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

1. Exposure to organic solvents and health in developing countries -perspectives on preventionKhaldoun Nijem

2. 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

3. 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)

4. 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)

5. Routeof entry • Inhalation • Skin absorption • Ingestion

6. 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)

7. 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)

8. Literature review A- developed countries well studied: many studies B- developing countries poorly studied: few studies

9. Organic solvents exposure and health effect in developing countries: Literature Review

10. Organic solvents exposure and health effect in developing countries: Literature Review- cont Country Occupation Main effect Reference 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 Korea Car painting Poor performance Lee 1993 Fatigue, difficulties in memory, confusion, sleep disturbances, paresthesias in extremities. Adhesive factory Escalona et al 1995 Venezuela

11. 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

12. For many people in developing countries, any job, no matter how hazardous, is seen as preferable to the alternative of unemployment(Vilanilam 1980)

13. Use of personal protective equipment in shoe workshops, Hebron 1996-1997

14. Levels of Prevention • Primary prevention • Secondary prevention • Tertiary prevention

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

16. 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

17. 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.

18. Primary prevention • engineering control • behavioral control • administrative control

19. Elimination or Substitution Change process Segregation / encapsulation Ventilation Work practices Engineering control

20. 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

21. 2- Changing the process • Changing the process or utilizing a new one to reduce the hazardous exposure.

22. 3. Encapsulation (segregation) • Total or partial enclosed process and handling system. • Segregation of the hazardous process from the operator.

23. 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

24. 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

25. 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

26. Primary prevention • engineering control • behavioral control • administrative control

27. 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.

28. Primary prevention • engineering control • behavioral control • administrative control

29. 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

30. Legislation: internal control: Norway

31. 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

32. 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.

33. 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

34. 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

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

36. 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.

37. 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.