MANAGING BEST PRACTICES: At your wits end (part 2)
In last monthâ€™s column, we briefly explored how our thoughts may cause or aggravate an illness. In this column weâ€™ll explore the concept of â€œidiopathic environmental intoleranceâ€ (IEI).
â€œIdiopathicâ€ means â€œof unknown origin.â€ IEI is the newest term for the concepts of â€œmultiple chemical sensitivity (MCS),â€ â€œenvironmental illness,â€ â€œsick building syndrome,â€ â€œuniversal allergyâ€ or â€œclinic ecology.â€ All of these terms attempt to attribute illness causation, usually subjective health complaints, from the slightest amount of a chemical, biological, or physical exposure.
Hot button topicAs you might suspect, IEI is an emotionally charged topic. Most mainstream scientists and physicians discount IEI because it is inconsistent with known principles of physiology and toxicology. Other groups, often called â€œclinical ecologists,â€ hotly dispute this position and claim IEI, or what they prefer to call MCS, is real.
Most employers encounter IEI as an indoor air quality issue related to chemicals, usually chemicals having an odor. Mold exposure, though, has been taking center stage lately. And growing on the horizon is IEI related to people claiming hypersensitivity to electricity as an allergic reaction to electric and magnetic stimulation. Learn more about IEI at: http://en.wikipedia.org/wiki/Multiple_chemical_sensitivity.
Neutral viewsTo help workers get well from unknown causes, we should consider that all illness has psychological and physiological components. Choosing one exclusively over the other encourages conflict, which should be avoided.
Last monthâ€™s column was written to help employees/employers seek a balance between illness that may originate in the head â€” psychosomatic disorders â€” and IEI. Employers should consider both as equal possibilities, and this position should be conveyed to employees through management communications and actions.
Expert helpThe following experts are often needed to help resolve employee health concerns from unknown causes:
Industrial hygienist â€” A certified industrial hygienist (CIH), see http://www.abih.org/, is highly, if not exclusively, recommended for these projects. The CIH should be queried on their views of illness causation from psychosomatic disorders and IEI. Find a CIH who understands the balance between these two concepts.
The CIH should:
- Interpret and help communicate the results of all environmental samples;
- Thoroughly examine the entire workplace and use professional judgment to determine risks from combined chemical, biological, and physical exposures;
- Be allowed by management to freely interact and discuss health concerns with employees; and,
- Issue a report with conclusions and recommendations.
Physician/medical clinic â€” A physician who supports evidence-based statements on IEI from the American College of Occupational and Environmental Medicine, reference http://www.acoem.org/guidelines/article.asp?ID=46, should see workers having subjective health complaints.
Although there is no single course of treatment for IEI patients, clinics can perform challenge testing with selected low-level chemical exposures found in the workplace, while noting change in blood or end-tidal volume carbon dioxide (CO2) in the employee. Reduced CO2 may reveal that the employee was hyperventilating, indicating that acute anxiety and emotional distress is a likely cause of problems, and not chemical exposure.
Human resource specialist â€“ A HR specialist should advise the employer/employee:
- If IEI is compensable within their state;
- Whether reasonable accommodations under Americans with Disabilities Act (ADA) or other laws are applicable;
- If the employee is eligible to participate in any Employee Assistance Programs that may help resolve underlying causes for health problems, such as stress management; and,
- If other HR actions, such as establishing a policy on IEI, are necessary to help the employer/employee administratively address and resolve current and future concerns on the topic.
An occupational health nurse, safety committee, or other individuals/groups can be helpful in addressing IEI concerns, depending on individual circumstances and opportunities. A team approach, including contributions from affected employees, must assure that no workplace cause for illness has been overlooked. The team should rely heavily upon the CIHâ€™s and physicianâ€™s expertise in this matter.
ImprovementsEmployers often worry that heroic efforts, such as immediate and major changes in engineering controls, chemical substitutions, and other actions are needed to resolve IEI issues. In most cases, a calm and planned approach, with incremental environmental and job improvements, is more successful.
Your first step is to ensure regulatory compliance. Next, strive to meet threshold limit values (TLVs) established by the American Conference of Governmental Industrial Hygienists. Then develop or enhance your facilityâ€™s occupational health and safety management system, preferably patterned after ANSI/AIHA Z10-2005. A workplace and equipment that is clean, organized, with good lighting and natural ventilation, where practical, goes a long way to resolving IEI concerns. Giving employees some control over their work and environment also is helpful. And just simply saying to employees, â€œI care and Iâ€™m willing to helpâ€ yields benefits.
Your main objective is to limit employee exposure to suspected stimulating agents as much as practical. Whether exposure to 50 percent or 10 percent of a TLV is practical is not the point. The point is this: the employee must understand all practical actions have been taken by his/her employer to help resolve concerns.
Harsh decisionsShould employers fire employees who have subjective health complaints, when nothing in the workplace can be found to be the cause of their problems? What about an employee quitting the job and finding a â€œsaferâ€ place to work?
Thereâ€™s no easy answer to these questions. Something has to give if an employee has excessive absences or they are routinely non-productive at work because of illness.
Hiring and retaining only healthy workers may be a lost luxury in the modern work era. For reasons that have yet to be explained, the human population is becoming more sensitive to chemicals (and probably other agents as well), with approximately 15 percent of the population being affected today. Gender, socioeconomic status, and race/ethnicity are not effective screens for determining who may experience psychosomatic disorders or IEI.
Sometimes we just donâ€™t know why people get sick. Theories abound and sides may be taken. Employers and employees should support more research in this area, such as through NIOSHâ€™s National Occupational Research Agenda (NORA). We must recognize that health includes physical, mental and social well-being. And finally, itâ€™s generally only when people get sick that we realize how valuable good health really is. Health promotion on and off-the-job should be encouraged.