Role of Various Enterotoxins in Aeromonas hydrophila-Induced
Fecal contamination and related health effects at a ... contamination and related health effects at...
Transcript of Fecal contamination and related health effects at a ... contamination and related health effects at...
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Fecal contamination and related health effects at a manufacturing site
Lynda Ewers, Ph.D., CIHLoren Tapp, M.D.Chandran Achutan, Ph.D.
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The Process
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First site visit(January 13)
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• 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
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First visit results
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Enteric bacterial concentrations in tank water of three machines
None None
1 X 107
128HX 128BT 127HX
CFU/mL
Washer Machines
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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
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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
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Second Site Visit(February 1)
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• 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
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Second visit results
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Potentially pathogenic bacteria in 128 HX washer
Aeromonashydrophila
Aeromonashydrophila
Enterobacteragglomerans
Citrobacteryoungae
Citrobacterkoseri
February 1(after cleaning)
January 13
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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
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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
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Third site visit(March 17)
• Collected water/sludge sample from 128 HX washer to test for enteric pathogens
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Third visit results
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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
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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??
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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
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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.