Unintentional chemical exposures in New Hampshire workplaces: Using poison control center information to understand circumstances to better affect prevention

Approximately 150 calls per year are made to a poison control center regarding unintended, occupational poisonings in New Hampshire. Challenge exists in using this clinical information to discover circumstances to best target effective prevention. Exposures are generally acute; and resulting severity, generally moderate. Some chronic conditions exist, and inquiries about teratogens are made. Case-series investigation (cases=417; January 2005 to October 2007) identifies, information permitting, exposure circumstances. An extracting protocol helps insure transparency, consistency, and reproducibility of information taken from narratives. ‘Causation' is treated at the level of possible contributing factors (PCFs). Cases are related to safer chemical-handling practices. Cases having similar circumstances are qualitatively clustered based on attributes like age, gender, route, chemical substance, business type, occupation, and PCFs. PCFs point to the multi-dimensional nature of exposures. Chemical substance properties have relevance. Additional risk is introduced through pressure-delivery systems. Mechanical failures to heating and air conditioning systems, and propane tank discharges, pose risk. Questionable operating practice are evidenced by inappropriate mixing and handling, eating or drinking while working, not wearing PPE, lacking knowledge about a substance used for the first time or used occasionally, and substance use not being communicated to fellow employees. Organizational issues include inadequate planning, delay of maintenance and repair, reports of safety culture deficiencies, and employees not wanting to perform a task. Approximately 25 percent of study calls originate from a friend or relative. In some cases, these callers mentioned a patient's reluctant to seek treatment, thus underscoring the importance of social networks in health outcomes.