EVALUATING EXPOSURES UNDER OSHAS 1984 ETO STANDARD

我们建议根据OSHA 1984年的环氧乙烷(ETO)标准对工人的暴露进行历史评估。大多数可能受到感染的工人是受雇于医院部门的女性，在医院部门，ETO被用来对医疗器械进行消毒。定量和定性干预研究方法将应用于现有的三个数据来源：马萨诸塞州医院ETO健康和安全研究、OSHA的综合管理信息系统(IMIS)和ETO被动剂量计的商业供应商科恩医疗公司的全国数据库。我们的具体目标是：1)表征ETO暴露：表征将包括医院和其他行业中ETO暴露随时间的汇总测量，以及按行业、工作场所和个人工人的暴露分布的初步表征。在可行的情况下，还将进行基于职称或工作任务的定性。2)确定ETO过度暴露的潜在决定因素：将利用马萨诸塞州医院研究和克恩医学数据库的数据，建立三种类型的ETO过度暴露事件(是/否)和两种类型的定量暴露水平(平均轮班和短期)的潜在决定因素的多元回归模型。自变量包括工程控制、灭菌器类型、ETO使用频率、监测频率以及ETO健康和安全培训。这一量化方法将得到对ETO标准通过、控制措施实施和暴露水平随时间变化之间关系的定性评估的补充。3)评估ETO标准的遵从性：为了评估OSHA执法工作检测到违规的程度，我们将比较OSHA IMIS数据库对不遵守ETO标准的流行率的估计与来自马萨诸塞州医院研究和KEM医疗数据库的独立估计。将进行这些分析，以确保符合标准的所有主要部分以及接触限值。最后，单独使用KEM医学数据库，将使用传统的OSHA方法(是否超过限制)与替代方法(将所有收集的暴露数据合并到真实平均暴露超过限制的可能性的度量中)来比较对符合OSHA的ETO暴露限值的判断。

We propose to conduct a historical evaluation of worker exposures under OSHA's 1984 ethylene oxide (EtO) standard. Most potentially-exposed workers are women employed in the hospital sector where EtO is used to sterilize medical devices. Quantitative and qualitative intervention research methods will be applied to three existing sources of data: the Massachusetts Hospital EtO Health and Safety Study, OSHA's Integrated Management Information System (IMIS), and the nationwide database of Kern Medical Corporation, a commercial vendor of EtO passive dosimeters. Our specific aims are to: 1) Characterize EtO Exposures: Characterization will include summary measures of EtO exposures over time in the hospital and other industries and preliminary characterization of exposure distributions by industry, by workplace, and by individual worker. To the extent feasible, job title- or job task-based characterizations will also be conducted. 2) Identify Potential Determinants of EtO Overexposures: Multivariate regression models of the potential determinants of the three types of EtO overexposure events (Yes/No) and two types of quantitative exposure levels (average workshift and short-term) will be developed using data from the Massachusetts Hospital Study and the Kern Medical Database. Independent variables include engineering controls, sterilizer types, EtO usage frequency, monitoring frequency, and EtO health and safety training. This quantitative approach will be complemented by qualitative assessments of the relationships between the passage of the EtO standard, the implementation of control measures, and changes in exposure levels over time. 3) Assess Compliance with the EtO Standard: To assess the extent to which OSHA enforcement efforts have detected non-compliance, we will compare OSHA IMIS database estimates of the prevalence of non-compliance with the EtO standard with independent estimates from the Massachusetts Hospital Study and the Kem Medical database. These analyses will be conducted for compliance with all principal sections of the standard as well as with exposure limits. Finally, using the Kem Medical database alone, judgments of compliance with OSHA's EtO exposure limits will be compared using traditional OSHA approaches (exceeded limits or not) versus an alternative approach that incorporates all collected exposure data into a measure of the likelihood that true mean exposure exceeds limits.