How important is inadvertent ingestion of hazardous substances at work?

Much is known about human exposure to workplace hazardous substances by inhalation and from skin contact, but there has been little systematic research into ingestion of hazardous substances used at work. This review attempts to identify whether inadvertent ingestion of hazardous substances is an important route of exposure in the workplace and examines possible methods that could be used to quantify ingestion exposure. A number of papers highlight jobs and substances where inadvertent ingestion may be important, typically through case reports or from a theoretical analysis. These scenarios involve exposure to some metals or metal compounds, pharmaceuticals, pesticides, some infectious agents, unsealed radioactive sources and some high molecular weight allergens. In total we estimate that about 4.5 million workers in the UK could have some regular non-trivial intake of hazardous substances by inadvertent ingestion. A conceptual analysis of inadvertent ingestion exposure highlights the role of hand-to-mouth and object-to-mouth events as the primary exposure processes. Two exposure 'compartments' are defined: the peri-oral area (i.e. the area of skin around the outside of the mouth) and the oral cavity. Several options are highlighted for exposure-related measurements, including peri-oral wipes, saliva samples, mouth-rinse samples, hand-wipes and under-nail scrapings. Further research is necessary to define which measurements may be most informative. Human behaviour has a key role in determining inadvertent ingestion exposure. For example, some people are habitual nail biters or repeatedly touch their mouth, both of which will increase the chance of ingesting contaminants on their hands. The frequency that people touch their face is dependant on the circumstances of their work and probably the degree of psychological stress they are under. A proper understanding of the importance of these factors will help in designing interventions to reduce the risks from ingesting hazardous substances at work. When making inhalation or dermal exposure measurements we recommend that details of personal behaviours should be recorded so that some estimate of ingestion risks can be inferred. It is possible that inadvertent ingestion of hazardous substances at work may become more important as employers put more emphasis on controlling inhalation and dermal exposures. Further research is necessary to ensure that risk reduction strategies for inadvertent ingestion of hazardous substances are appropriate and effective.

Comparison of measured dermal dust exposures with predicted exposures given by the EASE expert system.

Estimation and Assessment of Substance Exposure (EASE) is a rule-based computer expert system used by regulatory authorities within the European Union to assist in assessing exposure for both new and existing substances. It can provide estimates of both inhalation exposure levels and dermal exposure levels to the hands and forearms. This article describes the results of a study in which measurements of workplace dermal zinc exposures were collected for an industry-wide risk assessment and also compared with the levels predicted by EASE. Measurements were obtained from subjects in seven different workplaces that were producing or working with zinc metal or zinc compounds. The work activities were grouped a priori into one of three categories used by EASE for dermal exposure assessment: 'non-dispersive use with intermittent direct handling', 'wide dispersive use with intermittent direct handling' and 'wide dispersive use with extensive direct handling'. The predicted exposure ranges for these categories are 0.1-1, 1-5 and 5-15 mg cm(-2) day(-1). Although the average measured exposure levels for each of the categories increased in line with the predictions from EASE, the model overestimated dermal exposure to the hands by a factor of approximately 50 when the mid-point of the EASE range was compared with the measured mean exposure. Furthermore, a significant additional exposure was found on other parts of the workers' bodies for which EASE does not provide any estimates. Interpretation of the dermal exposure data was complicated by the use of protective gloves, which might have limited the amount of zinc dust adhering to the workers' skin. However, observation of the work activities suggested that the pattern of glove use was such that they would not provide a consistent level of protection. This study provided an opportunity to collect a large amount of dermal zinc exposure data for risk assessment purposes and also enabled a dermal sampling method to be developed and assessed. There is no standard method for dermal dust exposure measurement, and the choice of method was a key factor in the exposure estimation process. With regard to comparison with the EASE predictions, it is possible that EASE could appear to perform more accurately if its predictions were compared with measurements obtained using surrogate skin sampling methods. However, we believe that such sampling can provide a gross overestimate of the dust on the skin surface. We suggest that further development of the EASE system is necessary to ensure that it better reflects whole-body dermal exposures to dusts.

The validity of the EASE expert system for inhalation exposures.

Estimation and Assessment of Substance Exposure (EASE) is a computerized expert system developed by the UK Health and Safety Executive to facilitate exposure assessments in the absence of exposure measurements. The system uses a number of rules to predict a range of likely exposures or an 'end-point' for a given work situation. The purpose of this study was to identify a number of inhalation exposure measurements covering a wide range of end-points in the EASE system to compare with the predicted exposures. Occupational exposure data sets were identified from previous research projects or from consultancy work. Available information for each set of measurements was retrieved from archive storage and reviewed to ensure that it was adequate to enable EASE (version 2) predictions to be obtained. Exposure measurements and other relevant contextual data were abstracted and entered into a computer spreadsheet. EASE predictions were then obtained for each task or job and entered into the spreadsheet. In addition, we generated a random exposure range for each data set for comparison with the EASE predictions. Finally, we produced exposure assessments for a subset of the data using a structured subjective assessment method. We were able to identify approximately 4000 inhalation exposure measurements covering 52 different scenarios and 28 EASE end-points. The data included measurements of solvent vapours, non-fibrous dusts and fibres. In 62% of the end-points the EASE predictions were generally greater than the exposure measurements and in 30% of the end-points the EASE estimates were comparable with the measurements. The random allocation of exposure ranges was, as expected, less reliable than EASE, although there were still about one-third of the cases where the randomly generated exposure ranges generally agreed with the measurements. The structured subjective assessments undertaken by a human expert produced exposure estimates in better agreement with the measurements with about two-thirds of the end-points derived from these assessments in good agreement with the data. We argue that the inhalation exposure estimates from EASE could be improved by incorporating some of the parameters included in the structured subjective assessment methodology.