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BackgroundIn the United States, 1.7 million immunocompromised patients contract a healthcare-associated infection, annually. These infections increase morbidity, mortality and costs of care. A relatively unexplored route of transmission is the generation of bioaerosols during patient care. Transmission of pathogenic microorganisms may result from inhalation or surface contamination of bioaerosols. The toilet flushing of patient fecal waste may be a source of bioaerosols. To date, no study has investigated bioaerosol concentrations from flushing fecal wastes during patient care.MethodsParticle and bioaerosol concentrations were measured in hospital bathrooms across three sampling conditions; no waste no flush, no waste with flush, and fecal waste with flush. Particle and bioaerosol concentrations were measured with a particle counter bioaerosol sampler both before after a toilet flushing event at distances of 0.15, 0.5, and 1 m from the toilet for 5, 10, 15 min.ResultsParticle concentrations measured before and after the flush were found to be significantly different (0.3–10 μm). Bioaerosol concentrations when flushing fecal waste were found to be significantly greater than background concentrations (p-value = 0.005). However, the bioaerosol concentrations were not different across time (p-value = 0.977) or distance (p-value = 0.911) from the toilet, suggesting that aerosols generated may remain for longer than 30 min post flush. Toilets produce aerosol particles when flushed, with the majority of the particles being 0.3 μm in diameter. The particles aerosolized include microorganisms remaining from previous use or from fecal wastes. Differences in bioaerosol concentrations across conditions also suggest that toilet flushing is a source of bioaerosols that may result in transmission of pathogenic microorganisms.ConclusionsThis study is the first to quantify particles and bioaerosols produced from flushing a hospital toilet during routine patient care. Future studies are needed targeting pathogens associated with gastrointestinal illness and evaluating aerosol exposure reduction interventions.

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The global dairy industry is composed of a multitude of countries with unique production practices and consumer markets. The global average number of cows per farm is about 1-2 cows; however, as a farm business model transitions from sustenance to market production, the average herd size, and subsequent labor force increases. Dairy production is unique as an agricultural commodity because milk is produced daily, for 365 days per year. With the introduction of new technology such as the milking parlor, the global industry trend is one of increasing farm sizes. The farm sizes are the largest in the United States; however, the European Union produces the most milk compared with other global producers. Dairy production is essential for economic development and sustainable communities in rural areas. However, the required capital investment and availability of local markets and labor are continued challenges. Due to farm expansion, international producers are faced with new challenges related to assuring food safety and a safe working environment for their workforce. These challenges exist in addition to the cultural and language barriers related to an increasing dependence on immigrant labor in many regions of the world. Continued success of the global dairy industry is vital. Therefore, research should continue to address the identification of occupational risk factors associated with injuries and illnesses, as well as develop cost-effective interventions and practices that lead to the minimization or elimination of these injuries and illnesses on a global scale, among our valuable population of dairy producers and workers.

Gottipati KR, Bandari SK, Nonnenmann MW, Levin JL, Dooley GP, Reynolds SJ, Boggaram V. Transcriptional mechanisms and protein kinase signaling mediate organic dust induction of IL-8 expression in lung epithelial and THP-1 cells.

Work in animal production facilities often results in exposure to organic dusts. Previous studies have documented decreases in pulmonary function and lung inflammation among workers exposed to organic dust in the poultry industry. Bacteria and fungi have been reported as components of the organic dust produced in poultry facilities. To date, little is known about the diversity and concentration of bacteria and fungi inside poultry buildings. All previous investigations have utilized culture-based methods for analysis that identify only biota cultured on selected media. The bacterial tag-encoded flexible (FLX) amplicon pyrosequencing (bTEFAP) and fungal tag-encoded flexible (FLX) amplicon pyrosequencing (fTEFAP) are modern and comprehensive approaches for determining biodiversity of microorganisms and have not previously been used to provide characterization of exposure to microorganisms in an occupational environment. This article illustrates the potential application of this novel technique in occupational exposure assessment as well as other settings. An 8-hr area sample was collected using an Institute of Medicine inhalable sampler attached to a mannequin in a poultry confinement building. The sample was analyzed using bTEFAP and fTEFAP. Of the bacteria and fungi detected, 116 and 39 genera were identified, respectively. Among bacteria, Staphylococcus cohnii was present in the highest proportion (23%). The total inhalable bacteria concentration was estimated to be 7503 cells/m³. Among the fungi identified, Sagenomella sclerotialis was present in the highest proportion (37%). Aspergillus ochraceus and Penicillium janthinellum were also present in high proportions. The total inhalable fungi concentration was estimated to be 1810 cells/m³. These estimates are lower than what has been reported by others using standard epifluorescence microscope methods. However, no study has used non-culture-based techniques, such as bTEFAP and fTEFAP, to evaluate bacteria and fungi in the inhalable fraction of a bioaerosol in a broiler production environment. Furthermore, the impact of this bTEFAP and fTEFAP technology has yet to be realized by the scientific community dedicated to evaluating occupational and environmental bioaerosol exposure.

This paper presents a summary of a panel presentation by agriculture health and safety scientists on ergonomics of industrialized dairy parlor operations in the United States. Dairy industry trends in the United States were discussed in the panel presentation, which took place during the New Paths: Health and Safety in Western Agriculture conference, November 11-13, 2008. Dairy production is steadily moving to large-herd operations because of associated economies of scale and other economic and social conditions. Large-herd operations utilize a parlor milking system, as compared to a stanchion system used primarily in smaller operations. Each milking system presents different risks for worker injury. Low back, knee, and shoulder musculoskeletal symptoms were most frequently reported among workers in smaller dairy operations. Another study analyzing workers' compensation (WC) data from large-herd milking operations found nearly 50% of livestock-handling injury claims involved parlor milking activities. Nearly 27% of injuries were to the wrist, hand, and fingers, nearly 13% to the head or face, and 11% to the chest. Results indicated the vulnerability of these body parts to injury due to the worker-livestock interface during milking. More focused research should investigate milking practices and parlor designs as they relate to worker safety and health. Additional dairy-related injury research is vital given the trend towards large industrial milking operations.

The dairy industry is changing on a global scale with larger, more efficient operations. The impact of this change on worker health and safety, specifically, associations between occupational lung disease and inhalation exposures, has yet to be reported in a comprehensive review of the scientific literature. Therefore, a three-tier process was used to identify information using a keyword search of online databases of scientific literature. Of the 147 citations reviewed, 52 met initial screening criteria, and 30 were included in this review. Dairy workers experience lung conditions such as asthma, chronic obstructive pulmonary disease, hypersensitivity pneumonitis, chronic bronchitis, and cancer. Recent pulmonary function studies have identified obstructive lung changes among dairy farm workers. The increased scale of dairy production with significant changes in technology and work practices has altered inhalation exposure patterns among dairy workers. The inhalation exposure in the dairy work environment may elicit differing inflammatory responses in relation to timing of initial exposure as well as to repeated exposures. Few studies have measured inhalation exposure while simultaneously assessing the impact of the exposure on lung function of dairy farm workers. Even fewer studies have been implemented to assess the impact of aerosol control technology to reduce inhalation exposure. Future research should evaluate worker exposure to aerosols through a task-based approach while utilizing novel methods to assess inhalation exposure and associated inflammatory responses. Finally, potential solutions should be developed and tested to reduce inhalation exposure to inflammatory agents and respiratory diseases in the dairy farm work environment.