The union distributed the survey, and 49 janitors (35% of potential respondents) completed it, including morning, evening, and overnight staff from three wings of the transportation center. Twenty-one respondents wrote descriptive comments beyond the check-off items allowed on the survey.
Forty-six (94%) respondents reported chemical use. Thirty-eight (78%) respondents reported at least one symptom that they associated with chemical use, including headache, itchy skin, and eye irritation. Forty-five (92%) respondents described at least one symptom that they attributed to excessive workload, most commonly headache, depression, and lack of appetite. Thirty-five (71%) respondents marked at least one body part as painful, “falling asleep,” or bothered due to their work (Table 1). Areas of the body most marked were the neck (n=16, 33%) and feet (n=14, 29%).
Symptoms that survey respondents reported as associated with exposure to workplace chemicals or overwork, Boston, March 2005
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Other hazards most reported were exposure to dust, heavy work, body fluids, and general harassment (Table 2). Written comments responding to other concerns described bad treatment, ignoring seniority, understaffing, instability in the work, poor treatment of people active in the union, and “playing with their feelings.” One respondent wrote, “Every day they give us more work, they harass us, and watch us as though we are prisoners.”
Workplace hazards identified by survey respondents in Boston, March 2005
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Between 25 and 29 respondents (51% to 59%) reported having received no training on using chemicals or personal protective equipment, cleaning potentially infectious body fluids, finding or using material safety data sheets (MSDSs), or undertaking safety procedures for heavy equipment or emergency procedures. These are all elements required by the Occupational Safety and Health Administration’s Hazard Communication and Bloodborne Pathogens standards.48 Nineteen (39%) respondents reported no training on rules about sexual harassment.
Survey results were not intended for scientific review or to calculate attack rates, and the instrument did not undergo the rigorous design and review typical of survey research. Characteristics of nonrespondents were not known, so the representativeness of the sample could not be assessed. Also, the questionnaire included no questions specifically about respiratory symptoms, such as wheezing, shortness of breath, or asthma. Therefore, the results were not comparable to previous health-related findings about cleaning worker populations
Instead, the survey was designed to solicit worker input and uncover symptoms, concerns, and any related workplace exposures. In addition, the process itself represented a first step in the campaign to raise and address pressing health issues.
Participatory hazard assessment
The following summer, several workers reported increasingly severe symptoms (e.g., nosebleeds and gastrointestinal problems) to union staff, who requested information from the employer on the potential health effects of the cleaning product used. The employer provided a 7-inch-thick binder with dozens of MSDSs without specifying which products were being used or were likely to cause the symptoms reported.
One worker suggested a method for soliciting worker input about the products. A table in the breakroom in Area A was dedicated to information gathering. Workers and supervisors gathered every product used. Then, each container was numbered and placed on a piece of paper for note-taking. The workers then walked around and discussed each product’s use and associated symptoms or health hazards, marking on each paper their symptoms and concerns. They also identified additional products that had caused problems. SEIU Local 615, with assistance from MassCOSH, repeated this process during each shift.
These activities revealed a number of underlying issues. Supervisors indicated that several of the products should not be in use and that it was a mistake that they were available. Workers identified products that they used directly from the bottle that were in fact concentrates requiring dilution. The worker who had apparently become the most sensitized to chemicals was now bothered by the most products and had the most severe reactions (e.g., nosebleeds) rather than just irritation. In discussing hazards and warning labels, it became clear that language and literacy issues reduced their effectiveness.
SEIU Local 615 then asked MassCOSH for technical assistance in reviewing all products regarding specific ingredients and products associated with the acute symptoms, and to ensure that long-term health effects were also considered. MassCOSH involved its health and safety expert volunteers and the OHSP. SEIU Local 615 collected the MSDSs, and MassCOSH divided them among a group that included a physician, an OHSP industrial hygienist, and an occupational health researcher.
The 18 products reviewed contained approximately 50 ingredients listed on the MSDSs. Additional ingredients could have been present at less than 1%, and were therefore not listed on the MSDSs or considered in this analysis. The volunteers applied criteria promulgated by the Massachusetts Operational Services Division, Environmentally Preferable Products49 and Green Seal Standard for Industrial and Institutional Cleaners (GS-37), and reviewed the hazards of the ingredients using various occupational health, environmental, and chemical references. Characteristics examined included carcinogenicity, reproductive toxicity, neurotoxicity, corrosivity to skin or eyes, respiratory and skin sensitization, combustibility, biodegradability, and aquatic toxicity.50
The experts considered the relative harm of immediate corrosive and irritating effects in comparison with the chemicals that had risks of long-term health effects. The capacity for dermal absorption, in addition to inhalation, increased the risk of bodily burden. They also considered the weight of evidence regarding carcinogenicity and reproductive harm, especially with regard to glycol ethers. Information about the cleaning effectiveness of each product was not provided or considered, although it might affect the muscular force required to achieve the same cleaning effect. They did note that the 18 products identified exceeded the number needed for cleaning operations.
Hazardous ingredients included alkyl phenol ethoxylates (estrogen-mimicking endocrine disruptors), 2-butoxyethanol (respiratory tract and eye irritant; causes headache, vomiting, and potential risks of long-term effects on blood, kidneys, and liver), diethylene glycol monoethyl ether (eye and skin irritant; potential long-term effects on liver, kidney, blood, and central nervous system), sodium hydroxide (eye, skin, and respiratory system irritant), and quaternary ammonium compounds and monoethanolamine (sensitizers and irritants). Acidity and alkalinity contributed to the potential for eye, nose, throat, and skin irritation; one toilet bowl cleaner had a pH
Telephone conferences among MassCOSH staff and the volunteer experts prioritized the most hazardous products to present in a final table. The table consolidated information, including the name of the product and manufacturer, the use frequency and volume, the health effects of the listed ingredients, the National Fire Protection Association and Hazardous Materials Identification System health listings for the product, and any known safer alternative. The reviewers maintained records of all ingredients and health effects and, for simplicity, presented their conclusions based on the hazardous ingredients and concentrations. They selected four products deemed the most hazardous, and proposed that these be eliminated or replaced with safer alternatives. Several others were designated as “use with caution,” including specific safety practices and equipment.
The union reviewed the technical information summarized by the experts, as well as the work practices in the transportation center. They uncovered practices that were putting workers at risk and could also pose a hazard to the public. These included the use of discontinued products, mixing of incompatible chemicals, and concentrates designed for automatic dispensing systems that were used without dilution.