2017-02-01 12:00 - Messages

Protoxyde d'azote lors de l'utilisation du MEOPA en milieu de soins

Toxicité, situations d'exposition, données métrologiques, pistes de prévention et rôle du médecin du travail
Le MEOPA (mélange équimolaire d'oxygène et de protoxyde d'azote) est de plus en plus largement utilisé en milieu de soins, que ce soit en structure hospitalière ou autres (hospitalisation à domicile, odontologie...).
Des campagnes de mesures récentes, menées par les CARSAT et l'INRS, ont montré des niveaux d'exposition professionnelle au
protoxyde d'azote supérieurs aux recommandations disponibles. Devant les interrogations des professionnels sur les risques liés à l'exposition professionnelle potentielle au MEOPA, cet article présente les données existantes sur la toxicité du protoxyde d'azote, les situations d'exposition au MEOPA, les pistes de prévention ainsi que le rôle du médecin du travail.

Source: http://www.rst-sante-travail.fr/rst/pages-article/ArticleRST.html?ref=RST.TP 26

State-of-the-art report on reproductive toxicants

Summary
Workers' reproductive health can be put at risk by hazardous chemicals, such as pesticides and pharmaceuticals, as well as biological, physical, organisational and psychosocial factors.
The issue of reproductive OSH risks has largely been focused on women, and mostly pregnant women, but reprotoxic risks can in fact affect both women's and men's reproductive health. Reprotoxicants can also affect foetal and human development and effects include miscarriages, malformations and functional deficits.
The summary presents in short the results of a report that examines the current knowledge on workplace risks to reproduction. It highlights gaps in that knowledge and recommends ways forward to increase awareness and improve prevention.

Source: https://osha.europa.eu/en/tools-and-publications/publications/summary-state-art-report-reproductive-toxicants/view

Fabrication de prothèses dentaires

Guide pratique de ventilation
Cette brochure se voulant essentiellement un guide pratique, seuls les points essentiels relatifs à la conception des installations de ventilation y sont traités. Les nuisances d'ordre toxicologique, c'est-à-dire les effets sur l'homme des différents polluants émis (poussières, vapeurs et gaz), sont particulièrement détaillées. Ce guide a ainsi le double objectif de mettre en évidence le risque d'intoxication lié à l'inhalation de divers polluants aux postes de travail et de proposer des solutions de prévention adaptées à chaque situation. Les autres nuisances (bruit, agents infectieux, travail en position maintenue, rayonnements ultraviolets, laser et infrarouge, etc. et l'utilisation éventuelle d'équipements de protection individuelle ne sont peu ou pas développées.
Les mesures de prévention décrites dans ce guide portent principalement sur :
- la réduction des émissions de polluants : implantation du laboratoire et choix des matériaux, des produits, des techniques les moins émissifs ;
- le captage et la ventilation des polluants : descriptif du ou des dispositifs de captage à la source adaptés à chaque poste de travail (préparation des revêtements, fusion et coulée des alliages, sablage, modelage de la cire, finition à l'établi...) ; point sur le réseau de transport des polluants, l'air de compensation, le rejet de recyclage de l'air extrait, la ventilation générale, les contrôles, l'entretien et le nettoyage.

Source: http://www.inrs.fr/media.html?refINRS=ED%20760

Occupational use of high-level disinfectants and fecundity among nurses

Objective: This study aimed to examine the relationship between occupational use of high-level disinfectants (HLD) and fecundity among female nurses.
Methods: Women currently employed outside the home and trying to get pregnant (N=1739) in the Nurses' Health Study 3 cohort (2010–2014) were included in this analysis. Occupational exposure to HLD used to disinfect medical instruments and use of protective equipment (PE) was self-reported on the baseline questionnaire. Every six months thereafter women reported the duration of their ongoing pregnancy attempt. Multivariable accelerated failure time models were used to estimate time ratios (TR) and 95% confidence intervals (95% CI).
Results: Nurses exposed to HLD prior to and at baseline had a 26% (95% CI 8–47%) and 12% (95% CI -2–28%) longer median duration of pregnancy attempt compared to nurses who were never exposed. Among nurses exposed at baseline to HLD, use of PE attenuated associations with fecundity impairments. Specifically, women using 0, 1, and ≥2 types of PE had 18% (95% CI -7–49%), 16% (95% -3–39%), and 0% (95% -22-28%) longer median durations of pregnancy attempt compared to women who were never exposed. While the use of PE varied greatly by type (9% for respiratory protection to 69% for protective gloves), use of each PE appeared to attenuate the associations of HLD exposure with reduced fecundity.
Conclusion: Occupational use of HLD is associated with reduced fecundity among nurses, but use of PE appears to attenuate this risk.

Source: Gaskins, AJ, Chavarro, JE, Rich-Edwards, JW, Missmer, SA, Laden, F., Henn, SA, & Lawson, CC. (2017). Scandinavian Journal of Work, Environment & Health.
http://dx.doi.org/10.5271/sjweh.3623

Indoor Air Quality in Photocopy Centers, Nanoparticle Exposures at Photocopy Workstations, and the Need for Exposure Controls

Background: Photocopiers emit large amounts of nanoparticles (NP) and are a significant source of indoor air pollution. These emissions induce airway inflammation, irritation, and systemic oxidative stress in humans, lung injury and inflammation in animals, and cytotoxicity and epigenetic modifications in vitro. However, little is known regarding NP exposures at the workstation in the photocopy work environment, or the extent and use of emission controls.
Objective: To survey the photocopy work environment with regards to emissions controls and to evaluate IAQ with emphasis on NP exposure at the operator's workstation.
Methods: Work process, physical characteristics of the centers, and use of controls were recorded. Particle total number concentration (TNC), temperature, carbon dioxide, carbon monoxide, and percent relative humidity were measured during a random workday.
Results: Geometric mean (GM) TNC at workstations ranged between 1900 and 23000 particles cm−3, GSD 1.2–2.8, and maximum of 217000 particles cm−3. Fresh air ventilation was found to be less than American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) guidelines in 7 of 15 centers. Only one center used any type of emissions control. Elevated TNC at workstations was significantly correlated with number of copies (r = 0.72). While indoor/outdoor TNC ratios might be expected to be ≤1.0, the ratio here was >1.0 in 40% of centers visited, supporting the finding that copier emissions are a significant source of indoor air pollution. Number of copies per day was the most significant contributor to TNC.

Source: Martin, John, Demokritou, Philip, Woskie, Susan, & Bello, Dhimiter. (2017). Annals of Work Exposures and Health, 61(1), 110-122.
https://doi.org/10.1093/annweh/wxw016

Rayonnements optiques & électromagnétiques au travail

Pour accompagner les entreprises dans l'amélioration de la prévention des risques professionnels, l'INRS a organisé le colloque " Rayonnements optiques & électromagnétiques - De l'exposition à la prévention " en octobre 2015 à Paris. Durant trois jours, ce colloque a rassemblé près de 300 participants de profils variés : médecins du travail, IPRP, préventeurs d'entreprise, préventeurs institutionnels, scientifiques, consultants, bureaux d'études, organismes de contrôle... venus s'informer au travers de 48 présentations orales et échanger entre eux et avec les intervenants.
L'INRS met aujourd'hui à disposition de ce public et, au-delà, de toutes les personnes intéressées qui n'ont pu participer au colloque, ce numéro hors-série de la revue Hygiène & sécurité du travail. Ce compte-rendu, rassemblant 34 articles couvrant tous les thèmes abordés, a pour ambition d'être une référence au service de tous ceux qui s'intéressent à la prévention de ces nuisances physiques
dans l'entreprise. Bien entendu, les connaissances s'accroissent, les réglementations évoluent, les pratiques industrielles se modernisent, mais nous savons que le contenu de ces articles restera d'actualité pendant encore plusieurs années.

Source: http://www.inrs.fr/media.html?refINRS=CC%2016

Liquid release as a source of potential drug exposure during the handling of intravenous infusions in nursing

Purpose: This study aims at experimentally determining the incidence and extent of liquid releases onto the operator's hands and into the work environment during common nursing operations involving infusions.
Methods: A sequence of operations related to the preparation and administration of infusions was conducted by three subjects for 15 times each using fluorescein marked infusion solutions and two different infusion sets (standard set vs. safety-optimized set). Unintended release of liquid was quantified by glove and surface wipe sampling and HPLC/FD analysis of the samples. Operations concerning the disposal of infusions were also part of the study.
Results: In over 90% of the simulations, a release of infusion solution was observed in a standard workflow, comprising priming and decapping the infusion set, connecting it to a peripheral intravenous (IV) cannula, and detaching it again. Based on median values (229 vs. 26 μl), the release of infusion solution was about ninefold higher when using the non-optimized standard infusion set. During decapping, a hand contamination was found in a majority of cases.
Conclusions: The handling of infusions may involve a risk of nurses' exposure to active agents by release of infusion solution into the work environment. According to our results with different infusion sets, exposure risks can be reduced technically and by appropriate handling. Nevertheless, hand contaminations found for both sets emphasize the necessity for additional measures such as more consistent use of protective gloves.

Source: Segner, V., Kimbel, R., Jochems, P., Heinemann, A., Letzel, S., Wollschläger, D., & Roßbach, B. (2017). International Archives of Occupational and Environmental Health, 1-10.
http://dx.doi.org/10.1007/s00420-017-1196-0

Trichloramine: de l’émergence d’un risque aux solutions de prévention

La trichloramine, formée à partir du chlore et des substances apportées par les baigneurs dans les piscines, est un irritant des voies respiratoires des salariés de ces lieux de loisirs. Dans une démarche de prévention globale, et après plusieurs études, l'INRS propose des outils pour la prévention de ce risque professionnel qui sont présentés dans cet article.

Source: Gérardin, Fabien. (2016). Hygiène et sécurité du travail, 245, 59-65. 
http://www.inrs.fr/dms/inrs/CataloguePapier/HST/TI-NT-44/nt44.pdf

Urinary Bisphenol A (BPA) Concentrations among Workers in Industries that Manufacture and Use BPA in the USA

Background: Bisphenol A (BPA) toxicity and exposure risk to humans has been the subject of considerable scientific debate; however, published occupational exposure data for BPA are limited. Methods: In 2013-2014, 77 workers at six US companies making BPA, BPA-based resins, or BPA-filled wax provided seven urine samples over two consecutive work days (151 worker-days, 525 samples). Participant information included industry, job, tasks, personal protective equipment used, hygiene behaviors, and canned food/beverage consumption. Total (free plus conjugated) BPA, quantified in urine by mass spectrometry, was detected in all samples. Results: The geometric mean (GM) creatinine-adjusted total BPA (total BPACR) concentration was 88.0 μg g−1 (range 0.78–18 900 μg g−1), ~70 times higher than in US adults in 2013–2014 (1.27 μg g−1).
GM total BPACR increased during Day 1 (26.6–127 μg g−1), decreased by pre-shift Day 2 (84.4 μg g−1) then increased during Day 2 to 178 μg g−1. By industry, baseline and post-baseline total BPACR was highest in BPA-filled wax manufacturing/reclaim (GM = 111 μg g−1) and lowest in phenolic resin manufacturing (GM = 6.56 μg g−1). By job, total BPACR was highest at baseline in maintenance workers (GM = 157 μg g−1) and post-baseline in those working with molten BPA-filled wax (GM = 441 μg g−1). Workers in the job of flaking a BPA-based resin had the lowest concentrations at Baseline (GM = 4.81 μg g−1) and post-baseline (GM = 23.2 μg g−1). In multiple regression models, at baseline, industry significantly predicted increased total BPACR (P = 0.0248); post-baseline, handling BPA containers (P = 0.0035), taking ≥3 process/bulk samples with BPA (P = 0.0002) and wearing a Tyvek® coverall (P = 0.0042) significantly predicted increased total BPACR (after adjusting for total BPACR at baseline, time point, and body mass index).

Source: Hines C.J. et al. (2017). Annals of Work Exp, 1-19.
http://dx.doi.org/10.1093/annweh/wxw021

Risks to respiratory health in the grain industry

A detailed literature search was carried out to summarise evidence about respiratory disease caused by exposure to grain dust. Long term epidemiological studies examining the risk for respiratory disease in grain workers were undertaken in Canada and the USA from the 1970s to the late 1990s. Smaller studies were undertaken in the UK and Europe but mostly focussed on respiratory disease in arable and livestock farmers.
The conclusion of this review is that the damaging effects of grain dust on the respiratory tract are accumulative and occur at high concentrations of exposure. Acute responses also occur and include declines in lung function as well as irritation and inflammation of the airways. There is less evidence that grain dust exposure causes occupational asthma despite the dusts containing allergens. This may be due to a ‘healthy worker' effect with those already having, or developing, asthma leaving employment earlier than others. There is stronger evidence that the long term effects of exposure include emphysema, chronic obstructive pulmonary disease and interstitial fibrosis of the lung. The risk of developing extrinsic allergic alveolitis has reduced through preventing damp conditions in stored grain.

Source: http://www.hse.gov.uk/research/rrhtm/rr1083.htm

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