Coby Jansen, Matthew Keifer, Helen Murphy-Robinson. University of Washington; WA Departments of Agriculture, Health and Labor and Industries. PNASH Data Sources: 1.WA Department of Health Pesticide Illness Investigations (2003-8) 2.Occupational determinants of serum cholinesterase inhibition among organophosphate- exposed agricultural pesticide handlers in Washington State. JN Hofmann, MC Keifer, AJ DeRoos, RA Fenske, CE Furlong, G vanBelle, H Checkoway. Occup Environ Med On-line October 9, WA Labor & Industries – Cholinesterase Monitoring Program Consultations (2007-9) 4. WA LNI & WS Dept. of Agriculture. WPS Investigations (2007-9) Data Sources: 1.WA Department of Health Pesticide Illness Investigations (2003-8) 2.Occupational determinants of serum cholinesterase inhibition among organophosphate- exposed agricultural pesticide handlers in Washington State. JN Hofmann, MC Keifer, AJ DeRoos, RA Fenske, CE Furlong, G vanBelle, H Checkoway. Occup Environ Med On-line October 9, WA Labor & Industries – Cholinesterase Monitoring Program Consultations (2007-9) 4. WA LNI & WS Dept. of Agriculture. WPS Investigations (2007-9) For more information contact: (800) A collaborative effort by: Prevention Focus TRENDSTRENDS Training Messages Policy Changes Technical Solutions WPS Inspections: WSDA (~150 sites, 439 violations) WPS Inspections: WSDA (~150 sites, 439 violations) Labor & Industries ChE Monitoring Consultations (60 handlers, 34 sites) Labor & Industries ChE Monitoring Consultations (60 handlers, 34 sites) Dept. of Health Pesticide Illness Route Cause Interviews (351 cases) Dept. of Health Pesticide Illness Route Cause Interviews (351 cases) University of Washington ChE Risk Factors Study (154 participants) University of Washington ChE Risk Factors Study (154 participants) WPS Inspections: L&I (31 sites, 79 violations) WPS Inspections: L&I (31 sites, 79 violations) Background The University of Washington and Washington State Departments of Agriculture, Health, and Labor and Industries are collaborating on a project to use agency data and scientific research to identify factors contributing to pesticide over-exposure among agricultural workers. The group plans to use these findings to create and implement recommendations for preventing these exposures. Project Objectives Use data to identify factors contributing to pesticide over-exposure Craft prevention messages and identify solutions Share data and prevention messages with handlers, agricultural community and policy-makers The leading contributing factors of handler pesticide poisonings are lack of required personal protective equipment (PPE) and other PPE problems. 1 Personal Protective Equipment Eye Protection 1 42 (25%) of 167 handlers with pesticide poisoning were not wearing required eye protection. Many ill handlers wore the wrong type or poorly fitting PPE. Problem: Early entry contributed to pesticide illness in 19 workers 1 ; 39% of WPS violations were related to central or field postings 4 ; 4 handlers had ChE inhibition >20% after too early re-entry 3 Central Posting Issues 3  Incomplete spray records  REI not included in postings  Records not displayed for 30 days after REI expires  No spray records posted at all Drift Restricted Entry Interval Reduce pesticide over-exposures among agricultural employees 56% handlers with a pesticide illness were missing required PPE (68) or had a PPE problem (29) 1 Graph 1. Type of PPE missing by Ill handlers 1 Personal Protective Equipment Workplace Practices Drift Restricted Entry Interval Protection by Labels Training Supervision UNDERLYING FACTORS PROBLEM AREAS Why? 1  “Didn’t think I needed it”  Employer didn’t provide  Inadequate supervision  Poor fit (mist enters side of goggle) Why? 1  Employer did not provide  Wrong type  Not instructed to wear  Removed for dexterity  Not used when cleaning, fixing equipment (or other tasks besides mix/load, apply) Chemical Resistant Boots Handlers who wore chemical resistant boots were SEVEN TIMES less likely to have inhibited ChE. 2 Respirators: Poor Fit One quarter of handlers with ChE inhibition had poorly fitting respirators and/or were not fit tested. 3 Six handlers with pesticide poisoning had poorly fitting respirators that did not seal properly. 1 Respirators: Cartridge Change-out More than half of worksites with a ChE inhibited handler violated cartridge change-out regulations, affecting 27 workers. 3 The most common technical PPE issue for ill handlers was over use of cartridges and use of incorrect cartridges. 1 Why? Handlers with inhibited ChE often worked at sites not complying with proper change-out schedules. 3  9% No change-out schedule  42% did not follow change-out schedule Gloves 31 handlers (19%) who got sick from pesticide poisoning were not wearing required gloves 1 Handlers became ill while unclogging spray nozzles 1 MAINTAINING & CLEANING SPRAY EQUIPMENT Handlers who cleaned spray equipment were NINE TIMES more likely to have inhibited cholinesterase than handlers who did not 2 18 handlers fell ill while maintaining & cleaning spray equipment. Most common practices: 1) unclogging nozzles or 2) washing sprayers 1 Most common problem for mixer/loaders is eye injury from splash. In 73% of these cases, handler was missing eye protection 1 There were 48 WPS violations for not providing either: There were 48 WPS violations for not providing either: Eyewash at M&L stations (24), or Eyewash at M&L stations (24), or Pint of water for emergencies (24) 4 = risk of more serious eye injury Pint of water for emergencies (24) 4 = risk of more serious eye injury Caution!Caution! Why? 1  Signs not seen  Workers follow verbal orders, not postings  No sign was posted  Wrong sign posted  Old signs not removed Problem: Drift was the leading factor in pesticide overexposure of non- handler, agricultural workers. 1  80 incidents involving 191 people (03-08)  More than half were drift to bystanders or non-agricultural workers  34 events affected 103 agricultural workers Why? 1  Neighbor farm or workers not notified  Workers unsure if okay to leave  Sprayer or worker thought they were at a safe distance RESPIRATORS: Handlers wearing full-face instead of half-face respirators were seven times less likely to have ChE inhibition 2 Dermal exposure at end of row? PERSONAL DECONTAMINATION Poor decontamination practices may have contributed to: 1) Pesticide over-exposure among more than half of handlers with inhibited cholinesterase (31 cases); 2) 14 cases of handler illness Why? Insufficient time to decontaminate 3 Decontamination not adequate or timely 1,3 Insufficient supplies (towels, soap, change of clothes) 4 Handlers wearing well-sealed respirators and full PPE report feeling spray on face and neck when turning at the end of a row. May drive through spray mist when beginning next row. 1  EYE PROTECTION Safety glasses not as effective in protecting against splashes or wind-blown spray mist 1 PPE Missing/Problem Little to no supervision No decon post- exposure Unaware of hazard Label not explained to non-reader Assigned/ Allowed Unsafe Practice Insufficient or poor training 3 Trainings too infrequent 3 - Trainers not qualified - Training did not meet the WPS requirements (ex. No written materials; did not covered req’d pts) - Trainers not qualified - Training did not meet the WPS requirements (ex. No written materials; did not covered req’d pts) Evidence of Poor Supervision 1 - Handlers and workers not trained at all - Handlers trained less than every 5 years PNASH Ag Workers Over- Exposed to Pesticides Using Data to Identify and Address Causes of Pesticide Over-Exposure in Washington State Agricultural Employees Why? 1  Facial hair  No regular on-the-job seal testing  No pre-season fit test Handlers think gloves too thick? 6x more likely to use bare hands, disposable gloves for unclogging 2 Handlers think gloves too thick? 6x more likely to use bare hands, disposable gloves for unclogging 2 Workplace Practices MIXING AND LOADING 17 handlers poisoned by pesticides while M&L 1 Handlers who M&L were TWICE as likely to have inhibited ChE as handlers who did not 2 Why? 1 Protection by Labels Training and Supervision Introduction Perceived task as low risk Handler did not know PPE was required for task