摘要：Objectives. We assessed long-term trends in ethylene oxide (EtO) worker exposures for the purposes of exposure surveillance and evaluation of the impacts of the Occupational Safety and Health Administration (OSHA) 1984 and 1988 EtO standards. Methods. We obtained exposure data from a large commercial vendor and processor of EtO passive dosimeters. Personal samples (87 582 workshift [8-hr] and 46 097 short-term [15-min] samples) from 2265 US hospitals were analyzed for time trends from 1984 through 2001 and compared with OSHA enforcement data. Results. Exposures declined steadily for the first several years after the OSHA standards were set. Workshift exposures continued to taper off and have remained low and constant through 2001. However, since 1996, the probability of exceeding the short-term excursion limit has increased. This trend coincides with a decline in enforcement of the EtO standard. Conclusions. Results indicate the need for renewed intervention efforts to preserve gains made following the passage and implementation of the 1984 and 1988 EtO standards. The need for expanded research efforts on how best to translate occupational health and safety knowledge into exposure prevention and control in the workplace is widely recognized. 1 Two areas with particularly high potential in this regard are intervention effectiveness research and surveillance, both of which have been identified by broad stakeholder input as National Occupational Research Agenda priorities. 2, 3 Exposure or hazard surveillance is relatively underdeveloped in relation to occupational health outcome surveillance, which has a much longer history. 2, 4, 5 Although both exposure and health outcome surveillance are relevant to addressing the unacceptably high burden of occupational disease, 6 health outcome surveillance is infeasible for many occupational diseases, such as those with multifactorial etiologies or long latency periods. Nevertheless, exposure surveillance continues to be underutilized as a surveillance strategy as well as an effectiveness measure in governmental policy evaluation and other intervention research. 4, 7, 8 One reason for this underuse is the lack of data sources. Although the US Occupational Safety and Health Administration (OSHA) Integrated Management Information System data on occupational exposures is broad based both geographically and in terms of the range of hazards represented, 5, 9 data on personal exposures to specific agents over time is limited. The National Institute for Occupational Safety and Health (NIOSH) National Occupational Exposure Survey also has broad coverage but little in the way of quantitative measurements. Although NIOSH is planning new exposure surveillance initiatives, 10 substantial quantitative exposure databases on specific hazards are only rarely reported on. One strategy for addressing this data gap is to improve relations between researchers and data gatherers (employers) to make use of the vast amount of exposure data routinely collected by employers and other groups. 4, 8 From a perspective of intervention effectiveness research, the literature is dominated by reports on the development, implementation, and evaluation of worksite-level intervention programs. 11 Evaluations of policy-level interventions, such as OSHA standards, are relatively few but provide valuable guidance for the implementation of current policy as well as new policymaking. 11– 13 Finally, legislative mandates requiring governmental agencies to demonstrate the need for occupational health and safety regulations, their effectiveness, and the achievement of performance benchmarks point to the potential utility of integrating exposure surveillance with intervention effectiveness research. 4, 7, 8, 14 In this article, we analyze long-term ethylene oxide (EtO) exposure trends in US hospitals using an integrated approach that draws from the perspectives of both traditional surveillance and newer intervention effectiveness research. EtO is a known human carcinogen, a potential reproductive hazard, an allergic sensitizer, a potential asthmagen, and a potent neurotoxin that continues to be used widely for the sterilization of heat- and moisture-sensitive medical supplies. 15, 16 An OSHA section 6(b) EtO health standard (hereafter referred to as the Standard ) was promulgated in 1984. The Standard included a permissible exposure limit (PEL) of 1 ppm and an action level (AL) of 0.5 ppm for EtO workshift exposures (time-weighted average parts per million over 8 hours). 17 In 1988, OSHA revised the Standard to include a short-term excursion limit (STEL) of 5 ppm for EtO (time-weighted average parts per million over 15 minutes). 18
