Misclassification and characterization of exposure to humidifier disinfectants using a questionnaire.

BACKGROUND: Lung disease caused by exposure to chemical substances such as polyhexamethylene guanidine (PHMG) used in humidifier disinfectants (HDs) has been identified in Korea. Several researchers reported that exposure classification using a questionnaire might not correlate with the clinical severity classes determined through clinical diagnosis. It was asserted that the lack of correlation was due to misclassification in the exposure assessment due to recall bias. We identified the cause of uncertainty to recognize the limitations of differences between exposure assessment and clinical outcomes assumed to be true value. Therefore, it was intended to check the availability of survey using questionnaires and required to reduce misclassification error/bias in exposure assessment. METHODS: HDs exposure assessment was conducted as a face-to-face interview, using a questionnaire. A total of 5245 applicants participated in the exposure assessment survey. The questionnaire included information on sociodemographic and exposure characteristics such as the period, frequency, and daily usage amount of HDs. Based on clinical diagnosis, a 4 × 4 cross-tabulation of exposure and clinical classification was constructed. When the values of the exposure rating minus the clinical class were ≥ 2 and ≤ - 2, we assigned the cases to the overestimation and underestimation groups, respectively. RESULTS: The sex ratio was similar in the overestimation and underestimation groups. In terms of age, in the overestimation group, 90 subjects (24.7%) were under the age of 10, followed by 52 subjects (14.2%) in their 50s. In the underestimation group, 195 subjects (56.7%) were under the age of 10, followed by 80 subjects (23.3%) in their 30s. The overestimation group may have already recovered and responded excessively due to psychological anxiety or to receive compensation. However, relatively high mortality rates and surrogate responses observed among those under 10 years of age may have resulted in inaccurate exposure in the underestimation group. CONCLUSIONS: HDs exposure assessment using a questionnaire might not correlate with adverse health effects due to recall bias and various other causes such as recovery of injury and psychological anxiety. This study revealed exposure misclassification and characteristics affected by HDs and proposed a questionnaire-based exposure assessment methodology to overcome the limitations of past exposure assessment.

Potential health risks to disinfection workers from exposure to active substances in COVID-19 biocidal products.

The importance of disinfection has recently been emphasized due to the increasing risk of the spread of infections such as coronavirus disease-2019 (COVID-19). In addition, disinfection for preventing the spread of COVID-19 is highly recommended. The increased use of biocidal products raises concerns regarding the potential health risks from exposure among disinfection workers. This study aimed to assess these exposure and health risks using questionnaires targeting disinfection workers who were exposed to the active substances in biocidal products used for disinfection during the COVID-19 pandemic. A follow-up survey was conducted among 271 disinfection workers for 10 working days within two weeks, and exposure factors with reference to disinfection were evaluated through interview-administered questionnaires. An exposure algorithm was used to evaluate the exposure of disinfection workers during disinfection. The hazard index (HI) was calculated by dividing the inhalation concentration obtained using the exposure algorithm and the dermal dose according to occupational exposure limits (OEL). A sensitivity analysis was conducted to identify the exposure factors with the greatest impact on the inhalation and dermal exposure algorithms. A logistic regression analysis was performed to verify the relationship with health effects and sociodemographic and exposure characteristics. The average number of disinfections performed during 10 working days was 17.5 ± 12.3 times. The type of disinfection work was divided into 2806 cases of COVID-19 prevention and disinfection and 1956 cases of regular pesticide application to prevent and remove any pests. The HI was ≥1, indicating a potential health risk, with the use of ethanol (6.50E+00), quaternary ammonium compounds (QACs; 1.49E+01), and benzalkonium chloride (BKC; 1.73E+00). Dermal exposure was more hazardous than inhalation exposure for 6 of the 11 active substances in biocidal products. The weight fraction and exposure time were the factors that most significantly influenced the inhalation and dermal exposure algorithms in the sensitivity analysis. Higher exposure concentrations were more likely to affect health (AOR: 3.239, 95% CI: 1.155-9.082). This study provides valuable information regarding the exposure and risk of disinfection workers to 11 biocidal active substances included in common disinfectants. Our results suggest that the use of ethanol, BKC, and QACs has potential health risks to disinfection workers, with a higher possibility of negative health impacts with increasing exposure concentration.

Updated general exposure factors for risk assessment in the Korean population.

BACKGROUND: There has been an increasing need to update the recommended values of Korean exposure factors for adults aged 19 and older, as using exposure factors developed over a decade ago could reduce risk assessment reliability. OBJECTIVE: Exposure factor data have been compiled and standardized using the latest national statistical reports and academic literature, as well as studies conducted from 2016 to 2018. METHODS: The updated data contained anthropometric parameters, inhalation rates, food and drinking water ingestion rates, and time-activity patterns and provided technical information on Koreans' exposure factors classified by sex, age group, per capita and general population, and doer-only for various exposure assessments. RESULTS: Although the average life expectancy, body weight, body surface area, and inhalation rate increased slightly compared to the 2007 Korean Exposure Factor Handbook, differences various in food consumption were remarkable. Because of Asians' similar food preferences, the intake rate of grain products and vegetables in Koreans, Chinese, and Japanese contributed much toward total intake. Koreans spent half their times outdoors compared to Americans and Chinese. SIGNIFICANCE: This study provided the currently updated exposure factor information for Koreans and could be compared with recommendations provided by exposure factor resources in various countries. IMPACT STATEMENT: Exposure to environmental pollutants may significantly vary depending on the exposure factors related to human behaviors and characteristics. Therefore the exposure factors need to be continuously updated along with more extensive survey areas and improved measurement methods. We utilized the existing data with the aim to develop general exposure factors for risk assessment in Korean aged ≥19 years. Measurements and questionnaire surveys were also performed if there were no existing data. This study provided the currently updated exposure factor information for Koreans and could be compared to those of other countries.

Risk Assessment of Indoor Air Quality and Its Association with Subjective Symptoms among Office Workers in Korea.

The 2014 Time-Use Survey of Statistics Korea revealed that office workers are increasingly spending more than eight hours at work. This study conducted an exposure assessment for office workers in Korea. Indoor and outdoor air pollutants were measured in offices. A self-administered questionnaire was employed to determine work information, indoor air quality (IAQ) awareness, and subjective symptoms for 328 workers. Indoor air concentrations for measured air pollutants were below IAQ guideline values. The average concentrations of target air pollutants did not show significant differences except for benzene, which had relatively a higher concentration in national industrial complexes. The indoor benzene, ethylbenzene, and acetaldehyde concentrations were higher in offices where workers were having dry eye, ophthalmitis, and headache symptoms. This study provides reference values to manage IAQ in offices, suggesting that if the benzene concentration exceeds 4.23 µg/m3 in offices, it could cause dry eye symptoms. Considering the increasing working hours for office workers and health effects, workers' exposure to indoor pollutants should be reduced. In addition, the IAQ was heavily influenced by outdoor air levels and various indoor sources. Therefore, in areas with relatively high air pollution, greater monitoring and management is required considering the influence of outdoor air quality.