A survey of dust exposure, respiratory symptoms, lung function, and response to skin prick tests was conducted in a modern British bakery. Of the 318 bakery employees, 279 (88%) took part. Jobs were ranked from 0 to 10 by perceived dustiness and this ranking correlated well with total dust concentration measured in 79 personal dust samples. Nine samples had concentrations greater than 10 mg/m3, the exposure limit for nuisance dust. All participants completed a self administered questionnaire on symptoms and their relation to work. FEVy and FVC were measured by a dry wedge spirometer and bronchial reactivity to methacholine was estimated. Skin prick tests were performed with three common allergens and with 11 allergens likely to be found in bakery dust, including mites and moulds. Of the participants in the main exposure group, 35% reported chest symptoms which in 13% were work related. The corresponding figures for nasal symptoms were 38% and 19%. Symptoms, lung function, bronchial reactivity, and response to skin prick tests were related to current or past exposure to dust using logistic or linear regression analysis as appropriate. Exposure rank was significantly associated with most of the response variables studied. The study shows that respiratory symptoms and sensitisation are common, even in a modern bakery.Occupational asthma and rhinitis occur in bakers' and the environmental agents responsible appear to be components of the grain itself" or grain contaminants, such as mites, weevils, and moulds"7 The relative importance of these potential allergens may vary according to the source of the flour, conditions of storage, and intensity of exposure. Recent papers describing grain components as important allergens have come from Australia,24 where grain has a low moisture content. A higher moisture content, or storage ofgrain or flour for long periods, may promote the growth of contaminant micro-organisms, mites, and insects. Materials added to flour before baking, such as yeast and amylase, derived from Aspergillus species,' may also be allergenic. As many as a third ofbakers and grain workers may show evidence of sensitisation,9" which appears to be related to intensity and duration of exposure in the industry as well as to host factors, such as atopy." 12 Mechanisms involving IgE and the mast cell have been implicated,'2 13 but precipitins to components of flour have also been identified' and non-immunological processes, such as direct activation of complement pathways, may be involved.'4Apart from case reports, there is little information about asthma and sensitisation in British bakers. This study was designed to (a) describe the levels of exposure to bakery dust in a modern British bakery, (b) estimate the prevalence of symptoms and sensitisation in the workforce of the bakery, and (c) explore relations between indices of exposure and response. Methods STUDY DESIGN AND SUBJECTSThe study was a cross sectional survey of current employees conducted over six consecutive days and nights. All current...

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Fumigation of high-containment microbiology facilities is an international requirement and in the UnitedKingdom this process is still commonly undertaken using formaldehyde vaporization. Formaldehyde usage is simple and inexpensive, but concerns exist over its toxicity and carcinogenicity. Alternative fumigants exist, although independent, parallel comparison of these substances is limited. This study determined the level of biocidal efficacy achievable with formaldehyde and compared this with other commonly used fumigants. Three different hydrogen peroxide-based fumigation systems were evaluated (two vapor and one dry-mist methods), along with true gas systems employing ozone and chlorine dioxide. A range of challenge microorganisms was used at different room locations to assess the efficacy, usability, and safety of the fumigation equipment. These microorganisms included Geobacillus stearothermophilus, Clostridium difficile, Mycobacterium fortuitum, and Vaccinia virus. Only chlorine dioxide and formaldehyde fumigants gave consistently high levels of antimicrobial efficacy across all bacterial challenge tests (typically greater than a 5-log reduction). All systems performed similarly against Vaccinia virus, but variable results were noted for Geobacillus, C. difficile, and M. fortuitum for the hydrogen peroxide-and ozone-based systems. The study also revealed inconsistencies in system reliability and reproducibility, with all fumigant systems aborting midcycle on at least one occasion. In contrast, formaldehyde fumigation was confirmed as extremely reliable, largely because of its simplicity (liquid plus hot plate). All the fumigants tested have UK workplace exposure limits of 2 ppm or less, yet residual fumigant was detected for the formaldehyde and hydrogen peroxide systems following cycle completion, even after room aeration. Articles

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Background: Exposure to metal working fluid (MWF) has been associated with outbreaks of extrinsic allergic alveolitis (EAA) in the USA, with bacterial contamination of MWF being a possible cause, but is uncommon in the UK. Twelve workers developed EAA in a car engine manufacturing plant in the UK, presenting clinically between December 2003 and May 2004. This paper reports the subsequent epidemiological investigation of the whole workforce. The study had three aims: (1) to measure the extent of the outbreak by identifying other workers who may have developed EAA or other work-related respiratory diseases; (2) to provide case detection so that those affected could be treated; and (3) to provide epidemiological data to identify the cause of the outbreak. Methods: The outbreak was investigated in a three-phase cross-sectional survey of the workforce. In phase I a respiratory screening questionnaire was completed by 808/836 workers (96.7%) in May 2004. In phase II 481 employees with at least one respiratory symptom on screening and 50 asymptomatic controls were invited for investigation at the factory in June 2004. This included a questionnaire, spirometry and clinical opinion. 454/481 (94.4%) responded and 48/50 (96%) controls. Workers were identified who needed further investigation and serial measurements of peak expiratory flow (PEF). In phase III 162 employees were seen at the Birmingham Occupational Lung Disease clinic. 198 employees returned PEF records, including 141 of the 162 who attended for clinical investigation. Case definitions for diagnoses were agreed. Results: 87 workers (10.4% of the workforce) met case definitions for occupational lung disease, comprising EAA (n = 19), occupational asthma (n = 74) and humidifier fever (n = 7). 12 workers had more than one diagnosis. The peak onset of work-related breathlessness was Spring 2003. The proportion of workers affected was higher for those using MWF from a large sump (27.3%) than for those working all over the manufacturing area (7.9%) (OR = 4.39, p,0.001). Two workers had positive specific provocation tests to the used but not the unused MWF solution. Conclusions: Extensive investigation of the outbreak of EAA detected a large number of affected workers, not only with EAA but also occupational asthma. This is the largest reported outbreak in Europe. Mist from used MWF is the likely cause. In workplaces using MWF there is a need to carry out risk assessments, to monitor and maintain fluid quality, to control mist and to carry out respiratory health surveillance.

All suspected case PPE ensembles either had post-doffing contamination events or other significant disadvantages to their use. This identified the need to design a unified PPE ensemble and doffing procedure, incorporating the most protective PPE considered for each body area. This work has been presented to, and reviewed by, key stakeholders to decide on a proposed unified ensemble, subject to further evaluation.

After several cases of occupational asthma had been reported in a coffee processing factory in England, 197 coffee workers representing 80% of the production workforce were studied to determine the factors affecting the development of work related respiratory symptoms of wheeze, cough, and dyspnoea. Two computer administered questionnaires concerning the presence of respiratory symptoms and the occurrence of work related respiratory symptoms were used. Workers underwent skin prick testing to green coffee bean extract (GCB) and 11 common inhalant allergen extracts and bronchial provocation testing with methacholine. The presence of specific immunoglobulin E (IgE) antibodies to GCB and castor bean extract (CAB) were determined by a radioallergosorbent test (RAST). The prevalence of work related respiratory symptoms was 12.7%, bronchial hyperresponsiveness 30%, atopy 54%, positive GCB skin prick test 14.7%, positive GCB RAST 14%, and positive CAB RAST 14.7%. None of the workers was sensitised to fungi present in the factory and the numbers of certain species of fungi, despite being greater than may be found out of doors or in an uncontaminated indoor environment, were fewer than are generally associated with the presence of work related respiratory symptoms among agricultural workers. Storage mites were not isolated. Green coffee bean extract and CAB RAST were significantly correlated using the McNemar test but there was limited allergenic cross reactivity in RAST inhibition studies of the two extracts. The only factors that were significantly and independently associated with work related symptoms were CAB RAST and duration of employment. Bronchial hyperresponsiveness was not independently associated with work related respiratory symptoms. The significant independent associations of bronchial hyperresponsiveness included GCB RAST, duration of employment, and resting forced expiratory volume in one second. Exposure to CAB, a highly potent antigen, may be overriding the effects of other factors such a GCB, atopy, bronchial hyperresponsiveness, and smoking. This study suggests that CAB contamination remains a potential problem in the coffee processing industry and all efforts to eliminate it from the working environment should continue.