关键词：对健康的危害；职业安全与健康；环境暴露
摘 要：In September 2012, the National Institute for Occupational Safety and Health (NIOSH) received a confidential health hazard evaluation request from employees at a specialty chemicals plant. They were concerned about skin and respiratory exposures to chemicals used at the plant. They felt that workers were at risk for lung disease, rashes, and cancer, among other illnesses. In February 2013, NIOSH visited the plant. During the visit, we confidentially interviewed a variety of employees, talked to company officials (local and corporate), met with the union president, and toured the plant. We also reviewed documents provided by the company, including a list of some chemicals used at the plant, results of recent industrial hygiene sampling, injury and illness logs, and information about how unsafe conditions are reported. We found that the plant uses and produces many chemicals with respiratory toxicity, and two employees have sought medical attention for respiratory illnesses. One employee's physician diagnosed him/her with bronchiolitis obliterans, which is an irreversible lung disease that the physician attributed to chemical exposures at the plant. Another employee was diagnosed with occupational asthma and reactive airways dysfunction syndrome. In conversations with employees, we found that many had concerns about the effect of work-related exposures on their health, though most did not have symptoms they specifically attributed to the plant. Workers expressed concern about mechanisms for reporting of safety concerns, feeling that filing a complaint led to a 'black mark' on their record, instead of being recognized as a proactive safety initiative. Some workers reported concerns about accidents as well, saying people who were involved in accidents were eventually fired or disciplined, and stated that they would hesitate to report an accident. The plant does not allow retaliation for accidents, but notes that workers can be disciplined for failing to follow safety procedures. During the tour we noticed that the plant had a variety of chemical odors in different areas, and although workers were careful about required personal protective equipment and local ventilation, bystanders in similar areas were not required to adhere to the same protection standards. The industrial hygiene sampling plan focused on measuring task-based exposure and workers with the highest exposure potential. Sampling was not performed on bystanders; neither did the plan account for simultaneous exposures to multiple chemicals during an eight-hour shift or the extended shifts worked by many employees. We made several recommendations in an interim letter in May 2013. Since that time, the company has begun to implement some changes. These include adding spirometry to annual medical exams and planning for changes in the industrial hygiene monitoring protocol for 2014. Given the potential exposure to recognized respiratory toxins, the occurrence of respiratory illness in the workforce, and employees' concerns about exposure and health, we recommend that the company use an improved comprehensive exposure assessment strategy and medical monitoring to guide preventive interventions.