Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-30 (of 38 Records) |
Query Trace: Yorio P[original query] |
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The association between safety climate and noncombat injury events among United States Air Force workers
Socias-Morales CM , Haas EJ , Gwilliam M , Yorio PL , Delaney NB , Falcon RG , Stallings HA , Burnham BR , Stuever DM , Stouder SM , Ewing GL , Collins JW , Chaumont Menendez CK . J Saf Res null [Epub ahead of print] Introduction: Work-related injuries are a common lagging safety indicator whereas safety climate assessments can help identify constructs serving as leading indicators. The National Institute for Occupational Safety and Health (NIOSH) partnered with the U.S. Department of the Air Force (DAF) Safety Center to examine the association between perceptions of safety climate survey constructs and the number of injury events within the DAF workforce. Methods: The DAF administers voluntary, anonymous, occupation-specific safety climate surveys to DAF workers using the internal Air Force Combined Mishap Reduction System (AFCMRS). Survey responses from 2014 to 2018 provided by DAF workers and injury events in maintenance, support, and operations occupations were shared with NIOSH. Exploratory Factor Analysis revealed five constructs: Leadership and Communication; Organizational Safety Priority; Error Management; Resource Adequacy; and Deployment/Official Travel Impact. Squadron-level analysis included bivariate correlations and estimated Rate Ratios (RRs). Results: 1,547 squadrons administered the survey, averaging 144 workers and 15.8 reportable injuries per squadron. Higher (more favorable) squadron-level construct scores were consistently correlated with fewer reported injuries (p < 0.001). Controlling for the number of workers, RRs revealed significant reductions in injury rates with each one-unit increase in responses: Leadership and Communication RR = 0.40 (95 %CI: 0.32-0.48); Organizational Safety Priority RR = 0.50 (95 %CI: 0.40-0.64); Error Management RR = 0.37 (95 %CI: 0.30-0.47); Deployment/Official Travel Impact RR = 0.36 (95 %CI: 0.29-0.45). Resource Adequacy revealed a non-significant lower injury rate RR = 0.87 (95 %CI: 0.73-1.04). Conclusions: This unique study quantified safety climate and the association with injuries across a multi-year period. While safety climate measurements may be limited by frequent turnover and the self-reported, voluntary, anonymous nature of AFCMRS, the strength of this study is in the census of injuries. Practical Applications: Future research should include longitudinal analyses to examine the impact on injuries when squadron leaders are provided feedback on safety climate survey results. |
The impact of surface tension on the barrier performance of gowns and coveralls
Selcen Kilinc-Balci F , Kahveci Z , Yorio PL . Am J Infect Control 2023 51 (12) 1392-1400 BACKGROUND: Healthcare workers (HCWs) and laboratory workers who are routinely exposed to potentially life-threatening infectious diseases should wear protective clothing when anticipating contact with infectious materials. The most critical property for protective clothing is its ability to prevent liquids and viruses from passing through the garment. There are a number of potentially infectious liquids that workers may be exposed to during routine tasks. Each liquid has different physical and chemical properties that affect penetration. However, current test methods use a limited number of liquids for classifying the barrier performance. OBJECTIVE: The impact of the surface tension of the challenge liquid on the penetration resistance of gowns and coveralls was investigated in this study. METHODS: Eight isolation gowns and two coveralls were tested in accordance with AATCC 42 and AATCC 127 test methods, which were modified to incorporate the substitute challenge liquids. RESULTS: Although current standard test methods only use water to categorize liquid penetration resistance of minimal to moderate barrier performance gowns, a significant difference in the penetration was found when simulated body fluids were used. CONCLUSIONS: Results suggest safety professionals and wearers should consider the varying barrier performance of PPE with different liquids and use limitations when selecting PPE for the required tasks. Furthermore, standard development organizations should consider multiple challenge liquids when classifying protective clothing for healthcare settings. |
Evaluation of fluid leakage at the coverall and glove interface in single and double glove conditions
Kahveci Z , Kilinc-Balci FS , Yorio PL . Am J Infect Control 2023 51 (10) 1145-1150 BACKGROUND: Fluid leakage through the glove-protective clothing interface is an area of concern for many healthcare personnel, including emergency medical service providers, who may wear coveralls to protect themselves from multiple types of hazards. There is currently no established standard test method to specifically evaluate the barrier performance of the glove-protective clothing interface region for any personal protective equipment ensemble. OBJECTIVE: This study quantifies the fluid leakage at the coverall and glove interface using single and double gloving. METHODS: A robotic arm, which can simulate upper extremity movements of healthcare personnel, was used to test five coverall models and an extended examination glove model in single and double glove conditions. RESULTS: The results show that there was a significant difference in fluid leakage amounts between some of the coverall models and the number of glove layers studied. Findings also highlight that there is a high correlation between basis weight and stiffness of the coverall fabrics and the fluid leakage amounts. CONCLUSIONS: These results underline that coverall constructed from thin and less stiff fabrics can result in lower fluid leakage levels. Also, there was no significant difference in fluid leakage amounts between single and double gloves when tested with each of the coverall models, with the exception of the coveralls with the highest basis weight and stiffness. |
Effect of Cloth Masks and N95 Respirators on Maximal Exercise Performance in Collegiate Athletes.
Darnell ME , Quinn TD , Carnahan SP , Carpenter T , Meglino N , Yorio PL , Doperak JM . Int J Environ Res Public Health 2022 19 (13) This study compared exercise performance and comfort while wearing an N95 filtering facepiece respirator (N95), cloth mask, or no intervention control for source control during a maximal graded treadmill exercise test (GXT). Twelve Division 1 athletes (50% female, age = 20.1 ± 1.2, BMI = 23.5 ± 1.6) completed GXTs under three randomized conditions (N95, cloth mask, control). GXT duration, heart rate (HR), respiration rate (RR), transcutaneous oxygen saturation (SpO(2)), transcutaneous carbon dioxide (TcPCO(2)), rating of perceived exertion (RPE), and perceived comfort were measured. Participants ran significantly longer in control (26.06 min) versus N95 (24.20 min, p = 0.03) or cloth masks (24.06 min, p = 0.04). No differences occurred in the slope of HR or SpO(2) across conditions (p > 0.05). TcPCO(2) decreased faster in control (B = -0.89) versus N95 (B = 0.14, p = 0.02) or cloth masks (B = -0.26, p = 0.03). RR increased faster in control (B = 8.32) versus cloth masks (B = 6.20, p = 0.04). RPE increased faster in the N95 (B = 1.91) and cloth masks (B = 1.79) versus control (B = 1.59, p < 0.001 and p = 0.05, respectively). Facial irritation/itching/pinching was higher in the N95 versus cloth masks, but sweat/moisture buildup was lower (p < 0.05 for all). Wearing cloth masks or N95s for source control may impact exercise performance, especially at higher intensities. Significant physiological differences were observed between cloth masks and N95s compared to control, while no physiological differences were found between cloth masks and N95s; however, comfort my differ. |
Laboratory assessment of bacterial contamination of a sterile environment when using respirators not traditionally used in a sterile field environment
Myers W , Ajewole S , Xu S , Yorio P , Hornbeck A , Zhuang Z . Infect Control Hosp Epidemiol 2022 43 (12) 1-6 OBJECTIVE: During infectious disease outbreaks or pandemics, an increased demand for surgical N95s that create shortages and necessitate the use of alternative National Institute for Occupational Safety and Health (NIOSH)-approved respirators that do not meet the Food and Drug Administration (FDA) additional requirements. The objective of this research was to quantify the level of bacterial contamination resulting from wearing NIOSH-approved respirators lacking the additional protections afforded by surgical N95s. METHODS: Participants performed simulated healthcare tasks while wearing 5 different respirators approved by the NIOSH. Sterile field contamination resulting from use of a surgical mask cleared by the FDA served as a baseline for comparison with the NIOSH-approved respirators. RESULTS: The bacterial contamination produced by participants wearing the N95 filtering facepiece respirators (FFRs) without an exhalation valve, the powered air-purifying respirators (PAPRs) with an assigned protection factor of 25 or 1,000 was not significantly different compared to the contamination resulting from wearing the surgical mask. The bacterial contamination resulting from wearing the N95 FFR with an exhalation valve and elastomeric half-mask respirator (EHMR) with an exhalation valve was found to be statistically significantly higher than the bacterial contamination resulting from wearing the surgical mask. CONCLUSIONS: Overall, NIOSH-approved respirators without exhalation valves maintain a sterile field as well as a surgical mask. These findings inform respiratory guidance on the selection of respirators where sterile fields are needed during shortages of surgical N95 FFRs. |
Applying the CDC Science Impact Framework to the results of the National Institute for Occupational Safety and Health and the Bureau of Labor Statistics 2001 Survey of Respirator Use and Practices
Yoon N , Ari M , Yorio P , Iskander J , D'Alessandro M . J Occup Environ Hyg 2022 19 (6) 1-31 During 2001-2002, the National Institute for Occupational Safety and Health (NIOSH), at the United States Centers for Disease Control and Prevention, collaborated with the Bureau of Labor Statistics (BLS) at the United States Department of Labor to conduct a voluntary survey of U.S. employers regarding the use of respiratory protective devices. In 2003, the survey results were jointly published by NIOSH and BLS. This study highlights and evaluates the scientific impact of the 2001-2002 survey by using Science Impact Framework that provides a historical tracking method with five domains of influence. The authors conducted interviews with original project management as well as a thorough document review and qualitative content analysis of published papers, books, presentations, and other relevant print media. A semi-structured and cross-vetted coding was applied across the five domains: Disseminating Science, Creating Awareness, Catalyzing Action, Effecting Change, and Shaping the Future. The 2001-2002 survey findings greatly enhanced understanding and awareness of respirator use in occupational settings within the United States. It also led to similar surveys in other countries, regulatory initiatives by the Occupational Safety and Health Administration and Mine Safety and Health Administration, and ultimately to a renewed partnership between NIOSH and BLS to collect contemporary estimates of respirator use in the workplace within the United States. |
A simulation study to assess fluid leakage through the glove-gown interface in isolation settings
Kahveci Z , Kilinc-Balci FS , Yorio PL . Am J Infect Control 2021 49 (12) 1481-1487 BACKGROUND: Isolation gowns are recommended to protect healthcare personnel (HCP), patients, and visitors from transfer of microorganisms and body fluids in patient isolation situations. Standards provide limited information about barrier performance of isolation gowns for possible exposure scenarios. One of the most vulnerable areas of the personal protective equipment (PPE) ensemble is considered the glove-gown interface. However, current classification standards do not consider the interface regions of the PPE system while assessing the level of protection. The purpose of this study was to quantitatively evaluate the fluid leakage through the glove-gown interface by simulating exposures and HCP arm movements in patient care. METHODS: We tested fluid leakage of two examination gloves with different cuff lengths and seven isolation gown models designed with varying levels of barrier resistance and multiple cuff types. RESULTS: Our results demonstrated that leakage through the glove-gown interface depends on multiple factors, including glove cuff length and gown cuff design. Gowns with the thumb loop design provided better protection than the elastic cuff design, and the elastic cuff design provided better protection compared to the knit cuff design for a given AAMI PB70 level. More importantly, a substantial penetration through gown fabrics was observed. CONCLUSION: This research identifies a need to develop a standardized method to evaluate leakage at the glove-gown interface to improve worker protection. |
Evaluation of total inward leakage for NIOSH-approved elastomeric half-facepiece, full-facepiece, and powered air-purifying respirators using sodium chloride and corn oil aerosols
Rengasamy S , Zhuang Z , Lawrence RB , Boutin B , Yorio P , Horvatin M , McClain C , Harris JR , Coffey C . J Occup Environ Hyg 2021 18 (7) 1-9 Recently, total inward leakage (TIL) for filtering facepiece and elastomeric half-mask respirators (EHRs) was measured according to the International Organization for Standardization (ISO) test method standard 16900-1:2014 that showed larger TIL for corn oil aerosol than for NaCl aerosol. Comparison of TIL measured for different aerosols for higher protection level respirators is lacking. The objective of this study was to determine TIL for EHRs, full-facepiece respirators, and loose-fitting and tight-fitting powered air-purifying respirators (PAPRs) using NaCl and corn oil aerosols to compare. TIL was measured for two models each of EHRs, full-facepiece respirators, and loose-fitting and tight-fitting PAPRs. After fit testing with a PortaCount (TSI, St. Paul, MN) using the Occupational Safety and Health Administration (OSHA) protocol, eight subjects were tested in the NaCl aerosol chamber first and then in the corn oil aerosol chamber, while another eight subjects tested in the reverse order. Subjects were randomly assigned to one of the two groups. TIL was measured as a ratio of mass-based aerosol concentrations inside the mask to the test chamber while the subjects performed ISO 16900-1-defined exercises using continuous sampling methods. The concentration of corn oil aerosol was measured with one light scattering photometer, alternately, and NaCl aerosol was measured using two flame photometers. Results showed the geometric mean TIL for EHR was significantly (p < 0.05) larger for corn oil aerosol than for NaCl aerosol. EHR models equipped with P100 filters showed relatively smaller TIL values than the same models with N95 filters showing that TIL was inversely related to filter efficiency. Interestingly, TIL was significantly (p < 0.05) larger for NaCl aerosol than for corn oil aerosol for PAPRs, but not for full-facepiece respirators. TIL was inversely related to fit factors of respirator types. Overall, filter efficiency and faceseal leakage determine TIL. The relative trends in TIL for the two aerosols' test methods differ between respirator types indicating that generalization of TIL for respirator types may not be appropriate when using different test agents. |
Probability of hyperthermia in a hot environment while wearing a liquid cooling garment underneath firefighters' protective clothing
Aljaroudi AM , Bhattacharya A , Yorio P , Strauch AL , Quinn TD , Williams WJ . J Occup Environ Hyg 2021 18 1-13 Firefighters' protective clothing (FPC) can limit human thermoregulation due to limited water vapor permeability and insulation. This study investigated the effect of cooling on the physiological responses and probability of hyperthermia in subjects wearing FPC during exercise in a hot environment. Twelve males participated in this study. A maximal graded treadmill exercise test was performed to measure maximal oxygen uptake (V̇O(2max)) and to assess subjects' capacity to perform the assigned exercise. Exercise included treadmill walking at 40% V̇O(2max) in warm (30 °C) and humid (70% RH) conditions for 40 min while wearing FPC. Subjects participated in two randomly counterbalanced assigned experimental protocols: control (no cooling) and intervention (cooling). The experimental intervention consisted of a cooling garment infused with cooled water (18 °C) through silastic tubing sewn into the fabric and worn underneath FPC. Each subject served as their own control and, therefore, completed both the control and intervention of the protocol. A logistic regression model was used to analyze the interaction effect of cooling on the probability of progression to hyperthermia (T(c) ≥ 38 °C). Subjects' physiological responses increased during exercise in a warm and humid environment. Active cooling decreased (p < 0.05) the thermal stress thereby reducing the probability of hyperthermia while exercising in hot and humid conditions. The results indicate that when cooling was used each subject, on average, was 91% less likely to reach the lower threshold limit of hyperthermia. Exercise in hot environments while wearing FPC results in significant physiological strain, which may lead to hyperthermia. Utilization of a cooling garment reduced physiological strain and the probability of hyperthermia. |
Occupational physical activity and cardiovascular disease in the United States
Quinn TD , Yorio PL , Smith PM , Seo Y , Whitfield GP , Barone Gibbs B . Occup Environ Med 2021 78 (10) 724-730 BACKGROUND: Emerging evidence, predominately from European and Asian countries, describes opposing effects of occupational physical activity (OPA) and leisure-time physical activity (LTPA) on cardiovascular health. This analysis examined cardiovascular disease (CVD) prevalence associated with OPA and LTPA. METHODS: This cross-sectional analysis of 2015 National Health Interview Survey data (n=16 974) employed logistic regression to estimate odds (OR) of self-reported CVD (coronary heart disease, heart attack, stroke or angina) with self-reported total occupational activity (TOA), occupational exertion (OE), occupational standing and walking (OSW) and LTPA. OPA was measured using two questions: 'How often does your job involve…' (1) 'repeated lifting, pushing, pulling or bending?' (OE) and (2) 'standing or walking around?' (OSW) with responses on a 5-item Likert scale (0=never, 4=always). TOA was categorised similarly after summing OE and OSW scores. LTPA was defined as 0, 1-149 or ≥150 min/week of moderate-to-vigorous activity. All models adjusted for common socioeconomic variables and additional analyses were stratified by sex, smoking status and LTPA. RESULTS: Odds for CVD were higher when 'always' performing TOA (OR 1.99 95% CI 1.12 to 3.53), OE (OR 2.15, 95% CI 1.45 to 3.19) or OSW (OR 1.84, 95% CI 1.07 to 3.17) compared with 'never'. When restricting to never-smokers, odds for CVD were higher when 'always' performing TOA (OR 3.00, 95% CI 1.38 to 6.51) and OE (OR 3.00, 95% CI 1.80 to 5.02) versus 'never'. CONCLUSION: Associations of high OPA with CVD were equally apparent across sexes, stronger in lower LTPA levels and stronger in never-smokers. While uncontrolled confounding is still possible, even after extensive adjustment, the seemingly paradoxical adverse associations with OPA and CVD should be investigated further. |
Behavioral Safety Compliance in an Interdependent Mining Environment: Supervisor Communication, Procedural Justice, and the Mediating Role of Coworker Communication
Haas EJ , Yorio PL . Int J Occup Saf Ergon 2021 28 (3) 1-29 Purpose. Although a focus on safety communication between managers and employees has been prevalent, research around coworker influence in this communication has been fragmented in the literature. Methods. To examine these issues, researchers gathered survey data from 1,955 mine employees from surface stone, sand, and gravel (SSG) and industrial mineral operations across the United States between 2016 and 2018 and studied the relationships between justice perceptions, supervisor communication, and coworker communication on behavioral safety compliance. Results. Using structural equation modeling, coworker communication partially mediated the direct effects of supervisor communication and justice perceptions on behavioral safety compliance-where the indirect effects were greater for justice perceptions. Conclusion. The results demonstrate the value in formal and informal communication paths to facilitate employee safety compliance; and that enhanced perceptions of job fairness and adaptability enhances coworker communication, further improving compliance in an interdependent environment.Author Note:Emily J. Haas ORCID ID: https://orcid.org/0000-0001-5128-470X, Emily J. Haas is a Senior Research Behavioral Scientist at the National Institute for Occupational Safety and Health, Pittsburgh Mining Research Division. Patrick L. Yorio is a Statistician at the National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory. We have no known conflict of interest to discloseDisclaimerThe findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. Mention of any company or product does not constitute endorsement by NIOSH. |
Respiratory Protection in a Time of Crisis: NIOSH Testing of International Respiratory Protective Devices for Emergency Use.
Andrews AS , Powers JR Jr , Cichowicz JK , Coffey CC , Fries ML , Yorio PL , D'Alessandro MM . Health Secur 2021 19 (4) 379-385 National Institute for Occupational Safety and Health (NIOSH)-approved respirators are required by the Occupational Safety and Health Administration (OSHA) when personal respiratory protection is used in US occupational settings. During the COVID-19 pandemic, the demand for NIOSH-approved N95 filtering facepiece respirators overwhelmed the available supply. To supplement the national inventory of N95 respirators, contingency and crisis capacity strategies were implemented and incorporated a component that endorsed the use of non-NIOSH-approved respiratory protective devices that conformed to select international standards. The development and execution of this strategy required the collaborative effort of numerous agencies. The Food and Drug Administration temporarily authorized non-NIOSH-approved international respiratory protective devices through an emergency use authorization, OSHA relaxed their enforcement guidance concerning their use in US workplaces, and NIOSH initiated a supplemental performance assessment process to verify the quality of international devices. NIOSH testing revealed that many of the non-NIOSH-approved respiratory protective devices had filtration efficiencies below 95% and substantial inconsistencies in filtration performance. This article reports the results of the NIOSH testing to date and discusses how it has contributed to continuous improvement of the crisis strategy of temporarily permitting the use of non-NIOSH-approved respirators in US occupational settings during the COVID-19 pandemic. |
Exploring the differences in safety climate among mining sectors
Haas EJ , Yorio PL . Min Metall Explor 2021 38 (1) 655-668 Currently, the US mining industry is encouraged, but not required to adopt a formal health and safety management system. Previous research has shown that the adoption of such systems has been more difficult in some subsectors of the mining industry than others. Given the interdependencies between management systems and safety climate in addition to their predictive utility of incidents, it is important to assess differences in the perceptions of safety climate among mining subsectors in the USA. If significant differences exist, then mining subsectors may not necessarily be able to adopt a one-size approach to system implementation. To that end, the National Institute for Occupational Safety and Health assessed mineworkers’ perceptions of several individual and organizational safety climate constructs. Participants consisted of 2945 mineworkers at coal, industrial mineral, and stone/sand/gravel mine sites throughout 18 states. Linear regressions were used to answer the research question. The results suggest that coal miners, in comparison to those miners in industrial mineral and stone/sand/gravel sectors, had significantly less favorable perceptions on each of the organizational climate constructs measured (i.e., organizational support, supervisor support and communication, coworker communication, engagement/involvement, and training) (p < 0.001 in all cases). Importantly, these results parse out organizational indicators to show that perceptions are not only lower in one area of organizational or supervisor support. Rather, engagement, training, and communication practices were all significantly lower among coal miners, prompting considerations for these significant differences and actions that can be taken to improve system practices. |
Speech intelligibility test methodology applied to powered air-purifying respirators used in healthcare
Xu S , Simons J , Yorio P , Rottach D , Zhuang Z , Radonovich L . J Occup Environ Hyg 2020 18 (1) 1-11 Powered air-purifying respirators (PAPRs) are worn to protect workers from hazardous respiratory exposures in a wide range of workplaces, including healthcare. However, PAPRs may diminish the ability of wearers to correctly hear words spoken by others, potentially interfering with safe performance of healthcare duties. Accordingly, the impact of PAPRs during healthcare use on speech intelligibility (SI) and consequently on user safety, usability, and patient care is not well studied. The objectives of this study were to (1) determine a listener's ability to comprehend single-syllable words spoken by a PAPR wearer; (2) determine a PAPR wearer's ability to intelligibly hear and identify single-syllable words spoken by a PAPR wearer; (3) to assess the variability between speakers, listeners, and PAPR models; (4) to investigate the effects of PAPR design features on SI; and (5) inform a SI requirement for certifying future PAPRs for use in healthcare. This study utilized a Modified Rhyme Test to assess SI for PAPRs. The current National Institute for Occupational Safety and Health (NIOSH) methods for assessing SI are limited to the recently introduced PAPR100 respirator class and the class of respirators claiming chemical, biological, radiological, and nuclear (CBRN) protections. Four NIOSH-approved PAPRs were evaluated using four human subjects. Four experimental conditions were examined:(1) Speaker and Listener with no PAPR; (2) Speaker and Listener both wearing PAPRs; (3) Speaker with a PAPR, Listener without a PAPR; and (4) Speaker without a PAPR, Listener with a PAPR resulted in a total of 144 experiments. Statistical analysis showed that the SI performance ratings were not significantly different among the PAPR models, but experimental conditions had significant impact on SI. The pattern of SI across the conditions of the experiment also showed a significant difference depending on PAPR model. The SI performance rating for all PAPRs could meet the current NIOSH CBRN certification requirement for speech intelligibility. |
Barrier resistance of double layer isolation gowns
Kahveci Z , Kilinc-Balci FS , Yorio PL . Am J Infect Control 2020 49 (4) 430-433 Isolation gowns are one of the crucial pieces of personal protective equipment (PPE) to prevent the migration of microorganisms and body fluids from patients to healthcare personnel and vice versa. Underperforming isolation gowns in terms of fluid resistance, could potentially put lives in danger. Wearing multiple layers of isolation gowns could theoretically increase the fluid penetration resistance. Extraordinary circumstances such as epidemics/pandemics and product recalls, bring extra burden on the health institutions in terms of PPE availability. Thus, shortages could occur, and PPE that provides an appropriate level of protection might not be available. Therefore, wearing multiple layers of lower barrier level gowns could be assumed as a solution. This study investigates if two-layer lower barrier level isolation gowns meet the barrier effectiveness requirements of a single higher barrier level isolation gown. Three ANSI/AAMI PB70 Level 2 isolation gowns were tested based on the ANSI/AAMI PB70 standard, in single and double-layer configuration. Test results demonstrated that the double layer isolation gown configuration does not always provide equal fluid resistance as the higher level of isolation gown according to results from the AATCC 42 and AATCC 127 standard test methods, which are described in ANSI/AAMI PB70. |
Lagging or leading Exploring the temporal relationship among lagging indicators in mining establishments 2006-2017
Yorio PL , Haas EJ , Bell JL , Moore SM , Greenawald LA . J Safety Res 2020 74 179-185 PROBLEM: Safety management literature generally categorizes key performance indicators (KPIs) as either leading or lagging. Traditional lagging indicators are measures related to negative safety incidents, such as injuries, while leading indicators are used to predict (and therefore can be used to prevent) the likelihood of future negative safety incidents. Recent theory suggests that traditional lagging indicators also possess characteristics of leading indicators, and vice versa, however empirical evidence is limited. METHOD: The current research investigated the temporal relationships among establishment-level injuries, near misses, and fatal events using injury and employment data from a sample of 24,910 mining establishments over a 12-year period. RESULTS: While controlling for employee hours worked, establishment-level reported injuries and near misses were associated with of future fatal events across the sample of mines and over the time period studied. Fatal events were also associated with increases in future reported near misses, providing evidence of a cyclic relationship between them. DISCUSSION: These findings challenge the strict categorization of injuries, near misses, and fatal events as lagging indicators. Practical applications: Understanding the KPIs that should be used to manage organizational safety, and how they can be used, is of critical practical importance. The results of the current study suggest that, depending on several considerations, metrics tied to negative safety incidents may be used to anticipate, and possibly prevent, future negative safety events. |
Heinrich revisited: A new data-driven examination of the safety pyramid
Moore SM , Yorio PL , Haas EJ , Bell JL , Greenawald LA . Min Metall Explor 2020 37 (6) 1857-1863 Although researchers have struggled to replicate Heinrich’s safety triangle findings (Heinrich 1931) for various reasons (e.g., no access to his original database and it is unclear if the database was of a single establishment/operation or for an entire industry), the occupational safety community has continued to adopt and expand the applications of this theory (e.g., McSween 2003). Within the mining industry, the potential exists for operations and companies to use concepts from the safety triangle as a way to inform or challenge the practices employed within their health and safety management systems (HSMS) to prevent incidents (Backlund 2016). This paper considers data obtained from the Mine Safety and Health Administration’s databases and demonstrates the validity of applying the safety triangle theory at the mine level. The results support the use of this theory and demonstrate that lower severity incidents can predict fatalities in a subsequent year where significant nuances and caveats to applying the theory are identified and discussed. |
Developing a methodology to collect empirical data that informs policy and practices for stockpiling personal protective equipment
Greenawald LA , Moore SM , Wizner K , Yorio PL . Am J Infect Control 2020 49 (2) 166-173 BACKGROUND: Personal protective equipment (PPE) are stockpiled across the nation to offset supply depletion during public health emergencies. Stockpiled PPE inventories vary across the U.S. by type, model, quantity, and the conditions in which they are stored. Over the past decade, federal, state, and local stockpile managers have had concerns for the viability of aging PPE. METHODS: To understand factors that may affect stockpiled PPE, we explored the breadth of stockpile storage conditions and respirator and surgical gown inventories through collaboration with the national PPE community, qualitative observations collected at 10 different U.S. stockpiles, and by compiling stockpile PPE inventories and climate data from a convenience sample of U.S. stockpiles. RESULTS: The aggregated inventory from 20 stockpiles is reported, accounting for approximately 53 million respirators. Most respirators (69% or 35.8 million) have been stored between 5 and 10 years. Upon visiting 10 stockpile facilities, we report on the storage conditions observed and summarize the storage environment data collected. CONCLUSIONS: This is the first study to identify common PPE types, inventories, and storage conditions across federal, state, and local government stockpile facilities as well as healthcare organization-managed caches. These findings will be leveraged to guide the development of sampling protocols for air-purifying respirators and surgical gowns in U.S. stockpiles to understand the performance viability after long-term storage. |
A General Framework to Test and Evaluate Filtering Facepiece Respirators Considered for Crisis Capacity Use as a Strategy to Optimize Supply.
Yoon KN , Greenawald LA , Rottach DR , Pollard JP , Yorio PL . J Int Soc Respir Prot 2020 36 (1) 36-51 During a public health emergency, respirator shortages can have a profound impact on the national response, such as for the current coronavirus disease 2019 (COVID-19) pandemic. Due to a severe shortage of respirators (particularly filtering facepiece respirators [FFRs]), there may be contexts in which understanding the performance of FFRs that are approved for use as part of a crisis capacity strategy is desired. This includes FFRs that are not covered under the National Institute for Occupational Safety and Health (NIOSH) Respirator Approval Program because they have been stored past their designated shelf life, have been decontaminated, or are approved by international certification bodies other than NIOSH. The purpose of this document is to provide a general framework to assess the performance of FFRs that are only being used as a crisis capacity strategy. The intended audience are those who are responsible for managing large amounts of FFRs. This framework includes a four-step process consisting of: 1) defining the population of FFRs to be sampled; 2) providing sampling strategy options; 3) inspecting and testing the sampled units; and 4) evaluating the results. In addition to the four-step process, we provide an example of how NIOSH recently evaluated the quality of FFRs sampled from ten U.S. stockpiles. |
Planning for epidemics and pandemics: assessing the potential impact of extended use and reuse strategies on respirator usage rates to support supply-and-demand planning efforts
Yorio PL , Fisher EM , Kilinc-Balci FS , Rottach D , Harney J , Seaton M , Dahm MM , Niemeier T . J Int Soc Respir Prot 2020 37 (1) 52-60 During epidemics and pandemics healthcare personnel (HCP) are on the front line of disease containment and mitigation. Personal protective equipment (PPE), such as NIOSH-approved N95 filtering facepiece respirators (FFRs), serve an important role in minimizing HCP risks and are in high demand during public health emergencies. Because PPE demand can exceed supply, various public health strategies have been developed to reduce the rate of PPE consumption as supply dwindles. Extended use and limited reuse of N95 FFRs are strategies advocated by many governmental agencies used to increase the number of times a device can be used. Increased use of respirators designed for reuse-such as powered air-purifying respirators (PAPRs) and elastomeric half-mask and full facepiece air-purifying respirators- is another option designed to reduce the continuous need for new devices as the daily need for respirator use increases. Together, these strategies are designed to reduce the number of PPE units that must be discarded daily and, therefore, extend the longevity of available supply. The purpose of this paper is to theoretically estimate the impact of extended use and limited reuse strategies for N95 FFRs and the increased use of reusable respirator options on PPE consumed. The results suggest that a considerable reduction in PPE consumption would result from extended use and limited reuse of N95 FFRs and the increased use of respirators designed for reuse; however, the practical benefits must be balanced with the risks and economic costs. In addition, extended use and reuse strategies must be accompanied by proper procedures to reduce risk. The study is designed to support epidemic and pandemic PPE supply and demand planning efforts. |
Quality assurance sampling plans in US stockpiles for personal protective equipment: A computer simulation to examine degradation rates
Dubaniewicz MT , Rottach DR , Yorio PL . Health Secur 2019 17 (4) 324-333 Medical countermeasure stockpiles in the United States are designed to support healthcare workers and the public during public health emergencies; they include supplies of personal protective equipment (PPE). As part of typical PPE manufacturing processes, appropriate test methods are used to ensure that the devices provide adequate protective performance. At the time of manufacture, performance is often measured and weighed against an objective standard of quality, resulting in a pass or fail attribute being assigned to individual PPE items and thence to production lots. Incorporating periodic performance testing for stockpiled PPE can ensure that they maintain their protective qualities and integrity over time while in storage. There is an absence of guidance regarding how to design quality assurance programs for stockpiled PPE. The applicability of the Lot Quality Assurance Sampling (LQAS) approach to stockpiled PPE was examined in a previous study that compared and contrasted different sample sizes in recovering the true percentage of defective units in large lots in the LQAS framework. The current study carries this line of inquiry forward by integrating PPE degradation over time and comparing different sampling time intervals in recovering the true underlying degradation rate. The results suggest that product degradation is more easily detected when tested at shorter time intervals and for higher degradation rates. They further suggest that sampling interval groupings can be made based on the proficiency with which they recover the true underlying degradation rate. |
Safety culture across cultures
Yorio PL , Edwards J , Hoeneveld D . Saf Sci 2019 120 402-410 National culture colors nearly every aspect of human behavior (Javidan et al., 2006). Despite this truism, the concept has yet to be integrated into organizational safety culture theory. The purpose of this article is to bring awareness as to how national culture can influence organizational safety culture. We do so by theorizing that the shared organizational beliefs, assumptions, and values related to safety (i.e., the anthropologic component of safety culture) are a reflection of the national culture in which the organization's workers are embedded. These organizational values, beliefs, and assumptions directly influence worker perceptions of organizational life and their behavioral choices. Given this prospectively strong direct influence on organizational behavior, we reason that the effectiveness of different organizational structure designs, safety management practices, and leadership characteristics (i.e., safety culture's normative component) can depend on characteristics of the national culture within which the organization resides. We conclude by providing a few key practical suggestions and directions for future research. |
Intersegmental differences in facial warmth sensitivity during rest, passive heat and exercise
Kim JH , Seo Y , Quinn T , Yorio P , Roberge R . Int J Hyperthermia 2019 36 (1) 654-659 Background: Increased facial warmth sensations could lead to thermal discomfort, and different facial regions may demonstrate concurrent temperature differences. The study aim was examining facial warmth sensitivity differences by facial region under differing environmental conditions. Methods: Twelve men had heat flux measurements of six facial regions during 30 min each of rest in thermoneutral conditions (25 degrees C, 30% relative humidity (RH)), rest in warm conditions (40 degrees C, 30% RH), and cycling at 400 W of metabolic heat production (40 degrees C, 30% RH). Results: The forehead demonstrated highest temperatures at termination of all study conditions; lowest temperatures were noted for the nose under thermoneutral conditions and chin during warmth and exercise conditions. Five of six facial regions demonstrated significant differences in warmth sensitivity, decreasing to two of six regions during warm conditions and one of six regions during exercise, with the upper lip most sensitive in all conditions. Body thermal comfort (TC) perceptions, regressed individually on mean facial temperature (Tface) vs. core temperature (Tco), indicated that Tface was significantly more related than Tco to perceived TC (p = .001). Perceived TC, regressed individually on perceived overall body thermal sensation (TS) vs. facial TS, demonstrated that Tface was significantly more related to perceived TC (p = .004). Conclusion: There were regional differences in facial warmth sensitivity together with different facial temperatures moving toward equilibration when the body is subjected to heat-producing activities. Perceptions of TC were more strongly related to Tface than to Tco or overall body TS. |
Critical investigation of glove-gown interface barrier performance in simulated surgical settings
Kahveci Z , Selcen Kilinc-Balci F , Yorio PL . J Occup Environ Hyg 2019 16 (7) 1-9 The barrier properties of personal protective equipment are vital to healthcare personnel to protect themselves from possible infectious body fluids. Intraoperative exposure of healthcare personnel to body fluids can be substantial in both inpatient and outpatient settings. The glove-gown interface is known as one of the weakest points of the whole personal protective equipment system. However, there is a lack of scientific research designed to investigate the problem. This paper reports the results of experiments using a new testing methodology developed to quantify fluid leakage through the glove-gown interface while simulating surgical settings in terms of operating room personnel activities, exposure types, exposure durations, and physical stresses applied on the interface. This study represents one of the first efforts investigating the amount of fluid leakage through the glove-gown interface for a number of surgical gown and glove models while considering glove material differences and single vs. double gloving. The test results showed that there is a significant difference in fluid leakage amounts between three gown models and four glove models studied. The results also demonstrated that double gloving significantly reduced the fluid leakage compared to single glove use. The mean fluid leakage was lower in the double synthetic glove configurations (M = 2.76g) compared with all other configurations (3GLV, M = 8.3g; 4GLV, M = 9.49g; 5GLV, M = 3.08g; 6GLV, M = 20.03g; double latex, M = 5.22g). Findings highlighted a significant interaction between glove and gown designs, which suggests that gown and gloves should be designed together as a system to minimize or eliminate the fluid leakage. |
Quality assurance sampling plans in US stockpiles for personal protective equipment
Yorio PL , Rottach DR , Dubaniewicz M . Health Secur 2019 17 (2) 140-151 Personal protective equipment (PPE) stockpiles in the United States were established to facilitate rapid deployment of medical assets to sites affected by public health emergencies. Large quantities of PPE were introduced into US stockpiles because of the need to protect healthcare and other professionals during these events. Because most stockpiled PPE was acquired during, or immediately following, large-scale public health events, such as pandemic influenza planning (2005-20080), SARS (2003), H1N1 (2009-10), and Ebola (2014-15), aging PPE poses a significant problem. PPE such as N95 filtering face piece respirators were not designed to be stored for long periods, and much of the currently stored PPE has exceeded its manufacturer-assigned shelf life. Given the significant investment in the procurement and storage of PPE, along with projections of consumption during public health emergencies, discarding large quantities of potentially viable PPE is not an attractive option. Although shelf-life extension programs exist for other stockpiled medical assets, no such option is currently available for stockpiled PPE. This article posits stockpile quality assurance sampling plans as a mechanism through which shelf-life extension programs for stockpiled PPE may be achieved. We discuss some of the nuances that should be considered when developing a plan tailored to stockpiles and provide basic decision tools that may be used in the context of a quality assurance program tailored to stockpiled PPE. We also explore basic information by comparing and contrasting different sample size options. |
The role of risk avoidance and locus of control in workers near miss experiences: Implications for improving safety management systems
Haas EJ , Yorio PL . J Loss Prev Process Ind 2019 59 91-99 The process industry has made major advancements and is a leader in near-miss safety management, with several validated models and databases to track close call reports. However, organizational efforts to develop safe work procedures and rules do not guarantee that employees will behaviorally comply with them. Assuming that at some point, every safety management system will need to be examined and realigned to help prevent incidents on the job, it is important to understand how personality traits can impact workers’ risk-based decisions. Such work has been done in the mining industry due to its characteristically high risks and the results can be gleaned to help the process industry realign goals and values with their workforce. In the current study, researchers cross-sectionally surveyed 1,334 miners from 20 mine sites across the United States, varying in size and commodity. The survey sought to understand how mineworkers’ risk avoidance could impact their near miss incidents on the job – a common precursor to lost-time incidents. Multiple regressions showed that as a miner's level of risk avoidance increased by 1 unit in the 6-point response scale, the probability of experiencing a near miss significantly decreased by 30% when adjusting for relevant control variables. Additionally, a significant interaction between risk avoidance and locus of control suggested that the effect of risk avoidance on near misses is enhanced as a miner's locus of control increases. A one-unit increase in locus of control appends the base effect of risk avoidance on near misses with an additional 8% decrease in the probability. Findings are discussed from a near-miss safety management system perspective in terms of methods to foster both risk avoidance and locus of control in an effort to reduce the probability of near misses and lost time at the organizational level within the process industry and other high-hazard industries. |
A new approach to measure the resistance of fabric to liquid and viral penetration
Li M , Furlong JL , Yorio PL , Portnoff L . PLoS One 2019 14 (2) e0211827 Protective clothing manufacturers routinely test their products for resistance to liquid and viral penetration. Several of the test methods specified by the American Society for Testing and Materials (ASTM) and the International Organization for Standardization (ISO) for penetration testing produce binary results (i.e. pass or fail), deliver imprecise pressure regulation, and do not record the location at which penetration events occur. Instead, our approach measures a continuous variable (time of penetration) during a slow and continuous increase of hydrostatic pressure and retains the location of penetration events. Using a fluorescent dye to enhance visual detection, we evaluate temporal and spatial patterns of penetration events. We then compare the time of liquid penetration with the time of penetration of two bacteriophages (Phi-X174 and MS2). For the fabric tested, the mean viral penetration occurred 0.29 minutes earlier than liquid penetration when solved by logistic regression. The breakthrough time of MS2 was not different from the Phi-X174 bacteriophage. The time of liquid penetration was a latent indicator of the time of viral penetration. |
Using trunk posture to monitor heat strain at work
Quinn TD , Seo Y , Yorio PL , Aljaroudi A , Coca A , Kim Jung-Hyun , Roberge RJ , Williams WJ . Ergonomics 2018 61 (11) 1-9 AbstractThis study aimed to determine if trunk posture during walking is related to increases in rectal temperature (Tre). 24 males treadmill walked in one of four conditions (1): 30 min at 3.0 mph and 0% grade, 20C and 50% relative humidity (RH), wearing healthcare worker (HCW) PPE; (2): 30 min at 3.0 mph and 0% grade, 27.5C and 60% RH, HCW PPE; (3): 30 min at 3.0 mph and 0% grade, 32.5C and 70% RH, HCW PPE; and (4): 40 min at 40% VO2max, 30C and 70% RH, wearing firefighter PPE. Trunk posture (Zephyr BioHarness 3) and Tre were measured continuously. Tre was positively related to trunk posture, controlling for covariates (B=3.49, p<.001). BMI and age moderated this relationship (Tre age, B = 0.76, p<.001; Tre*BMI, B=1.85, p<.001). Trunk posture measurement may be useful in monitoring fall potential and magnitude of heat stress of workers in hot environments.Practitioner Summary: Occupational hyperthermia increases worker risk for heat illness and injury but is difficult to monitor in the field. This investigation shows that trunk posture is independently and positively related to core temperature. Non-invasive measurement or visual inspection of trunk posture could provide novel insight on individual heat strain level. |
A tolerability assessment of new respiratory protective devices developed for health care personnel: A randomized simulated clinical study
Radonovich LJ , Wizner K , LaVela SL , Lee ML , Findley K , Yorio P . PLoS One 2019 14 (1) e0209559 BACKGROUND: U.S. health care personnel (HCP) have reported that some respiratory protective devices (RPD) commonly used in health care have suboptimal tolerability. Between 2012 and 2016, the U.S. National Institute for Occupational Safety and Health, and the Veterans Health Administration collaborated with two respirator manufacturers, Company A and B, to bring new RPD with improved tolerability to the U.S. health care marketplace. The purpose of this study was to compare the tolerability of four new prototype RPD to two models commonly used in U.S. health care delivery. METHODS: A randomized, simulated workplace study was conducted to compare self-reported tolerability of four new prototype RPD (A1, A2, B1, and B2) worn by HCP and two N95 control respirators commonly used in U.S. health care delivery, the 1870 and 1860, manufactured by 3M Corporation. A new survey tool, the Respirator Comfort, Wearing Experience, and Function Instrument (R-COMFI), developed previously in part for the current study, was used as the primary outcome metric. With a maximum total score of 47, lower R-COMFI scores reflected better self-reported tolerability. Poisson regression analyses were used to estimate prototype relative risks compared to controls. RESULTS: Conducted between 2014 and 2015 in two inpatient care rooms at the North Florida/South Georgia Veterans Health System, among 383 participants who enrolled, 335 (87.5%) completed the study. Mean total R-COMFI scores for the 3M 1870, 3M 1860, and prototypes A1, A2, B1, and B2 were 8.26, 9.36, 5.79, 7.70, 6.09, and 5.71, respectively. Compared to the 3M 1870, total R-COMFI unadjusted relative risks (RR) and 95 percent confidence intervals (CI) were A1 (RR 0.70, CI 0.60, 0.82), A2 (RR 0.93, CI 0.82, 1.06), B1 (RR 0.74, CI 0.64, 0.85), and B2 (RR 0.69, CI 0.60, 0.80). Compared to the 3M 1860, prototype total R-COMFI unadjusted RR and 95 percent CI were A1 (RR 0.62, CI 0.53, 0.72), A2 (RR 0.82, CI 0.73, 0.93), B1 (RR 0.65, CI 0.57, 0.74), and B2 (RR 0.61, CI 0.53, 0.70). Similarly, models adjusted for demographic characteristics showed that prototypes A1, B1, and B2 significantly improved tolerability scores compared to both controls, while prototype A2 was significantly improved compared to the 3M 1860. CONCLUSIONS: Compared to the 3M 1870 and 3M 1860, two RPDs commonly used in U.S. health care delivery, tolerability improved for three of four newly developed prototypes in this simulated workplace study. The R-COMFI tool, used in this study to assess tolerability, should be useful for future comparative studies of RPD. |
Novel test method for the evaluation of fluid leakage at the glove-gown interface and investigation of test parameters
Kilinc-Balci FS , Kahveci Z , Yorio P . J Am Coll Surg 2018 227 (6) 573-586 BACKGROUND: Exposure to patients' blood/body fluids could be life-affecting, when providing care to patients with infectious diseases. Although the glove-gown interface is considered one of the weakest points of the protective ensemble system, there is a lack of research and existing standards do not provide much guidance on the strategies to minimize gaps between the gowns and gloves. Currently, there is no known standard test method to evaluate fluid leakage or assess performance improvements with new gowns/gloves. STUDY DESIGN: A novel test method with a robotic arm, which has the capability to simulate healthcare personnel's arm movements during fluid exposures, was developed to determine the leakage at the glove-gown interface. This paper explains the test method and investigates the effect of movement, exposure type, exposure duration, procedure duration, and existence of pressure on the amount of leaked fluid at the glove-gown interface. RESULTS: Test results suggest that, with the exception of procedure duration, all parameters significantly affected the amount of fluid leaked at the glove-gown interface. Leakage was higher for soaking when compared to spraying, increased as the exposure duration increased, and was greater with the application of pressure. CONCLUSIONS: The novel method developed in this study could be used by manufacturers of personal protective equipment to evaluate their products. Standard development organizations could adapt this test method in their specifications, testing standards, and guidelines. |
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