Cholinesterase (ChE) Monitoring Training for Pesticide Handlers

1. Cholinesterase (ChE) MonitoringTraining for Pesticide Handlers Department of Labor & Industries WISHA Services

2. How are some pesticides a human health risk? Certain pesticides called cholinesterase-inhibitors affect the nervous system in ways that can cause illness.

3. Nervous system • Nerve cells send electrical signals to each other • A chemical called a “transmitter” communicates the electrical signal across the gap between the nerves

4. Nervous system • CHOLINESTERASE removes the transmitter so the nerve is ready for the next signal • Insects and humans share the same transmitter and cholinesterase system

5. What can effect cholinesterase levels? • Medical conditions • Liver diseases • Blood diseases • Certain medications • Certain pesticides

6. What pesticides effect the cholinesterase system? • Organophosphates and N-methyl-carbamates • Over-exposure may decrease available cholinesterase • Nerves continuously fire (no “off switch”) • Effecting muscles, glands, and organs

7. Which pesticides are most dangerous? • Toxicity category I • on the label • Toxicity category II • on the label "DANGER" "WARNING"

8. Organophosphates Guthion Lorsban Imidan Monitor Mocap N-methyl-carbamates Sevin Temik Lannate Vydate Examples of covered pesticides* *These are just examples, you can get a full list from L&I or the Department of Agriculture

9. Headache Blurred vision Loss of balance Nausea Diarrhea Sweating Change in heart rate Difficulty breathing Muscle twitching Convulsions Unconsciousness Death What are some symptoms of overexposure?

10. Will you always be sick? • No, ChE levels return on their own • Most common treatment is removal from exposure • Hospitalization only with severe poisoning • There is some evidence of long-term effects (memory loss, depression, poor muscle control)

11. Can cholinesterase (ChE) levels be monitored? YES, • Simple blood test •  blood ChE =  nervous system ChE • Yearly off season baseline test followed by tests during the season

12. Types of cholinesterase • Nervous system cholinesterase • Blood cholinesterases • Red blood cell (RBC) cholinesterase - Same as nervous system cholinesterase • Plasma (serum) cholinesterase

13. Why is a baseline test necessary? • Each person has their own normal ChE levels • Periodic tests are compared to baseline • Allows doctors to determine when cholinesterase levels have: • Dropped • Returned to your normal level

14. What are the benefits of cholinesterase monitoring? • Helps to prevent illness • Increases hazard awareness • Supports a safer workplace • Allows for better medical care • Helps to protect your family

15. Cholinesterase Monitoring Rule • Chapter 296-307-148 • Part of the Pesticide Worker Protection Standard • Adopted December 2003 • Became effective February 2004

16. Background • 1993 - Cholinesterase monitoring recommendation • 1995 - TAG report on cholinesterase monitoring • 1997 - L&I sued for not adopting a mandatory monitoring rule • 2002 - Rios decision, L&I directed to initiate rulemaking on a mandatory monitoring rule.

17. Who does the rule apply to? • Agricultural pesticide handlers Who • Handle category I and II organophosphate or N-methyl-carbamate pesticides

18. What is pesticide handling? It includes: • Mixing / loading / applying • Disposing of pesticides or containers • Handling open pesticide containers • Maintaining application equipment • Acting as a flagger

19. When must your employer provide cholinesterase monitoring? • Provided at no cost when you: • Handle covered pesticides 30 or more hours in any consecutive 30 days* • Employer must keep records of all hours handling covered pesticides *First day of handling starts the clock

20. Are all hours spent handling included? NO, • Employers do not need to provide testing to employees who handle only N-methyl-carbamate pesticides • Hours spent mixing and loading using closed systems do not need to be included in determining periodic testing

21. How does the 30 day schedule work? • Your employer has two options: 1. Test every 30 daysno matter how long you handle pesticides OR 2. Test when 30 hour handling time is met • No more often than every 30 days

22. Must you be tested? NO, • Employer must give you the opportunity • You make the decision about testing after talking to a doctor or nurse • You can accept or decline testing by signing a form at the medical clinic • You may your change mind at any time

23. Must I go to the doctor or clinic my employer chooses? YES, • Your employer will be paying the cost for all medical services • Only your test results may be shared with your employer. All other medical information remains confidential

24. When do Cholinesterase (ChE) test results require action? • Work practice evaluation • ChE drop of >20% from baseline • Exposure removal • RBC ChE drop of >30% • Plasma ChE drop of >40% • Resume handling when levels return to within 20% of baseline

25. If I am removed does this mean I can’t work? • No, you can perform other duties • Your job, salary and benefits will be protected for up to 3 months • Pay • Seniority • Other rights and benefits

26. How long does it take for cholinesterase to return to normal? • Plasma cholinesterase levels may return to normal within hours to several days • RBC cholinesterase levels take longer, returning at about 1% per day

27. Can I see my records? • Yes, you’re employer is required to keep: • Time spent handling • Medical provider (contact info. posted) • Test results (medical provider may keep) • Work recommendations • Work program evaluations • Medical removal dates • Declination statements

28. Will you be given training? • Your employer must provide training on the: • Hazards of cholinesterase-inhibiting pesticides • The purpose and requirements of cholinesterase testing

29. How will this rule be enforced? • L&I will collect information from employers and workers in order to evaluate the rule whenever: • Cholinesterase depression is reported • As part of targeted inspection activities • Whenever a complaint is received

30. How will we know if the rule is working? • Scientists and a group of employer and worker representatives will evaluate the rule • All reports and recommendations will be available to the public • L&I must submit reports to the legislature at the end of each year

31. 2004 experience

32. Consultation findings* • Respiratory protection • No fit testing • No cartridge change schedule • Removing respirator during application • Not cleaning respirator after use • Improper storage *Possible exposure routes no common link has been established

33. Consultation findings* • Decontamination • Inadequate eyewash or emergency showers • Inconsistent hand washing • Protective coveralls worn home home • Baseball type caps worn during application • Equipment not rinsed after each use *Possible exposure routes no common link has been established

34. Consultation findings* • Personal Protective Equipment (PPE) • Inconsistent use • PPE not rinsed after each use • Gloves not always worn during equipment maintenance e.g. unplugging nozzles *Possible exposure routes no common link has been established

35. Consultation findings • In most cases employers and handlers are found to be in compliance with all WPS requirements • Handlers are encouraged to pay attention to the details of safe pesticide handling • Report any problems to your employer

36. 2005 • The exposure threshold changes to 30 hours in any consecutive 30 days • Baseline testing will begin in the beginning of January • Be active in your medical care • Participate in L&I consultation activities • Contact your local L&I office if you have any questions

37. Questions???