All the observed associations of risk factors disappeared and were further away from patient handling on the causal pathway to MSDs. Patient handling involves numerous work elements and dynamic physical activities. Understanding the work elements of patient handling and conducting interventions based on specific patient handling tasks can substantially reduce MSDs among hospital workers.

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As the hotel industry leads in environmental, social, and corporate governance (ESG) criteria, cleaning hotel rooms on a daily basis promotes public health. This activity leads to cleaner air and reduces the potential for exposure and spread of biohazards. Daily room cleaning is also in direct concordance with building a robust and effective green (environmental) policy. Although guests will always have the option to choose individual frequency, at the hotel management and policy level, daily room cleaning and checks are part of a sound greening program, consistent with advancements and innovation in environmental and social governance programs that are integral to public safety and health.

We present the case of a worker with occupational exposure to a pyrethroid insecticide who acutely developed nontransient third-degree heart block. In 2000, a 57-year-old male truck driver on his delivery route was accidentally exposed to pyrethroid insecticide being sprayed for West Nile virus containment. Both the driver and his vehicle were coated with the spray. The exposure was prolonged because he did not change his clothes until after his shift ended and he used the same contaminated truck for a week. Within days, he presented with a third-degree heart block, for which he was emergently treated, and a pacemaker was placed. He had no past history of arrhythmias. In the weeks thereafter, he also developed reactive airway dysfunction syndrome (RADS). In the second decade following the exposure, the patient replaced his pacemaker, confirming the permanent nature of his heart block. In addition to the persistence of his exposure-related RADS, he developed restrictive lung disease and was diagnosed with pulmonary interstitial fibrosis in the absence of established risk factors. The patient died in October 2019 from respiratory illness. Most previous reports of pyrethroid-related disorders are limited to acute exposures, in which transient symptoms predominate. To our knowledge, this is the first report of an exposed worker experiencing permanent third-degree heart block, as well as persistent respiratory findings, as possible shortand long-term sequelae of pyrethroid exposure. K E Y W O R D Sexposure, occupational health, pyrethroids, RADS, third-degree heart block