Health Hazards of Solvents

8/8/2019 Health Hazards of Solvents

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Health Hazards of Solvents

James E. Cone MD, MPH

and Karen Packard, RDH, MSThis presentation is made possible by a grant from the Association

of Occupational and Environmental Clinics and the National Institute

for Occupational Safety & Health.


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Module Goals

To provide an overview of occupationalsolvent exposure

To review potential health outcomes andpublic health prevention options.

To provide step by step approach todiagnostic testing and treatment of solvent-

related diseases To provide background information on

specific solvents

To illustrate the diverse effects of solvents

through cases involving solvent toxicity


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What is a solvent?

Classes of Common Organic Solvents:

aliphatic hydrocarbons amines

cyclic hydrocarbons esters

aromatic hydrocarbons alcohols halogenated hydrocarbons ketones

aldehydes ethers

A solvent is a

liquid at roomtemperatureused to dissolveother substances

Permission to use photo requested from AIHA Lab Safety Committee


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Scope of the Problem

Over 49 milliontons of solventchemicals are

produced andused each year inthe US alone.

Often exposureinvolves a mixtureof solvents.

Permission requested from US Navy


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Occupational Disease due to Solvents?

390,000 new cases of all types ofoccupational disease appear annuallyin the US.

It is unknown how many of these casesmay be related to solvent exposure.

Similar to other occupational diseases,

95% of all occupational solvent-relateddisease cases are never reported,most are never recognized as beingoccupationally-related.


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OccupationalEnvironmental

Workplace solvents may also result inexposures to neighborhoodresidents if

discharged fromworkplaces withoutadequate controls.

Other hazards:

Fire or explosion Improper storage or disposal

Used with Permission of


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OccupationalEnvironmental

Residualperchloroethylenesolvent may be present

in freshly dry cleanedclothes


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Properties of Solvents

Solubility

Non-flammability/

Flammability/

Explosivity

Volatility

Metabolism

Complex mixtures

Used with permission of Advanced Chemistry Development Co. Graphic


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Routes of Solvent Exposure

Inhalation

Absorption

-skin

-mucous

membranes

Ingestion

InjectionJane Norling Graphic


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Organ System Effects


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BiologicalMonitoring

For Example:

Urine testing for:

Benzene Phenol

Toluene Hippuric Acid, o-Cresol

Xylene Methyl Hippuric Acid

n-Hexane 2,5 hexanedione*

-References:

ACGIH Biological Exposure Indices

* Not commercially available at this timeCorel Graphic


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Occupations Exposed to Solvents Painters

Construction workers Semiconductor workers

Machinists / auto mechanics

Manufacturing workers Glue, Paint, Chemical, Plastics

Rotogravure Printers, Metal Degreasers

Graffiti removers

Refinery workers Manicurists

Drycleaners

Many others


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Solvent Related Diseases

Acute Intoxication Chemical Headache

Chemical Hepatitis

Chronic Toxic

Encephalopathy

Hematological

Effects

Renal Effects Reproductive Health

Effects

Toxic Peripheral

Neuropathy

Bill Bowerman developed

n-Hexane related peripheral

neuropathy from glues used forrunning shoes


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Dx of Solvent-Related Disease

10 Step Process

Certain conditions shouldtrigger the thought that it

might be solvent-related:

Chemical hepatitis, peripheralneuropathy, chronic headache,

chronic cognitive impairment,

miscarriage, and asthma.

Corel Graphic


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Dx: Step 1 - Medical & Exposure

Records Prior medical records

Industrial Hygiene data Labels, Material Safety

Data Sheets (MSDS),

Chemical Inventory Lists

OSHA reports


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Dx: Step 2 - Exposure History

Symptoms &

Exposure History

Complete History &

PhysicalExamination

Specific job duties,

solvent exposures

Exposure monitoring

Frequency of acute

solvent intoxication

episodes


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Acute Solvent Intoxication -Stages

Narcosisimpaired psychomotor

function as measured by

reaction time, manual

dexterity, coordination, or

body balance

Anesthesia

Central nervoussystem depression

Respiratory arrest

Unconsciousness


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Dx: Step 3 - Medical History

Asthma

History of Blood

Dyscrasias

Hearing loss

History of PsychologicalProblems Prior to exposure

After exposure


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Dx: Step 4 - Physical Examination

Focus on:

Skin

Eyes

Gastro -

intestinal

Neurologic

system

Mental Status


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Dx: Step 5 - Laboratory Tests

Screening

Biological Indices

Pathologic

Indices

NIOSH Database of Medical Tests for OSHA

Regulated Substances:

http://www.cdc.gov/niosh/nmed/medstart.html

Corel Graphic


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Dx: Step 6 - Other Testing Nerve Conduction

Studies

Color Vision

Hearing

Pontogram (blinkreflex facial and

trigeminal nerveevaluation)

Peak flow


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Dx: Step 7 - Site Visit

Walk Through of Patients Workplace

Assess workplace

and potential exposures

Personal or area

industrial hygiene

sampling

Ventilation of worksite

Potential skin exposure

Obtain prior environmental test results, ifavailable


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Dx: Step 8 - Relationship?

Decide whether the the

patients diagnosis is

more likely than not

work-related.

Is the latency period

adequate?

Exposure data

consistent?


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Dx: Step 9 - Make the Diagnosis

Was the dose of the solvent exposure

adequate, in your opinion, to cause the

problem? (e.g., is there a history of

acute intoxication episodes?)

OR Is patient particularly sensitive to

the effects of solvents (e.g. increasedindividual susceptibility or acquired

intolerance)?


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Dx: Step 9 - Diagnosis

Rule out other diseases with similar

outcomes:

e.g., Alcoholic Hepatitis/ Hepatitis B

Decide if a pre-existing condition exists

that has been exacerbated.

File Clinicians First Report, if required

by State Law.


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Dx: Step 10 - Disposition

Return to work

Modified duty / preclusions

Factors of disability Objective/ Subjective

Vocational rehabilitation

Apportionment

Future medical care


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Prevention of Solvent Exposures

Elimination Substitution

Engineering

Controls

Administrative

Controls

Isolation

Personal ProtectiveEquipment

Education

Used with permission from


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Personal Protective Equipment

Protective Clothing-Impermeable aprons

Gloves Breakthrough

time depends on type of

glove, solvent exposureand activity.

Chemically resistant gloves: natural rubber,

butyl rubber, chloroprene, nitrile, andfluorocarbon; or various plastics: polyvinylchloride, polyvinyl alcohol, polyethylene

Permission requested from


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Personal Protective Equipment-

RespiratorsRespirator Program must

include:

Training

Cleaning

Fit testing

Medical Clearance

Change of filters scheduledepends on exposure type andamount


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Environmental pressures are

often the primary cause ofsolvent substitution.

Montreal Protocol

Clean Air Act

Pollution Prevention (P2)


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Additional Resources

Handouts

Bibliography

Web Sites

Jonathan S Rutchik, MD, MPH Organic Solventshttp://www.emedicine.com/neuro/topic285.htm

Acknowledgements:

Photos by Janet Delaney Elizabeth Katz, MPH, CIH

Rosemarie Bowler, PhD

Public Health Institute, AOEC and NIOSH staff

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Health Hazards of Solvents

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