biocidals and respiratory effects - adverse respiratory...
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Biocidals and Respiratory Effects- Adverse respiratory effects
related to occupational exposure to chlorine-based cleaning products
Institute for Occupational Health of R. Macedonia, SkopjeWHO Collaborative Center
GA2LEN Collaborative Center
Prof. Jordan Minov, MD PhD
3rd International Biocidal Congress Antalya, Turkey, November 22-25, 2016
Biocides
Biocides are defined in the European legislation as chemical substances or microorganisms
intended to destroy, deter, render harmless, or exert a controlling effect on any harmful organisms by chemical or biological means
Biocides
Biocidal products (BP)
The products containing one or more biocidal active substances (mostly chemical products)
and other non-active co-formulants that ensure the effectiveness as well as desired characteristics
(pH, viscosity, color, odor, etc.) of the final product
BP classification
According to the Biocidal Product Regulation (BPR) EU 528/2012,BP are classified into 22 product types (application categories),
grouped in four main groups:
- Disinfectants and general biocidal products (five product types)- Preservatives (eight product types)- Pest control (seven product types)
- Other biocidal types (two product types)
BP Main Group 1 – Disinfectants and general biocidal products Chemical substances used to destroy
vegetative microbes (bacteria and fungi) and viruses on surfaces, materials, medical equipment and other man-made objects
SanitizersChemicals able to kill 99+ % of microorganisms in applicable situations
Antiseptics Chemicals able to prevent growth and reproduction of various microbes, but do not destroy them,
used to disinfect skin
The ideal disinfectant should offer complete sterilization without harming other forms of life, be inexpensive, and non-corrosive.
An ideal disinfectant does not exist.
All disinfectants are, by their very nature, potentially harmful for humans and animalsand should be used with appropriate care
Disinfectants
Common disinfectants:
- Chlorine and its compounds(hypochlorites, chlorine dioxide, chloramine, sodium chlorite/chlorate, etc.)
- Iodine - Alcohol
- Hydrogen peroxide- Phenol and other phenolics
- Ozone- Potassium permanganate
- Quaternary ammonium salts- Toluene
Disinfectants
Disinfectants
The choice of disinfectant to be used depends on the particular situation.Some disinfectants have a wide spectrum (kill nearly all microrganisms),
other kill a smaller range of disease-causing microorganisms, but are preferred for other properties
(may not be corrosive and relatively not toxic to humans)
There is a recommendation not to mix disinfectants(especially those used in people’s homes)
with other cleaning products as chemical reactions can occur
www.globalsafe.com.au
Chlorine
symbol Cl, atomic number 17, relative atomic mass 35.5
halogen groupyellow-green diatomic gas
highly reactivethe highest electron affinity
and the third highest electronegativity of all reactive elements
strong oxidizing agent
free chlorine is rare on Earth
chlorine compounds:chlorides, chlorine oxides, chlorates, perchlorates, chlorites, hypochlorites,
chloramine, organic chlorine compounds
Chlorine
Chlorine is the most widely used industrial biocide today
(a broad-spectrum germicide)- disinfection of drinking water
and swimming pool water- insecticides, disinfectants and
cleaning products
Chlorine is used in the production of a wide range of
industrial and consumer products and materials from paper to plastics, from paints to dyes,
and from textiles to agrochemicals
Chlorine
Concentration(ppm in air)
Acute Health Effects
1-3 ppm Mild mucous membrane irritation
5-15 ppm Upper airways inflammation
30 ppm Lower airways inflammation
40-60 ppm Toxic pneumonitis / toxic lung edema
450 ppm Death within 30 minutes
1,000 ppm Death within a few minutes
Listed as a hazardous air pollutant in 1990 Clean Air ActRegulated workplace exposureOSHA – PEL 1 ppm (3 mg/m3)
NIOSH – 0.5 ppm/15 minutes
Hypochlorites
Salts from hypochlorous acid (HOCl)formulated in several different forms.
As biocides are usually applied sodium hypochlorite (NaOCl) and calcium hypochlorite (Ca(OCl)2)
Hypochlorites function the same way as chlorine, although they are a bit less effective
Neutrophils of the human immune system produce small amounts of hypochlorite inside phagosomes,
which digest bacterias and viruses
Sodium hypochlorite
An effective sanitizer as low as 2%As a household bleach available as 5-6%As a disinfectant available as 8-12-15%
Effective on a wide variety of bacteriaInhibits algae growth (cooling towers)
Not affected by hard water saltsGenerally inexpensive
CorrosiveIrritating to the skin and airways
Decreased effectiveness in the presence of organic matter
Decreased effectiveness with increasing pHDeteriorates when exposed to light
Sodium hypochlorite
Sodium hypochlorite
Production of hypochlorites in R. Macedonain 2011 – 115 t (Cl)
State Statistical Officewww.stat.gov.mk
Sodium hypochlorite
Health effects and hazards of exposure to hypochlorites are similar to those of chlorine
Exposure to sodium hypochlorite is associated with: - short-term respiratory effects
(upper airways syndrome, transient obstructive syndrome, etc.)- long-term respiratory effects
(reduced lung function, bronchial hyperresponsiveness, exercise-induced bronchoconstriction, occupational asthma, etc.)
Type and severity of respiratory impairment vary according to amount and duration of exposure,
as well as to endogenous characteristics of the exposed individual
Indoor cleaners
Indoor cleaning work is carried out in homes, offices, public and commercial objects, as well as in industrial objects
Indoor cleaners
Indoor cleaning-related exposure includes a number of irritants and sensitizers
which may cause adverse respiratory effects or contribute to their occurrence
Common compounds of indoor cleaning-related exposure include:
- active substance (e.g. chlorine and its compounds, ammonia, caustic soda,
quaternary ammonium compounds, etc.), - perfumes and scents (e.g. lemon or pine scent),
- preservatives (e.g. isothiozolinones), - corrosion inhibitors (e.g. ethanolamines)
Use of natural rubber latex gloves may involve the risk of sensitization to latex allergens
A higher risk of mite sensitization, especially in household cleaning
Short-term effectsAcute irritative respiratory sy
Acute irritative respiratory sy related to workplace exposuresIOH – WHO CC
84 patients in the period 2011-2015
22 indoor cleaners (26.2%) - upper airways sy in all of them
- transient obstructive sy in five of them
Symptoms occurred 15-30 minutes after work with sodium hypochlorite-based cleaning product/disinfectant (5.25-8%)
Short-term effectsAcute irritative respiratory sy
Positive bronchodilator test in office cleaner with transient obstructive sy
Negative metacholine challenge in the same patient six months after resolution of the symptoms
Long-term effectsReduced lung function
84 female office cleaners 27 exposed and 57 unexposed to environmental tobacco smoke (ETS) at the workplace
54 female office workers
matched to office cleaners by age and smoking status
Long-term effectsReduced lung function
Spirometric parameter
Exposed to ETSin the workplace
(n = 27)
Unexposed to ETSin the workplace
(n = 57)
P-value
FVC (% pred) 90.8 ± 10.6 91.6 ± 9.1 P > 0.05
FEV1 (% pred)FEV1/FVC%
82.8 ± 10.974.1 ± 5.4
85.1 ± 8.775.2 ± 4.5
P > 0.05P > 0.05
MEF50 (% pred)MEF25 (% pred)
62.3 ± 7.853.6 ± 6.0
65.9 ± 9.963.7 ± 9.4
P > 0.05P < 0.05
MEF25-75 (%pred) 69.1 ± 12.7 71.8 ± 13.2 P > 0.05
Mean values of spirometric parameters in office cleaners in regard to their exposure to environmental tobacco smoke (ETS) at the workplace
Mean values of spirometric parameters in office cleaners and matched controls
Spirometric parameter
Office cleaners(n = 84)
Office workers(n = 54)
P-value
FVC (% pred) 91.3 ± 11.9 95.7 ± 13.2 P < 0.05
FEV1 (% pred)FEV1/FVC%
84.1 ± 12.774.9 ± 5.2
88.6 ± 10.878.1 ± 4.8
P < 0.05P < 0.05
MEF50 (% pred)MEF25 (% pred)
64.7 ± 8.955.4 ± 7.8
72.5 ± 11.267.3 ± 7.2
P < 0.05P < 0.05
MEF25-75
(%pred)70.3 ± 11.9 78.7 ± 13.4 P < 0.05
Long-term effectsBHR
38 female domestic cleaners
38 female office cleaners
38 female office workers
complementary by age and smoking status
Long-term effectsBHR
21.1%
18.4%
13.2%
0
5
10
15
20
25
Domestic cleaners Office cleaners Office workers
7.8%
10.5%
2.6%
0
2
4
6
8
10
12
Domestic cleaners Office cleaners Office workers
Prevalence of BHR in examined subjects
Prevalence of borderline BHR in examined subjects
Mild BHR in domestic cleaner (PC20 = 2.3 mg/mL)
Borderline BHR in domestic cleaner (PC20 = 5.1 mg/mL)
Long-term effectsEIB
43 female office cleaners
45 female office workers
matched to office cleaners by age and smoking status
Long-term effectsEIB
Spirometric parameter Office cleaners(n = 43)
Office workers(n = 45)
P - value
FVC (%pred)FEV1 (%pred)FEV1/FVC%MEF50 (%pred)MEF25 (%pred)MEF25-75 (%pred)
87.2 14.482.3 9.472.6 4.163.4 10.951.6 12.270.2 11.7
104.8 10.196.1 6.779.6 3.882.6 12.774.8 10.991.7 13.4
P < 0.05P < 0.05P < 0.05P < 0.05P < 0.05P < 0.05
Mean values of spirometric parameters in office cleaners and matched controls
Variable Office cleaners(n = 43)
Office workers
(n = 45)
P- value
EIB prevalence (%)
Mean exercise load (Watt)
Mean fall index FEV1 in the subjects with positive exercise challenge (%)
Mean time of EIB occurrence (minutes after exercise)
9.3
96.7 15.4
23.7 4.8
6.4 2.3
6.7
98.8 17.6
16.1 5.3
6.9 3.1
P > 0.05
P > 0.05
P < 0.05
P > 0.05
EIB characteristics in office cleaners and matched controls
Long-term effectsOA
The products used to clean and disinfect can cause sensitizer- or irritant-induced OA or to aggravate pre-existing asthma
Chlorine compounds may cause sensitizer-induced OA (chloramine-T, chlorhexidine, hexachlorophene, etc.)
Chlorine compounds, including sodium hypochlorite, may cause irritant-induced OA
- Reactive airway dysfunction syndrome (RADS)single exposure to very high level of chlorine compounds
- Non-RADS-irritant-induced OArepeated exposure to moderate-to-high level of chlorine compounds
Chlorine compounds may aggravate pre-existing asthmawork-aggravated asthma (WAA) or work-exacerbated asthma (WEA)
Differentiation of the certain OA types is a matter of growing interest, and not with a little controversy
Long-term effectsOA
Long-term effectsOA
0
50
100
150
200
250
300
350
400
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30
Days
mL
min max mean
Serial PEFR measurements at and away from work in female cleaner with OA
Prevention
Adverse respiratory effects related to workplace exposure
to chlorine-based cleaning products/disinfectants are potentially preventable
Primary preventionControl of exposure:Engineering control
respiratory protective devices
Secondary preventionEarly detection and intervention:
Regular periodical check-ups
Tertiary preventionManagement of advanced disease
Thank You!