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Protection of the Lung Health of Poultry Farmers in Ontario: Results of Outreach Rural Lung Health Clinics with N95 Respirator Fit-testing.
Rose-Marie Dolinar MScN, RN(EC), PhD(C), The University of Western Ontario
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in Canada1. COPD develops slowly over time and Canadian farmers with COPD often present for health care in late stages of the disease because they accept cough or breathlessness as “normal”, and because access to health clinics, and the timing of appointments may be limiting factors. COPD is preventable and is easily detected2. Knowing lung health risks, and protecting the airways by wearing the appropriate fit-tested respirator, reduces exposure to harmful respiratory hazards.
Changes in agriculture affecting lung health
Agriculture in Canada has grown from single family farms, to large-scale farming operations in response to the shift of populations to large urban centres. In 2011, over 80% of Canadians lived in urban centres3 compared to over 80% being rural dwellers in Canada in the early 1900s.
Because of this population shift, farming operations such as poultry production have moved towards industrial large-scale confinement facilities. Dust particles in poultry barns can be comprised of bird feed, bedding material, bird feces, feathers, dander, and bioactive components of bacteria, fungi/molds, dust mites and endotoxins (cell wall components of gram-negative bacteria), all of which could trigger cellular reactions within the lung tissue4. Studies have identified that poultry workers’ exposure to bioactive dust affects the health of the lungs and is a potential occupational hazard5,6.
As the dust is inhaled, the particles can deposit along the conducting airways, as well as reach the respiratory units of the lungs. The smaller the dust particles, the deeper they can reach within the lungs.
Dust within a poultry barn can range in size, from large visible-to-the-eye dust particles (greater than 20 microns), to microscopic dust particles (less than 0.3 microns). To put this in perspective, the diameter of human hair is approximately 80 microns, and the diameter of the respiratory bronchioles is between 500 and 800 microns8.
Particles smaller than 10 microns in diameter have the potential of causing biologic harm to the lungs of susceptible individuals7,8. Over time, dust exposure can harm the respiratory units of the lungs, and start the progression of COPD. The good news is that COPD is a preventable and treatable condition2,10.
Protection of lung health
According to a Canadian study with non-smoking participants who have not previously been exposed to a swine barn environment, wearing of an N95 disposable respirator can significantly reduce acute lung health effects11. Respirators, when fit-tested to reduce air leaks, will perform better, and have a greater ability to protect lungs from biohazardous dust. There is greater danger in wearing a respirator that has air leaks, since the worker will assume that he or she is protected.
According to the Canadian Standards Association Z94.4-11 “Selection, use and care of respirators” (2016), workers should wear respiratory protection at all times in areas with atmospheric hazards and inspect the respirator prior to use; maintain and store respirators in accordance with training and manufacturer’s recommendations; perform seal checks after donning a respirator; be clean shaven when wearing respirator and understand the limitations associated with the use of respiratory protection12.
N95 is a designation of a respirator that has been approved by the National Institute of Occupational Safety and Health (NIOSH, 2014) to block at least 95% of very small (0.3 micron) airborne particles13.
Knowing the hazard within the poultry barn is essential to knowing which type of respirator to wear. Table 1 provides a summary of different types of respirators, matched to the lung health hazard.
Table 1: Lung health hazards within poultry barns and recommended type of respirator
|Hazards found in Poultry Barns||Type of Respirator||How the respirator protects from the hazard|
|Bioactive dust||N95 disposable respirator||Needs respirator fit-testing in order to protect.
“N” means the respirator is not resistant to oil and is 95% efficient13.
|Ammonia||Air-purifying, full-face-piece respirator (gas mask) with two canister providing protection specifically against ammonia||Needs respirator fit-testing in order to protect.
The recommended level for short-term exposure (15 minutes) is no greater that 35 ppm. Many poultry producers become accustomed to the ammonia, and are less able to detect ammonia gas below 50 ppm14.
|Carbon dioxide, hydrogen sulfide, carbon monoxide||Air-supplied respirator needed||Fit testing is not needed, since air is supplied within a hood over the head.|
Learning about the work of poultry farmers was essential for planning an effective lung health study. A series of meetings were held between the poultry farmers and the author, to plan for the outreach rural lung health clinics. The Poultry Producers Lung Health pilot study was launched, after obtaining ethics approval from the University of Western Ontario, Research Ethics Board.
The lung health clinics’ times and locations were decided in collaboration with the farmers, to fit between harvest times, and in close proximity to their farms. The lung health clinic appointment sections devoted to lung health protection included four steps:
Step 1: Each participant completed a lung health questionnaire, developed specifically by this author for the poultry producers, which contained specific lung protection questions, asking each poultry farmer:
Step 2: After the questionnaire was completed, a review of the lung health risks and respirators types for each lung health risk was discussed.
Step 3: The farmers participated in a standardized N95 respirator fit test. Each participant was given a choice of three N95 respirators, to try on, and see which they found most comfortable and fit best. Next, each participant tested their respirator for leaks during inhalation and exhalation to confirm a suitable seal, and were asked if they tasted or smelled a scent when the respirator was on, under a paper-like hood.
Step 4: After three months, a questionnaire was sent to each participant, to ask how often they wore their fit-tested respirator.
Two rural lung health clinics were held in Seaforth, Ontario and Clinton, Ontario, on August 3 and August 4, 2016, respectively. Eight participants per day attended 1-hour long appointments, for a total of 16 poultry farmers (N=16). The average age of participants was 56.8 years (SD 9.74), with 82% males, and 18% females. Table 2 summarizes the results of dust exposure, occupational risks present in poultry barns, respirator use all of the time, and information and resources that would be useful to help protect their lungs.
Table 2: Results from the Lung Health Questionnaire
|Lung health question||Result (N=16)|
|Average exposure to farm dust in years||38 yrs (SD 14.95)|
|Occupational risks identified||Organic dust 100%
Ammonia 81.2 %
|Wearing of respirator all of the time||Baseline 6.3%
3 months 18.8%
|What information and resources would be useful to you in your job, to help you protect your lungs?||25% requesting more information about respirators|
Respirator training and fit-testing of N95 respirators results:
There is a need for more outreach lung health clinics and respirator training opportunities for farmers in Ontario, to address the urgent need for protection of lung health and the prevention of COPD. The present study demonstrated that rural lung health clinics are well-attended at 100% when location (close proximity to the farming community), and timing (between harvests) are planned in collaboration with the farmers through knowledge exchange.
The need for more respirator training has been identified by the farmers. Rural lung health clinics offer one way to deliver the training. Websites dedicated to lung health protection, with videos, may be another way to reach to the farmers who live across large geographic areas of Ontario, however N95 fit-testing would require face-to-face appointments. Respiratory care professionals are needed to deliver this training, in our efforts to prevent chronic lung disease and promote the lung health of farmers.
Funding for this study was provided by The Lung Association through an Ontario Respiratory Care Society Fellowship Award.
This study was supported by the Gateway Centre of Excellence in Rural Health.
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