2015 Annual Report

Department of Health and Human Services

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health
HHE Requests in 2015
By the Numbers
Risk of Tuberculosis Exposure at an Elephant Refuge

Request

● Who? A state health department 

● Why? Potential elephant-to-human 

transmission of tuberculosis (TB)

Photo by NIOSH

What We Did

● Interviewed 27 employees 

about their known TB 

exposure, respiratory 

protection, and work tasks

● Tested ventilation systems 

in barns using smoke and 

tracer gas and measured air 

pressure differences to see 

which direction the air flowed

● Reviewed TB screening and 

respiratory protection programs

Photo by NIOSH

What We Found

● The TB screening and 

respiratory protection 

programs were incomplete

● Air flowed from elephant stalls 

to employee areas. Following 

recommended changes, this 

problem was fixed 

Recommendations

● Treat elephants with active TB as soon as possible

● Maintain ventilation systems and follow protocols so that air does 

not flow from elephant stalls to employee work areas

● Wear a respirator around elephants with confirmed/suspected TB

● Test employees for TB every year

See full report at: http://go.usa.gov/cuyjR
Exposure to New Solvents in Drycleaning Shops

A local government program asked for our help in evaluating 

two new drycleaning solvents

SolvonK4

● butylal, n-butanol, 

and formaldehyde

DF-2000

● a mix of 

hydrocarbons

Photo by NIOSH

What We Did

● Visited 1 shop using SolvonK4 

and 2 using DF-2000

● Analyzed the chemical 

composition of both solvents

● Took air samples for 

DF-2000, butylal, butanol, 

and formaldehyde

● Tested for solvents on 

employees’ hands under 

their gloves

What We Found

● Chemical compositions matched the manufacturers’ descriptions

● Highest air levels of SolvonK4 were near the drycleaning machine

● DF-2000 levels were below most protective exposure limit

● Both chemicals were on employees’ hands under their gloves

● Employees did not have safety glasses or goggles for splash protection

Recommendations

● Brush prespotting mixture onto fabric rather than spraying it on

● Wear eye protection and the right type of gloves when using spot 

cleaners and cleaning the machines

● Wash hands and exposed skin after contact with chemicals 

● Wash hands before and after removing gloves

See full report at: http://go.usa.gov/cuyjF
Our Followback Program

After an evaluation, we follow up with the managers, 

employees, and union representatives at the workplace to see 

how we did. We do this through mailed surveys, phone calls, 

and return visits.

These are the most common adjectives used to describe the 

HHE Program, our investigators, and our evaluations in our 

mailed Followback surveys in 2015.
Positive Changes Reported at 

Workplaces We’ve Visited

“The independent and accurate

assessment along with the employee 

interaction helped to allay concerns, 

identify problems, and discern a way 

forward.” – Employer

“[Management is] not pushing us to

work in the extreme temperatures that 

could cause long term health effects 

on the workers.” – Employee

“Workers are better protected from

infectious disease transmission.”

– State epidemiologist
Respiratory Health at a Syntactic Foam Manufacturer

Request

● Employees were concerned about chemical exposures and

respiratory, skin, and eye problems

What We Did

● Observed work practices and interviewed managers and

employees

● Took air samples for amines, volatile organic compounds

(VOCs), and particles

● Surveyed employees about symptoms and medical diagnoses

What We Found

Found 

VOCs & 

particles, 

but not 

amines, in 

the air

Skin rash, 

cough, nasal 

allergies, 

& asthma 

symptoms 

common

Asthma 

symptoms 

more likely 

among 

workers with 

5+ year work 

at 

the plant

6 workers 

diagnosed 

with asthma 

after starting 

work at the 

plant

Risk of 

asthma 

12x higher 

after hire 

compared to 

before hire

Recommendations

● Use chemicals with fewer potential health effects 

● Use engineering controls to reduce workers’ exposure to chemicals

● Use quantitative fit testing in a respiratory protection program

● Encourage employees to report symptoms; refer them to 

occupational medicine physicians 

● Use vacuum cleaners with HEPA filters rather than sweeping

● Move clean worker uniforms out of production areas; require 

workers to change into everyday clothes before leaving plant

See full report at: http://go.usa.gov/cuyDT
Heat-Related Illness and 

Rhabdomyolysis during 

Structural Firefighter 

Training

Rhabdomyolysis (or Rhabdo)

● Muscle tissue breakdown 

● Releases electrolytes and proteins into the bloodstream

● Can cause heart and kidney damage, permanent disability, and death

● Often mistaken for heat-related illness (HRI), such as heat stroke

● Can be diagnosed only through blood test for creatine kinase (CK) 

What We Did

In a 4-day evaluation of cadet training, we measured:

Photo by NIOSH

Symptoms 

of rhabdo & 

HRI

CK levels 

in blood

Heart 

rate

Change 

in body 

weight

Core body 

temperature 

(CBT)

What We Found

● 1 cadet had rhabdo; 16 others had elevated CK levels

● 1 cadet had CBT of 107.2°F during a live fire exercise

● Most cadets had excessive heat strain according to their CBT, heart 

rate, and body weight loss

Recommendations

● Schedule training and physically demanding activities during 

cooler months and cooler parts of the day

● Educate firefighters about signs, symptoms, and dangers of rhabdo

See full report at: http://go.usa.gov/cuyDm
Modern nail salons

Photo by NIOSH

Vape 

shops

Photo by NIOSH

Peroxyacetic 

acid disinfectant 

use in hospitals

Photo by ©Thinkstock

Flame retardants 

in e-recycling

Photo by NIOSH

Coffee 

roasting

Photo by ©Thinkstock

Copper slag 

and coal slag 

processing

Photo by ©Thinkstock
The mission of the NIOSH Health Hazard 

Evaluation Program is to respond to requests from 

employees, employers, and union representatives 

to evaluate potential health hazards in their 

workplace. These evaluations are done at no cost 

to the requestor. Once the evaluation is complete, 

recommendations are made on ways to reduce 

or eliminate identified hazards. Health Hazard 

Evaluations can help reduce hazards and create 

more healthful workplaces. 

If you have questions, please contact the HHE 

Program Monday–Friday, 9 a.m. – 4:30 p.m. EST

Phone: 1-513-841-4382

@ HHERequestHelp@cdc.gov

NIOSH Health Hazard Evaluation Program

1090 Tusculum Avenue, Mail Stop R-9

Cincinnati, OH 45226-1988