nose, frequent

sneezing, and cough, and burning or stinging eyes, were found to be significantly more prevalent in the

evisceration line workers than in the dark meat workers. The levels of soluble chlorine compounds measured

by PBZ samples were significantly higher for those employees who reported these symptoms compared to

those employees who did not. In addition, the levels of trichloramine were significantly higher in employees

who reported burning or stinging eyes. Mean PBZ concentrations of trichloramine and soluble chlorine were

higher in workers with significant cross-shift declines in lung function. The levels of endotoxin in the pinning
v

room were found to be much higher than in any other area of the evisceration or dark meat areas. Endotoxin

levels were significantly higher in the evisceration area than the dark meat area, although they were not

significantly related to reported employee symptoms. 

Results of this evaluation suggest a health hazard may exist from exposure to soluble chlorine compounds and

trichloramine. Recommendations include further assessment and potential modification of the facility’s

ventilation system in order to maximize its ability to dilute and exhaust such airborne contaminants. Further

collaboration between Bil-Mar Foods and NIOSH is planned for such an assessment. An exposure evaluation

by NIOSH is also recommended after any ventilation recommendations are implemented.

Keywords: SIC 2015 (Poultry Slaughtering and Processing). Chloramine, chlorine, ammonia, endotoxin,

sodium hypochlorite, superchlorination, eye irritation, respiratory irritation, ventilation.
TABLE OF CONTENTS

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii

Acknowledgments and Availability of Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii

Highlights of the HHE Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

Introduction ......................................................................... 1

Background ......................................................................... 1

Facility Operations ................................................................ 1

Irritative Symptoms in the Poultry Processing Industry .................................... 2

Methods ............................................................................ 3

Industrial Hygiene ................................................................. 3

Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Selection of participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Screening Questionnaire ......................................................... 5

Selection of Participants for Follow-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Spirometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Follow-up Questionnaire ........................................................ 5

Statistical Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Evaluation Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Ammonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Carbon Dioxide ................................................................... 7

Endotoxins ....................................................................... 7

Chlorine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Chloramines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Soluble chlorine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Trichloramine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Sodium Hypochlorite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Discussion and Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Health Hazard Evaluation Report No. 2002-0257-2916 Page 1

INTRODUCTION

In May 2002, the National Institute for

Occupational Safety and Health (NIOSH) received

a health hazard evaluation (HHE) request from the

Occupational Safety and Health Bureau of the

Iowa Division of Labor after they received a

complaint from an employee of Bil-Mar Foods,

Inc., in Storm Lake, Iowa. This request for

technical assistance noted that employees in the

evisceration department were experiencing

symptoms such as eye and respiratory irritation,

and that the Occupational Safety and Health

Bureau had not been able to determine the cause.

An initial site visit was conducted by a NIOSH

team on June 26-27, 2002. An opening conference

was held with management and employee

representatives, and a walk-through inspection of

the facility was performed where measurements for

chlorine and ammonia in the air were taken. On

June 26th and 27th, employees on the first shift in

the evisceration and dark meat departments were

administered questionnaires regarding medical,

job, and personal history, and work-related

symptoms. An interim letter describing the initial

site visit and preliminary findings was mailed to

Bil-Mar Foods representatives on October 28,

2002. 

On June 2-6, 2003, a return site visit was

conducted by NIOSH investigators. Area air and

personal breathing zone (PBZ) samples were

collected for trichloramine, soluble chlorine, and

endotoxins, as well as additional air samples for

chlorine, in both the evisceration and dark meat

areas of the facility. Pulmonary function tests

were performed both pre- and post-shift by

workers who had worn sampling equipment.

Employees were also questioned about respiratory

symptoms experienced during the work shift. 

BACKGROUND

Facility Operations

Bil-Mar Foods, a division of Sara Lee Inc.,

employs approximately 600 workers at the Storm

Lake, Iowa, turkey processing facility.

Approximately half of these employees speak

Spanish as their primary language with the

majority of others speaking English and a small

minority speaking Laotian. Of the three eight-hour

shifts per day, two are used for turkey processing

(10 p.m.- 6 a.m. and 6 a.m.- 2 p.m.) while the third

is used for cleaning the facility (2 p.m. to 10 p.m.).

Approximately 17,000 turkeys are processed on

each shift. 

Turkeys are initially unloaded by hand and hung

by their feet on a shackle conveyor, after which

they are electrically stunned and killed by a

mechanical throat slitter. An employee in this area

will manually slit throats if the machine fails. The

turkeys then pass through a "bleed-out" room into

a hot-water scald tank. The temperature of the

water in these tanks is 138 to 140 degrees

Fahrenheit (°F), which allows for easier removal of

the feathers due to the opening of the pores in the

turkey’s skin. Following the scald tank, the

turkeys are mechanically de-feathered in the

picking room. After the picking room, an

employee in the pinning room inspects the birds

for any remaining feathers, and removes them as

necessary. Additionally, hock cutters remove the

legs and feet from the body of the turkeys, then the

bodies are re-hung on the evisceration line. 

Activities which employees perform in the

evisceration line area include removal of the

turkeys’ entrails, head, neck, and lungs, as well as

trimming off defective parts of the birds. U.S.

Department of Agriculture (USDA) inspection of

the birds for visible contamination also occurs on

the evisceration line. Substantial amounts of

super-chlorinated water (through the addition of

sodium hypochlorite) are used at a number of

stations on the evisceration line for disinfection of

the birds. These stations include a bird-scrubber
Page 2 Health Hazard Evaluation Report No. 2002-0257-2916

located at the start of the line, reprocessing stations

where birds with potential fecal contamination are

sent, and the high-pressure inside/outside bird

wash. An open trough running throughout the

evisceration line area catches the used superchlorinated water along with discarded or dropped

turkey parts. At the end of the evisceration line,

the turkeys are split into hind (dark meat) and front

(white meat) halves, which are then dropped into

tanks of super-chlorinated water, and chilled to

temperatures of 32 to 36°F through ammonia

refrigeration. 

Following a period of up to three hours in the chill

tanks, the white and dark meat portions of the

turkeys are sent to separate white meat and dark

meat departments for further processing and

packaging for shipment. Little, if any, superchlorinated water is used in these processing and

packaging departments.

Irritative Symptoms in the Poultry

Processing Industry

There have been numerous reports of eye and

upper respiratory tract irritation among poultry

processing workers and USDA inspectors during

processing steps involving the use of superchlorinated water, and this is considered to be a

widespread problem in this industry.1,2,3,4 Reported

symptoms generally are intermittent in nature, vary

in severity, and may be accompanied by reports of

a "chlorine-like" odor. Whether sodium

hypochlorite or chlorine is used as the source of

super-chlorination does not appear to account for

any differences in the reporting of irritation.

Investigations to identify the cause of irritation and

determine appropriate remedial action have been

conducted by the USDA, NIOSH, and others at

several different poultry processing plants. Efforts

to identify obvious contaminants such as chlorine

or ammonia in air as the cause of irritation have

generally been inconclusive. Chloramines,

specifically trichloramine (NCl3), have been

suspected as a primary cause of the reported

symptoms because of the interaction between the

chlorinated water and the nitrogenous material

from the turkeys.1

 

The lack of an acceptable air monitoring technique

for chloramines has been a primary obstacle to

obtaining conclusive verification of chloramines as

a cause of irritation. Additionally, targeting

control measures has been difficult due to the lack

of an air monitoring technique to evaluate the

efficacy of modifications. 

In 1998, researchers at the Institut National de

Recherche et de Sécurité (INRS) in France

developed a sampling and analytic method for

assessing workers’ exposure to chloramines in a

facility that processes green salads in water

containing hypochlorite.5

 The concern in this

facility was for the formation of chloramines from

the interaction of the hypochlorite in the water

with the nitrogen compounds in the sap proteins

released when cutting the vegetables. Acute eye

and upper respiratory irritation were reported

among the workers at the facility, and were

thought to be caused by exposure to chloramines.5

In March 2000, NIOSH investigators conducted an

HHE at a poultry processing facility in Hinton,

Virginia, where employees had reported eye, nose,

and throat irritation.6

 In addition to investigating

chlorine and ammonia exposures, the evaluation

also included a chloramine exposure evaluation

using the INRS method. NIOSH investigators

partnered with INRS, which had agreed to supply

samplers for the chloramine exposure evaluation,

as well as services for sample analysis. In addition

to finding inadequate ventilation in the facility, as

well as poor control of chlorine levels in the water

used in the facility, NIOSH investigators

concluded that chloramines may, indeed, be the

cause of the irritation reported.

Because of continuing reports of such irritation

among poultry plant workers, further requests for

HHEs in such facilities, and the absence of other

known potential irritants at the Bil-Mar Foods

facility, NIOSH investigators identified the need to

further develop a laboratory method for the

analysis of chloramines. 
Health Hazard Evaluation Report No. 2002-0257-2916 Page 3

METHODS

Industrial Hygiene

On the initial site visit in June 2002, area air

samples were collected for screening purposes

using two direct reading methods. The first

method involved the use of a bellows pump and

colorimetric detector tubes (Dräger®, Inc.,

Pittsburgh, PA) for chlorine and ammonia.

Samples were taken at various stations throughout

the evisceration line and the dark meat area.

Efforts were made to sample near stations where

the use of the super-chlorinated wash occurred and

in areas where symptoms were reported more

frequently. The detector tubes have a standard

deviation of ±10-15% and a measuring range of

0.3 to 5 parts per million (ppm) for chlorine, and 2

to 30 ppm for ammonia. The second screening

method involved the use of a Dräger Chip

Measurement System (CMS®). This method uses

a hand-held analyzer for measurement and

evaluation, and a gas- or vapor-specific chip which

is inserted into the analyzer. Each chip contains

ten measurement channels, each containing a

substance-specific reagent. The reaction between

the reagent and the airborne gas is measured and

the concentration is calculated and shown on the

digital readout of the analyzer. Side-by-side

measurements for chlorine were taken using the

CMS® at the same time and locations as

measurements with the detector tubes. The

accuracy of this device is approximately ± 10 % of

the measured value over the measurement range

(e.g., ±0.02 ppm at 0.2 ppm); the measuring range

for chlorine is 0.2 to 10 ppm.

Carbon dioxide, relative humidity, and temperature

were measured at the same locations and times as

chlorine. These measurements were taken with a

TSI Inc. Q-TrakTM Indoor Air Quality (IAQ)

Monitor model 8551. The Q-TrakTM monitors

carbon dioxide using non-dispersive infrared

detection technology, has an accuracy of ±3% of

reading, and a range of 0 to 6000 ppm. 

A Rosco Fog Machine 1600 was used following

the 6 a.m. - 2 p.m. shift prior to the start of the

cleaning crew shift on June 26th. Fog was

generated and released through the evisceration

room to observe air flow patterns and to monitor

for areas of stagnant air.

On the second site visit in June 2003, area air

samples were collected for chlorine, carbon

dioxide, relative humidity, and temperature at

various stations throughout the evisceration line

and the dark meat area (for comparison purposes)

using methods similar to those used during the

initial site visit. Due to high readings, colorimetric

detector tubes were used to sample for carbon

dioxide, not only to verify the readings of the QTrakTM, but also to provide a higher range than

what the Q-TrakTM offered. The detector tubes

have a standard deviation of ±10-15% and a

measuring range of 1000 to 60,000 ppm for CO2.

PBZ and area air samples were collected for

trichloramines and soluble chlorine using the

newly developed method in the evisceration line

area and the dark meat area. The NIOSH approach

incorporated the INRS samplers. These samplers

are a combination of an absorption tube (analyzed

for soluble chlorine, the combination of chlorine

compounds such as monochloramine,

dichloramine, hypochlorite, and free chlorine) and

a treated filter cassette (analyzed for

trichloramine). Samplers were constructed from a

tube containing silica gel coated with sulphamic

acid and a 37-millimeter (mm) polystyrene cassette

containing two quartz fiber filter pads in series

soaked in sodium carbonate and diarsenic trioxide.

NIOSH researchers modified the INRS method by

using an ion selective electrode to analyze both the

sample tube and the filters rather than an ion

selective electrode technique for the tube and ion

chromatography for the filter. Analysis involved

a simple extraction followed by inductively

coupled plasma atomic emission spectroscopy

(ICP-AES) for both tube and filter. During

sampling, air was pulled through the silica gelcontaining tube prior to passing through the filtercontaining cassette. The soluble chlorine

compounds (monochloramine, dichloramine,
Page 4 Health Hazard Evaluation Report No. 2002-0257-2916

hypochlorous acid, and hypochlorite) were

collected on the silica gel-containing tubes, while

the trichloramine passes through the filter and is

collected on the sorbent tube. The trichloramine

was then trapped separately by the filters as it

chemically reacted with them. The air samples

were collected using calibrated SKC Hi-Flow

sampling pumps at a flow rate of one liter per

minute (L/m). The sampling pumps were pre- and

post-calibrated using a primary standard to verify

the flow rate. Samplers were shipped overnight to

the NIOSH laboratory after daily sampling. Upon

receipt, the samples were immediately desorbed

and stored in the dark in the refrigerator until

analysis. 

During analysis of the tubes, extraction was

performed by placing the impregnated silica gel

from the tube into a 20 milliliter (mL) vial. Ten

mL of a 1 g/L sulfamic acid solution was added to

each vial and allowed to sit for one hour with

occasional agitation. The sample extracts were

decanted into another vial and refrigerated until

analysis. Samples were analyzed for chloride

using an ICP-AES method at a wavelength of

134.724 nm. An instrumental LOD was

determined to be 0.7 micrograms (:g)/sample.

During analysis of the filters, each filter was

removed from the cassette, placed in a 20 mL

sample vial, and 10 mL of deionized water was

added. The filters were sonicated for one hour and

allowed to sit an additional 30 minutes for the

solution to cool. Sample filters were refrigerated

and then filtered through a 0.45 Teflon filter prior

to analysis on the ICP-AES at a wavelength of

134.724 nanometers (nm). An instrumental limit

of detection (LOD) for trichloramine was

determined to be 0.6 :g/sample with a limit of

quantitation (LOQ) of 1.9 :g/sample.

PBZ and area air samples were collected for

endotoxins using pre-weighed, 5 micron (:m)

pore-size filters in 2-piece 37 mm polyvinyl

chloride (PVC) cassettes. The samples were

collected using calibrated SKC Hi-Flow sampling

pumps at a flow rate of 2 L/m. The sampling

pumps were pre- and post-calibrated using a

primary standard to verify the flow rate. Samples

were shipped to the NIOSH contract laboratory for

analysis. Gravimetric analysis for total dust was

performed according to NIOSH Manual of

Analytic Methods (NMAM) Method 0500 (4th ed.).

For analysis of endotoxins, a 10 mL extraction

solution using pyrogen-free water was obtained

from the filter. The solution was centrifuged and

vortexed appropriately. The sample extractions

were analyzed with Kinetic-QCL instrumentation

using the LAL assay. The LOD was determined to

be 0.005 endotoxin units (EU)/sample with an

LOQ of 0.05 EU/sample.

Medical 

Overview

Workers engaged in poultry processing are

conceivably exposed to chorine and chloramine

compounds by inhalation if adequate engineering

controls are not in place. The goal of this HHE

was to determine if employees in the evisceration

area of the plant, where work tasks expose them to

substantial amounts of chlorinated water, have

more upper and/or lower respiratory symptoms

than workers whose work tasks involve

significantly less chlorinated water. 

Because we determined that evisceration workers

in this plant were more likely to experience a

variety of respiratory symptoms, but we did not

detect any chlorine in the air of the plant, a followup evaluation was carried out that included

extensive sampling for chloramines and endotoxin,

as well as a medical evaluation including

spirometry to measure lung function. The

objective of the follow-up visit was to determine if

exposure to chloramines and/or endotoxin was

associated with upper and/or lower respiratory

symptoms and/or declines in lung function among

workers at Bil-Mar. 

Selection of participants 

During the initial site visit in June 2002, workers

on the day shift of the evisceration and dark meat

departments were administered a questionnaire.

The evisceration workers were chosen because of
Health Hazard Evaluation Report No. 2002-0257-2916 Page 5

the extensive use of super-chlorinated water in

their department and because the concerns

originated there. The dark meat workers were

chosen as a comparison group because of the

limited use of super-chlorinated water in that

department.

Screening Questionnaire

The questionnaire was administered by NIOSH

personnel in either Spanish or English. It consisted

of questions concerning demographics (age,

gender, job title, years worked, work department),

personal history of allergies, eczema, asthma, and

smoking, upper and lower respiratory symptoms at

work in the last four weeks (not related to cold or

seasonal allergies), and whether those symptoms

remained the same, got worse, or got better on

days off work. Upper respiratory symptoms

included burning or stinging eyes, watery eyes,

itchy or runny nose, stuffy nose, frequent sneezing,

and sore throat. Lower respiratory symptoms

included wheezing, shortness of breath, and chest

tightness. Cough was also included on the

questionnaire and can be either an upper or lower

respiratory symptom. 

Selection of Participants for Follow-up

Workers who met the case definition for workrelated asthma symptoms on the initial screening

questionnaire and a comparison group of workers

who reported no work-related respiratory

symptoms were asked to participate in the followup evaluation in June 2003. A subject was

considered to have asthma symptoms if they

reported wheezing, or any two of the following

three symptoms: cough, shortness of breath, and

chest tightness. Atopy was defined as having a

history of hay fever or other allergies (not

including allergies to medications), eczema, or

asthma. Symptoms were considered work-related

if they were present at work, and improved or

disappeared on days away from work. Cigarette

smokers were classified as current, former, or

never smokers. Informed consent was obtained. 

Spirometry

Pre- and post-shift spirometry was performed on

each participant. Spirometry refers to the

measurements of exhaled air volume and flow rates

from individuals who are coached by trained

technicians using either volume-based or flowbased measuring equipment. The important

measurements include forced vital capacity (FVC)

or the greatest volume of air exhaled from a

maximal inspiration to a complete exhalation; the

forced expiratory volume in one second (FEV1) or

the volume of air exhaled in the first second of a

FVC maneuver; and the ratio between these two

values: FEV1/FVC. These measurements were

made using a dry rolling-seal spirometer (volumebased system) interfaced to a dedicated computer.

All procedures conformed to standard guidelines.7

At least three maximal expiratory maneuvers or

FVC maneuvers were performed at each session.

The selection and interpretation of results also

conformed to standard guidelines.8

 Predicted

values were determined from published reference

equations.9

 

Follow-up Questionnaire

A brief follow-up questionnaire was administered

the end of the shift to determine if upper or lower

respiratory symptoms noted above were present

during the shift. Symptoms related to cold or

seasonal allergies were not included. 

Statistical Analysis

Crude associations between work area and workrelated symptoms were evaluated using 2x2

contingency tables and the Chi square test. To

adjust these analyses for smoking status, logistic

regression models were constructed. Odds ratios

(OR) were reported as a measure of association.

We also calculated 95% confidence intervals (CI).

If the 95% CI excluded one, then the OR was

considered statistically significant. 

The industrial hygiene exposure measures (PBZ

endotoxin, trichloramine, and soluble chlorine

concentrations) were not normally distributed, and

were log-transformed for data analysis. Values for

sampling results that were below the minimum
Page 6 Health Hazard Evaluation Report No. 2002-0257-2916

detectable concentration were estimated by

dividing the MDC by two.10 Concentrations of

endotoxin, trichloramine, and soluble chlorine for

the two work areas were compared using the t test.

In addition, t-tests were used to determine whether

PBZ exposures levels differed for those with and

without respiratory symptoms, as well as those

with and without meaningful declines in FEV1 (>

10%). Geometric means were used to report

exposure concentrations. P-values of <0.05 were

considered statistically significant. 

The t-test was used to evaluate whether subjects

with and without asthma symptoms had differing

mean changes in cross-shift FEV1. Multivariable

linear regression models were used to examine this

relationship while adjusting for smoking status.

SAS software Version 8 (SAS Institute, Cary,

North Carolina) was used for statistical analysis. 

EVALUATION CRITERIA

As a guide to the evaluation of the hazards posed

by workplace exposures, NIOSH field staff employ

environmental evaluation criteria for the

assessment of a number of chemical and physical

agents. These criteria are intended to suggest

levels of exposure to which most workers may be

exposed up to 10 hours per day, 40 hours per week

for a working lifetime without experiencing

adverse health effects. It is, however, important to

note that not all workers will be protected from

adverse health effects even though their exposures

are maintained below these levels. A small

percentage may experience adverse health effects

because of individual susceptibility, a pre-existing

medical condition, and/or a hypersensitivity

(allergy). In addition, some hazardous substances

may act in combination with other workplace

exposures, the general environment, or with

medications or personal habits of the worker to

produce health effects even if the occupational

exposures are controlled at the level set by the

criterion. These combined effects are often not

considered in the evaluation criteria. Also, some

substances are absorbed by direct contact with the

skin and mucous membranes, and thus potentially

increases the overall exposure. Finally, evaluation

criteria may change over the years as new

information on the toxic effects of an agent

become available.

The primary sources of environmental evaluation

criteria for the workplace are: (1) NIOSH

Recommended Exposure Limits (RELs),11 (2) the

American Conference of Governmental Industrial

Hygienists’ (ACGIH®) Threshold Limit Values

(TLVs®),12 and (3) the U.S. Department of Labor,

Occupational Safety and Health Administration

(OSHA) Permissible Exposure Limits (PELs).13

Employers are encouraged to follow the OSHA

limits, the NIOSH RELs, the ACGIH TLVs, or

whichever are the more protective criterion.

OSHA requires an employer to furnish employees

a place of employment that is free from recognized

hazards that are causing or are likely to cause death

or serious physical harm [Occupational Safety and

Health Act of 1970, Public Law 91–596, sec.

5.(a)(1)]. Thus, employers should understand that

not all hazardous chemicals have specific OSHA

exposure limits such as PELs and short-term

exposure limits (STELs). An employer is still

required by OSHA to protect their employees from

hazards, even in the absence of a specific OSHA

PEL.

A time-weighted average (TWA) exposure refers

to the average airborne concentration of a

substance during a normal 8- to 10-hour workday.

Some substances have recommended STEL or

ceiling values which are intended to supplement

the TWA where there are recognized toxic effects

from higher exposures over the short-term.

Ammonia

Ammonia is a severe irritant of the eyes,

respiratory tract and skin. It may cause coughing,

burning, and tearing of the eyes; runny nose; chest

pain; and at higher concentrations, which have

ranged from 2500 to 6500 ppm, cessation of

respiration; and death. Symptoms may be delayed

in onset. Exposure of the eyes to high gas

concentrations may produce temporary blindness
Health Hazard Evaluation Report No. 2002-0257-2916 Page 7

and severe eye damage. Exposure of the skin to

high concentrations of the gas may cause burning

and blistering. Repeated exposure to ammonia gas

may cause chronic irritation of the eyes and upper

respiratory tract14,15 but may result in tolerance to

the effects of exposure. The NIOSH REL for

ammonia is 25 ppm for a 10-hour TWA. The

NIOSH short-term exposure limit (STEL) for

ammonia is 35 ppm. ACGIH has set limits of 25

ppm as an 8-hour TWA and a STEL of 35 ppm.

The OSHA PEL for ammonia is 50 ppm for an

8-hour TWA.

Carbon Dioxide

Carbon dioxide is a normal constituent of exhaled

breath and, if monitored, can be used as a

screening technique to evaluate whether adequate

quantities of outside air are being introduced into

an occupied space. ASHRAE's most recently

published ventilation standard, ASHRAE 62-1989,

Ventilation for Acceptable Indoor Air Quality,

recommends outdoor air supply rates of 20 cubic

feet per minute per person (cfm/person) for office

spaces, and 15 cfm/person for reception areas,

classrooms, libraries, auditoriums, and corridors.16

Maintaining the recommended ASHRAE outdoor

air supply rates when the outdoor air is of good

quality, and there are no significant indoor

emission sources, should provide for acceptable

indoor air quality.

Indoor CO2 concentrations are normally higher

than the generally constant ambient CO2

concentration (range 300-350 parts per million

[ppm]). When indoor CO2 concentrations exceed

800 ppm in areas where the only known source is

exhaled breath, inadequate ventilation is

suspected.17 Elevated CO2 concentrations suggest

that other indoor contaminants may also be

increased. It is important to note that CO2 is not an

effective indicator of ventilation adequacy if the

ventilated area is not occupied at its usual level.

Endotoxins

Endotoxins, which are lipopolysaccharide

compounds from the outer cell wall of gramnegative bacteria (GNB), are released when the

bacteria die.18,19 GNB are ubiquitous in the

environment. Endotoxins have a wide range of

biological activities involving inflammatory,

hemodynamic, and immunological responses. Of

most importance to occupational exposures are the

activities of endotoxin in the lung.20

In experimental studies, human volunteers exposed

via inhalation to high levels of endotoxins

experience airway and alveolar inflammation as

well as chest tightness, fever, and malaise and have

an acute reduction in lung function, as measured

by the forced expiratory volume in one second

(FEV1).21,22 Airborne endotoxin exposures

between 45 and 400 EU/m3

 have been associated

with acute airflow obstruction, mucous membrane

irritation, chest tightness, cough, shortness of

breath, fever, and wheezing.23,24,25 Chronic health

effects that have been associated with airborne

endotoxin exposures include chronic bronchitis,

bronchial hyperreactivity, chronic airways

obstruction, hypersensitivity pneumonitis, and

emphysema.22 A permanent decrease in pulmonary

function, along with respiratory symptoms, has

been reported in epidemiological studies.21

Endotoxin levels are known to be high in the live

hanging and catching areas of poultry plants,

where organic dust levels are elevated.26

Endotoxin exposure has not been investigated in

the areas where processing and packaging are

done. These areas are not typically dusty.

However, a recent evaluation in a french fry

processing plant documented high levels of

endotoxin in the air in areas where wastewater was

collected in a drainage system in the floor.27

While a causal role for endotoxins in human health

effects has become more generally accepted in

recent years, a dose-response relationship has not

been established. One reason for the lack of

relationship is that the most commonly used

method of analyzing endotoxins, the Limulus

amebocyte lysate (LAL) assay, is a comparative

bioassay.28 In other words, changes in the LAL

test procedures themselves can erroneously appear

as changes in the measured endotoxin activity
Page 8 Health Hazard Evaluation Report No. 2002-0257-2916

levels. Until problems with the LAL test are

resolved, it is not possible to compare endotoxin

samples collected at different times or analyzed by

different laboratories. For these reasons, ACGIH

has proposed that relative limit values (RLVs),

rather than the more usual TLVs, be used as a

reference for endotoxin.28

RLVs require that samples be collected from an

area considered to represent background levels of

endotoxin and be analyzed at the same time as the

samples of interest. The RLV is expressed in

terms of a comparison between the exposed and

background areas. ACGIH proposes that, if there

are health effects consistent with endotoxin

exposure, and if the endotoxin exposures exceed

10 times the simultaneously determined

background levels, the RLV action level has been

exceeded.28 The proposed maximum RLV rises to

30 times the background level in an environment

where no symptoms are reported.28 When

exposures exceed the RLV action level or

maximum RLV, remedial actions to control

endotoxin levels are recommended. It is important

to note that the nature of the relationship between

the RLV and health effects has not been elucidated

at the time of writing this report.

Chlorine

Chlorine is a greenish-yellow gas with a

characteristic irritating odor. Exposure to chlorine

gas can cause severe irritation of the eyes and

respiratory tract, resulting in tearing, runny nose,

sneezing, coughing, choking, and chest pain.14,29

Breathing difficulty, with a delayed onset, can also

occur. Severe exposure can result in edema and

can be fatal. Mucous membrane and eye irritation

has been reported to occur at concentrations as low

as 0.2-2 ppm.14 The NIOSH REL for chlorine is

0.5 ppm as a ceiling limit. The ACGIH TLV for

chlorine is 0.5 ppm; ACGIH has established a

STEL for chlorine of 1 ppm. The OSHA PEL for

chlorine is 1 ppm as a ceiling limit.

Chloramines

Chloramines are formed by the reaction between

chlorine disinfectants and nitrogenous compounds

such as ammonia, amines, or organic

nitrogen-containing material. The species and

concentrations of chloramine are influenced by the

concentration of residual chlorine, ammonia (or

other nitrogen sources), pH, and temperature.4

 In

general, the lower the pH and the greater the

chlorine:ammonia ratio the higher the likelihood of

producing chloramines. 

Soluble chlorine

The term soluble chlorine has been used in this

report to designate a combination of chlorine

compounds thought to be collected using the silicagel containing tube portion of the sampler used.

These chlorine compounds include

monochloramine, dichloramine, hypochlorous

acid, and hypochlorite. No occupational exposure

criteria have been developed for soluble chlorine

or for its specific possible constituents.

Trichloramine

Trichloramine, or nitrogen trichloride (NCl3), is a

brownish-yellow gas, has a pungent chlorine odor

(sometimes described as rotting grapefruit or

geraniums) and is a strong irritant and

lacrimator.4,30 NCl3 has low solubility, aerates

easily, and decomposes rapidly in sunlight. Eye

and respiratory tract irritation appear to be the

primary effects of exposure, although asthma has

been documented in lifeguards and swimming

instructors.31 The irritant characteristics of NCl3

seem to be similar to that of chlorine.32

Occupational exposure criteria for NCl3 have not

been established.

Sodium Hypochlorite

Sodium hypochlorite is a greenish-yellow liquid

with a moderate chlorine odor that is commonly

used as a general purpose germicidal agent,

disinfectant, and bleach. Household bleach is a

5.25% solution of sodium hypochlorite and water.

The pH of a 5% aqueous solution of sodium
Health Hazard Evaluation Report No. 2002-0257-2916 Page 9

hypochlorite is approximately 10-11; a 15%

solution has a pH of 11.2.32

Sodium hypochlorite can generate harmful gases

such as chlorine or chloramine if mixed with acids,

acidic salts, ammonia, or ammonia-containing

products. Sodium hypochlorite is an oxidizing

agent and can produce a number of reactions,

depending on what other chemicals are mixed with

it. There have been a number of cases of severe

illness from inhalation of toxic vapors in both

residential and commercial settings, resulting from

intentional or inadvertent mixing of bleach with

incompatible cleaning or disinfecting agents.33,34,35

Airborne exposure to sodium hypochlorite is likely

to be in the form of an aerosol, or mist. NIOSH,

OSHA, or ACGIH occupational exposure criteria

have not been established for sodium hypochlorite.

The American Industrial Hygiene Association has

established a Workplace Environmental Exposure

Limit (WEEL) guide for sodium hypochlorite of 2

milligrams per cubic meter (mg/m3

), however an

air sampling method for sodium hypochlorite was

not referenced.32

RESULTS

Results from the sampling in the evisceration line

area on June 27, 2002, are summarized in Table 1.

Chlorine was not detected at any sampling station

by either sampling method used. Sampling

locations included those which use or are near

large quantities of the super-chlorinated wash such

as the 1st Bird Brush Wash, the Inside/Outside

Wash, and the Chillers. Elevated levels of CO2

were, however, found in two areas: the 1st Bird

Brush Wash and the Vent Gun/Fecal Vac. The

levels recorded during these short term, or ‘spot’

samples, measured above 5000 ppm, and were

almost certainly due to the carts of dry ice located

nearby. Most likely, 8-hour TWA exposures at

these two locations would be below the PEL of

5000 ppm due to the fact that these carts of dry ice

are routinely brought into and out of the area, so

that constant exposure to the source of carbon

dioxide is unlikely.

Similar results were obtained for samples taken in

the dark meat area. These results are summarized

in Table 2. Again, chlorine was not detected at any

sampling station by either sampling method used.

CO2 monitoring at the thigh skin remover and the

hot dog meat station revealed levels above the

5000 ppm level:.

Direct-reading Dräger tubes were used in various

locations of the facility to measure ammonia levels

in the air. Five samples were drawn in and around

areas such as the engine room (from where the

chemical is pumped), the trimmer area outside the

door of the engine room, and the chillers.

Ammonia was not detected in any sample. 

The concentration of chlorine in the wash water

was reported to be 20 ppm as recorded in company

records for that day. This concentration is equal to

the level required by the U.S. Department of

Agriculture for spray water on evisceration lines

and in salvage and reprocessing areas of poultry

processing facilities.

Fog release showed that the airflow in the

evisceration line was in a direction consistent with

the design of the ventilation system, flowing from

the main supply vent toward the return vents to be

exhausted. However, many of the cooling fans

positioned above stations along the line caused a

great deal of turbulence in the airflow, many times

blowing the air in a direction opposite to which it

was intended. The effect was air re-circulated

from other areas of the line, including areas which

had heavy use of the super-chlorinated water

sprays.

During the initial site visit, in June 2002,

questionnaires were administered to 109 of 115

(95%) eligible employees (68 out of 69 [98%] in

evisceration and 41 out of 46 [89%] in dark meat).

The participation rate for evisceration was slightly

higher than dark meat because four workers in dark

meat only spoke Laotian and a translator was not

available. Workers in both departments were

similar in age, tenure, and history of atopy.

Evisceration workers were significantly more

likely to be current or former smokers, however.

These results are summarized in Table 3. 
Page 10 Health Hazard Evaluation Report No. 2002-0257-2916

The prevalence of work-related wheezing,

coughing, sneezing, and watery eyes was

significantly higher among evisceration workers

(See Table 4). Work-related sore throat, burning

or stinging eyes, and asthma symptoms were also

more frequently reported by evisceration workers,

but this was not statistically significant. There was

no significant difference between departments in

prevalence of shortness of breath, chest tightness,

itchy runny nose, and stuffy nose. Multivariate

analysis was conducted to control for the potential

effects of smoking status (never, former, current

smoker), but did not meaningfully alter the

relationships seen above, with the exception of

burning or stinging eyes, the prevalence of which

became statistically significantly higher in

evisceration workers after controlling for smoking.

These results are also in Table 4. 

Forty-seven persons were selected to participate in

the second survey in June 2003, 23 of whom met

our screening questionnaire definition of

occupational asthma and 24 of whom reported no

work-related respiratory symptoms. At the time of

the second survey, seven of these persons were no

longer employed, three were not present at the time

of the survey, two had changed shifts, and one

refused to participate. The remaining 34

employees participated fully in the environmental

sampling and the medical evaluation, including the

pre and post-shift spirometry and the

questionnaire. Sixteen worked in dark meat and 18

in evisceration. 

During the second survey, carbon dioxide,

temperature and relative humidity were measured

at various locations in the evisceration area and the

dark meat area during the week of the site visit.

These results are summarized in Table 5. Most

notably, CO2 levels were elevated in both the

evisceration and dark meat areas. On the first three

days, readings of at least 6000 ppm were recorded

using the TSI Inc. Q-TrakTM. 6000 ppm is the

highest level that can be measured by the QTrakTM. A measurement of 1750 ppm was also

recorded in the cafeteria on one of these days. The

results returned from two Q-TraksTM and Dräger

tubes for CO2 on June 5 all revealed levels of CO2

approximately half or below those measured on

previous days. As seen on the initial site visit,

large containers of dry ice used to maintain the

freshness of the processed turkey parts were

present in the processing areas of the facility on

these first few days and are most likely the source

of the CO2. It was reported by an employee that

these large containers of dry ice are used

approximately three of five days during a typical

week.

No chlorine was detected at any location tested

using Dräger tubes.

Results from the sampling for trichloramines,

soluble chlorine, and endotoxins performed in the

dark meat area are summarized in Tables 6 and 7,

according to the type of sample taken (i.e., area air

sample or PBZ sample). Tables 8 and 9

summarize sampling results from the evisceration

line area, also according to type of sample taken. 

Sampling for trichloramines and soluble chlorine

revealed considerably higher levels in the

evisceration line area versus the dark meat area.

Table 10 compares the full shift PBZ air sampling

results. The mean TWA concentration of

trichloramine was significantly higher in the

evisceration department than in the dark meat

department (5.07 vs. 1.20 :g/m3

, p<0.01), as was

the mean TWA concentration of soluble chlorine

(63.45 vs. 9.38 :g/m3

, p<0.01). 

The pinning room had endotoxin levels

considerably higher than all other areas monitored.

The two area air samples taken in this room

measured concentrations of 398 and 278 EU/m3

.

The endotoxin concentrations in these two samples

were at least one order of magnitude higher than in

the majority of area samples. The endotoxin

concentrations in the two PBZ samples taken on

employees in this room were also considerably

higher than those taken in the remainder of the

evisceration area and in the dark meat area. These

results were 85 and 82 EU/m3

, taken on June 3 and

5, respectively. Therefore, ACGIH’s proposed

RLV action level was exceeded in that the levels in

the pinning room were greater than 10 times higher

than the background level in the dark meat area

(when health effects were reported) and ACGIH’s

proposed maximum RLV was exceeded in that the
Health Hazard Evaluation Report No. 2002-0257-2916 Page 11

levels in the pinning room were greater than 30

times higher than background level (when no

symptoms are reported.) Overall, endotoxin

concentrations were significantly higher in the

evisceration department (1.08 vs. 0.11 EU/m3

,

p<0.01), also shown in Table 10. 

Workers who reported either wheezing, or two of

the following three symptoms: chest tightness,

shortness of breath, or cough on the day they were

surveyed were considered to have current

symptoms of asthma. Forty-four percent of

workers with current asthma symptoms were

current or former smokers, compared to 20% of

those without current asthma symptoms (p=0.20).

The mean change in cross-shift FEV1 in those with

current asthma symptoms was -4.83 %, compared

to -0.89 % in those without current asthma

symptoms (p=0.01). Controlling for smoking, the

mean changes were -4.55% and -0.99%,

respectively (p=0.02). In addition, workers who

reported current asthma symptoms had higher

geometric mean exposure to soluble chlorine than

those without current asthma symptoms (47.76

:g/m3 vs. 18.75 :g/m3, p=0.04) (Table 11).

Geometric mean concentrations of endotoxin and

trichloramine did not differ significantly between

those with and without current asthma symptoms

(0.30 EU/m3

 vs. 0.40 EU/m3, and 2.85 :g/m3 vs.

2.48 :g/m3

, respectively). 

Three persons had significant cross-shift declines

(> 10%) in their FEV1.36 Two of these persons

were not able to meet reproducibility criteria on

their pre-shift spirometry; one had normal results

and one (a smoker) showed borderline restriction.

Both, however, were able to meet criteria on their

post-shift spirometry. Including these two

individuals, the geometric mean TWA

trichloramine concentration in persons with a

significant cross-shift decline in their FEV1.was

21.74 :g/m3

 compared to 2.09 :g/m3 in those

without a significant cross-shift declines in their

FEV1 (p=0.04). Geometric mean TWA endotoxin

did not differ significantly between those who

experienced a significant cross-shift decline in

FEV1 and those who did not (0.36 and 0.38 EU/m3

,

respectively; p=0.9). Geometric mean TWA

soluble chlorine compounds concentration was

70.5 :g/m3

 in those with a significant cross-shift

decline in FEV1 compared to 21.86 :g/m3

 in those

without (p=0.10).

Mean TWA soluble chlorine concentrations were

significantly higher in persons who reported

burning or stinging eyes, itchy or stuffy nose,

cough, asthma symptoms, and frequent sneezing,

as compared to those who did not report such

symptoms, as shown in Table 11. Mean TWA

soluble chlorine concentrations were also higher in

persons who reported watery eyes and sore throat,

but not significantly so. Mean TWA trichloramine

concentrations were significantly higher in persons

who reported burning or stinging eyes, but not

other symptoms. There were no significant

associations between any symptom and mean

endotoxin concentration. The relationship between

asthma symptoms and exposure was also examined

while controlling for smoking status and findings

did not change meaningfully. 

DISCUSSION AND

CONCLUSIONS

Respiratory, especially upper respiratory,

symptoms are common among poultry workers,

who usually relate their symptoms to chlorine

exposure because of symptom correlation with

odor. However, numerous evaluations of chlorine

levels, including ours, have failed to document

chlorine concentrations that could account for

these symptoms. It has been postulated that

trichloramine, produced by the reaction of

nitrogenous materials from the poultry and the

chlorinated water used to disinfect the birds, may

be responsible for these symptoms. In our study,

trichloramine did not appear to be the predominant

chlorine compound produced. This corresponds,

however, to the results reported by INRS in their

study of chloramine exposure in a green salad

processing plant.5

 Their reported results showed

that, unlike swimming pools where chloramine

exposure is mainly composed of trichloramine,

between 30 and 70% of the amount of chlorine

species in the atmosphere of the facility were
Page 12 Health Hazard Evaluation Report No. 2002-0257-2916

chlorine species trapped on the silica gel tube (i.e.,

the soluble chlorine) rather than trichloramine. It

was suggested that the majority of the soluble

chlorine trapped on the tube could be composed of

mono- and dichloramine. One reason given for

this was the fact that aerosolization of the

chlorinated water was much more intense in the

facility, as compared to a swimming pool

environment, which would lead to a proportionally

higher emission of mono-and dichloramine.5

 This

reasoning may help explain the higher quantities of

soluble chlorine measured at the Bil-Mar facility,

where aerosolization can easily occur due to the

number of spray washes used throughout the

evisceration area.

Despite the small number of participants in this

study, statistically significantly positive

associations were demonstrated between soluble

chlorine concentrations and burning or stinging

eyes, itchy or stuffy nose, cough, and frequent

sneezing. In addition, trichloramine concentrations

were positively associated with burning or stinging

eyes. 

Reported symptoms of asthma on the day of the

survey corresponded to a statistically significantly

greater decline in FEV1 and to higher

concentrations of soluble chlorine. However, the

magnitude of the differences in the FEV1 was small

and may not reflect any clinical impairment of

breathing. In addition, persons with cross-shift

declines in FEV1 of > 10% had higher PBZ

concentrations of soluble chlorine and

trichloramine. 

It is expected that trichloramine and soluble

chlorine compounds would cause similar health

effects. In this evaluation, soluble chlorine

compounds predominated, and therefore more

symptoms were associated with exposure to them.

 Soluble chlorine has been related to irritative

symptoms in green salad processors, where it is

generated in larger quantities than trichloramine.5

In swimming pools, trichloramine predominates

and has been related to irritative symptoms in

lifeguards and swimming pool instructors.37 In

addition, trichloramine has been reported to cause

asthma.31 

As stated previously, the endotoxin exposures were

recorded to be highest in the pinning room of the

evisceration line area. The pinning room is an

enclosed room adjoining the defeathering room

with an open doorway between them. After the

majority of feathers have been mechanically

plucked from the turkeys, workers in the pinning

room manually remove any remaining feathers.

This may lead to the potential for increased levels

of organic dust of which endotoxin can be a

contaminant. Also running closely by the pinning

room is a large trough in the floor carrying

substantial amounts of wastewater leading out of

the plant. The combination of these conditions may

be the cause of the higher endotoxin levels

exceeding ACGIH’s proposed RLVs for endotoxin

exposure. We did not find an association between

endotoxin levels and either reported symptoms or

changes in lung function, however. 

Limitations of this study include intermittent and

unpredictable nature of the symptoms, which

restricted our ability to perform spirometry and

environmental sampling on days when symptoms

occurred. Reasons for the intermittence may

include fluctuations in chlorine concentration in

the water and in the amount of nitrogenous

material from the turkeys. An additional limitation

was the comparatively high minimum quantifiable

concentration (MQC) values for the soluble

chlorine samplers as compared to the MDC value

for soluble chlorine and the MQC and MDC for

trichloramine. Although the instrumental LOQ

was much lower, the method LOQ (upon which the

MQC is based) was estimated from the first

recovery study performed by the NIOSH

laboratory during method development. The

estimate was based on a desorption efficiency less

than the NIOSH acceptable limit of 75% for media

spikes of 55 :g/sample. Since that time, further

recovery studies have taken place and have seen a

reduction in the method LOQ. While some data

points do fall between the MQC and the MDC, the

statistical analysis lends significant support to the

observed trend of higher levels in the evisceration

line compared to the dark meat area, suggesting

this did not have an important impact on our

findings. 
Health Hazard Evaluation Report No. 2002-0257-2916 Page 13

1. Sanderson W, Weber A, Echt A [1995]. Case

reports: epidemic eye and upper respiratory

irritation in poultry processing plants. Appl Occup

Environ Hyg 10(1): 43-49.

2. NIOSH [1994]. Hazard evaluation and

technical assistance report: Tyson Foods, Monett,

Missouri. Cincinnati, OH: U.S. Department of

Health and Human Services, Public Health

Service, Centers for Disease Control and

Prevention, National Institute for Occupational

Safety and Health, NIOSH HETA Report No. 93-

230-2405.

3. NIOSH [1989]. Hazard evaluation and

technical assistance report: Columbia Farms

Poultry Plant, Columbia, South Carolina.

Cincinnati, OH: U.S. Department of Health and

Human Services, Public Health Service, Centers

for Disease Control and Prevention, National

Institute for Occupational Safety and Health,

NIOSH HETA Report No. 87-110-1943.

4. Segna L [1988]. Nitrogen trichloride

summary. Reston, VA: Applied Environmental

Health and Safety Inc. USDA Contract No. 53-

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5. Hery M, Gerber JM, Hecht G, Subra I, Possoz

C, Aubert S, Dieudonne M, Andre JC [1998].

Exposure to chloramines in a green salad

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6. NIOSH [2000]. Hazard evaluation and

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Hinton, Virginia. Cincinnati, OH: U.S.

Department of Health and Human Services, Public

Health Service, Centers for Disease Control and

Prevention, National Institute for Occupational

Safety and Health, NIOSH HETA Report No.

2000-0105-2794.

7. American Thoracic Society [1995].

Standardization of Spirometry - 1994 Update, Am

J Respir Crit Care Med. 152:1107-1136.

8. American Thoracic Society [1991]. Lung

Function Testing: Selection of Reference Values

and Interpretative Strategies. Am Rev Respir Dis

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9. Hankinson JL, Odencrantz JR, Fedan KB

[1999]. Spirometric reference values from a

sample of the U.S. general population. Am J

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10. Hornung RW, Reed LD. Estimation of

average concentration in the presence of

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1990;5(1):46–51.

11. NIOSH [1992]. Recommendations for

occupational safety and health: compendium of

policy documents and statements. Cincinnati, OH:

U.S. Department of Health and Human Services,

RECOMMENDATIONS

1. Proper ventilation is likely a component of the

solution to reduce contaminant levels in the work

area. The proper use of components such as

overhead fans (observed on the initial visit to

distribute the air in a manner counter to the

ventilation system) and drip pans collecting

condensate water (positioned directly under the

exhaust fans, potentially inhibiting their ability to

exhaust workplace air) is important in maintaining

adequate dilution ventilation. Collaboration

between Bil Mar and NIOSH ventilation engineers

is planned in order to identify optimum ventilation

solutions. 

2. Perform frequent testing in the chiller tanks to

ensure that chorine levels remain constant between

20 and 50 ppm, and decrease the levels of the

chlorine in the chiller tank water should they

surpass 50 ppm. 

3. Consider covering/enclosing the chiller tanks

and placing them under slight negative pressure via

an exhaust system to minimize the contact that

employees have with any chlorine by-products

rising from the interaction of the chlorinated water

in the tanks and organic matter from the turkeys.

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of respiratory insult in the poultry processing

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27. NIOSH [1989]. Hazard evaluation and

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Plover, Wisconsin. Cincinnati, OH: U.S.

Department of Health and Human Services, Public

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Safety and Health, NIOSH HETA Report No.99-

0091-2846.
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28. Milton DK [1999]. Endotoxin and other

bacterial cell-wall components. In: Macher J, ed.

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OH: American Conference of Governmental

Industrial Hygienists. pp 23-1 to 23-14.

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occupational health guideline for chlorine.

Cincinnati, OH: U.S. Department of Health and

Human Services, Public Health Service, Centers

for Disease Control and Prevention, National

Institute for Occupational Safety and Health.

DHHS (NIOSH) Publication No. 81-123.

30. Barbee SJ, Thackara JW, Rinehart WE [1983].

Acute inhalation toxicology of nitrogen trichloride.

Am Ind Hyg Assoc J 44(2): 145-146.

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caused by chloramines in indoor swimming-pool

air. Eur Respir J. 19:827-832. 

32. Gagnaire F, Axim S, Bonnet P, Hecht G, Hery

M [1994]. Comparison of the sensory irritation

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Industrial Hygiene Association. Fairfax, VA.

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Severe lung injury after exposure to chloramine

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849.

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621,627-629.

35. Olson K, Shusterman D [1993]. Mixing

incompatibilities and toxic exposures. Occ. Med.

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statement on spirometry in the occupational

setting. J Occ Environ Med. 42(3):228-245. 

37. Hery M, Hecht G, Gerber JM, Gendre JC,

Hubert G, Rebuffaud J [1995]. Exposure to

chloramines in the atmosphere of indoor

swimming pools. Ann Occ Hygiene. 39(4):427-

439. 
Page 16 Health Hazard Evaluation Report No. 2002-0257-2916

Table 1. Sampling Results: Evisceration Line, Initial Site Visit: June 27, 2002

Location and Time of

Sample

Chlorine:

Dräger

Tube (ppm)

Chlorine:

Dräger

CMS (ppm)

Carbon

Dioxide

(ppm)

Temp.

 (°F)

Relative

Humidity

(%)

Conference Room NDa < 0.200 – – --

1st Bird Brush Wash (a.m.) ND < 0.200 5800 65.9 66.9

Vent Gun/Fecal Vac (a.m.) ND < 0.200 5650 65.1 72.0

USDA Inspectors (a.m.) ND < 0.200 3500 69.7 79.9

Reprocess 1 & 2 (a.m.) ND < 0.200 2205 69.2 79.2

Neck Breaker/Chiller (a.m.) ND < 0.200 2360 67.5 78.3

Salvage (a.m.) ND < 0.200 2795 65.6 72.9

OM (a.m.) ND < 0.200 2590 67.8 75.6

Trimmers (a.m.) ND < 0.200 2494 68.9 77.5

Trimmers (a.m.) ND < 0.200 2720 67.0 73.9

I/O Wash (a.m.) ND < 0.200 3060 65.4 69.5

Next to Chiller A (a.m.) ND < 0.200 2936 64.6 65.5

Next to Chiller B (a.m.) ND < 0.200 3330 57.1 58.7

1st Bird Brush Wash (p.m.) ND < 0.200 1714 71.5 79.0

Vent Gun/Fecal Vac (p.m.) ND < 0.200 1630 71.3 78.0

USDA Inspectors (p.m.) ND < 0.200 2000 74.6 79.6

Reprocess 1 & 2 (p.m.) ND < 0.200 3296 71.7 58.6

Salvage (p.m.) ND < 0.200 3094 71.0 63.7

OM (p.m.) ND < 0.200 2390 73.3 67.4

Trimmers (p.m.) ND < 0.200 2159 72.9 69.4

IO Wash (p.m.) ND < 0.200 2045 72.3 55.2

Next to Chiller A (p.m.) ND < 0.200 3082 66.1 59.9

a

 ND denotes ‘non-detectable level’ 

Table 2. Sampling Results: Dark Meat Area, Initial Site Visit: June 27, 2002
Health Hazard Evaluation Report No. 2002-0257-2916 Page 17

Location and Time of

Sample

Chlorine:

Dräger

Tube (ppm)

Chlorine:

Dräger

CMS (ppm)

Carbon

Dioxide

(ppm)

Temp.

 (°F)

Relative

Humidity

(%)

Thigh Deboning (a.m.) NDa < 0.200 3412 56.3 67.0

Thigh Skin Remover (a.m.) ND < 0.200 6000 49.5 67.1

Hot Dog Meat Station (a.m.) ND < 0.200 5048 53.2 72.2

Drum Packaging (a.m.) ND < 0.200 4340 49.0 67.4

Entrance to Dark Meat Area

(a.m.)

ND < 0.200 3298 52.0 75.9

a

 ND denotes ‘non-detectable level’

Table 3. Demographics and Selected Characteristics by Exposure Group, Initial Site Visit: 

June 27, 2002
Page 18 Health Hazard Evaluation Report No. 2002-0257-2916

Evisceration Dark Meat

Participation Rate 68/69 (98%) 41/46 (89%)

Mean Age (Years) 36 39

Mean Tenure at Bil-Mar (Years) 8 7

Gender

 Male

 Female

57%

43%

44%

56%

History of Atopya 21% 23%

Smoking Status

 Currentb

 Formerb

 Neverb

24%

32%

44%

5%

13%

82%

a

 Atopy is history of any of the following: hay fever or other allergies (except for allergies to medications),

asthma, or eczema

b p< 0.05

Table 4. Work-Relateda

 Symptoms by Department, Initial Site Visit: June 27, 2002
Health Hazard Evaluation Report No. 2002-0257-2916 Page 19

Evisceration

n=68

Dark Meat

n=40

OR (95% CI) Adjusted ORc

(95% CI)

Itchy, runny nose 32 (47%) 18 (45%) 1.09 (0.50, 2.38) 1.41 (0.60, 3.42)

Watery eyes 31 (46%) 5 (13%) 5.86 (2.05, 16.79) 7.00 (2.43,

23.89)

Frequent sneezing 30 (44%) 8 (20%) 3.16 (1.27, 7.85) 4.89 (1.84,

14.29)

Cough 28 (41%) 5 (13%) 4.90 (1.71, 14.06) 6.16 (2.14,

20.96)

Burning or stinging

eyes

27 (40%) 9 (23%) 2.27 (0.93, 5.51) 3.29 (1.26, 9.22)

Asthma symptomsb 18 (26%) 5 (13%) 2.52 (0.86, 7.43) 2.77 (0.93, 9.54)

Stuffy nose 17 (25%) 10 (25%) 1.00 (0.41, 2.46) 1.79 (0.68, 4.95)

Wheezing# 15 (22%) 2 (5%) 5.38 (1.16, 24.91) 5.91 (1.44,

40.38)

Sore throat 14 (21%) 4 (10%) 2.33 (0.71, 7.66) 3.15 (0.96,

12.49)

Shortness of breath 10 (15%) 9 (23%) 0.59 (0.22, 1.62) 0.69 (0.23, 2.05)

Chest tightness 10 (15%) 6 (15%) 0.98 (0.33, 2.93) 1.16 (0.35, 3.98)

a

defined as experienced at work during the last four weeks, but improved on days away from work

b

 defined as wheezing, or any two of the following three symptoms: cough, chest tightness, and shortness

of breath

c adjusted for smoking status
Page 20 Health Hazard Evaluation Report No. 2002-0257-2916

Table 5. CO2 and Environmental Sampling Results: Evisceration, Return Site Visit: 

June 2-6, 2003

Date Location Chlorine: 

Drager

Tube (ppm)

Carbon

Dioxide

(ppm)

Temperatur

e (°F)

Relative

Humidity

(%)

June 2 Dark Meat - near boxing NDa 6000b 50.7 69.2

June 2 Dark Meat - trim table ND 6000 49.7 71.4

June 2 Evisceration - trimming ND 6000 56.1 92.3

June 2 Evisceration - USDA

inspect.

ND 6000 61.2 91.8

June 2 Cafeteria – 1750 – --

June 3 Dark Meat - trim table ND 6000 53.1 58.4

June 4 Dark Meat - trim table ND 6000 53.2 54.2

June 4 Evisceration - reprocessing ND 6000 66.9 55.5

June 4 Evisceration - standing

under supply vent

– 3000 – --

June 5 Evisceration - gut drop ND 2750 69.8 77.9

June 5 Evisceration - pinning room ND 630 75.7 91.3

June 5 Evisceration - salvage ND 2100 72.3 78.5

June 5 Dark Meat - trim table ND 3200c

2800d

2000e

63.1 48.6

a

 ND denotes ‘non-detectable level’

b

 6000 ppm Q-Trak max

c

 result from original Q-TrakTM monitor

d side-by-side result from second Q-TrakTM monitor

e

 side-by-side result from Dräger tube for CO2
Health Hazard Evaluation Report No. 2002-0257-2916 Page 21

Table 6. Area Air Sampling Results by Dark Meat Location, Return Site Visit: June 2-6, 2003

Date Location EU/m3 Soluble chlorine

(tube) 

:g active Cl/m3

Trichloramine

(filter) 

:g NCl3/m3

June 2 hot dog grind 0.12 4.90 NDa

June 3 hot dog grind 0.19 10.20 ND

June 4 hot dog grind 0.31 7.13 ND

June 5 hot dog grind 0.73 6.12 ND

June 6 hot dog grind 0.18 9.57 ND

June 2 thigh table ND 2.70 ND

June 2 thigh table 0.09 9.73 ND

June 3 thigh table ND lost b ND

June 4 thigh table 0.13 6.76 ND

June 5 thigh table 0.45 10.20 ND

June 6 thigh table 0.18 9.57 ND

June 6 thigh table 0.15 9.83 ND

GEOMETRIC MEAN: 0.10 7.38 0.625

MDC: 0.005 1.46 1.25

 MQC: 0.05 183.33 3.96

a

 ND denotes ‘non-detectable level’

b

 sample lost during analysis due to pump malfunction on the ICP-AES
Page 22 Health Hazard Evaluation Report No. 2002-0257-2916

Table 7. Personal Breathing Zone Sampling Results by Dark Meat Location, Return Site Visit: June

2-6, 2003

Date Location EU/m3 Soluble chlorine 

(tube)

:g active Cl/m3

Trichloramine

(filter)

:g NCl3/m3

June 4 cold room packaging 0.05 5.46 NDa

June 2 floater 0.17 11.93 ND

June 2 floater 0.16 9.40 ND

June 5 L piece 0.26 19.23 ND

June 4 lead person 0.09 7.48 ND

June 6 packing 0.10 6.64 37.85

June 2 push carts and hangs 0.06 45.17 2.05

June 4 shipping 0.54 7.22 ND

June 2 thigh table trimmer 0.07 3.52 1.38

June 2 thigh table trimmer 0.05 9.86 ND

June 2 thigh table trimmer 0.08 10.42 ND

June 2 thigh table trimmer 0.06 10.00 ND

June 5 thigh table trimmer 0.12 8.10 ND

June 5 thigh table trimmer 0.12 7.74 ND

June 6 thigh table trimmer 0.17 10.66 47.12

June 2 unknown 0.14 7.69 ND

GEOMETRIC MEAN: 0.11 9.38 1.20

MDC: 0.005 1.46 1.25

MQC: 0.05 183.33 3.96

a

 ND denotes ‘non-detectable level’

Table 8. Area Air Sampling Results by Evisceration Location, Return Site Visit: June 2-6, 2003
Health Hazard Evaluation Report No. 2002-0257-2916 Page 23

Date Location EU/m3 Soluble chlorine

(tube)

:g active Cl/m3

Trichloramine

(filter)

:g NCl3/m3

June 6 chillers 0.23 23.81 NDa

June 5 gut drop 6.77 185.86 9.35

June 6 gut drop 6.60 183.91 12.67

June 2 inside/outside wash 0.86 145.28 11.28

June 3 inside/outside wash 0.09 lost b 8.31

June 4 inside/outside wash 0.47 198.90 26.10

June 5 pinning room 398.08 91.32 6.74

June 6 pinning room 278.80 93.68 2.34

June 2 reprocessing 1.18 167.87 11.25

June 3 reprocessing 0.37 lost 8.78

June 6 reprocessing 21.33 81.30 ND

June 4 salvage 1.10 261.54 23.56

June 5 salvage 8.20 60 10.14

June 6 salvage 3.77 240.85 ND

June 2 trimming 0.51 170.32 5.60

June 3 trimming 0.53 lost 14.26

June 4 trimming 0.91 178.17 14.19

June 5 trimming 18.37 142.86 19.65

June 6 trimming 14.25 138.89 22.55

GEOMETRIC MEAN: 2.96 (1.69)c 129.49 7.05

MDC: 0.005 1.46 1.25

MQC: 0.05 183.33 3.96

a

 ND denotes ‘non-detectable level’

b sample lost during analysis due to pump malfunction on the ICP-AES

c mean of sample results including pinning room results ( mean of sample results excluding pinning room

results)

Table 9. Personal Breathing Zone Sampling Results by Evisceration Location , Return Site Visit:

June 2-6, 2003
Page 24 Health Hazard Evaluation Report No. 2002-0257-2916

Date Location EU/m3 Soluble chlorine

(tube)

:g active Cl/m3

Trichloramine

(filter)

:g NCl3/m3

June 4 assistant supervisor 3.59 84.39 5.27

June 3 bird wash 0.08 64.52b NDa

June 5 condemn 23.94 77.82 10.54

June 3 cropper 0.08 70.18 156.73

June 5 cropper 17.69 116.05 14.66

June 5 floater 2.32 77.22 6.70

June 4 inspector’s help 5.61 126.32 8.82

June 4 neck boxer 0.36 116.96 14.66

June 3 oil gland cutter 0.16 17.99 1.80

June 3 pinning room 84.76 38.10 3.94

June 5 pinning room 82.23 59.43 1.71

June 5 room technician 0.11 10.51 ND

June 3 tank washer 1.50 lost c ND

June 3 trimming 0.10 39.53 7.43

June 3 trimming 0.07 lost 6.66

June 4 trimming 0.51 99.21 10.50

June 4 trimming 0.32 124.74 8.36

June 4 vent gun 0.61 84.57 4.19

GEOMETRIC MEAN: 1.08 (0.63)d 63.45 5.07

MDC: 0.005 1.46 1.25

MQC: 0.05 183.33 3.96

a

 ND denotes ‘non-detectable level’

b result of 2nd tube of 2 used during shift; 1st tube sample lost during analysis due to pump malfunction on

the ICP-AES

c sample lost during analysis due to pump malfunction on the ICP-AES

mean of sample results including pinning room results ( mean of sample results excluding pinning room

results)

Table 10. Full-shift PBZ Concentrations for Chlorine Compounds and Endotoxin by Location

Return Site Visit: June 2-6, 2003
Health Hazard Evaluation Report No. 2002-0257-2916 Page 25

Evisceration (n=18) Dark Meat (n=16)

Geometric

Mean

Range Geometric

Mean

Range

Trichloraminea 5.07 :g/m3 ND - 156.73 :g/m3 1.20 :g/m3 ND - 47.12 :g/m3

Soluble chlorinea 63.45 :g/m3 10.42 - 126.32

:g/m3

9.38 :g/m3 3.52 - 45.17 :g/m3

Endotoxina 1.08 EU/m3 0.07 - 84.76 EU/m3 0.11 EU/m3 0.05 - 0.54 EU/m3

a mean concentrations differ by location (p<0.01)
Table 11. Endotoxin, Trichloramine, & Soluble Chlorine Levels by Respiratory Symptoms

Return Site Visit: June 2-6, 2003

Endotoxin (EU/m3

) Trichloramine (:g/m3) Soluble chlorine (:g

/m3

)

n geometric

mean

p

value

n geomtric

mean

p

value

n geometric

mean

p

value

Burning, stinging eyes

present 12 0.50 0.58 12 5.77 0.02 10 56.85 <0.01

absent 22 0.32 22 1.66 22 16.60

Itchy or stuffy nose

present 11 0.55 0.47 11 4.61 0.13 9 66.23 <0.01

absent 23 0.31 23 1.95 23 16.50

Cough

present 9 1.18 0.06 9 4.08 0.31 8 58.16 < 0.01

absent 25 0.25 25 2.18 24 18.26

Frequent sneezing

present 6 0.75 0.39 6 5.36 0.21 5 95.48 <0.01

absent 28 0.32 28 2.20 27 18.95

Watery eyes

present 6 0.71 0.43 6 2.69 0.94 6 36.44 0.35

absent 28 0.33 28 2.55 26 22.23

Sore throat

present 3 0.36 0.97 3 3.39 0.75 2 70.22 0.19

absent 31 0.38 31 2.50 30 22.73

Asthma Symptomsa

present 9 0.30 0.73 9 2.85 0.82 9 47.76 0.04

absent 25 0.40 25 2.48 23 18.75

a

 Workers who reported either wheezing, or two of the following three symptoms: chest tightness,

shortness of breath, or cough on the day they were surveyed were considered to have current symptoms of

asthma
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