Evaluation of Occupational Exposure to Perchlorethylene in a Group of Italian Dry Cleaners Using Noninvasive Exposure Indices.

Recent data suggest a general trend in decreased occupational exposure to perchlorethylene (PCE) in the dry-cleaning sector. The aims of this study were to confirm this trend to lower exposure levels in a group of Italian dry cleaners and to evaluate the current occupational PCE exposure in these works using noninvasive biological indices. Environmental exposure was assessed by personal sampling in 60 operators working in 21 dry cleaning shops in North Italy. PCE in the exhaled alveolar air (PCEalv), urinary concentration of PCE and of trichloroacetic acid (TCA) (PCEu and TCAu respectively), were measured as biological exposure indices. Median PCE environmental concentration in the whole sample was 10.6 mg/m3 (i.e., less than the 25% of the levels measured in the same area in a previous study). All values were less than 10% of the occupational limits. PCEu measured in samples collected at the end of the work shift resulted the biological markers having the strongest correlation with environmental PCE (r = 0.81). PCEalv also resulted in a high correlation (r = 0.66), while a lower correlation was found for TCAu measured at the end shift (r = 0.32). According to our results, PCEu can be proposed as a valid, noninvasive, and easily reliable exposure index to evaluate PCE exposure at the low levels currently observed in dry cleaners, therefore representing a promising alternative to invasive blood sample collections needed to determine PCE blood concentration.

Monochloramine and chlorine dioxide for controlling Legionella pneumophila contamination: biocide levels and disinfection by-product formation in hospital water networks.

Legionella colonization in hospital hot water distribution networks was evaluated following 36 months of continuous treatment with monochloramine and compared with chlorine dioxide. Nitrite, nitrate, chlorite, chlorate, bromide, trihalomethanes and haloacetic acids as well as the biocide concentration at sampled points were measured. Only 8/84 samples treated with monochloramine were found contaminated and after the first 8 months of treatment no Legionella was isolated. Chlorine dioxide was associated with a strong reduction in Legionella contamination compared to pre-treatment, but differences according to the device were observed. Monochloramine between 2 and 3 mg l(-1) and chlorine dioxide between 0.50 and 0.70 mg l(-1) were needed to control Legionella colonization. Comparing no- and post-flush samples, a higher frequency of no-flush positive samples was noted using chlorine dioxide, suggesting an increased risk for patients when they open the tap. No increase in chlorite levels and no water nitrification occurred by using monochloramine. Chlorite at levels exceeding the limit requested for drinking water was measured when chlorine dioxide was applied. In conclusion, we highlight that continuous injection of monochloramine should be considered as an effective alternative to chlorine dioxide in controlling legionellae contamination inside hospital water distribution systems.

Airborne trichloramine (NCl(3)) levels and self-reported health symptoms in indoor swimming pool workers: dose-response relationships.

The hypothesis that attendance at indoor chlorinated swimming pool is a risk factor for irritative ocular and respiratory symptoms and bronchial asthma is well known in literature, although epidemiological evidence is still inconclusive. The aim of this study was to evaluate the association between airborne trichloramine (NCl(3)) levels and irritative symptoms in swimming pool employees in order to obtain detailed data regarding dose-response relationships and to identify the airborne NCl(3) exposure level, if any, without health effects. A total of 20 indoor swimming pools in the Emilia Romagna region of Italy were included in the study. Information about the health status of 128 employees was collected using a self-administered questionnaire. Exposure to airborne NCl(3) was evaluated in indoor swimming pools by a modified DPD/KI method. The results of the study evidenced a mean value of airborne NCl(3) of 0.65±0.20 mg/m(3) (ranging from 0.20 to 1.02 mg/m(3)). Both ocular and upper respiratory symptoms, in particular red eyes, runny nose, voice loss and cold symptoms, were declared more frequently by lifeguards and trainers when compared with employees working in other areas of the facility (office, cafe, and so on). Pool attendants exposed to airborne NCl(3) levels of >0.5 mg/m(3) experienced higher risks for runny nose (OR: 2.91; 95% CI: 1.22-6.93) red eyes (OR: 3.16; 95% CI: 1.46-6.82), voice loss (OR: 3.56; 95% CI: 1.60-7.95) and itchy eyes (OR: 2.23; 95% CI: 1.04-4.78) than other employees. Moreover, red eyes, itchy eyes, runny nose and voice loss are related to airborne NCl(3) levels, with strong dose-response relationships. In conclusion, this study shows that lifeguards and trainers experience ocular and respiratory irritative symptoms more frequently than employees not exposed. Irritative symptoms become significant starting from airborne NCl(3) levels of >0.5 mg/m(3), confirming that the WHO-recommended value can be considered protective in occupational exposure to airborne NCl(3) in indoor swimming pools.

Prevalence of ocular, respiratory and cutaneous symptoms in indoor swimming pool workers and exposure to disinfection by-products (DBPs).

The objective of this cross-sectional study was to investigate the prevalence of self-reported respiratory, ocular and cutaneous symptoms in subjects working at indoor swimming pools and to assess the relationship between frequency of declared symptoms and occupational exposure to disinfection by-products (DBPs). Twenty indoor swimming pools in the Emilia Romagna region of Italy were included in the study. Information about the health status of 133 employees was collected using a self-administered questionnaire. Subjects working at swimming pools claimed to frequently experience the following symptoms: cold (65.4%), sneezing (52.6%), red eyes (48.9%) and itchy eyes (44.4%). Only 7.5% claimed to suffer from asthma. Red eyes, runny nose, voice loss and cold symptoms were declared more frequently by pool attendants (lifeguards and trainers) when compared with employees working in other areas of the facility (office, cafe, etc.). Pool attendants experienced generally more verrucas, mycosis, eczema and rash than others workers; however, only the difference in the frequency of self-declared mycosis was statistically significant (p = 0.010). Exposure to DBPs was evaluated using both environmental and biological monitoring. Trihalomethanes (THMs), the main DBPs, were evaluated in alveolar air samples collected from subjects. Swimming pool workers experienced different THM exposure levels: lifeguards and trainers showed the highest mean values of THMs in alveolar air samples (28.5 +/- 20.2 microg/m(3)), while subjects working in cafe areas (17.6 +/- 12.1 microg/m(3)), offices (14.4 +/- 12.0 microg/m(3)) and engine rooms (13.6 +/- 4.4 microg/m(3)) showed lower exposure levels. Employees with THM alveolar air values higher than 21 microg/m(3) (median value) experienced higher risks for red eyes (OR 6.2; 95% CI 2.6-14.9), itchy eyes (OR 3.5; 95% CI 1.5-8.0), dyspnea/asthma (OR 5.1; 95% CI 1.0-27.2) and blocked nose (OR 2.2; 95% CI 1.0-4.7) than subjects with less exposure. This study confirms that lifeguards and trainers are more at risk for respiratory and ocular irritative symptoms and cutaneous diseases than subjects with other occupations at swimming pool facilities.

A retrospective cohort study of trihalomethane exposure through drinking water and cancer mortality in northern Italy.

A few epidemiologic studies have suggested that consumption of drinking water with high trihalomethane content increases the risk of cancer. We investigated the mortality of a cohort of 5144 residents in Guastalla, northern Italy, who were supplied tap water with high chloroform and trihalomethane content between 1965 and 1987. Using death rates of a nearby community as reference rates, the standardized mortality ratio from all cancers between 1987 and 1999 was slightly increased for both males (1.2, 95% confidence interval 1.1-1.4) and females (1.1, 95% confidence interval 1.0-1.3). This was mainly due to a higher mortality from stomach, liver, lung, prostate and bladder cancer in males and from stomach, pancreas, breast and ovarian cancer and lymphocytic leukemia in females. We also noted excess mortality from melanoma in both males and females. Overall, our findings were consistent with an association between trihalomethane exposure and increased cancer risk at some sites. However, the point estimates were statistically imprecise, due to the limited number of deaths for some site-specific cancers. In addition, we were unable to rule out the possibility of confounding due to smoking and other life-style factors with regard to some of the excess rates.

Perchloroethylene in alveolar air, blood, and urine as biologic indices of low-level exposure.

We studied the reliability of biologic indices for monitoring perchlorethylene (PCE) exposure at low environmental solvent concentrations. Environmental monitoring was performed by personal sampling, biologic monitoring by measuring PCE in alveolar air (PCE-Alv), blood (PCE-B), and urine (PCE-U) in 26 low-exposed dry-cleaners. Correlation coefficients (r) between environmental PCE and PCE-B, PCE-Alv, and PCE-U were 0.94, 0.81, and 0.67 respectively. A high correlation was also found among biologic indices: r value was 0.96 between PCE-B and PCE-Alv, 0.95 between PCE-B and PCE-U, and 0.87 between alveolar PCE-Alv and PCE-U. The examined biologic indices proved sensitive enough for biologic monitoring of low exposure to PCE and can give substantially similar information in terms of exposure evaluation. PCE-Alv offers some advantages because it correlated better with exposure and is analytically simpler.