Exposure to volatile organic compounds in healthcare settings.
ABSTRACT: To identify and summarise volatile organic compound (VOC) exposure profiles of healthcare occupations.Personal (n=143) and mobile area (n=207) evacuated canisters were collected and analysed by a gas chromatograph/mass spectrometer to assess exposures to 14 VOCs among 14 healthcare occupations in five hospitals. Participants were volunteers identified by their supervisors. Summary statistics were calculated by occupation. Principal component analysis (PCA) was used to reduce the 14 analyte inputs to five orthogonal factors and identify occupations that were associated with these factors. Linear regressions were used to assess the association between personal and mobile area samples.Exposure profiles differed among occupations; ethanol had the highest geometric mean (GM) among nursing assistants (?4900 and ?1900?µg/m(3), personal and area), and 2-propanol had the highest GM among medical equipment preparers (?4600 and ?2000?µg/m(3), personal and area). The highest total personal VOC exposures were among nursing assistants (?9200?µg/m(3)), licensed practical nurses (?8700?µg/m(3)) and medical equipment preparers (?7900?µg/m(3)). The influence of the PCA factors developed from personal exposure estimates varied by occupation, which enabled a comparative assessment of occupations. For example, factor 1, indicative of solvent use, was positively correlated with clinical laboratory and floor stripping/waxing occupations and tasks. Overall, a significant correlation was observed (r=0.88) between matched personal and mobile area samples, but varied considerably by analyte (r=0.23-0.64).Healthcare workers are exposed to a variety of chemicals that vary with the activities and products used during activities. These VOC profiles are useful for estimating exposures for occupational hazard ranking for industrial hygienists as well as epidemiological studies.
Project description:Objectives:Use of cleaning and disinfecting products is associated with work-related asthma among healthcare workers, but the specific levels and factors that affect exposures remain unclear. The objective of this study was to evaluate the determinants of selected volatile organic compound (VOC) exposures in healthcare settings. Methods:Personal and mobile-area air measurements (n = 143) from 100 healthcare workers at four hospitals were used to model the determinants of ethanol, acetone, 2-propanol, d-limonene, α-pinene, and chloroform exposures. Hierarchical cluster analysis was conducted to partition workers into groups with similar cleaning task/product-use profiles. Linear mixed-effect regression models using log-transformed VOC measurements were applied to evaluate the association of individual VOCs with clusters of task/product use, industrial hygienists' grouping (IH) of tasks, grouping of product application, chemical ingredients of the cleaning products used, amount of product use, and ventilation. Results:Cluster analysis identified eight task/product-use clusters that were distributed across multiple occupations and hospital units, with the exception of clusters consisting of housekeepers and floor strippers/waxers. Results of the mixed-effect models showed significant associations between selected VOC exposures and several clusters, combinations of IH-generated task groups and chemical ingredients, and product application groups. The patient/personal cleaning task using products containing chlorine was associated with elevated levels of personal chloroform and α-pinene exposures. Tasks associated with instrument sterilizing and disinfecting were significantly associated with personal d-limonene and 2-propanol exposures. Surface and floor cleaning and stripping tasks were predominated by housekeepers and floor strippers/waxers, and use of chlorine-, alcohol-, ethanolamine-, and quaternary ammonium compounds-based products was associated with exposures to chloroform, α-pinene, acetone, 2-propanol, or d-limonene. Conclusions:Healthcare workers are exposed to a variety of chemicals that vary with tasks and ingredients of products used during cleaning and disinfecting. The combination of product ingredients with cleaning and disinfecting tasks were associated with specific VOCs. Exposure modules for questionnaires used in epidemiologic studies might benefit from seeking information on products used within a task context.
Project description:Healthcare workers have an elevated prevalence of asthma and related symptoms associated with the use of cleaning/disinfecting products. The objective of this study was to identify and characterize cleaning/disinfecting tasks and products used among hospital occupations.Workers from 14 occupations at five hospitals were monitored for 216 shifts, and work tasks and products used were recorded at five-minute intervals. The major chemical constituents of each product were identified from safety data sheets.Cleaning and disinfecting tasks were performed with a high frequency at least once per shift in many occupations. Medical equipment preparers, housekeepers, floor strippers/waxers, and endoscopy technicians spent on average 108-177?min/shift performing cleaning/disinfecting tasks. Many occupations used products containing amines and quaternary ammonium compounds for >100?min/shift.This analysis demonstrates that many occupations besides housekeeping incur exposures to cleaning/disinfecting products, albeit for different durations and using products containing different chemicals.
Project description:Nail technicians are exposed to volatile organic compounds (VOCs) from nail products, but no studies have previously measured VOC biomarkers for these workers. This study of 10 nail technicians aimed to identify VOCs in nail salons and explore relationships between air concentrations and biomarkers. Personal and area air samples were collected using thermal desorption tubes during a work shift and analyzed using gas chromatography/mass spectrometry (GC/MS) for 71 VOCs. Whole blood samples were collected pre-shift and post-shift, and analyzed using GC/MS for 43 VOCs. Ventilation rates were determined using continuous CO2 measurements. Predominant air VOC levels were ethyl methacrylate (median 240 µg/m3 ), methyl methacrylate (median 205 µg/m3 ), toluene (median 100 µg/m3 ), and ethyl acetate (median 639 µg/m3 ). Blood levels were significantly higher post-shift than pre-shift for toluene (median pre-shift 0.158 µg/L and post-shift 0.360 µg/L) and ethyl acetate (median pre-shift <0.158 µg/L and post-shift 0.510 µg/L); methacrylates were not measured in blood because of their instability. Based on VOCs measured in these seven nail salons, we estimated that emissions from Greater Boston area nail salons may contribute to ambient VOCs. Ventilation rates did not always meet the ASHRAE guideline for nail salons. There is a need for changes in nail product formulation and better ventilation to reduce VOC occupational exposures.
Project description:Exposures to volatile organic compounds (VOCs) are ubiquitous due to emissions from personal, commercial and industrial products, but quantitative and representative information regarding long term exposure trends is lacking. This study characterizes trends from1988 to 2004 for the 15 VOCs measured in blood in five cohorts of the National Health and Nutrition Examination Survey (NHANES), a large and representative sample of U.S. adults. Trends were evaluated at various percentiles using linear quantile regression (QR) models, which were adjusted for solvent-related occupations and cotinine levels. Most VOCs showed decreasing trends at all quantiles, e.g., median exposures declined by 2.5 (m, p-xylene) to 6.4 (tetrachloroethene) percent per year over the 15 year period. Trends varied by VOC and quantile, and were grouped into three patterns: similar decreases at all quantiles (including benzene, toluene); most rapid decreases at upper quantiles (ethylbenzene, m, p-xylene, o-xylene, styrene, chloroform, tetrachloroethene); and fastest declines at central quantiles (1,4-dichlorobenzene). These patterns reflect changes in exposure sources, e.g., upper-percentile exposures may result mostly from occupational exposure, while lower percentile exposures arise from general environmental sources. Both VOC emissions aggregated at the national level and VOC concentrations measured in ambient air also have declined substantially over the study period and are supportive of the exposure trends, although the NHANES data suggest the importance of indoor sources and personal activities on VOC exposures. While piecewise QR models suggest that exposures of several VOCs decreased little or any during the 1990's, followed by more rapid decreases from 1999 to 2004, questions are raised concerning the reliability of VOC data in several of the NHANES cohorts and its applicability as an exposure indicator, as demonstrated by the modest correlation between VOC levels in blood and personal air collected in the 1999/2000 cohort. Despite some limitations, the NHANES data provides a unique, long term and direct measurement of VOC exposures and trends.
Project description:PURPOSE:Exposures of nail salon technicians have received attention due to the potentially toxic materials used in nail products, which include volatile organic compounds (VOCs) such as formaldehyde and methyl methacrylate (MMA). This study characterized area and personal concentrations and other indoor air parameters in 17 nail salons in fall and winter seasons in three areas of Michigan. METHODS:VOC samples were analyzed using thermal desorption, gas chromatography and mass spectroscopy, and the VOC composition of 35 nail products (e.g., polish, top coat, base coat) was measured using headspace sampling. Ventilation rates were derived using CO2 concentrations, occupancy and building information, and VOC sources were apportioned by a novel application of chemical mass balance models. RESULTS:We detected ethyl acetate, propyl acetate, butyl acetate, MMA, n-heptane and toluene in most salons, and benzene, D-limonene, formaldehyde, and ethyl methacrylate in some salons. While MMA was not measured in the consumer and professional products, and the use of pure MMA in salons has been not been permitted since the 1970s, MMA was found in air at concentrations from 100 to 36,000 µg/m3 in 15 of 17 salons; thus its use appears to be commonplace in the industry. Personal measurements, representing exposures to workers and clients, were about twice those of the area measurements for many VOCs. CONCLUSION:This study identifies the products responsible for emissions, shows the widespread presence of MMA, and documents low ventilation rates in some salons. It also demonstrates that "informal" short-term sampling approaches can evaluate chemical exposures in nail salons, providing measurements that can be used to protect a potentially susceptible and vulnerable population. Additional controls, including restrictions on the VOC compositions and improved ventilation, can reduce exposures to salon workers and clients.
Project description:BACKGROUND:Previous studies have suggested an association of asthma onset and exacerbation with cleaning and disinfecting activities in a number of industries, including healthcare. The objective of the current study was to investigate the association of asthma and related outcomes with occupations and tasks in urban healthcare workers in the United States. METHODS:A questionnaire was implemented in a sample of workers from nine healthcare occupations in New York City. We used regression models to examine the association of post-hire asthma, current asthma, exacerbation of asthma, a symptom algorithm for bronchial hyper-responsiveness (BHR-related symptoms), a symptom-based asthma score, and the symptom wheeze with occupation and four healthcare tasks, while adjusting for other risk factors and potential confounders. RESULTS:A total of 2030 participants completed the questionnaire. The task of cleaning fixed surfaces was significantly associated with most outcome variables, including current asthma (odds ratio (OR)?=?1.84, 95% confidence interval (CI) 1.26-2.68), moderate exacerbation (OR?=?3.10, 95% CI 1.25-7.67), and BHR-related symptoms (OR?=?1.38, 95% CI 1.08-1.77). In comparison to nursing assistants, the occupations environmental service workers and registered nurses were at higher risk for current asthma, and licensed practical nurses were at higher risk for moderate exacerbation. Other tasks associated with outcomes were administering aerosolized medications with current asthma and moderate exacerbation, and sterilizing medical equipment with BHR-related symptoms. CONCLUSIONS:These findings add to the growing body of evidence for the association of asthma with cleaning and other activities in healthcare. Further research is especially needed to investigate the association of asthma-related outcomes with exposure metrics based on tasks, products, and chemical exposures in healthcare.
Project description:Facing rising inequities and poorer accessibility of physicians in rural areas, new healthcare delivery structures are being considered to support local healthcare in German communities. To better understand perspectives on and attitudes towards different supplementary models, we examined attitudes among local politicians in the German federal state of Lower Saxony towards the suitability of supplementary care models.As part of a cross-sectional study, we surveyed local politicians in Lower Saxony at the local authority and district levels (n =?449) by mail questionnaire. We asked for an assessment of four potential supplementary healthcare models at the local level: the use of trained medical assistants, patients' buses, mobile physicians' offices, and telemedicine.The response rate was 71.0% for mayors (n =?292) and 81.6% (n =?31) for county administrators. In summary, 72.4% of respondents supported the use of trained medical assistants, 48.9% voted for patients' buses, 22.0% for mobile physicians' offices, and 13.9% for telemedicine. Except for telemedicine, the politicians' approval of the supplementary models in rural areas was higher than in urban areas. The assessment regarding the suitability of each model was not significantly connected with indicators of a positively or negatively assessed local healthcare situation. The analyses showed that the use of trained medical assistants was associated with the positive effects of division of labor and potential to relieve physicians. In contrast, there was skepticism about technical support via telemedicine, mostly due to concerns about its unsuitability for elderly people and the potential lower quality of healthcare delivery.Local politicians widely accept the use of trained medical assistants, whereas the applicability of technical solutions such as telemedicine is perceived with skepticism. Therefore, the knowledge gap between evidence for and prejudices against telemedicine needs to be addressed more effectively. Reasons for the assessments of the presented models are more likely traceable to personal views than to assessments of the actual estimated local primary care situation.
Project description:Although short-duration elevated exposures (peak exposures) to pollutants may trigger adverse acute effects, epidemiological studies to understand their influence on different health effects are hampered by lack of methods for objectively identifying peaks. Secondhand smoke from cigarettes (SHS) in the residential environment can lead to peak exposures. The aim of this study was to explore whether peaks in continuous PM2.5 data can indicate SHS exposure. A total of 41 children (21 with and 20 without SHS exposure based on self-report) from 28 families in New York City (NY, USA) were recruited. Both personal and residential continuous PM2.5 monitoring were performed for five consecutive days using MicroPEM sensors (RTI International, USA). A threshold detection method based on cumulative distribution function was developed to identify peaks. When children were home, the mean accumulated peak area (APA) for peak exposures was 297 ± 325 hour*µg/m3 for children from smoking families and six times that of the APA from non-smoking families (~50 ± 54 hour*µg/m3 ). Average PM2.5 mass concentrations for SHS exposed and unexposed children were 24 ± 15 µg/m3 and 15 ± 9 µg/m3 , respectively. The average SHS exposure duration represents ~5% of total exposure time, but ~13% of children's total PM2.5 exposure dose, equivalent to an additional 2.6 µg/m3 per day. This study demonstrated the feasibility of peak analysis for quantifying SHS exposure. The developed method can be adopted more widely to support epidemiology studies on impacts of short-term exposures.
Project description:OBJECTIVES:The aims of the study were to trace the patterns of work environment factors and compensated sickness absence (SA) among nurses and care assistants compared with other occupations and to compare SA among exposed and non-exposed nurses and care assistants. DESIGN:A cross-sectional survey on work environment factors based on the biennial Swedish Work Environment Surveys 1991-2013, linked to longitudinal register data on SA 1993-2014. PARTICIPANTS:The study included 98?249 individuals, stratified into nurses and care assistants (n=16?179) and a reference population including all other occupations (n=82?070). OUTCOME MEASURE:Annual days of compensated SA (>14 days) 3?years after exposure years. RESULTS:Nurses and care assistants had higher SA in 1993-2014 compared with all other occupations, and differences in background factors only partly explained this relationship. For both groups, exposure to physical work factors remained steady, but the number of exposed were 10%-30%?higher among nurses and care assistants. Those exposed to heavy physical work and strenuous working postures had in most years significantly higher SA when compared with non-exposed (rate ratio range: 1.4-1.9). Exposure to high job demands increased 10%-25%?in 1991-1999 among nurses and care assistants but became more stable in 2001-2013 and high proportions of high job demands coincided with the increase in SA in 1995-1999. Nurses and care assistants exposed to high job demands had for most years significantly higher SA than non-exposed (rate ratio range: 1.5-2.1). Low job control and low support from supervisors elevated SA significantly only for a few years. CONCLUSIONS:Exposure to negative work factors among nurses and care assistants was weakly associated with variations in SA, but may be related to their higher level of SA when compared with other occupations. Improved physical and psychosocial working conditions may reduce the elevated SA level in these occupations.
Project description:OBJECTIVES:We aim to characterize the qualities of estimation approaches for individual exposure to ambient-origin fine particulate matter (PM2.5), for use in epidemiological studies. METHODS:The analysis incorporates personal, home indoor, and home outdoor air monitoring data and spatio-temporal model predictions for 60 participants from the Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air). We compared measurement-based personal PM2.5 exposure with several measured or predicted estimates of outdoor, indoor, and personal exposures. RESULTS:The mean personal 2-week exposure was 7.6 (standard deviation 3.7) µg/m3. Outdoor model predictions performed far better than outdoor concentrations estimated using a nearest-monitor approach (R?=?0.63 versus R?=?0.43). Incorporating infiltration indoors of ambient-derived PM2.5 provided better estimates of the measurement-based personal exposures than outdoor concentration predictions (R?=?0.81 versus R?=?0.63) and better scaling of estimated exposure (mean difference 0.4 versus 5.4?µg/m3 higher than measurements), suggesting there is value to collecting data regarding home infiltration. Incorporating individual-level time-location information into exposure predictions did not increase correlations with measurement-based personal exposures (R?=?0.80) in our sample consisting primarily of retired persons. CONCLUSIONS:This analysis demonstrates the importance of incorporating infiltration when estimating individual exposure to ambient air pollution. Spatio-temporal models provide substantial improvement in exposure estimation over a nearest monitor approach.