exposure to organic solvents and health in developing countries - perspectives on prevention...
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Exposure to organic solvents and Exposure to organic solvents and health in developing countries -health in developing countries -
perspectives on preventionperspectives on prevention
Khaldoun NijemKhaldoun Nijem
ContentContent - - organic solventsorganic solvents - literature review on organic solvent - literature review on organic solvent exposure and health effects in exposure and health effects in developing countries developing countries - working conditions in developing - working conditions in developing countriescountries -Palestinian case -Palestinian case- principles of primary prevention to - principles of primary prevention to solvent exposuresolvent exposure- applying principles in developing - applying principles in developing countriescountries- summary and conclusions- summary and conclusions
Definition of organic solventsDefinition of organic solvents
Organic solvents are a group of volatile Organic solvents are a group of volatile compound that are relatively stable and compound that are relatively stable and used for extraction, dissolving or used for extraction, dissolving or suspending materials not soluble in suspending materials not soluble in water water
(Lees-Haley and Williams 1997; NIOSH 1987)(Lees-Haley and Williams 1997; NIOSH 1987)
Exposure to organic solvents is Exposure to organic solvents is widespread in both industrialized widespread in both industrialized and developing countriesand developing countries
-House painting, dry cleaning, machine -House painting, dry cleaning, machine degreasing, printing, degreasing, printing,
(Triebig et al 1992; Paul et al 1997)(Triebig et al 1992; Paul et al 1997)
Route of entry
InhalationInhalation Skin absorptionSkin absorption IngestionIngestion
Health effectsHealth effects
Neurotoxic effectsNeurotoxic effects- CNS- CNS
toxic encephalopathy (Baker et al 1985), toxic encephalopathy (Baker et al 1985),
headache (Wang and Chen 1993) headache (Wang and Chen 1993)
depression, fatigue (Morrow et al 1993), depression, fatigue (Morrow et al 1993),
dizziness, nausea (Fiddler et al 1987) dizziness, nausea (Fiddler et al 1987)
neuropsychiatric symptoms (Struwe and neuropsychiatric symptoms (Struwe and Wenberg1983)Wenberg1983)
- PNS- PNSpolyneuropathy (Takeuchi 1993)polyneuropathy (Takeuchi 1993)
Skin and respiratory system effectsSkin and respiratory system effectschronic cough, wheezing (Paggiaro et al 1985)chronic cough, wheezing (Paggiaro et al 1985)bronchial irritant (Harving et al 1991)bronchial irritant (Harving et al 1991)bronchial hyper reactivity (Jones and Brautbar 1997)bronchial hyper reactivity (Jones and Brautbar 1997)
Other eOther effectsffectsKidneyKidneyacute tubular necrosis acute tubular necrosis (Gerr 1992),(Gerr 1992),
chronic kidney failure chronic kidney failure (Kluwe et al 1984)(Kluwe et al 1984) LiverLiver
toxic liver injury toxic liver injury (Dossing et al 1983)(Dossing et al 1983) CancerCancer
leukemialeukemia (Rinsky 1987)(Rinsky 1987)
Literature reviewLiterature review
A- developed countriesA- developed countries
well studied: many studieswell studied: many studies
B- developing countriesB- developing countries
poorly studied: few studiespoorly studied: few studies
Organic solvents exposure and health effect in Organic solvents exposure and health effect in developing countriesdeveloping countries: : Literature Review Literature Review
CountryCountryOccupationOccupationMain effectMain effectReference Reference
TurkeyTurkeyShoe Shoe industryindustry
LeukemiaLeukemiaAksoy et Aksoy et al 1974al 1974
TaiwanTaiwanPaint Paint factoryfactory
Impaired Impaired performanceperformance
Tsai et al Tsai et al 19971997
Brazil Brazil Petro-Petro-chemicalchemical
Decreased Decreased emotional status, emotional status, memory impairmentmemory impairment
Saretto et Saretto et al 1997al 1997
PalestinePalestineShoe Shoe industryindustry
Headache, mental Headache, mental irritability, sore eyesirritability, sore eyes
Nijem et Nijem et al 2000al 2000
Organic solvents exposure and health effect in Organic solvents exposure and health effect in developing countriesdeveloping countries: : Literature Review- contLiterature Review- cont
Escalona et Escalona et al 1995al 1995
Fatigue, difficulties in Fatigue, difficulties in memory, confusion, sleep memory, confusion, sleep disturbances, paresthesias disturbances, paresthesias in extremities.in extremities.
Adhesive Adhesive factoryfactoryVenezuelaVenezuela
Lee 1993Lee 1993Poor performancePoor performanceCar paintingCar paintingKoreaKorea
Chia et al Chia et al 19931993
Poor visual motor control, Poor visual motor control, memory impairmentmemory impairmentElectronic Electronic
industryindustrySingapore Singapore
Ng et Ng et al 1990al 1990
Fatigue, irritability, Fatigue, irritability, depression, poor memory, depression, poor memory, sleep disturbance, sleep disturbance, neurobehavioral defects.neurobehavioral defects.Paint Paint
productionproductionChinaChina
ReferenceReferenceMain effectMain effectOccupationOccupationCountryCountry
Work condition in developing Work condition in developing countriescountries
Uncontrolled with many hazardous Uncontrolled with many hazardous exposuresexposures
Poorly shielded machineryPoorly shielded machinery Minimum or non existing safety Minimum or non existing safety
standardsstandards Factory regulation enacted several Factory regulation enacted several
decades ago in colonial times decades ago in colonial times
For many people in developing For many people in developing countries, any job, no matter how countries, any job, no matter how hazardous, is seen as preferable to hazardous, is seen as preferable to the alternative of unemploymentthe alternative of unemployment
(Vilanilam 1980)(Vilanilam 1980)
Use of personal protective equipment in shoe workshops, Hebron 1996-1997
Protective gears Never N%
Some times N %
Always N %
Gloves97 94.22 1.94 3.9
Filter Masks100 97.12 1.91 1.0
Goggles102 990 0.01 1.0
Head covers102 990 0.01 1.0
Special shoes93 90.30 0.010 9.7
Working clothesAny type
84 81.6 78 75.7
0 0.02 1.9
19 18.423 22.3
Levels of PreventionLevels of Prevention
Primary preventionPrimary prevention Secondary preventionSecondary prevention Tertiary preventionTertiary prevention
Primary preventionPrimary prevention
Primary prevention Primary prevention defined as: including defined as: including all strategies designed all strategies designed to eliminate the to eliminate the probability of exposure probability of exposure to hazardous to hazardous conditions.conditions.
Secondary preventionSecondary prevention
““Secondary prevention can be Secondary prevention can be defined as the measures defined as the measures available to individuals and available to individuals and population for the early population for the early detection and prompt and detection and prompt and effective intervention to correct effective intervention to correct departures from good health.”departures from good health.”
Last, 1995Last, 1995
Tertiary preventionTertiary prevention
Tertiary prevention: attempt Tertiary prevention: attempt to reduce the consequences to reduce the consequences of diseases by treatment and of diseases by treatment and rehabilitation of workers. rehabilitation of workers. Also to minimize emotional Also to minimize emotional and practical difficulties of and practical difficulties of ill health retirements.ill health retirements.
Primary preventionPrimary prevention
engineering controlengineering control behavioral controlbehavioral control administrative controladministrative control
Engineering controlEngineering control
Elimination or SubstitutionElimination or Substitution Change processChange process Segregation / encapsulationSegregation / encapsulation VentilationVentilation Work practicesWork practices
Engineering control:Engineering control:
1- Elimination or Substitution1- Elimination or Substitution Ceasing to use the chemicalCeasing to use the chemical Replace the harmful compound by less Replace the harmful compound by less
hazardous formhazardous form
i.e. substitution of benzene by i.e. substitution of benzene by cyclohexane or toluenecyclohexane or toluene
2- Changing the process2- Changing the process
Changing the process or Changing the process or utilizing a new one to reduce utilizing a new one to reduce the hazardous exposure.the hazardous exposure.
3. Encapsulation (segregation)3. Encapsulation (segregation)
Total or partial enclosed process and handling system.
Segregation of the hazardous process from the operator.
4. Ventilation4. Ventilation
Ensure safe and effective removal of contaminated air to a safe place
a-local exhaust ventilation
b-dilution ventilation (precipitation): high air flow
5. Work practices5. Work practices
Keeping chemicals in safe place Provision of means for safe storage,
storage areas should be kept separate from process areas
Not leaving dangerous materials lying about
Regular cleaning of contaminated walls, surfaces
Prohibition of eating, drinking, and smoking
Work practices- continued
- Emergency procedures
- Adequate precautions against accidental release, fire, and chemical reactivity
- PPE: Most such devices are not comfortable for long-term use and give only partial protection. included in this category are respirators, protective clothing and gloves, eye shields and hearing defenders
Primary preventionPrimary prevention
engineering controlengineering control behavioral controlbehavioral control administrative controladministrative control
Behavioral controlBehavioral control
EducationEducation
-workers should be informed of the -workers should be informed of the hazards associate with chemicals.hazards associate with chemicals.
-they should be instructed about how to -they should be instructed about how to obtain and use the information.obtain and use the information.
-workers should be trained on using -workers should be trained on using control measures.control measures.
Primary preventionPrimary prevention
engineering controlengineering control behavioral controlbehavioral control administrative controladministrative control
Administrative controlAdministrative control
OrganizationOrganization
- - in work place:in work place: - worker inspector- worker inspector
- - governmental:governmental: - acts which deal specifically with chemicals- acts which deal specifically with chemicals - acts concentrate on health and - acts concentrate on health and
(OSHA, NIOSH) (OSHA, NIOSH) - inspection: Chemical Inspectorates - inspection: Chemical Inspectorates
agencies agencies
Legislation: Legislation: internal control: Norway internal control: Norway
Internal controlInternal control
Risk assessment: The process of Risk assessment: The process of determining risks to health determining risks to health attributable to hazards.attributable to hazards.
Steps in risk assessment:Steps in risk assessment:
1-1- Hazard identificationHazard identification
2- Risk characterization2- Risk characterization3- Exposure assessment 3- Exposure assessment
4- Risk estimation4- Risk estimation
DefinitionsDefinitions Hazard identification: Identify the Hazard identification: Identify the
agent responsible for the health agent responsible for the health problem, its adverse effects, the problem, its adverse effects, the target population and the target population and the conditions of exposure.conditions of exposure.
Risk characterization: describing Risk characterization: describing the potential health effects of the the potential health effects of the hazard-quantifying dose effect hazard-quantifying dose effect and dose- response relationships.and dose- response relationships.
Definitions Definitions cont.cont.
Exposure assessment: quantifying Exposure assessment: quantifying exposure (dose) in a specified exposure (dose) in a specified population based on measurement population based on measurement of emissions, environmental levels of emissions, environmental levels of toxic substances and biological of toxic substances and biological monitoringmonitoring
Risk estimation: combining risk Risk estimation: combining risk characterization, dose-response characterization, dose-response relationships and exposure relationships and exposure estimates to quantify the risk level estimates to quantify the risk level in a specific populationin a specific population
Risk managementRisk management The steps taken by the employer or The steps taken by the employer or
decision maker, to alter i.e.. reduce decision maker, to alter i.e.. reduce the levels of risk to which a the levels of risk to which a population or individual is population or individual is subjected.subjected.
Steps in risk management:Steps in risk management:
1- Risk evaluation1- Risk evaluation
2- Exposure control2- Exposure control
3- Risk monitoring3- Risk monitoring
Primary prevention in Primary prevention in Palestine should be done Palestine should be done in a way suitable for the in a way suitable for the Palestinian communityPalestinian community
Summary and conclusionSummary and conclusion
In the industrialized countries stringent In the industrialized countries stringent legislation effectively control the exposure legislation effectively control the exposure level at workplaces, which had led to level at workplaces, which had led to dramatic drop in the incidence of dramatic drop in the incidence of occupational diseases.occupational diseases.
However, developing and newly However, developing and newly industrialized countries suffered from the industrialized countries suffered from the absence of effective prevention of chemical absence of effective prevention of chemical hazards (i.e. Organic solvents). The hazards (i.e. Organic solvents). The international guidelines strongly emphasize international guidelines strongly emphasize the value of prevention. the value of prevention.
Summary and conclusion Summary and conclusion cont.cont.
The history of industrialization has taught us The history of industrialization has taught us the importance of primary prevention. the importance of primary prevention. Effective prevention requires:Effective prevention requires:
1- Well-established infrastructure1- Well-established infrastructure
2- Legislation 2- Legislation
3- Appropriate control mechanism for all 3- Appropriate control mechanism for all steps, starting from the planning industrial steps, starting from the planning industrial facilities and ending with appropriate use, facilities and ending with appropriate use, collection and disposals of wastes.collection and disposals of wastes.