Expanding healthinsurance coverage is a critical step in health reform, but reforms willnot be successful if they fail to also address the quality and cost of care.
That is the conclusion of The Quality Crossroads Group, a broad groupof stakeholders drawn together to identify strategies to address thecomplex challenges confronting the U.S. health care system. The group laysout a five-point agenda in an article published today in Health Affairs that serves as a vision for quality in an election year when patient safety, the plight of the uninsured, and rising costs are making front-pagenews.
"Quality improvement is intricately connected with containing costs andexpanding coverage. Yet too often, quality is left out of the equation,"says co-author Margaret E. O'Kane, president of the National Committee forQuality Assurance. "Poor quality care is a major contributor to runaway health care costs.
Improving quality is a key part of making coverage affordable."
"The future of health care reform rests on the ability for diversegroups, at national, state, and community levels, to work to achieve consensus. We cannot achieve the important policy goals outlined in this paper without collaboration," says co-author Janet Corrigan, president and CEO of the National Quality Forum. "The thinking in this paper, by leadersin the quality movement across the country, represents a successful effort to collaborate in moving beyond rhetoric and sparking real change," sheadded.
If taken up by the new President, Congress and others, the five-point reform plan put forward by the 13 authors of the paper would mobilize true change in the nation's vast, complicated, and expensive health care system.
The reform plan calls for:
A national center to support effectiveness research. The U.S. invests too little in understanding what works and what does not for a whole array of technologies, drugs, and treatments. In order to ensure that our health care dollars are wisely spent, we need to systematically identify where critical gaps in evidence exist and fill them.
Models of accountable health care entities capable of providing integrated and coordinated care. The sickest patients often suffer the most from lack of care coordination across settings. They see multiple specialists, get an array of tests, and take multiple medications - usually without a "health care home" or central coordinator of care. Achieving high levels of coordination will require investments in organizational supports that go beyond information technology. IT is a critical enabler of management, but is not sufficient to produce high-quality, efficient, and patient-centered care.
Payment models that reward high-value care. There are nearly 10,000 codes for payment for medical procedures, but not one for outcomes or results. The Quality Crossroads Group believes that if quality is not tied to payment, providers' behavior will not appreciably change, and if it does not change, access to insurance and care will continue to decline.
We need to aggressively develop models of payment that reward clinically effective and efficient care and yield high patient satisfaction. Those might include innovative ideas like bundled chronic care episodes.
A national strategy for performance measurement, including standardized measures of patient and population health. We need a common vision of what quality care means. To get there, we need to agree on what we are measuring and how we are measuring it. Performance information is a public good and federal funding for the National Quality Forum, a private sector standard-setting organization, will facilitate development of a comprehensive portfolio of standardized measures that is continually assessed and updated.
A multistakeholder approach to improving population health. Obesity is a national crisis that demands solutions that lie mostly outside of health care. The public sector can do much to promote population health. For example, in Arkansas, nearly 38 percent of young people are overweight or at risk of becoming overweight. State officials implemented a strategy to target children in schools, focusing on what they eat and how often they exercise. We must make a concerted public- and private-sector effort -- similar to the one we mounted for tobacco control -- to achieve the outcomes we know are possible.
Wednesday, May 28, 2008
Tuesday, May 27, 2008
Executing the most popular Yoga position
HOW TO DO A DOWNWARD DOG
Place your feet hip-width apart on the floor, toes facing forward.
Place your hands shoulder-width apart on the floor, lightly spread the fingers.
Keep your tailbone lifted towards the sky and gently push down through the heels. If you're a beginner, you might not get your heels all the way to the floor at first -- that's OK.
Open your upper back by rotating the shoulder blades away from one another. Keep the shoulders away from the ears and press down firmly through all fingers and thumbs. Place more weight onto your feet than your hands.
Shifting the weight back to the hips is the key element in feeling the energizing effect of this posture. Pull your navel toward your spine and lift the pelvic floor muscles. Lift your kneecaps up and contract the quadriceps muscles.
Maintain this pose for 5 to 10 deep breaths.
Place your feet hip-width apart on the floor, toes facing forward.
Place your hands shoulder-width apart on the floor, lightly spread the fingers.
Keep your tailbone lifted towards the sky and gently push down through the heels. If you're a beginner, you might not get your heels all the way to the floor at first -- that's OK.
Open your upper back by rotating the shoulder blades away from one another. Keep the shoulders away from the ears and press down firmly through all fingers and thumbs. Place more weight onto your feet than your hands.
Shifting the weight back to the hips is the key element in feeling the energizing effect of this posture. Pull your navel toward your spine and lift the pelvic floor muscles. Lift your kneecaps up and contract the quadriceps muscles.
Maintain this pose for 5 to 10 deep breaths.
Monday, May 26, 2008
Stress Relief From Yoga
Funny thing. When Jenny Hayo first started practicing yoga in 1996, she thought of it as "purely an exercise option." Within two years, she was teaching classes and digging deeper.
Her appreciation of yoga as a personal methodology changed with each new mentor. Hayo realized yoga is energizing in ways beyond the workout, and said she sees no reason why the rest of us can't tap into it for stress relief and everyday vigor.
"The interesting point of modern-day yoga is it is looked at as exercise by most people," says Hayo, who teaches at 8 Limbs Yoga Center in the Capitol Hill neighborhood, plus some classes at the downtown Zum health club. "Ninety-five percent of people get into yoga that way. But no one is complaining. It puts people on the yoga mat and that's great."
In fact, Seattle P-I venture capital columnist and blogger John Cook noted earlier this month in an item about the TeachStreet free online directory that there are no fewer than 984 yoga classes in the Seattle area.
That's a lot of yoga mats.
For her part, Hayo, 33, learned yoga is more than meets the physical plane and any form of the seemingly undoable lotus position.
"The name, '8 Limbs,' comes from the eight principles of yoga," Hayo said. "As you practice yoga, you can begin to feel the physical, emotional, mental and energetic benefits."
There are different interpretations, but fundamentally the "eight limbs" of yoga include body postures, breathing exercises or control of "prana," personal observances, control of the senses, concentration and inner awareness, devotion or meditation, universal morality and union with the divine.
Hayo acknowledged that most of us would recognize the body postures, breathing and meditation components. The remaining "limbs" are less familiar but powerful, even if you commit to just minutes of yoga daily or one session a week.
The ideal strategy for yoga novices is a one-on-one session with an instructor -- "it will cost about the same as an appointment with your massage therapist," Hayo said. But you can certainly get an energy boost from a beginner's class at your local yoga studio (look for a teacher who offers different versions of the same posture depending upon experience and fitness level).
Or you can begin with the "downward-facing dog" pose, which Hayo said is one of the "inversion" postures that can instantly energize the body.
Yoga brings balance, said Hayo, who works with numerous clients to match a customized set of postures to their needs. "The downward dog can help if you feel tired or anxious (or both)."
The downward dog is a more accessible version of the handstand or headstand, which likely most American adults have not done since, oh, fifth grade. Yet maybe there is more to those childhood handstands than just playing or showing off.
"I have teacher who calls headstands and handstand the 'yogi's coffee,' " Hayo said.
The downward dog pose looks, not surprisingly, a lot like a dog stretching its paws in front and its rear high in the air. For us humans, it starts with putting your hands in alignment with your shoulders and hips as you move to hands and feet on the floor. Novices often spread the hands too far apart and the feet too close together.
Next, as you come into all fours, place your knees under your hips and gently extend your spine. As you put your hands on the mats, spread the fingers a bit with the middle finger straight ahead.
Lift your pelvis toward the ceiling and pull the hips back. Your eyes look to the feet. The feet are even with the hips. Resist moving them closer to the hands just put the heels down. If your heels don't touch, they will if you do the downward dog regularly.
Hayo said a good practice is to hold the posture for five slow, purposeful breaths.
"Keep at it," she said. "You will get mental clarity while in the pose. I tell students to experience it until it feels right. You will know."
What keeps yoga regulars coming back is, to be sure, a combination of results. But one of the most satisfying is increased energy, not just after class but the rest of the day or week. You feel more clear-headed. You stand more upright. There is less tiredness midday. Who can resist that in today's hurly-burly?
Well, there is one problem. You might call it the Foot-and-Leg-Over-the-Head mental block.
To that end, 8 Limbs and other local yoga studios are eager to attract beginners with basics classes and special weekend workshops, such as the "Yoga for Men" class, 2:30 to 4:45 p.m. at the 8 Limbs center in West Seattle, on May 18. Instructor Greg Owen will be working to help reluctant men get past "what they feel is their lack of flexibility."
Owen plans to help men connect yoga movement and breathing with ways to ease the strain and pain of "sore lower backs, tight hamstrings and stiff shoulders."
A good deal for at least four limbs.
Her appreciation of yoga as a personal methodology changed with each new mentor. Hayo realized yoga is energizing in ways beyond the workout, and said she sees no reason why the rest of us can't tap into it for stress relief and everyday vigor.
"The interesting point of modern-day yoga is it is looked at as exercise by most people," says Hayo, who teaches at 8 Limbs Yoga Center in the Capitol Hill neighborhood, plus some classes at the downtown Zum health club. "Ninety-five percent of people get into yoga that way. But no one is complaining. It puts people on the yoga mat and that's great."
In fact, Seattle P-I venture capital columnist and blogger John Cook noted earlier this month in an item about the TeachStreet free online directory that there are no fewer than 984 yoga classes in the Seattle area.
That's a lot of yoga mats.
For her part, Hayo, 33, learned yoga is more than meets the physical plane and any form of the seemingly undoable lotus position.
"The name, '8 Limbs,' comes from the eight principles of yoga," Hayo said. "As you practice yoga, you can begin to feel the physical, emotional, mental and energetic benefits."
There are different interpretations, but fundamentally the "eight limbs" of yoga include body postures, breathing exercises or control of "prana," personal observances, control of the senses, concentration and inner awareness, devotion or meditation, universal morality and union with the divine.
Hayo acknowledged that most of us would recognize the body postures, breathing and meditation components. The remaining "limbs" are less familiar but powerful, even if you commit to just minutes of yoga daily or one session a week.
The ideal strategy for yoga novices is a one-on-one session with an instructor -- "it will cost about the same as an appointment with your massage therapist," Hayo said. But you can certainly get an energy boost from a beginner's class at your local yoga studio (look for a teacher who offers different versions of the same posture depending upon experience and fitness level).
Or you can begin with the "downward-facing dog" pose, which Hayo said is one of the "inversion" postures that can instantly energize the body.
Yoga brings balance, said Hayo, who works with numerous clients to match a customized set of postures to their needs. "The downward dog can help if you feel tired or anxious (or both)."
The downward dog is a more accessible version of the handstand or headstand, which likely most American adults have not done since, oh, fifth grade. Yet maybe there is more to those childhood handstands than just playing or showing off.
"I have teacher who calls headstands and handstand the 'yogi's coffee,' " Hayo said.
The downward dog pose looks, not surprisingly, a lot like a dog stretching its paws in front and its rear high in the air. For us humans, it starts with putting your hands in alignment with your shoulders and hips as you move to hands and feet on the floor. Novices often spread the hands too far apart and the feet too close together.
Next, as you come into all fours, place your knees under your hips and gently extend your spine. As you put your hands on the mats, spread the fingers a bit with the middle finger straight ahead.
Lift your pelvis toward the ceiling and pull the hips back. Your eyes look to the feet. The feet are even with the hips. Resist moving them closer to the hands just put the heels down. If your heels don't touch, they will if you do the downward dog regularly.
Hayo said a good practice is to hold the posture for five slow, purposeful breaths.
"Keep at it," she said. "You will get mental clarity while in the pose. I tell students to experience it until it feels right. You will know."
What keeps yoga regulars coming back is, to be sure, a combination of results. But one of the most satisfying is increased energy, not just after class but the rest of the day or week. You feel more clear-headed. You stand more upright. There is less tiredness midday. Who can resist that in today's hurly-burly?
Well, there is one problem. You might call it the Foot-and-Leg-Over-the-Head mental block.
To that end, 8 Limbs and other local yoga studios are eager to attract beginners with basics classes and special weekend workshops, such as the "Yoga for Men" class, 2:30 to 4:45 p.m. at the 8 Limbs center in West Seattle, on May 18. Instructor Greg Owen will be working to help reluctant men get past "what they feel is their lack of flexibility."
Owen plans to help men connect yoga movement and breathing with ways to ease the strain and pain of "sore lower backs, tight hamstrings and stiff shoulders."
A good deal for at least four limbs.
Sunday, May 25, 2008
Stress in the Workplace
The longer he waited, the more David worried. For weeks he had been plagued by aching muscles, loss of appetite, restless sleep, and a complete sense of exhaustion. At first he tried to ignore these problems, but eventually he became so short-tempered and irritable that his wife insisted he get a checkup.
Now, sitting in the doctor's office and wondering what the verdict would be, he didn't even notice when Theresa took the seat beside him. They had been good friends when she worked in the front office at the plant, but he hadn't seen her since she left three years ago to take a job as a customer service representative.
Her gentle poke in the ribs brought him around, and within minutes they were talking and gossiping as if she had never left.
"You got out just in time," he told her. "Since the reorganization, nobody feels safe. It used to be that as long as you did your work, you had a job. That's not for sure anymore. They expect the same production rates even though two guys are now doing the work of three.
We're so backed up I'm working twelve-hour shifts six days a week. I swear I hear those machines humming in my sleep. Guys are calling in sick just to get a break. Morale is so bad they're talking about bringing in some consultants to figure out a better way to get the job done."
"Well, I really miss you guys," she said. "I'm afraid I jumped from the frying pan into the fire. In my new job, the computer routes the calls and they never stop. I even have to schedule my bathroom breaks.
All I hear the whole day are complaints from unhappy customers. I try to be helpful and sympathetic, but I can't promise anything without getting my boss's approval. Most of the time I'm caught between what the customer wants and company policy.
I'm not sure who I'm supposed to keep happy. The other reps are so uptight and tense they don't even talk to one another. We all go to our own little cubicles and stay there until quitting time. To make matters worse, my mother's health is deteriorating. If only I could use some of my sick time to look after her.
No wonder I'm in here with migraine headaches and high blood pressure. A lot of the reps are seeing the employee assistance counselor and taking stress management classes, which seems to help. But sooner or later, someone will have to make some changes in the way the place is run."
Job stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker. Job stress can lead to poor health and even injury.
The concept of job stress is often confused with challenge, but these concepts are not the same.
Challenge energizes us psychologically and physically, and it motivates us to learn new skills and master our jobs. When a challenge is met, we feel relaxed and satisfied. Thus, challenge is an important ingredient for healthy and productive work. The importance of challenge in our work lives is probably what people are referring to when they say "a little bit of stress is good for you.
But for David and Theresa, the situation is different-the challenge has turned into job demands that cannot be met, relaxation has turned to exhaustion, and a sense of satisfaction has turned into feelings of stress. In short, the stage is set for illness, injury, and job failure.
Nearly everyone agrees that job stress results from the interaction of the worker and the conditions of work. Views differ, however, on the importance of worker characteristics versus working conditions as the primary cause of job stress. These differing viewpoints are important because they suggest different ways to prevent stress at work.
According to one school of thought, differences in individual characteristics such as personality and coping style are most important in predicting whether certain job conditions will result in stress-in other words, what is stressful for one person may not be a problem for someone else. This viewpoint leads to prevention strategies that focus on workers and ways to help them cope with demanding job conditions.
Although the importance of individual differences cannot be ignored, scientific evidence suggests that certain working conditions are stressful to most people. The excessive workload demands and conflicting expectations described in David's and Theresa's stories are good examples. Such evidence argues for a greater emphasis on working conditions as the key source of job stress, and for job redesign as a primary prevention strategy.
Now, sitting in the doctor's office and wondering what the verdict would be, he didn't even notice when Theresa took the seat beside him. They had been good friends when she worked in the front office at the plant, but he hadn't seen her since she left three years ago to take a job as a customer service representative.
Her gentle poke in the ribs brought him around, and within minutes they were talking and gossiping as if she had never left.
"You got out just in time," he told her. "Since the reorganization, nobody feels safe. It used to be that as long as you did your work, you had a job. That's not for sure anymore. They expect the same production rates even though two guys are now doing the work of three.
We're so backed up I'm working twelve-hour shifts six days a week. I swear I hear those machines humming in my sleep. Guys are calling in sick just to get a break. Morale is so bad they're talking about bringing in some consultants to figure out a better way to get the job done."
"Well, I really miss you guys," she said. "I'm afraid I jumped from the frying pan into the fire. In my new job, the computer routes the calls and they never stop. I even have to schedule my bathroom breaks.
All I hear the whole day are complaints from unhappy customers. I try to be helpful and sympathetic, but I can't promise anything without getting my boss's approval. Most of the time I'm caught between what the customer wants and company policy.
I'm not sure who I'm supposed to keep happy. The other reps are so uptight and tense they don't even talk to one another. We all go to our own little cubicles and stay there until quitting time. To make matters worse, my mother's health is deteriorating. If only I could use some of my sick time to look after her.
No wonder I'm in here with migraine headaches and high blood pressure. A lot of the reps are seeing the employee assistance counselor and taking stress management classes, which seems to help. But sooner or later, someone will have to make some changes in the way the place is run."
Job stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker. Job stress can lead to poor health and even injury.
The concept of job stress is often confused with challenge, but these concepts are not the same.
Challenge energizes us psychologically and physically, and it motivates us to learn new skills and master our jobs. When a challenge is met, we feel relaxed and satisfied. Thus, challenge is an important ingredient for healthy and productive work. The importance of challenge in our work lives is probably what people are referring to when they say "a little bit of stress is good for you.
But for David and Theresa, the situation is different-the challenge has turned into job demands that cannot be met, relaxation has turned to exhaustion, and a sense of satisfaction has turned into feelings of stress. In short, the stage is set for illness, injury, and job failure.
Nearly everyone agrees that job stress results from the interaction of the worker and the conditions of work. Views differ, however, on the importance of worker characteristics versus working conditions as the primary cause of job stress. These differing viewpoints are important because they suggest different ways to prevent stress at work.
According to one school of thought, differences in individual characteristics such as personality and coping style are most important in predicting whether certain job conditions will result in stress-in other words, what is stressful for one person may not be a problem for someone else. This viewpoint leads to prevention strategies that focus on workers and ways to help them cope with demanding job conditions.
Although the importance of individual differences cannot be ignored, scientific evidence suggests that certain working conditions are stressful to most people. The excessive workload demands and conflicting expectations described in David's and Theresa's stories are good examples. Such evidence argues for a greater emphasis on working conditions as the key source of job stress, and for job redesign as a primary prevention strategy.
Saturday, May 24, 2008
Solvents in the Workplace
A solvent is a liquid that can dissolve another material. In industry the term solvent is generally applied to the kinds of substances known as "organic solvents" that are widely used to dissolve organic chemicals such as oils and resins.
Examples of such solvents include kerosene, acetone, petroleum distillates and naphthas. Potential solvent uses are limitless and include degreasing, cleaning, stripping, thinning and finishing. Solvents are used extensively in many industries.
How Can Exposure To Solvents Affect Health?
Excessive solvent exposures can lead to health problems.
Solvents are ABSORBED (enter the body) by the following routes:
Inhalation
This is the most important route of exposure for most solvents. Once inhaled, the vapors which arise from solvents can directly irritate the upper respiratory tract (nose, throat and bronchial tubes) and the lungs. Solvent vapors can also be easily absorbed from the lungs into the bloodstream and travel to other parts of the body to produce additional harmful effects.
Skin Contact
Solvents can be absorbed through the skin and travel to other parts of the body. Solvents can also break down the natural protective oils and fats of the skin. This can cause the skin to become dry, cracked and inflamed.
Mouth Contact
Solvents can enter the body and bloodstream through the mouth and digestive system. Although not a common route of entry, mouth contact with contaminated hands, food and cigarettes can occur and be dangerous.
Health Effects Are Dependent On What Factors?
Toxicity of the solvent.
Route of exposure.
Amount of exposure.
Individual worker's susceptibility.
Combination with other chemical exposures.
All of these factors are important in determining whether a person will experience any damaging health effects from solvent exposures. For example, a worker who already has respiratory breathing problems, such as asthma, may experience breathing difficulties while working around solvent vapors that do not produce any health effects in a person without respiratory problems.
What Acute (Short-Term) Effects Can Occur?
Solvent health effects that are ACUTE follow a single or short-term chemical exposure and usually occur soon after the exposure. Acute effects generally last only minutes, hours or days and are reversible once the exposure is over. Since they occur shortly after exposure, they are more easily identified. Common acute effects from solvent exposure include:
Respiratory Irritation
Exposure to solvent vapors can irritate respiratory mucous membranes. This can produce a burning sensation of the nose, throat or chest and lead to coughing. Inhalation of very high concentrations of solvents may result in severe irritation of the lungs and a condition called pulmonary edema, or fluid in the lungs. Symptoms of pulmonary edema include coughing and difficulty in breathing and require prompt medical attention.
Eye Irritation
Exposure to high concentrations of solvent vapors may produce eye irritation. This can lead to burning, tearing, and painful eyes. Dermatitis. Acute contact with a solvent can cause a breakdown of protective fats and oils in the skin. Skin may become reddened, itchy, and blistered. Central Nervous System Depression. The central nervous system consists of the brain and spinal cord. Solvent exposure can affect the brain like alcohol and lead to a state similar to being drunk. Large exposures can produce central nervous system effects including euphoria, feeling "high," dizziness, lack of coordination, headaches, fatigue and nausea.
Heart Arrhythmia
Solvents, particularly chlorinated hydrocarbons (those with chlorine molecules attached to carbon), can increase the irritability of the heart muscle at high exposure levels. This can lead to irregular heartbeats called cardiac arrhythmia.
What Chronic (Long-Term) Effects Can Occur?
Solvent exposures can produce CHRONIC health effects, which occur after repeated exposures and are often long-lasting or irreversible. Symptoms may appear gradually, so they may be initially ignored. This can make it hard to identify the chronic health problems related to solvent exposure.
Chronic health effects include:
Respiratory Effects
Repeated irritation of the respiratory tract may result in bronchitis and produce symptoms of chronic cough and sputum production. Dermatitis. Long-term exposure can lead to chronic dermatitis. The skin can become dry, thickened, cracked, hardened and flaky.
Nervous System
Most organic solvents affect the central nervous system, primarily the brain. With increasing levels of exposure, these effects include feeling "high," irritability, nervousness, weakness, tiredness, dizziness, sleeplessness, disorientation, confusion and even unconsciousness.
Long-term exposure has been associated with effects such as difficulty in thinking and personality changes. A few solvents, such as n-hexane and methyl n-butyl ketone, can damage the peripheral nerves, which are nerves to sensory organs and muscles. Symptoms of nerve damage include pain, loss of sensation, and weakness, usually beginning in the toes, then the fingers and moving up the legs and arms.
Liver
Some solvents, particularly chlorinated types, can damage the liver, causing a type of hepatitis. There may be no symptoms. If there are symptoms, they may include: nausea, pain in the right side, yellow skin and eyes, dark urine and light-colored bowel movements. Hepatitis may be detected by blood tests of liver function.
Blood
A few solvents, such as glycol ethers, affect the blood, either by damaging blood cells that are circulating in the body or decreasing the production of new blood cells. There usually are no symptoms until blood counts are extremely low, resulting in tiredness or infections. Benzene is one solvent that is known to be particularly dangerous; it can cause anemia (low blood counts) and also leukemia (cancer of the white blood cells).
Reproductive Effects
Although chemicals may affect reproduction in females and males, there are no definitive studies that demonstrate the effects of solvents on human reproduction. Cancer. Benzene is the only commonly used solvent that has been associated with cancer in exposed workers. A number of other solvents, including carbon tetrachloride, chloroform, 1,4-dioxane and trichloroethylene have caused cancer in laboratory animals. Vinyl chloride has been known to cause angiosarcoma of the liver in humans.
What Should You Do If You Develop Symptoms That May Be Related To Solvent Exposure?
Inform your employer and consult a physician. Many health problems that can be related to solvent exposures can also be caused by other medical problems which may need immediate treatment. Special laboratory tests can be performed to assess solvent exposures.
How Can Exposure To Solvents Be Reduced or Prevented?
The best way to guard against the harmful health effects of solvents is to prevent or minimize exposure. As a first step, be aware of the hazards and safe handling procedures for materials on the job. This information must be available to you and usually is provided in Material Safety Data Sheets (MSDS), employer instructions and container warning labels.
Secondly, use the procedures and equipment that are available. Employers are responsible for providing safe work conditions.
The most important ways of preventing exposure are:
What Other Hazards Are Posed By Solvents?
Solvents can be flammable or explosive, and exposing them to flame or hot surfaces can also form highly toxic decomposition products. Ignition sources such as welding torches, lit cigarettes and sparks should be kept away from solvent use and storage areas. I
n addition, some chemicals are incompatible with solvents and mixing will produce toxic gases, heat or fire. Oxidizers (e.g., sodium chlorate) and strong acids and bases (e.g. sulfuric acid, sodium hydroxide) should never come in contact with solvents. Refer to Material Safety Data Sheets or chemical suppliers' information for special hazards.
Examples of such solvents include kerosene, acetone, petroleum distillates and naphthas. Potential solvent uses are limitless and include degreasing, cleaning, stripping, thinning and finishing. Solvents are used extensively in many industries.
How Can Exposure To Solvents Affect Health?
Excessive solvent exposures can lead to health problems.
Solvents are ABSORBED (enter the body) by the following routes:
Inhalation
This is the most important route of exposure for most solvents. Once inhaled, the vapors which arise from solvents can directly irritate the upper respiratory tract (nose, throat and bronchial tubes) and the lungs. Solvent vapors can also be easily absorbed from the lungs into the bloodstream and travel to other parts of the body to produce additional harmful effects.
Skin Contact
Solvents can be absorbed through the skin and travel to other parts of the body. Solvents can also break down the natural protective oils and fats of the skin. This can cause the skin to become dry, cracked and inflamed.
Mouth Contact
Solvents can enter the body and bloodstream through the mouth and digestive system. Although not a common route of entry, mouth contact with contaminated hands, food and cigarettes can occur and be dangerous.
Health Effects Are Dependent On What Factors?
Toxicity of the solvent.
Route of exposure.
Amount of exposure.
Individual worker's susceptibility.
Combination with other chemical exposures.
All of these factors are important in determining whether a person will experience any damaging health effects from solvent exposures. For example, a worker who already has respiratory breathing problems, such as asthma, may experience breathing difficulties while working around solvent vapors that do not produce any health effects in a person without respiratory problems.
What Acute (Short-Term) Effects Can Occur?
Solvent health effects that are ACUTE follow a single or short-term chemical exposure and usually occur soon after the exposure. Acute effects generally last only minutes, hours or days and are reversible once the exposure is over. Since they occur shortly after exposure, they are more easily identified. Common acute effects from solvent exposure include:
Respiratory Irritation
Exposure to solvent vapors can irritate respiratory mucous membranes. This can produce a burning sensation of the nose, throat or chest and lead to coughing. Inhalation of very high concentrations of solvents may result in severe irritation of the lungs and a condition called pulmonary edema, or fluid in the lungs. Symptoms of pulmonary edema include coughing and difficulty in breathing and require prompt medical attention.
Eye Irritation
Exposure to high concentrations of solvent vapors may produce eye irritation. This can lead to burning, tearing, and painful eyes. Dermatitis. Acute contact with a solvent can cause a breakdown of protective fats and oils in the skin. Skin may become reddened, itchy, and blistered. Central Nervous System Depression. The central nervous system consists of the brain and spinal cord. Solvent exposure can affect the brain like alcohol and lead to a state similar to being drunk. Large exposures can produce central nervous system effects including euphoria, feeling "high," dizziness, lack of coordination, headaches, fatigue and nausea.
Heart Arrhythmia
Solvents, particularly chlorinated hydrocarbons (those with chlorine molecules attached to carbon), can increase the irritability of the heart muscle at high exposure levels. This can lead to irregular heartbeats called cardiac arrhythmia.
What Chronic (Long-Term) Effects Can Occur?
Solvent exposures can produce CHRONIC health effects, which occur after repeated exposures and are often long-lasting or irreversible. Symptoms may appear gradually, so they may be initially ignored. This can make it hard to identify the chronic health problems related to solvent exposure.
Chronic health effects include:
Respiratory Effects
Repeated irritation of the respiratory tract may result in bronchitis and produce symptoms of chronic cough and sputum production. Dermatitis. Long-term exposure can lead to chronic dermatitis. The skin can become dry, thickened, cracked, hardened and flaky.
Nervous System
Most organic solvents affect the central nervous system, primarily the brain. With increasing levels of exposure, these effects include feeling "high," irritability, nervousness, weakness, tiredness, dizziness, sleeplessness, disorientation, confusion and even unconsciousness.
Long-term exposure has been associated with effects such as difficulty in thinking and personality changes. A few solvents, such as n-hexane and methyl n-butyl ketone, can damage the peripheral nerves, which are nerves to sensory organs and muscles. Symptoms of nerve damage include pain, loss of sensation, and weakness, usually beginning in the toes, then the fingers and moving up the legs and arms.
Liver
Some solvents, particularly chlorinated types, can damage the liver, causing a type of hepatitis. There may be no symptoms. If there are symptoms, they may include: nausea, pain in the right side, yellow skin and eyes, dark urine and light-colored bowel movements. Hepatitis may be detected by blood tests of liver function.
Blood
A few solvents, such as glycol ethers, affect the blood, either by damaging blood cells that are circulating in the body or decreasing the production of new blood cells. There usually are no symptoms until blood counts are extremely low, resulting in tiredness or infections. Benzene is one solvent that is known to be particularly dangerous; it can cause anemia (low blood counts) and also leukemia (cancer of the white blood cells).
Reproductive Effects
Although chemicals may affect reproduction in females and males, there are no definitive studies that demonstrate the effects of solvents on human reproduction. Cancer. Benzene is the only commonly used solvent that has been associated with cancer in exposed workers. A number of other solvents, including carbon tetrachloride, chloroform, 1,4-dioxane and trichloroethylene have caused cancer in laboratory animals. Vinyl chloride has been known to cause angiosarcoma of the liver in humans.
What Should You Do If You Develop Symptoms That May Be Related To Solvent Exposure?
Inform your employer and consult a physician. Many health problems that can be related to solvent exposures can also be caused by other medical problems which may need immediate treatment. Special laboratory tests can be performed to assess solvent exposures.
How Can Exposure To Solvents Be Reduced or Prevented?
The best way to guard against the harmful health effects of solvents is to prevent or minimize exposure. As a first step, be aware of the hazards and safe handling procedures for materials on the job. This information must be available to you and usually is provided in Material Safety Data Sheets (MSDS), employer instructions and container warning labels.
Secondly, use the procedures and equipment that are available. Employers are responsible for providing safe work conditions.
The most important ways of preventing exposure are:
- Substitution of a solvent with a less hazardous substance.
- Enclosure of the process or containers where the solvent is being used (so it never enters the air you breathe).
- Exhaust ventilation systems that function effectively.
- Redesign of a process (to eliminate a step releasing vapors or requiring liquid contact).
- Personal protective equipment (should be used only when engineering controls such as enclosure of a process are not feasible).
- Respirators should be worn as a part of a comprehensive respiratory protection program. Other protective gear such as gloves, aprons, goggles and face shields should be used when appropriate.
- Good housekeeping practices (essential to ensure exposures are minimal).
What Other Hazards Are Posed By Solvents?
Solvents can be flammable or explosive, and exposing them to flame or hot surfaces can also form highly toxic decomposition products. Ignition sources such as welding torches, lit cigarettes and sparks should be kept away from solvent use and storage areas. I
n addition, some chemicals are incompatible with solvents and mixing will produce toxic gases, heat or fire. Oxidizers (e.g., sodium chlorate) and strong acids and bases (e.g. sulfuric acid, sodium hydroxide) should never come in contact with solvents. Refer to Material Safety Data Sheets or chemical suppliers' information for special hazards.
Friday, May 23, 2008
Protecting your ears
The safest way to protect your ears is to always wear hearing protectors anytime you are around loud noises. You can protect your ears by wearing special earplugs or special earmuffs. There are hundreds of kinds available. There are formable earplugs you can mold to your ears and premolded earplugs that come in several sizes. There are canal caps that are attached to headbands and are very convenient if you work in intermittent noise where you need to take your earplugs on and off throughout the day. Some earplugs have stems so you can insert them without touching the part that goes inside your ear. You can also get earplugs custom molded to fit your ear. Earmuffs come with large and small earcups, different types of headbands, and different types of ear cushions. There is something for everyone and for every environment.
Thursday, May 22, 2008
Ventilation for Airborne Hazards.
A good ventilation system at your work site is an effective method of keeping both toxic and nuisance materials out of the air and out of your lungs. Some toxic materials capable of causing chronic lung disease, if inhaled in large enough quantities, include asbestos fibers, chlorine, silica dust (silicon dioxide) and arsenic fumes. Examples of nuisance materials (those that don't usually have a bad effect on the lungs when exposures are kept under reasonable control) include cellulose fibers, glycerin mist, limestone, plaster of paris and tin oxide.
The first step in keeping the air clean is to prevent materials from escaping from their containers by using covers and lids. Solvent vapors can be kept out of the air by keeping solvent tanks covered when not in use. Furthermore, airborne dust levels can be reduced by keeping operations which generate dust, such as sandblasting operations, separated from other work areas.
However, when it is not possible to keep toxic materials contained, it is important to remove dirty or contaminated air from the work area and replace it with clean air.
How Should Dirty Air Be Removed From The Workplace?
The best way to remove contaminated air from the work area is with the use of what is called "local exhaust ventilation." Typical window or cooling fans were not designed to remove contaminated air from individual work areas and are not recommended for this purpose.
What Is Local Exhaust Ventilation?
Local exhaust ventilation is an effective method for removing airborne toxic or nuisance materials at their point of origin, thereby preventing them from entering your lungs. Examples of processes that use local exhaust ventilation include welding and grinding operations. To be effective, a local exhaust ventilation system should include: 1) a collector or hood, 2) ducts to carry the air, 3) the right choice of fan, 4) a device to clean the air if required, and 5) exhaust system.
What Should You Do To Use A Local Exhaust Ventilation System Correctly?
Simple but important points in working with a local exhaust ventilation system include:
Try not to put yourself between the source and the opening of the air exhaust hood. If you do this, you will breathe contaminants as they are drawn into the hood.
Problems can occur with ventilation equipment, like any other tool used at work. Contact your employer if you experience problems with a ventilation system. Most often a routine maintenance program of cleaning out ducts, replacing fan blades and repairing leaks will restore a system to full operation.
The first step in keeping the air clean is to prevent materials from escaping from their containers by using covers and lids. Solvent vapors can be kept out of the air by keeping solvent tanks covered when not in use. Furthermore, airborne dust levels can be reduced by keeping operations which generate dust, such as sandblasting operations, separated from other work areas.
However, when it is not possible to keep toxic materials contained, it is important to remove dirty or contaminated air from the work area and replace it with clean air.
How Should Dirty Air Be Removed From The Workplace?
The best way to remove contaminated air from the work area is with the use of what is called "local exhaust ventilation." Typical window or cooling fans were not designed to remove contaminated air from individual work areas and are not recommended for this purpose.
What Is Local Exhaust Ventilation?
Local exhaust ventilation is an effective method for removing airborne toxic or nuisance materials at their point of origin, thereby preventing them from entering your lungs. Examples of processes that use local exhaust ventilation include welding and grinding operations. To be effective, a local exhaust ventilation system should include: 1) a collector or hood, 2) ducts to carry the air, 3) the right choice of fan, 4) a device to clean the air if required, and 5) exhaust system.
What Should You Do To Use A Local Exhaust Ventilation System Correctly?
Simple but important points in working with a local exhaust ventilation system include:
Try not to put yourself between the source and the opening of the air exhaust hood. If you do this, you will breathe contaminants as they are drawn into the hood.
- Do not block fresh air supply for the workroom.
- Do not block or obstruct hoods.
- Protect ventilation ducts from damage and holes.
- Keep operation close to the hood to improve capture of vapors and fumes.
- Be aware of special precautions required when ventilating potentially explosive or corrosive vapors.
- Prevent recirculation of exhaust air back into the workplace.
- Evaluate the ventilation system periodically to ensure it is operating as designed.
Problems can occur with ventilation equipment, like any other tool used at work. Contact your employer if you experience problems with a ventilation system. Most often a routine maintenance program of cleaning out ducts, replacing fan blades and repairing leaks will restore a system to full operation.
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