Abstract
The Environmental & Occupational Epidemiology (EOE) section of the Oregon Public Health Division, Department of Human Services (OPHD, DHS) received funds between September 30, 2004 and February 28, 2006 to examine and reduce the rate of occupational burns, dermatitis, and acute pesticide poisonings in the State of Oregon. During the project period, EOE collected data from numerous surveillance partners about work-related burn injuries, dermatitis, and acute pesticide poisonings. Burn and dermatitis data was received from Oregon Workers' Compensation (OWC) and a Private Workers' Compensation (PWC) insurance company. Additional burn injury data was received from the Oregon Burn Center (OBC) and additional dermatitis data was received from the Oregon Health & Science University (OHSU) Contact Dermatitis Clinic. Acute, pesticide poisoning data was received from the Oregon Poison Center (OPC), the Pesticide Analytical Response Center (PARC), local county health departments, affected individuals, employers, and witnesses. The data for all three injuries/illnesses was analyzed to identify patterns of illnesses/injuries among industries, occupations, and other groups. From 9/30/04 - 2/28/06, there were 357 accepted burn claims identified through data provided by OWC, 454 from PWC, and 34 cases identified through OBC. For OWC, the major industry groups (Standard Industrial Classification 1987 (SIC '87)) with the highest accepted claims were Wholesale & Retail (36%), Manufacturing (22%), and Services (19%). Water (13%), Fat, Oil (10%) and Fire, Flame (9%) were the most represented source groups (Occupational Illness/Injury Coding System (OIICS)). The occupation groups (Bureau of Census 2000 (BOC '00)) with the highest number of accepted claims were Service occupations (33%) and Operators, Fabricators & Laborers (29%). For PWC, 454 accepted disabling burn claims were identified. Thermal skin burns were the most common type of burn accounting for 71% of the accepted disabling claims. There were a total of 93 eye burns accepted during the reporting period, 59% of which were thermal and 37% were chemical. Restaurants and Taverns was the specific industry (National Council on Compensation Insurance (NCCI)) with the highest number of claims (206, 46.5%). There were 34 case reports from OBC during the surveillance period, none of which were fatalities. The most frequent occupation was Electrician (6, 18%) followed by Laborers and Mechanics, both representing four claims (12% each). Forty-four percent of claims required a skin graft and two claims required amputation. From 9/30/04 - 2/28/06, there were 110 accepted dermatitis claims identified through data provided by OWC, 44 from PWC, and 33 from the OHSU Contact Dermatitis Clinic. For OWC, the major industry groups (SIC '87) with the highest accepted claims were Manufacturing (31%), Services (21%) and Retail Trade (18%). Chemicals & Chemical Compounds (46%) and Persons, Plants, Animals & Minerals (30%) were the most represented source groups (OIICS). The occupation groups (BOC '00) with the highest number of accepted claims were Operators, Fabricators & Laborers (29%) and Service occupations (19%). For PWC, 44 accepted, disabling dermatitis claims were identified, all of which were medical only claims. Restaurants and Taverns was industry with the highest number of claims (n=12, 27.3%). The 25 - 34 year old age group represented 14 claims (32%) followed by the 18 - 24 year old age group (n=11, 25%). There were 33 case reports from the OHSU Dermatitis Clinic during the surveillance period. The most common diagnosis was "allergic contact dermatitis" (63.6%), and the most frequent affected body part was hands (81.8%). Between 09/30/2004 and 02/28/2006, 29 acute, work-related pesticide poisoning events were reported to the Oregon SENSOR pesticide program. The 29 occupational events involved 42 cases. Nineteen of these cases were reported from the OPC, 14 from the affected individuals, seven from government agencies (i.e. PARC and local county health departments), one from a worker representative, and one from another source. Two cases were classified as definite, one as probable, 20 as possible, three as unlikely, and 13 as insufficient information, and three as exposed/asymptomatic. EOE staff was also able to complete work on the complex process of linking medical and administrative OWC datasets. Staff calculated that burn claims, completed between 2001 and 2003, incurred a mean cost of $2,775 per claim thus demonstrating the financial impact of burn-related workers' compensation claims. From 2001 - 2003, completed dermatitis claims incurred a mean cost of $1,463 per claim, demonstrating the financial impact of occupational dermatitis. The restaurant industry has been an important focus of our surveillance efforts. EOE staff collaborated with partners to develop educational materials and recommendations for workers in this industry. As a result staff developed burn prevention and first aid posters in 2 languages (English and Spanish) and a deep fat fryer checklist. EOE provided surveillance findings to partners and stakeholders, and developed collaborative intervention strategies prioritized according to frequency, rates of injury, cost, and worker populations at greatest risk. Two sources of dermatitis that have been an important focus of our surveillance efforts are plant-related dermatitis and latex allergy. EOE staff collaborated with partners to develop educational materials and recommendations for health care workers, dentists, new mothers, and wild land firefighters. EOE provided surveillance findings to partners and stakeholders and developed collaborative intervention strategies. Intervention strategies were prioritized by the frequency, rate, and cost of injuries as well as by assessing the worker populations at greatest risk. An analysis of latex glove violations before and after a March 2003 rule change (prohibiting the use of latex in food service establishments) found that violations increased in the two-year period, post-rule change. The rise in violations was possibly due to increased vigilance or use of older glove stocks. However, the third year of data found inconsistencies in violations by county, with some increases and some decreases. One event in particular involved three emergency medical technicians and two police officers who responded to an emergency where two individuals became ill (one of whom died) upon entering their home after an indoor commercial pesticide treatment. All five emergency responders were unprepared for entry into the hazardous atmosphere, but responded nevertheless and immediately experienced symptoms. EOE developed a training module based on this incident about personal protective equipment needs for emergency responders at the local level when a hazard is suspected. In addition, the Oregon Department of Agriculture (ODA), PARC, and our agency made recommendations to US Environmental Protection Agency (EPA) and asked them for clarification around ventilation and the re-entry period on the product label.
