Exposure to organic solvents and health in developing countries - perspectives on prevention Khaldoun Nijem

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Exposure to organic solvents and health in
developing countries -perspectives on
preventionKhaldoun Nijem
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Content - organic solvents
- literature review on organic solvent exposure
and health effects in developing
countries - working conditions in developing
countries -Palestinian case-
principles of primary prevention to solvent
exposure- applying principles in developing
countries- summary and conclusions
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Definition of organic solvents

• Organic solvents are a group of volatile compound
  that are relatively stable and used for
  extraction, dissolving or suspending materials
  not soluble in water
• (Lees-Haley
  and Williams 1997 NIOSH 1987)

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• Exposure to organic solvents is widespread in
  both industrialized and developing countries
• -House painting, dry cleaning, machine
  degreasing, printing,
• (Triebig et al 1992 Paul et al 1997)

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Route of entry

• Inhalation
• Skin absorption
• Ingestion

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Health effects

• Neurotoxic effects
• - CNS
• toxic encephalopathy (Baker et al 1985),
• headache (Wang and Chen 1993)
• depression, fatigue (Morrow et al 1993),
• dizziness, nausea (Fiddler et al 1987)
• neuropsychiatric symptoms (Struwe and
  Wenberg1983)
• - PNS
• polyneuropathy (Takeuchi 1993)

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Skin and respiratory system effectschronic
cough, wheezing (Paggiaro et al 1985)bronchial
irritant (Harving et al 1991)bronchial hyper
reactivity (Jones and Brautbar 1997)
Other effectsKidneyacute tubular
necrosis (Gerr 1992), chronic kidney failure
(Kluwe et al 1984) Livertoxic liver injury
(Dossing et al 1983) Cancerleukemia (Rinsky
1987)
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Literature review

• A- developed countries
• well studied many studies
• B- developing countries
• poorly studied few studies

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Organic solvents exposure and health effect in
developing countries Literature Review
Reference Main effect Occupation Country
Aksoy et al 1974 Leukemia Shoe industry Turkey
Tsai et al 1997 Impaired performance Paint factory Taiwan
Saretto et al 1997 Decreased emotional status, memory impairment Petro-chemical Brazil
Nijem et al 2000 Headache, mental irritability, sore eyes Shoe industry Palestine
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Organic solvents exposure and health effect in
developing countries Literature Review- cont
Reference
Main effect
Occupation
Country
Fatigue, irritability, depression, poor memory,
sleep disturbance, neurobehavioral defects.
Ng et al 1990
Paint production
China
Poor visual motor control, memory impairment
Chia et al 1993
Electronic industry
Singapore
Lee 1993
Poor performance
Car painting
Korea
Fatigue, difficulties in memory, confusion, sleep
disturbances, paresthesias in extremities.
Adhesive factory
Escalona et al 1995
Venezuela
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Work condition in developing countries

• Uncontrolled with many hazardous exposures
• Poorly shielded machinery
• Minimum or non existing safety standards
• Factory regulation enacted several decades ago in
  colonial times

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For many people in developing countries, any job,
no matter how hazardous, is seen as preferable to
the alternative of unemployment
(Vilanilam 1980)
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Use of personal protective equipment in shoe
workshops, Hebron 1996-1997
Protective gears Never N Some times N Always N
Gloves 97 94.2 2 1.9 4 3.9
Filter Masks 100 97.1 2 1.9 1 1.0
Goggles 102 99 0 0.0 1 1.0
Head covers 102 99 0 0.0 1 1.0
Special shoes 93 90.3 0 0.0 10 9.7
Working clothes ?Any type 84 81.6 78 75.7 0 0.0 2 1.9 19 18.4 23 22.3
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Levels of Prevention

• Primary prevention
• Secondary prevention
• Tertiary prevention

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Primary prevention

• Primary prevention defined as including all
  strategies designed to eliminate the probability
  of exposure to hazardous conditions.

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Secondary prevention

• Secondary prevention can be defined as the
  measures available to individuals and population
  for the early detection and prompt and effective
  intervention to correct departures from good
  health.
  
• Last, 1995

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Tertiary prevention

• Tertiary prevention attempt to reduce the
  consequences of diseases by treatment and
  rehabilitation of workers. Also to minimize
  emotional and practical difficulties of ill
  health retirements.

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Primary prevention

• engineering control
• behavioral control
• administrative control

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Engineering control

• Elimination or Substitution
• Change process
• Segregation / encapsulation
• Ventilation
• Work practices

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• Engineering control
• 1- Elimination or Substitution
• Ceasing to use the chemical
• Replace the harmful compound by less hazardous
  form
• i.e. substitution of benzene by
  cyclohexane or toluene

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2- Changing the process

• Changing the process or utilizing a new one to
  reduce the hazardous exposure.

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3. Encapsulation (segregation)

• Total or partial enclosed process and handling
  system.
• Segregation of the hazardous process from the
  operator.

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4. Ventilation

• Ensure safe and effective removal of contaminated
  air to a safe place
• a-local exhaust ventilation
• b-dilution ventilation (precipitation) high
  air flow

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5. 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

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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

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Primary prevention

• engineering control
• behavioral control
• administrative control

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Behavioral control

• Education
• -workers should be informed of the hazards
  associate with chemicals.
• -they should be instructed about how to
  obtain and use the information.
• -workers should be trained on using control
  measures.

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Primary prevention

• engineering control
• behavioral control
• administrative control

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Administrative control

• Organization
• - in work place
• - worker inspector
• - governmental
• - acts which deal specifically with
  chemicals
• - acts concentrate on health and
  (OSHA, NIOSH)
• - inspection Chemical Inspectorates
  agencies

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Legislation internal control Norway
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Internal control

• Risk assessment The process of determining risks
  to health attributable to hazards.
• Steps in risk assessment
• 1- Hazard identification
• 2- Risk characterization
• 3- Exposure assessment
• 4- Risk estimation

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Definitions

• Hazard identification Identify the agent
  responsible for the health problem, its adverse
  effects, the target population and the conditions
  of exposure.
• Risk characterization describing the potential
  health effects of the hazard-quantifying dose
  effect and dose- response relationships.

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Definitions cont.

• Exposure assessment quantifying exposure (dose)
  in a specified population based on measurement of
  emissions, environmental levels of toxic
  substances and biological monitoring
• Risk estimation combining risk characterization,
  dose-response relationships and exposure
  estimates to quantify the risk level in a
  specific population

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Risk management

• The steps taken by the employer or decision
  maker, to alter i.e.. reduce the levels of risk
  to which a population or individual is subjected.
• Steps in risk management
• 1- Risk evaluation
• 2- Exposure control
• 3- Risk monitoring

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• Primary prevention in Palestine should be done in
  a way suitable for the Palestinian community

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Summary and conclusion

• In the industrialized countries stringent
  legislation effectively control the exposure
  level at workplaces, which had led to dramatic
  drop in the incidence of occupational diseases.
• However, developing and newly industrialized
  countries suffered from the absence of effective
  prevention of chemical hazards (i.e. Organic
  solvents). The international guidelines strongly
  emphasize the value of prevention.

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Summary and conclusion cont.

• The history of industrialization has taught us
  the importance of primary prevention. Effective
  prevention requires
• 1- Well-established infrastructure
• 2- Legislation
• 3- Appropriate control mechanism for all steps,
  starting from the planning industrial facilities
  and ending with appropriate use, collection and
  disposals of wastes.