Fecal contamination and related health effects at a manufacturing site

Lynda Ewers, Ph.D., CIHLoren Tapp, M.D.Chandran Achutan, Ph.D.

The Process

First site visit(January 13)

• Screened water/sludge from three washers (128 HX, 127 HX, 128 BT) for molds, yeasts, and bacteria

• Tested water/sludge in 128 HX washer for Legionella and Mycobacterium

• Screened washer water supply and lubricating fluid supply for molds, yeasts, and bacteria

• Interviewed 11 workers

Methods

First visit results

Enteric bacterial concentrations in tank water of three machines

None None

1 X 107

128HX 128BT 127HX

CFU/mL

Washer Machines

Symptom frequency among 128 HX wash and run/test employees

January 12 (N = 11)

03Abdominal pain or cramp

04Rash

22Nausea or vomiting

05Diarrhea

Run/test employees

(3)

Washer employees

(8)

Persistent symptom

during prior 2 months

What happened after finding enteric bacteria?

• Results to company and union

• Laboratory identified pathogens in the water/sludge samples

• Company cleaned the 128 HX machine with chlorine solution

• Two more site visits

Second Site Visit(February 1)

• Sampled 128 HX washer water/sludge for enteric bacteria

• Administered a symptom questionnaire to all 20 workers near washer

• Collected stool samples from 3 workers who had active diarrhea

• Tested stool samples for pathogenic bacteria

Methods

Second visit results

Potentially pathogenic bacteria in 128 HX washer

Aeromonashydrophila

Aeromonashydrophila

Enterobacteragglomerans

Citrobacteryoungae

Citrobacterkoseri

February 1(after cleaning)

January 13

Symptom frequency among 128 HX washer workers

February 1-2 N=20

3

4

3

0 times in

prior month

1149Abdominal pain or

cramping

31412Diarrhea

167 18Nausea or upset

stomach

Daily or almost daily

1-3 times per

week

1-3 times

in prior month

Workers with

symptoms in prior 6 months

Symptoms

Stool specimens

• 3 workers reported active diarrhea on this date

• All agreed to donate stool specimens

• 1 stool sample grew Aeromonas veroniibiovar sobria (not A. hydrophila)

• The other 2 stool specimens did not grow pathogenic bacteria

Third site visit(March 17)

• Collected water/sludge sample from 128 HX washer to test for enteric pathogens

Third visit results

Potentially pathogenic bacteria in 128 HX machine

Aeromonashydrophila

Aeromonashydrophila

Citrobacter freundii

Citrobacterdiversus

Klebsiella oxytoca

Enterobacteragglomerans

Citrobacteryoungae

Citrobacterkoseri

March 17(after drain removal)

February 1(after cleaning)

January 13

Conclusions• The 128 HX washer was contaminated with

fecal material

• Some workers in the area of the 128 HX washer had GI problems likely caused by bacteria

• Work practices (eating, machine cleaning) put workers at risk for contamination

But….Were the health effects caused by the machine contamination??

Recommendations• Clean 128 HX washer

– Retest for bacteria

• Improve personal hygiene– No eating, drinking, chewing in work area– Wash hands and face before eating, drinking, or

smoking

• Use PPE until washer is effectively cleaned– Gloves, sleeves, aprons

• Report possible work-related illnesses to plant medical unit

Thanks to:

• Gregory Burr• Robin Smith

The findings and conclusions in this report have not been formally disseminated by the National Institute for Occupational Safety and Health and should not be construed to represent any agency determination or policy.