Hydrocarbons and Solvents.pptx Occupational health hazards that may arise out of solvent exposure while working in these industries. A must for all those AFIH students.

Occupational Health presentation, best content for students & trainees of occupational health

1. Hydrocarbons

2. Hydrocarbons Organic compounds containing H and C Derived from plants or from petroleum distillates 3 basic types aliphatic aromatic halogenated Petroleum distillates - produced from fractional distillation of crude petroleum Terpenes - distillates of pinewood

3. Hydrocarbons AAPCC lists HC’s as the 12th most common poison exposure 66, 645 cases of HC exposure in 1997, as reported by the American Association of Poison Control Centers 95% were unintentional, 60% were pediatric more than 1/2 of all exposures occur in children under the age of 6 years most exposures are accidental 20 people died in 1997, most in children > 5yrs.

4. Hydrocarbons, cont. Examples of petroleum distillates kerosene gasoline mineral spirits naphtha mineral seal oil diesel oil fuel oil

5. Hydrocarbons, cont. Characteristics that determine toxicity surface tension - cohesiveness of molecules on the surface of a liquid volatility - tendency of a liquid to change into a gas or vapor viscosity - resistance of a substance to flow over a surface, directly relates to the aspiration hazard low verses high viscosity

6. Hydrocarbons, cont. Mechanism of toxicity, cont. major threat is danger of aspiration pneumonitis vomiting increases the risk of aspiration when aspirated, petroleum distillates : inhibit surfactant - causing alveolar collapse and resultant hypoxemia can displace O2 in alveoli - hypoxia cause bronchospasm and capillary damage cause hemorrhagic bronchitis cause pulmonary edema

7. Hydrocarbons, cont. Mechanism of toxicity, cont. Systemic toxicity can occur after oral ingestion Most are lipophilic and attracted to the CNS - causing CNS depression Most cause direct mucosal irritation Certain volatile agents (toluene, benzene, butane and xylene ) have a disinhibiting euphoric effect Can cause AV block, bradycardia

8. Hydrocarbons, cont. Characteristics of poisoning: Signs and symptoms of pulmonary involvement coughing, gasping and choking smell of gasoline to the breath rales and wheezing upon auscultation hemoptysis and pulmonary edema Signs of CVS involvement: Dyspnea , syncope, sudden cardiac death ( sens. myocardium to catecholamines )

9. Hydrocarbons, cont. Signs and symptoms of GIT involvement irritation of oropharynx nausea and vomiting abdominal pain Signs and symptoms of CNS involvement cerebral hypoxemia lethargy somnolence coma or seizures

10. Hydrocarbons, cont. Management of poisoning Keep patient calm To induce vomiting or not to induce vomiting Do not induce vomiting in patients who have ingested low viscosity petroleum distillate hydrocarbons ingestion as it increases the risk of aspiration pneumonitis Do Maintain airway and support respiration

11. Hydrocarbons, cont. Do induce vomiting in patients who have ingested: halogenated hydrocarbons insecticides turpentine aromatic hydrocarbons or ones which contain of heavy metals - must protect airway ( endotracheal intubation)

12. Hydrocarbons, Terpenes Unsaturated aliphatic cyclic hydrocarbons derived from plants Includes pine oil, turpentine, and camphor oil 1998 AAPCC reported 10,482 exposures to disinfectants containing pine oil, 1,064 to turpentine, 8,945 to camphor and 1,237 to camphor/methyl salicylate . No fatalities were reported Most exposures are accidental

13. Hydrocarbons, Terpenes Mechanism of Action all terpenes are local irritants GIT signs and symptoms aspiration pulmonary toxicity coma seizures Treatment: Careful attention to airway DO NOT induce vomiting because of initial risk of aspiration and risk of CNS depression or seizure

14. 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 room temperature used to dissolve other substances

15. Scope of the Problem Over 49 million tons of solvent chemicals are produced and used each year in the US alone. Often exposure involves a mixture of solvents.

16. Occupational Disease due to Solvents? 390,000 new cases of all types of occupational disease appear annually in the US. It is unknown how many of these cases may be related to solvent exposure. Similar to other occupational diseases, 95% of all occupational solvent-related disease cases are never reported, most are never recognized as being occupationally-related.

17. Occupational çè Environmental Workplace solvents may also result in exposures to neighborhood residents if discharged from workplaces without adequate controls. Other hazards: Fire or explosion Improper storage or disposal

18. Occupational çè Environmental Residual perchloroethylene solvent may be present in freshly dry cleaned clothes

19. Properties of Solvents Solubility Non-flammability/ Flammability/ Explosivity Volatility Metabolism Complex mixtures

20. Routes of Solvent Exposure Inhalation Absorption -skin -mucous membranes Ingestion Injection

21. Organ System Effects

22. Biological Monitoring For Example: Urine testing for: Benzene è Phenol Toluene è Hippuric Acid, o-Cresol Xylene è Methyl Hippuric Acid n- Hexane è 2,5 hexanedione Vinyl Chloride Thiodiacetic acid Trichloroethylene metabolites in urine (TCA, trichloroethanol ) and blood ( trichloroethanol )

23. 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

24. 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 for running shoes

25. Dx of Solvent-Related Disease 10 Step Process Certain conditions should trigger the thought that it might be solvent-related : Chemical hepatitis, peripheral neuropathy, chronic headache, chronic cognitive impairment, miscarriage, and asthma.

26. Dx: Step 1 - Medical & Exposure Records Prior medical records Industrial Hygiene data Labels, Material Safety Data Sheets (MSDS), Chemical Inventory Lists OSHA reports

27. Dx : Step 2 - Exposure History Symptoms & Exposure History Complete History & Physical Examination Specific job duties, solvent exposures Exposure monitoring Frequency of acute solvent intoxication episodes

28. Acute Solvent Intoxication -Stages Narcosis impaired psychomotor function as measured by reaction time, manual dexterity, coordination, or body balance Anesthesia Central nervous system depression Respiratory arrest Unconsciousness

29. Dx: Step 3 - Medical History Asthma History of Blood Dyscrasias Hearing loss History of Psychological Problems Prior to exposure After exposure

30. Dx: Step 4 - Physical Examination Focus on: Skin Eyes Gastro - intestinal Neurologic system Mental Status

31. 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

32. Dx: Step 6 - Other Testing Nerve Conduction Studies Color Vision Hearing Pontogram (blink reflex – facial and trigeminal nerve evaluation) Peak flow

33. Dx: Step 7 - Site Visit “Walk Through” of Patient’s Workplace Assess workplace and potential exposures Personal or area industrial hygiene sampling Ventilation of worksite Potential skin exposure Obtain prior environmental test results, if available

34. Dx: Step 8 - Relationship? Decide whether the the patient’s diagnosis is more likely than not work-related. Is the latency period adequate? Exposure data consistent?

35. 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. increased individual susceptibility or acquired intolerance)?

36. 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 Clinician’s First Report, if required by State Law.

37. Dx: Step 10 - Disposition Return to work Modified duty / preclusions Factors of disability Objective/ Subjective Vocational rehabilitation Apportionment Future medical care

38. Prevention of Solvent Exposures Elimination Substitution Engineering Controls Administrative Controls – Isolation Personal Protective Equipment Education

39. Personal Protective Equipment Protective Clothing-Impermeable aprons Gloves – Breakthrough time depends on type of glove, solvent exposure and activity. Chemically resistant gloves: natural rubber, butyl rubber, chloroprene, nitrile , and fluorocarbon; or various plastics: polyvinyl chloride, polyvinyl alcohol, polyethylene

40. Personal Protective Equipment-Respirators Respirator Program must include: Training Cleaning Fit testing Medical Clearance Change of filters –schedule depends on exposure type and amount

41. Vinyl chloride highly stable in the absence of sunlight or oxygen. Above 400 °C, it dissociates into acetylene and hydrochlorine . In the atmosphere VC reacts with hydroxyl radicals and ozone, ultimately forming formaldehyde, carbon monoxide, hydrochloric acid and formic acid. half-time of VC in the atmosphere is about 20 hours. Sources- VC production plants, polyvinyl chloride (PVC) polymerization facilities, and plants where PVC products are fabricated Health Issues Raynaud’s phenomenon, acro-osteolysis of the hands, and pseudosceleroderma . Hepatomegaly and noncirrhotic portal fibrosis with portal hypertension and splenomegaly Mutagenic and carcinogenic effects Haemangiosarcomas of the liver cancers of brain , CNS and lung cancer - less clear evidence.

42. Trichloroethylene (TCE) Historically, TCE was used as a surgical anesthetic and inhaled analgesic. The Food and Drug Administration banned such use in the United States in 1977 Uses- Refrigerants and other hydrofluorocarbons manufacturing Degreasing solvent for metal equipment Household products, such as cleaning wipes, aerosol cleaning products, tool cleaners, paint removers, spray adhesives, and carpet cleaners and spot removers. Dry cleaners also use trichloroethylene as a spot remover. It readily passes through soil and can accumulate in groundwater. Health Effects May be irritant to Mucous Membrane. Cranial nerves V and VII are specific targets of trichloroethylene and/or its metabolites Sudden death due to cardiorespiratory Failure at High concentrations Arrythmia at Higher exposure due to cardiac sensitization.

43. A worker developed labored breathing and respiratory edema after welding stainless steel that had been washed in trichloroethylene (Sjogren et al. 1991). The effects were attributed to inhalation of the trichloroethylene decomposition products, phosgene and dichloroacetyl chloride, Trichloroethylene exposure can cause nervous system effects that include dizziness, headache, sleepiness, nausea, confusion, blurred vision, facial numbness, and weakness. Secondary effects on muscle strength. Massive Muscular Necrosis may occur at High Concentration. Acute Heaptic Necrosis at High Level. Menstrual abnormality Anorexia, nausea, and vomiting have also been reported as chronic effects of occupational exposure to trichloroethylene Renal toxicity is also reported. Simultaneous alcohol consumption and trichloroethylene inhalation increases the toxicity of trichloroethylene in humans.

44. IARC Class 1 Carcinogen Associated with increased risk of Renal Cell Carcinoma Positive association between NHL and Hepatic Sarcomas.

45. Carbon Tetrachloride Use and Source -produced in large quantities to make refrigerants and propellants for aerosol cans, as a solvent for oils, fats, lacquers, varnishes, rubber waxes, and resins, As a grain fumigant and A dry cleaning agent. Carbon tetrachloride is also a common contaminant of indoor air; the sources of exposure appear to be building materials or products, such as cleaning agents, used in the home. Individuals may also be exposed to carbon tetrachloride by drinking contaminated water. Health Effects Acute Effects Hepatic- Tender Heaptomegaly , changes in enzyme levels, and jaundice.  Renal - nephritis, nephrosis, proteinurea Neurological -Depression of the central nervous system and symptoms like headache, weakness, lethargy, nausea, and vomiting

46. Delayed pulmonary Edema (due to renal effects) Chronic Effects are more pronounced on Heaptic and Renal System. May lead to Reproductive and Developmental abnormality Class 2B carcinogen-causing Hepatic Tumors. Measurement of carbon tetrachloride in exhaled breath.