The occupational exposure of dermatology nurses to polycyclic aromatic hydrocarbons - evaluating the effectiveness of better skin protection.

OBJECTIVES: We studied the uptake of polycyclic aromatic hydrocarbons (PAH) in nurses who apply ointments containing coal tar to patients and investigated the effectiveness of skin protection methods. METHODS: We determined gas-phase PAH on XAD-2 and particle-associated PAH on filters. We also used pads to determine PAH on the skin. Pyrene and benzo(a)pyrene were analyzed by gas chromatography/mass spectrometry and gas chromatography/tandem mass spectrometry; their respective urinary metabolites 1-hydroxypyrene and 3-hydroxybenzo(a)pyrene were analyzed using high performance liquid chromatography with fluorescence detection. RESULTS: We ruled out the inhalation of airborne pyrene and benzo(a)pyrene as the sources of PAH exposure. However, substantial amounts of pyrene and benzo(a)pyrene were observed on the hands of the nurses (median 33.0 and 16.4 ng/cm (2), respectively). Excretion of urinary 1-hydroxypyrene indicated an increased uptake of pyrene in 8 out of 12 nurses. We asked 35 nurses to perform a treatment with gloves followed by a second treatment without gloves. The use of gloves changed the excretion of 1-hydroxypyrene by -0.58 mumol (range -5.1-1.0 mumol), corresponding to a median reduction of 51.5% (P<0.001). Based on this finding, a new protocol was adopted, involving the permanent use of vinyl gloves and Tyvek sleeves. The effectiveness of this protocol was tested against pre-existing work practices and showed a 97% reduction in skin contamination with pyrene and benzo(a)pyrene, and a lowering in urinary excretion of 1-hydroxypyrene of 57%. CONCLUSION: Protecting the skin more stringently reduced pyrene and benzo(a)pyrene contamination of the hands, and lowered urinary excretion of 1-hydroxypyrene.

Quantitative self-assessment of exposure to solvents among shoe repair men.

Self-assessment of exposure (SAE) refers to any exposure assessment methodology wherein the worker takes an active role in establishing his or her exposure status. The objective of this study was to investigate the reliability and feasibility of SAE approaches among shoe repair workers collecting exposure data over a 3 month period. This study was conducted in 26 Dutch shoe repair shops, which were divided into two groups of SAE with different levels of expert supervision. Participants in group 1 received only written instructions on sampling methods, whereas workers in group 2 were also instructed face-to-face by an occupational hygienist. Participants were asked to do 20 (group 1) or 14 (group 2) measurements by themselves. In group 2, an additional 6 measurements in each company were conducted under supervision of an expert. Organic solvents were measured by passive samplers (3M badges) and a sum score for volatile organic compounds (VOC score) was used in data analysis. Mixed effect models and principal component analysis were used to compare concentration levels and exposure variability between group 1 and group 2. Finally, 473 out of the 520 distributed samplers (91%) were available for analysis. Measurements in group 1 were not evenly spread over the 3 month period, whereas dispersal of measurements was much better if experts were more closely involved (group 2). No significant differences in average VOC scores were found between group 1 and group 2. The exposure variability in group 1 appeared to be significantly larger than that in group 2. However, analysis within group 2 showed that no differences exist in geometric means and exposure variability between 'expert' and 'self-assessment' measurements. Thus, the study results are ambiguous with respect to the reliability of SAE, and more research is needed to corroborate and refine the present results. This new methodology can, if proven reliable, be seen as a cost-effective way of collecting exposure data.