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 Study on the Health Hazards of Cold Stress in the Workplace

Study on the Health Hazards of Cold Stress

in the Workplace
Chiou-Jong Chen1 Yu-Tung Dai2 Chien-Jung Tien3
Yih-Min Sun4 Yow-Jer Juang4
1
Institute of Occupational Safety and Health, Council of Labor Affairs, Taiwan
2
Department of Occupational Safety and Health, Chang Jung Christian University
3
Department of Biotechnology, National Kaohsiung Normal University
4
Department of Occupational Safety and Health, Chung Hwa University of Medical Technology

Abstract

The workplaces with cold environment were screened from database to investigate (1) a
profile, (2) manufacturing process, raw materials and products, (3) state of cold environment, (4)
medical examination and (5) cold related symptoms by questionnaire and telephone interview.
Extensive workplaces with cold environment were found in aquatic products industry, frozen food
processing and meat processing factory, and most of them were located in southern Taiwan. It was
found that 38.5 % of cold environment exist both cold air exposure and cold touch among the
workplace investigated. In addition, 34.6 % workplace showed cold air exposure only, and 26.9 %
were referred to cold touch only. Most of the cold workplaces were found in cold storage
warehouse with temperature lower than -18 ℃, and in frozen meat processing industry with
temperature ranging between 10 ℃ and 18 ℃. The major symptoms or diseases for the workers
in the cold environment are coldness of hand or leg (21.1 %), numbness of hand or leg (21.1 %),
respiratory diseases (21.1 %) and feeling of tired (10.6 %).

Keywords: cold stress, cold work, questionnaire survey, frozen-food processing industry

Accepted XX XXXX, 20XX

Correspondence to: Yow-Jer Juang, Department of Occupational Safety and Health, Chung Hwa University
of Medical Technology, TEL: 06-267-4567#8057, Fax：06-289-4028, E-mail:
jyjstone@mail.hwai.edu.tw

1
Journal of Occupational Safety and Health 18: XXX-XXX (2010)
Introduction
After Taiwan joined the World Trade
Organization and opened up for the imports of
agricultural and livestock products, cold
storage or freezing preservation is the most
commonly used method in order to maintain or
preserve food or fruit. In recent years, along
with the increasing food refrigeration, the
construction and usage of freezers and cold
storage is more and more common, and is the
trend of booming development. Therefore, the
increasing number of workers worked in the
freezers or cold places. For workers who work
in a freezer or cold storage for a long period of
time, their health will have a certain level of
impact if they do not have proper cold
prevention. As the changing industry type and
the rise of cold logistics industry, in addition to
the outdoor cold work places impacted by
seasonal changes, freezer and cold storage can
be the most man-made cold work environment.
The cold effect of cold work environment
on workers is mainly intensified by temperature,
wind speed, personal cold-defense equipment,
body heat production and metabolic heat
balance status, adaptation to low temperature
and tolerance [1]. The studies on cold work
worker health hazard are still very limited in
Taiwan, and the cold work workers are also less
protected in occupational hazards prevention.
The commonly seen health hazards resulting
from cold air exposure include frostbite [2-3]
and lower efficiency of nerve and muscle
performance [4-9]. According to the survey by
Ding et al. [10], the major symptoms of cold
work workers were joint pain, lumbago,
headache, and dizziness. In addition, the
occurrence rate of these symptoms is related to
the freezer workers’ seniority and freezer
temperature. Tochihara [11] focused on the
questionnaire survey of Japanese freezer
workers and found that the most commonly
heard complaints from the workers are
lumbago, cold, neuralgia and rheumatism, and
low temperature and the big difference between
indoor and outdoor temperatures are considered
to cause the health problems. Work conditions
were also one of the factors. In Japan, even
when facing the impact of the bubble economy,
the frozen food chain industry still continued to
grow; it has been increasing [12], whether in
the amount or the capacity of freezer and cold
storage. Morioka et al. [13] focused on the
evaluation of low-temperature freezer forklift
operators’ circulatory function and the
subjective questionnaire survey, and found that
the major complained-about symptoms of over
60 % low-temperature freezer operators are
nasal discharge, hand coldness and pain. At the
same time, it is also found that during the work
period, blood pressure has a significant change,
the serum epinephrine level was significantly
increased, and the measured value of sublingual
temperature decreased significantly when the
work was finished; all these parameters are
related to the time length of spent in the freezer.
Huang et al. [14] focused on the cold storage
operators by questionnaires and found that, the
major symptoms of frozen seafood workers
(the temperature of the environment is
generally -10 ℃ ~ -18 ℃) are lumbago (57.8
%), knee pain (54.6 %), shoulder, elbow, and
wrist pain (19.8 %), stomach acid reflux (18.7
2

%), abdominal distention and diarrhea (13.9 %)
and chronic cough (13.9 %). The major
symptoms of ice workers (the temperature of
the environment is generally 0 ℃ ~ -5 ℃;
relative humidity is 95 % ~ 100 %) were
lumbago (54.8 %), knee pain (41.3 %),
shoulder, elbow, and wrist pain (20.7 %),
stomach acid reflux (23.1 %), abdominal
distention and diarrhea (11.9 %) and chronic
cough (19.1 %). Workers in cold work
environment often have more symptoms than
the regular warehouse workers. Chen and
Chiang[15] pointed out that low temperature
could reduce the metabolism of high-energy
phosphate in the brain, decline the neural
excitability and conduction ability, and coupled
with the partial effect of coldness, clumsiness,
speech difficulty, sleepiness, and forgetfulness
will further impact the operation capacity. The
cold work environment survey by Lee [16]
found that, knee pain (51 %) and lumbago (33
%) were the most commonly seen complained-
about symptoms of freezer workers. Knee pain
especially had a more significant impact from
weather and seasonal changes and the symp-
toms would become more obvious after cold
and wet exposure. It was also considered that
excessive working strength, manual operating
or loading were the major reasons. Some
workers will feel relief of the pain after not
working in the freezer operation. The air
humidity usually doesn’t have a big impact on
people in a cold environment. Temperature and
wind speed are the major deciding factors. In a
cold environment, people’s working ability
decline mainly due to physiological reasons,
such as numbness of fingers, and inflexible
Study on the Health Hazards of Cold Stress in the Workplace
joints, etc. [17-18]. Wyon [19] found that, if the
temperature is between 18 ℃ to 24 ℃, the
nervous conduction velocity would slow down.
When investigating the relationship between
body partial temperature (exposing to low
temperature environment) and the nerve
conduction velocity changes, it was found that
the skin temperature would drop about 10 ℃,
and the nerve conduction velocity would
reduce about 15 m/s [20]. Chiang et al. [21]
focused on the domestic frozen-food processing
industry for workers’ carpal tunnel syndrome
research, and found that gender, whether being
exposed to frozen food or not, and wrist
repetitive operations would have an impact on
the occurrence of carpal tunnel syndrome and
had a significant statistical correlation. For
workers who work in a low-temperature envi-
ronment for a long period of time, the blood
circulation would be blocked and resulted in
muscle necrosis, especially in limbs, the
forehead, cheeks and earswhich are vulnerable
[22]. People with high blood pressure may
resulted in an significant increase in their blood
pressure due to peripheral vasoconstriction
when staying in a low temperature environment.
Therefore, they should pay more attention to
the risk of cold air exposure [23-24].
The studies on the health hazards caused
by cold work environments is still limited in
Taiwan. Therefore, it is necessary to investigate
physiological effects and health hazards on
cold work environment workers This study
used the factory public information enquiry
system of the Industrial Development Bureau,
Ministry of Economic Affairs, the Industrial
Technology Research Information Center
3
Journal of Occupational Safety and Health 18: XXX-XXX (2010)
(IPIS), and other related enquiry system to
screen the factories with a cold work
environment. The survey was conducted by
questionnaires and telephone interviewing to
investigate the potential cold stress on workers
working in cold workplases in order to provide
the related information for safety and health
management on cold workplaces.
Method
In recent years, the number of freezers,
cold storages and workers has increased.
Therefore, in order to understand the impact of
the cold work environment on the workers
health, this study first processed questionnaire
design. After going through many testing and
content amendments, the questionnaires were
mailed to each business unit. The safety and
health managers was asked to fill in the
questionnaire and mailed it or faxed it back. If
there was no reply, the questionnaire would be
done by telephone interview. The statistical
analysis would be performed.
To date, there is still no clear definition for
cold work environments in the labor
administrative regulations of Taiwan. The
Canadian Workers’ Compensation Board
(WCB) [25] defines cold air exposure with the
following three conditions: (1) the thermal
environment that will cause cold stress or
injuries; (2) the thermal environment that will
cause the laborer’s body temperature to drop
below 36 ℃; (3) the thermal environment of
the wind-cooling power from cold stress on the
exposed skin reaches the U.S ACGIH’s slight
risk zone. Currently, there is still no clear
definition for cold work environments in
Taiwan. Therefore, after the literature inquiry,
we referred to the recommendation of ILO [26],
Pilcher et al. [27], Department of Minerals and
Energy, South Africa [28] and Cohen [29], to
define the work environment with a
temperature that is below 18 ℃ during the
manufacturing/ the production process, or
soaking in the water with a temperature that is
below 15 ℃ or in contact with the object’s
temperature below 0 ℃ as cold environment
work, to process the questionnaire survey of the
business unit.
1. Industry type database inquiries:
Inquire of the basic information of
domestic related business unit through the
Internet, Ministry of Economic Affairs,
Accounting and Statistics, Labor Committee,
and various labor unions and industrial
technology research institutes, and then screen,
classify and set up the basic information of the
frozen food industry, low temperature
warehousing industry, fish markets and
fishermen’s association, fresh packaging
wholesale markets and ice cream manu-
factories.
2. Questionnaire survey (Potential cold
work environment business unit survey)
T comprehensive survey was conducted
according to the above-mentioned information.
First, it used Taiwan’s geographical location to
divide the country into five regions, which are
North (from southern Keelung to northern
Hsinchu County and City), Middle (from
southern Miaoli to northern Chiayi), South
4

(from southern Tainan to northern Pingtung),
East (Ilan, Hualien and Taitung), and Remote
Islands (Penghu, Kinmen and Matsu). It also
mailed the questionnaires and coupled with
telephone interviewto the managers of the
business units to confirm whether the
temperature of workplaces was lower than 18
℃ during the manufacturing and production
work environment (it refers to, it may have cold
air exposure), or whether the hands of workers
were soaking in water lower than 15 ℃ or in
contact with objects with temperatures below
the freezing point (0 ℃) (it refers to, it may
have a cold touch or contact), and continued to
ask the exposure time frame of this type of
work. There were five parts of this
questionnaire: (1) Business units overview:
Including the name, address, telephone,
business registration certificate or approved
establishment number, labor insurance permit
number of the business unit, the name of the
business owner or representative, the job title
and name of the business owner, and its capital
and worker amount; (2) The manufacturing
process, raw material and major products:
Including factory type, department,
manufacturing process or production process
description, the name and production amount of
the raw material, product name and production
amount; (3) Cold work environment condition:
Including whether it has the condition of cold
air exposure or cold touch operation, and
participate in the workers’ amount, protective
clothing or equipment, and thermal equipment;
(4) Operating workers’ health examination
implementing condition; (5) Related symptoms
or diseases of the workers: Including cold
Study on the Health Hazards of Cold Stress in the Workplace
hands and feet, numb hands and feet, frostbite,
frozen, cardiovascular disease, respiratory
disease, joint muscle disease, mental decline,
heart disease, easily tired, atopic dermatitis, and
other symptoms or diseases.
3. Information data management and
statistical analysis
Process coding and input into the
computer according to the questionnaires
collected, and then check the accuracy of the
input data by the third party.After the data was
confirmed to be accurate, process statistical
analysis with STATISTICA 6.0.
Result
This study was conducted from March to
November 2004. It screened out the factories
that may have a cold work environment. The
results showed a total of 324 factories had
cold workplaces with 108 factories in the north,
58 in the middle, 118 in the south, 35 in the
east and 5 in the remote islands. After mailing
the questionnaire of current factory status
survey, we received 111 questionnaires, with
only 92 questionnaires indicating that the
factories had a cold work environment. There
were 43 in the south (which accounted for the
biggest part), followed by the north, which has
24, 13 in the east, and 12 in the middle. In
addition, the study processed telephone
interviews on the 213 factories that did not fill
in the questionnaires; there were 102 factories
which did not answer the phone or the numbers
were incorrect, there were 36 factories not
willing to take the telephone interview, and 75
5
Journal of Occupational Safety and Health 18: XXX-XXX (2010)

factories accepted the telephone interview. a cold work environment, the capital is between
Among the 75 factories, 64 of them confirmed $10 million and $50 million (37.6%), and
that they had a cold work environment. It could between $100 million and $1 billion (27.1%).
be seen after being summarized, among the 324 Generally the workers’ cold air exposure
f a c t o r i e s t h a t ma y h a v e a c o l d w o r k and cold touch location is in freezers, cold
environment, there are 156 which confirmed storages, food processing and packaging rooms.
that they had a cold work environment by In freezers and the cold storage rooms, due to
mailing back the questionnaires or being the multiple entrances and exits, it, at the same
telephone interviewed. Table 1 shows the time, has cold air exposure and cold touch; in
regional distribution of factories and the food processing and packaging rooms, it has
questionnaire recovery rate. Factories with cold only one or two entrances and exits, it is mainly
work environments were mostly located in is cold air exposure. For those with cold air
south (42.9%), followed by in north (29.5%), exposure, the average exposure time is 7.5
and the remote islands (0.7%) was the lowest. times per day, and the average exposure time is
The questionnaire recovery rate was 48.1%. 4.3 hours a day; for those with cold touch, the
average exposure time is 6.9 times per day, and
Table 1 Regional distribution and its the average exposure time is 2.6 hours a day.
questionnaire recovery rate of the
The frequency of workers touching objects that
cold work environment business
units are below 0 ℃ could reach 50 times, and the
Effective Telephone Recovery
Copies Sent
Copies A Interview B Rate (%)
average frequency per work day was 6 times.
North 108 24 22 42.6
Middle 58 12 12 41.4
South 118 43 24 56.8 Frozen Food (26%)
East 35 13 5 51.4 Frozen Seafood (36%)
Islands 5 0 1 20.0
Total 324 92 64 48.1
A
: Business units that mailed back the questionnaires
within the due date and are confirmed as having cold
work operation Frozen Fruits
B and Vegetables (4%)
: Business units that are confirmed as having cold work Beverage and
operation in a telephone interview Dairy Products (4%)
Ice Cream
Manufacturing (4%)

When classifying the 156 cold work Cold Storage (9%) Frozen Meat (17%)

environment factories according to their Figure 1 Domestic cold work environment

operating type, it can be divided into 7 types
(shown in Figure 1). Frozen seafood factories
were the most abundant (36%), followed by
frozen food (26%) and frozen meat (17%)
factories. When analyzing the capital
distribution among the cold work environment
factories, it is found that for most factories with
pattern distribution status (N=156)
The workers’ exposure type and protective
and thermal equipment used for the cold work
business units are summarized as Table 2. In
the factories with a cold work environment,
those with cold air exposure accounted for

6
 Study on the Health Hazards of Cold Stress in the Workplace

Table 2 Cold work exposure type and the more males than females. There were more
usage of cold work protective and
than 90% business units who hire less than 40
thermal equipment
Exposure Type workers to do cold work. The average number
Only Cold
Protective Measure Only Cold Air of workers hired to do cold touch work was
Touch or Both
Exposure
Contact (N=60)
(N=54) only around 1, the average number of workers
(N=42)
Personal protective
equipment
45 (83.3%) 36 (85.7%) 39 (65.0%) hired to do cold air exposure is 11.3, and the
Cold-proof wear 41 (75.9%) 30 (71.4%) 38 (63.3%)
Gloves 15 (27.7%) 15 (35.7%) 12 (20.0%)
number of workers hired to do both cold air
Protective shoes 11 (20.4%) 1 (2.4%) 11 (18.3%)
Caps 10 (18.5%) 2 (4.8%) 7 (11.7%)
exposure and cold touch is 22.6. The 156
Other (Masks,
Raincoats, etc.)
3 (5.6%) 1 (2.4%) 3 (5.0%) business units that have cold work, have 2010
Thermal devices 11 (20.4%) 1 (2.4%) 4 (6.7%) workers (Male: 1136, Female: 874). For the
(Heater)
Cold work cold work type that used thermal equipment
environment workers 612 45 1353
employed (heater), cold air exposure accounted for 20.4%,
Male 385 41 710
Female 227 4 643 followed by having cold air exposure and cold
touch operation at the same time (6.7%).
73.1% (114 factories), those with cold touch The exposed environmental temperature
accounted for 65.4% (102 factories), those with distribution of the factories with a cold work
cold touch and cold air exposure at the same environment is shown as Table 3. It was found
time accounted for 38.46% (60 factories), and that when focusing on the workers’ exposed
those with only cold touch accounted for 26.9% environmental temperature for analysis, that
(42 factories). Regardless of what the exposure workers were exposed to the environment that
type was, the protective measures were mainly is below -18 ℃ has the highest ratio (37.65%),
to provide personal protective equipments, followed by between -18 ℃ and 0 ℃ (24.70%),
which was at least 65.0%; the cold work however, there were 25.88% business units
environment with only cold touch even reached which cannot provide the data for the work
85.7%. Whether it is in a cold air exposure or environmental temperature, which indicated
cold touch environment, cold preventing that it was necessary to implement cold work
clothes were the major protective equipment, environment inspection.
and protective gloves were used more After analyzing the recovered question-
frequently in the cold touch operation than cold naires, it was found that 96% of factories that
air exposure operation. Regrading to workers had a cold work environment will have regular
who were hired to do cold work, there were health examination for the hired workers. The

Table 3 The operational environment temperature distribution of the cold work environment
factories
Temperature range (℃) X<-18 -18 ≤ X<0 0≤ X<4 4 ≤ X<10 10 ≤ X<18 No response

Factory number (N=85) 32 4 3 3 21 22

Distribution percentage 37.65% 4.71% 3.53% 3.53% 24.70% 25.88%

7
Journal of Occupational Safety and Health 18: XXX-XXX (2010)

top four symptoms in the cold work environ- workers use mainly were cold preventing
ment workers were cold hands and feet (21.1 clothes and gloves, especially the factories with
%), numb hands and feet (14.1 %), respiratory cold air exposure environments. They mostly
disease (12.9 %) and easily tired (10.6 %) used cold protective clothes for protection. In
(Table 4). addition, it was found in the initial
investigation about the worker’s symptoms,
Table 4 The symptoms occurrence distri-
cold hands and feet, numb hands and feet,
bution of cold work environ-
ment workers respiratory disease and easily tired are the most
Answer A commonly seen symptoms or diseases (Table 4).
Symptoms
Yes No
Hands and legs coldness 18 (21.1%) 67 (78.9%) However, we could not know which symptoms
Hands and legs numbness 12 (14.1%) 73 (85.9%)
Frostbite 2 (2.4%) 83 (97.6%) were caused by which cold work exposure type.
Frozen 1 (1.2%) 84 (98.8%) It can be seen from the analysis result, the
Cardiovascular disease 4 (4.7%) 81 (95.3%)
Respiratory disease 11 (12.9%) 74 (87.1%) symptoms of doing cold work generally are
Joint muscle disease 5 (5.9) 80 (94.1%)
Mental decline 3 (3.5%) 82 (96.5%) related to the skin cooling effect, the protective
Heart disease 2 (2.4%) 83 (97.6%)
Easily tired 9 (10.6%) 76 (89.4%)
measure adopted was mainly cold preventing
Atopic dermatitis 2 (2.4%) 83 (97.6%) clothes, gloves and shoes, which is consistent
A
: There are 85 business units that answered this part of
the questionnaire. with the commonly known cold hazard and its
prevention measure. However, the skin related
Discussion symptoms were still found in these factories, so
whether the employee’s training needs to be
It can be seen from the questionnaire strengthened or whether they need to be taught
survey that, currently, the factories with cold to wear proper equipment should be further
work environments was located mostly in the investigated and analyzed.
southern Taiwan. This may be because being an The workers who work in the meat
island country, frozen seafood industries packaging and frozen food processing
accounted for the biggest part in the regional operation were the ones who are most easily
industry type, followed by frozen food and affected by cold hazards. The protection for
meat industries. These factories mostly had cold hazards was only wearing proper clothes,
employees less than 40. Workers in t cold work gloves, and ear muffs to isolate the body and
places all have cold air exposure (73.1%), and the cold environment to achieve the effect of
the exposed temperature was below -18 ℃ and keeping warm, currently. Therefore, most
between 10 ℃ and 18 ℃, which is because of domestic and international literature rarely
the special environmental requirement of focuses on the damage caused by cold work
f r o z e n s e a f o o d o r r a w f o o d ma t e r i a l environments for further exploration, and also
low-temperature storage (below -18 ℃) and because of the above-mentioned reasons and
meat processing (10 ℃ ~18 ℃). Currently, the the cold hazards pointed out by the literature, it
protective equipment that Taiwanese cold work is necessary to have further local survey and

8

exploration focusing on the physiological
effects and damage risk caused by cold air
exposure, and try to find the related disease or
possible health hazard factors in the cold work
environment to provide the government with a
feasible design and specific control strategy to
protect the operators’ health.
Acknowledgements
We specially thanked the funding support
of the Institute of Occupational Safety and
Health (IOSH93-M307) for the successful
completion of the project. At the same time, we
also thanked all the business units that
cooperated with all the investigation, and we
sincerely appreciated those who provided their
valuable opinions and recommendations during
the project implementation period for pro-
moting domestic safety and health standard.
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