2015-07-01 12:00 - Messages

Métrologie en temps réel de substances chimiques au poste de travail

Intérêts et limites
Les gaz, vapeurs et aérosols peuvent aujourd'hui être mesurés en temps réel à un poste de travail. Les techniques utilisées sont nombreuses et, pour certaines, de plus en plus simples à utiliser. Après avoir présenté les enjeux liés à l'utilisation de ces techniques pour la sécurité et la santé au travail, cet article en explique les intérêts et les limites par type de substances chimiques (gaz/vapeur et aérosols).

Source: http://www.hst.fr/inrs-pub/inrs01.nsf/IntranetObject-accesParReference/HST_DC%209/$File/DC9.pdf

Neurotoxicity associated with exposure to 1-bromopropane in golf-club cleansing workers

BACKGROUND: 1-Bromopropane (1-BP) is an alternative to ozone-depleting solvent that is used in degreasing, dry cleaning, spray adhesives, and aerosol solvents. Occupational exposure to 1-BP is associated with adverse peripheral sensory, motor, and central nervous system (CNS) effects. We report our Health Hazard and Medical Evaluation of 6 patients with neurotoxicity associated with occupational exposure to 1-BP. Case series and environmental evaluation. Six workers, 1 male and 5 female, were exposed to high ambient 1-BP concentrations while employed in a golf club cleaning factory. 1-BP was identified in the bulk solvent sample used by the workers and confirmed the workers' daily occupational exposure to 1-BP for 3-10 months. The major presenting symptoms were tingling pain, soreness in lower extremities, and paresthesia. N-acetyl-S-(n-propyl)-L-cysteine (AcPrCys), a 1-BP metabolite, was identified by LC/MS/MS in the urine (0.171-1.74 mg/g-Cr) of these workers 5-26 days following 1-BP exposure.
DISCUSSION AND CONCLUSION: An occupational outbreak of 1-BP poisoning occurred as a result of recurrent power outages, condenser, and exhaust fans malfunction, and inadequate personal protection. Occupational exposure to 1-BP may result in peripheral neuropathy as well as adverse CNS effects. Urine AcPrCys may be a specific biomarker for 1-BP exposure.

Source: Wang TH, Wu ML, Wu YH, Tsai WJ, Lin KP, Wang CL, Yang CC, Deng JF. Clin. Toxicol. (T and F), 2015.
http://dx.doi.org/10.3109/15563650.2015.1064939
 

Formaldehyde Exposure and Mortality Risks From Acute Myeloid Leukemia and Other Lymphohematopoietic Malignancies in the US National Cancer Institute Cohort Study of Workers in Formaldehyde Industries

Objectives: To evaluate associations between cumulative and peak formaldehyde exposure and mortality from acute myeloid leukemia (AML) and other lymphohematopoietic malignancies.
Methods: Cox proportional hazards analyses.
Results: Acute myeloid leukemia was unrelated to cumulative exposure. Hodgkin lymphoma relative risk estimates in the highest exposure categories of cumulative and peak exposures were, respectively, 3.76 (Ptrend = 0.05) and 5.13 (Ptrend = 0.003). There were suggestive associations with peak exposure observed for chronic myeloid leukemia, albeit based on very small numbers. No other lymphohematopoietic malignancy was associated with either chronic or peak exposure.
Conclusions: Insofar as there is no prior epidemiologic evidence supporting associations between formaldehyde and either Hodgkin leukemia or chronic myeloid leukemia, any causal interpretations of the observed risk patterns are at most tentative. Findings from this re-analysis do not support the hypothesis that formaldehyde is a cause of AML.

Source: Checkoway, Harvey; Dell, Linda D.; Boffetta, Paolo; Gallagher, Alexa E.; Crawford, Lori; Lees, Peter; Mundt, Kenneth A. Journal of Occupational & Environmental Medicine: July 2015, Volume 57, Issue 7, p. 785-794.
http://dx.doi.org/10.1097/JOM.0000000000000466

Comparison of Acute Health Effects From Exposures to Diesel and Biodiesel Fuel Emissions

Objective: To investigate the comparative acute health effects associated with exposures to diesel and 75% biodiesel/25% diesel (B75) blend fuel emissions.
Methods: We analyzed multiple health endpoints in 48 healthy adults before and after exposures to diesel and B75 emissions in an underground mine setting—lung function, lung and systemic inflammation, novel biomarkers of exposure, and oxidative stress were assessed.
Results: B75 reduced respirable diesel particulate matter by 20%. Lung function declined significantly more after exposure to diesel emissions. Lung inflammatory cells along with sputum and plasma inflammatory mediators increased significantly to similar levels with both exposures. Urinary 8-hydroxydeoxyguanosine, a marker of oxidative stress, was not significantly changed after either exposure.
Conclusions: Use of B75 lowered respirable diesel particulate matter exposure and some associated acute health effects, although lung and systemic inflammation were not reduced compared with diesel use.

Source: Mehus, Aaron A.; Reed, Rustin J.; Lee, Vivien S. T.; Littau, Sally R.; Hu, Chengcheng; Lutz, Eric A.; Burgess, Jefferey L. Journal of Occupational & Environmental Medicine: July 2015, Volume 57, Issue 7, p. 705-712.
http://dx.doi.org/10.1097/JOM.0000000000000473

Les seuils d’action : comment les choisir en tenant compte de la variabilité de l’exposition des travailleurs et de la nature des substances toxiques?

En hygiène du travail, les seuils d'action devraient être ajustés en fonction de la variabilité de l'exposition des travailleurs. En pratique, les distributions observées sont le plus souvent des mélanges inhomogènes de distributions approximativement lognormales. Pour se servir correctement de la lognormale, il faut pouvoir enlever l'effet de plusieurs facteurs comme les dérives temporelles, la saison, l'expérience des travailleurs et la taille de l'entreprise. D'autres distributions à queue plus lourde, dont la logStudent, sont plus robustes et représentent mieux les risques de dépassement.

Source: http://www.santeautravail.qc.ca/web/rspsat/publications/-/asset_publisher/A5nT/content/les-seuils-d%E2%80%99action-:-comment-les-choisir-en-tenant-compte-de-la-variabilite-de-l%E2%80%99exposition-des-travailleurs-et-de-la-nature-des-substances-toxiques/20551

Engineering Controls, Work Practices, and Exposure Monitoring for Occupational Exposures to Diacetyl and 2,3-Pentanedione

Workers who handle diacetyl or work in areas where diacetyl exposure occurs are at risk of developing severe lung disease if their exposures are not properly controlled. The National Institute for Occupational Safety and Health (NIOSH) has developed guidance in a variety of areas to reduce workers' exposures to diacetyl through engineering controls, best work practices, and techniques for monitoring airborne diacetyl exposures. Although these guidelines emphasize diacetyl, they can be applied to reduce exposures to diacetyl substitutes such as 2,3-pentanedione and other alpha-diketones.

Source: http://www.cdc.gov/niosh/docs/2015-197/

The Relationship Between Cognitive Impairment and Global DNA Methylation Decrease Among Aluminum Potroom Workers

Objective: To investigate the relationship between cognitive impairment and global DNA methylation in aluminum (Al) potroom workers.
Methods: A total of 366 Al-exposed workers were investigated, and their cognitive functions were assessed with the Mini-Mental State Examination (MMSE). Aluminum in serum was quantified using graphite furnace atomic absorption spectrometry. Global DNA methylation was analyzed in whole blood using an enzyme-linked immunosorbent assay–like reaction.
Results: Mini-Mental State Examination scores and global DNA methylation decreased with the increase of serum Al concentration. Forty-three mild cognitive impairment (MCI) people were diagnosed. Global DNA methylation of the MCI was lower than the non-MCI. Multiple logistic analysis showed that the Al-exposed workers had lower global DNA methylation and higher serum Al concentration and were at the higher risk of MCI.
Conclusions: Long-term exposure to Al may cause MCI. Mild cognitive impairment was significantly associated with global DNA methylation in blood.

Source: Yang, Xiaojuan; Yuan, Yuzhou; Lu, Xiaoting; Yang, Jin; Wang, Linping; Song, Jing; Nie, Jisheng; Zhang, Qinli; Niu, Qiao. Journal of Occupational & Environmental Medicine: July 2015, Volume 57, Issue 7, p. 713-717.
http://dx.doi.org/10.1097/JOM.0000000000000474

Éléments techniques sur l’exposition professionnelle à cinq solvants ou familles de solvants oxygénés aliphatiques

Ce guide présente les matrices emplois-expositions à cinq solvants ou familles de solvants oxygénés ainsi qu'à au moins une de ces cinq familles, développées par le Département santé travail (DST) de l'Institut de veille sanitaire (InVS) et l'Unité mixte de recherche épidémiologique et de surveillance en transport, travail et environnement (Umrestte).
Ces matrices permettent une vision d'ensemble de l'utilisation de ces solvants en France de 1950 à 2012. Pour tous les emplois considérés comme exposés en France, l'exposition est évaluée par périodes, selon des critères de probabilité, fréquence et intensité d'exposition, détaillés dans ce guide technique. Par ailleurs, ce guide fournit des éléments techniques sur l'utilisation de ces solvants ainsi que sur l'exposition professionnelle à ces produits en France durant la période considérée. La matrice globale, accompagnée d'un document synthétique de présentation, est consultable sur le portail spécifique Exp-Pro mis en place par l'InVS (www.exppro.fr) dans plusieurs versions de nomenclatures nationales ou internationales de professions et de secteurs d'activité.

Source: http://www.invs.sante.fr/Publications-et-outils/Rapports-et-syntheses/Travail-et-sante/2015/Elements-techniques-sur-l-exposition-professionnelle-a-cinq-solvants-ou-familles-de-solvants-oxygenes-aliphatiques

Exposure to static magnetic fields and risk of accidents among a cohort of workers from a medical imaging device manufacturing facility

PURPOSE: To study the association between occupational MRI-related static magnetic fields (SMF) exposure and the occurrence of accidents.
METHODS: Recent and career SMF exposure was assessed by linking a retrospective job exposure matrix to payroll based job histories, for a cohort of (former) workers of an imaging device manufacturing facility in the Netherlands. Occurrence of accidents was collected through an online questionnaire. Self-reported injuries due to accidents in the past 12 months, and the first (near) traffic accident while commuting to work and from work were analyzed with logistic regression and discrete-time survival analyses, respectively.
RESULTS: High recent SMF exposure was associated with an increased risk of accidents leading to injuries [odds ratio (OR) 4.16]. For high recent and career SMF exposure, an increased risk was observed for accidents resulting in physician-treated injuries (OR 5.78 and 2.79, respectively) and an increased lifetime risk of (near) accidents during commute to work (hazard ratios 2.49 and 2.45, respectively), but not from work.
CONCLUSION: We found an association between MRI-related occupational SMF exposure and an increased risk of accidents leading to injury, and for commute-related (near) accidents during the commute from home to work. Further research into health effects of (long-term) SMF exposure is warranted to corroborate our findings.

Source: Bongers S, Slottje P, Portengen L, Kromhout H. Magn. Reson. Med. 2015.
http://dx.doi.org/10.1002/mrm.25768

Lung cancer among coal miners, ore miners and quarrymen

Smoking-adjusted risk estimates from the synergy pooled analysis of case–control studies
Objectives: Working in mines and quarries has been associated with an elevated lung cancer risk but with inconsistent results for coal miners. This study aimed to estimate the smoking-adjusted lung cancer risk among coal miners and compare the risk pattern with lung cancer risks among ore miners and quarrymen.
Methods: We estimated lung cancer risks of coal and ore miners and quarrymen among 14 251 lung cancer cases and 17 267 controls from the SYNERGY pooled case–control study, controlling for smoking and employment in other at-risk occupations.
Results: Ever working as miner or quarryman (690 cases, 436 controls) was associated with an elevated odds ratio (OR) of 1.55 [95% confidence interval (95% CI) 1.34–1.79] for lung cancer. Ore miners (53 cases, 24 controls) had a higher OR (2.34, 95% CI 1.36-4.03) than quarrymen (67 cases, 39 controls; OR 1.92, 95% CI 1.21–3.05) and coal miners (442 cases, 297 controls; OR 1.40, 95% CI 1.18–1.67), but CI overlapped. We did not observe trends by duration of exposure or time since last exposure.
Conclusions: This pooled analysis of population-based studies demonstrated an excess lung cancer risk among miners and quarrymen that remained increased after adjustment for detailed smoking history and working in other at-risk occupations. The increase in risk among coal miners were less pronounced than for ore miners or quarrymen.

Source: Scand J Work Environ Health, 2015.
http://dx.doi.org/10.5271/sjweh.3513

Allergies respiratoires professionnelles chez les professionnels du bois

Les professionnels du bois exercent de multiples activités allant de la sylviculture et exploitation forestière à la construction, en passant par le sciage, la manufacture du bois, le travail artisanal sur bois ou encore l'industrie du papier et du carton. Au cours de leur exercice, leurs expositions professionnelles sont multiples et peuvent occasionner des manifestations respiratoires. Les plus fréquentes sont les asthmes et rhinites, déclenchés par les poussières de bois mais aussi par des produits chimiques utilisés lors de la transformation du bois, à savoir isocyanates, formaldéhyde, dérivés acryliques... Les pneumopathies d'hypersensibilité, plus rares, sont essentiellement dues aux moisissures du bois. Le diagnostic de ces affections repose sur l'association d'un tableau clinique compatible, l'identification des expositions, une rythmicité professionnelle et des explorations complémentaires : mesures répétées du débit expiratoire de pointe, explorations fonctionnelles respiratoires, tests allergologiques et tests de provocation pour l'asthme, mise en évidence d'immunoglobulines G spécifiques et enquête mycologique pour la pneumopathie d'hypersensibilité.

Source: Vial-Dupuy, A. Références en santé au travail, n° 142, juin 2015.
http://www.rst-sante-travail.fr/rst/pages-article/ArticleRST.html?refINRS=RST.TR 58

Irritant hand dermatitis in health care workers

Background Health care workers (HCWs) are at increased risk of irritant contact dermatitis due to frequent hand washing and use of alcohol gel. This has increased the incidence of occupational skin diseases.
Aims To evaluate hand dermatitis in HCWs in our hospital by means of a survey which also examined trends of exposure and the utility of patch testing.
ethods HCWs diagnosed with hand dermatitis in our contact dermatitis clinic from January 2011 to July 2012 were included. Information was collected retrospectively from medical notes, computer records and the database of the British Cutaneous Allergy Society.
Results A total of 69 HCWs were diagnosed with hand dermatitis, with a prevalence of ~4%. The majority were female and the clinical areas in which they worked were diverse. About 98% (68) had irritant contact dermatitis, and hand washing was the commonest cause of symptoms. About 75% (51) had irritant dermatitis exclusively. Patch test was positive in 42% with the commonest reaction to nickel, followed by formaldehyde. Associated atopy was found in less than half of the cases.
Conclusions Irritant hand dermatitis is prevalent in HCWs in this setting. Patch testing is useful to identify any additional allergic element in such cases.

Source: Malik, M., & English, J. Occupational Médicine, 2015. 
http://dx.doi.org/10.1093/occmed/kqv067

Cancers professionnels : nouveaux enjeux pour la prévention

Parmi les nouveaux cas de cancers dénombrés chaque année en France, plusieurs milliers sont d'origine professionnelle. Si la prévention du risque amiante reste une priorité en milieu de travail, les organismes chargés de la prévention des risques professionnels ont beaucoup investi ces dernières années dans la création de dispositifs de vigilance, de veille et de surveillance afin de détecter au plus tôt de nouveaux produits ou de nouveaux procédés susceptibles de causer des cancers. Ce colloque, organisé en novembre 2014 par l'INRS en partenariat avec douze organismes, permet de faire le point sur ces dispositifs ainsi que sur les études et actions récentes menées dans cette logique de détection.

Source: Bijaoui, A.; Délépine, A.; Jussiaux, F.; Maisant, S.; Passeron, J. Références en santé au travail, n° 142, juin 2015.
http://www.rst-sante-travail.fr/rst/pages-article/ArticleRST.html?refINRS=RST.TD 219

Antibiorésistance et conséquences en santé au travail pour les soignants

Le dévellopement et la diffusion des bactéries multirésistantes (BMR) posent la question d'un éventuel risque professionnel supplémentaire pour les soigants exposés. Peu de cas sont décrits dans la littérature. Un dépistage orienté peut être organisé dans certaines circonstances (infections nosocomiales, épidémies...). Les mesures de prévention reposent sur le respect des mesures appliquées dans le cadre de la prévention de la transmission croisée des bactéries multirésistantes.

Source: Vincent, R.; Le Bacle, C. Références en santé au travail, n° 142, juin 2015.
http://www.rst-sante-travail.fr/rst/pages-article/ArticleRST.html?refINRS=RST.TC 151

Extreme heat and occupational heat illnesses in South Australia, 2001–2010

OBJECTIVES: This study aims to examine the epidemiological characteristics of occupational heat illnesses in South Australia, to quantify the association between ambient temperature and occupational heat illnesses, and to investigate the impact of heatwaves on occupational heat illnesses.
METHODS: Workers' compensation claims data and weather data were obtained from SafeWork South Australia and the Bureau of Meteorology, respectively, for 2001-2010. Time series analysis with generalised estimation equation models and linear spline functions was used to quantify the temperature-heat illness claims association. A case-crossover design was applied to investigate the impact of heatwaves on occupational heat illnesses.
RESULTS: There were 306 heat illness claims during the study period, with an incidence rate of 4.5 per 100 000 employees. The overall risk of occupational heat illness was positively associated with maximum temperature (Tmax), especially when Tmax was over the threshold of 35.5°C. One degree increase of Tmax was associated with a 12.7% (incidence rate ratio 1.127, 95% CI 1.067 to 1.190) increase of occupational heat illness claims. During heatwave periods, the risk of occupational heat illness was about 4-7 times higher than that of non-heatwave periods.
CONCLUSIONS: There is a need to develop or refine current heat-related regulations and guidelines to minimise the risk of occupational heat illnesses in vulnerable workers in a warming climate.

Source: Xiang J, Hansen A, Pisaniello D, Bi P. Occup. Environ. Med, 2015.
http://dx.doi.org/10.1136/oemed-2014-102706

Symptômes respiratoires liés au travail chez les vignerons de Champagne

Les ouvriers du vignoble sont exposés à de nombreux agents inhalés, dont différents allergènes respiratoires. Entre 2007 et 2010, 307 travailleurs du vignoble de Champagne ont été inclus dans une étude prospective afin de déterminer la prévalence des symptômes respiratoires liés au travail et leurs associations éventuelles avec le poste de travail et le profil de sensibilisation allergénique. La prévalence des symptômes respiratoires liés au travail est de 11 %. Les patients symptomatiques sont plus souvent sensibilisés au pollen de graminées et décrivent des symptômes saisonniers principalement pendant les activités de relevage et de palissage (fin de printemps). La proportion des femmes est relativement plus importante parmi les sujets présentant des symptômes liés au travail. Les résultats suggèrent qu'une surveillance rapprochée pourrait être proposée à ces patients afin d'évaluer l'impact sur leur fonction respiratoire.

Source: http://www.inrs.fr/media.html?refINRS=TF%20228

Silicosis Update

Silicosis is a potentially fatal but preventable occupational lung disease caused by inhaling respirable particles containing crystalline silicon dioxide (silica). Quartz, a type of crystalline silica, is the second most abundant mineral in the earth's crust and workers across a wide range of occupations and industries are exposed to silica-containing dusts. The risks, causes, and prevention of this avoidable disease have been known for decades. There is no cure for silicosis and only symptomatic treatment is available, including lung transplantation for the most severe cases. New national data have become available since a prior report on silicosis surveillance was published earlier this year. The new data show that silicosis continues to cause or contribute to the deaths of about 100 Americans each year. There were 88, 103, and 111 such deaths in 2011, 2012, and 2013 respectively.

Source: http://blogs.cdc.gov/niosh-science-blog/2015/06/15/silicosis-update/

Occupational Lead Exposure and Associations with Selected Cancers

The Shanghai Men's and Women's Health Study Cohorts
Background: Epidemiologic studies of occupational lead exposure have suggested increased risks of cancers of the stomach, lung, kidney, brain, and meninges; however, the totality of the evidence is inconsistent.
Objective: We investigated the relationship between occupational lead exposure and cancer incidence of these five sites in two prospective cohorts in Shanghai, China.
Methods: Annual job/industry-specific estimates of lead fume and lead dust exposure, derived from a statistical model combining expert lead intensity ratings with inspection measurements, were applied to the lifetime work histories of participants from the Shanghai Women's Health Study (SWHS; n=73,363) and the Shanghai Men's Health Study (SMHS; n=61,379) to estimate cumulative exposure to lead fume and lead dust. These metrics were then combined into an overall occupational lead exposure variable. Cohort-specific relative hazard rate ratios (RRs) and 95% confidence intervals (CI) comparing exposed to unexposed participants were estimated using Cox proportional hazards regression and combined by meta-analysis.
Results: The proportion of SWHS and SMHS participants with estimated occupational lead exposure was 8.9% and 6.9%, respectively. Lead exposure was positively associated with meningioma risk in women only (n= 38 unexposed and 9 exposed cases, RR = 2.4; 95% CI: 1.1, 5.0), particularly with above-median cumulative exposure (RR = 3.1; 95% CI: 1.3, 7.4). However, all 12 meningioma cases among men were classified as unexposed to lead. We also observed non-significant associations with lead exposure for cancers of the kidney (n= 157 unexposed and 17 ever exposed cases; RR = 1.4; 95% CI: 0.9, 2.3) and brain (n= 67 unexposed and 10 ever exposed cases; RR = 1.8; 95% CI: 0.7, 4.8) overall.
Conclusions: Our findings, though limited by small numbers of cases, suggest that lead is associated with risk of several cancers in women and men.

Source: Liao LM, Friesen MC, Xiang Y-B, Cai H, Koh D-H, Ji B-T, Yang G, Li H-L, Locke SJ, Rothman N, Zheng W, Gao Y-T, Shu X-O, Purdue MP. Environ Health Perspect, 2015.
http://dx.doi.org/10.1289/ehp.1408171

Fumigation

Health & safety guidance for employers & technicians carrying out fumigation operations
The guidance is primarily for employers and fumigators/fumigation technicians (including the self-employed) to help them comply with the Control of Substances Hazardous to Health Regulations 2002 (COSHH) when carrying out fumigation activities, both traditional pest control (invertebrate fumigation) and within the laboratory and biosecurity sectors. It will also be useful to their safety representatives.
It outlines the real risks and describes the law that applies to fumigation operations. There is specific advice on procedures common to all fumigation operations, including the use of monitoring equipment, personal protective equipment and respiratory protective equipment, health surveillance and first aid.

Source: http://www.hse.gov.uk/pubns/books/hsg251.htm

Ionising radiation and risk of death from leukaemia and lymphoma in radiation-monitored workers

An international cohort study
Background: There is much uncertainty about the risks of leukaemia and lymphoma after repeated or protracted lowdose radiation exposure typical of occupational, environmental, and diagnostic medical settings. We quantified associations between protracted low-dose radiation exposures and leukaemia, lymphoma, and multiple myeloma mortality among radiation-monitored adults employed in France, the UK, and the USA.
Methods: We assembled a cohort of 308 297 radiation-monitored workers employed for at least 1 year by the Atomic Energy Commission, AREVA Nuclear Cycle, or the National Electricity Company in France, the Departments of Energy and Defence in the USA, and nuclear industry employers included in the National Registry for Radiation Workers in the UK. The cohort was followed up for a total of 8·22 million person-years. We ascertained deaths caused by leukaemia, lymphoma, and multiple myeloma. We used Poisson regression to quantify associations between estimated red bone marrow absorbed dose and leukaemia and lymphoma mortality.
Findings: Doses were accrued at very low rates (mean 1·1 mGy per year, SD 2·6). The excess relative risk of leukaemia mortality (excluding chronic lymphocytic leukaemia) was 2·96 per Gy (90% CI 1·17–5·21; lagged 2 years), most notably because of an association between radiation dose and mortality from chronic myeloid leukaemia (excess relative risk per Gy 10·45, 90% CI 4·48–19·65).
Interpretation: This study provides strong evidence of positive associations between protracted low-dose radiation
exposure and leukaemia.

Source: Leuraud K. et al. The Lancet Haematology, juin 2015. 
http://dx.doi.org/10.1016/S2352-3026(15)00094-0

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