Metal exposure of workers during recycling of electronic waste: a cross-sectional study in sheltered workshops in Germany.

OBJECTIVES: In Germany, the initial step of electronic waste (e-waste) recycling frequently takes place in sheltered workshops for physically and mentally handicapped workers (Werkstätten für behinderte Menschen (WfbM), in german language). E-waste recycling involves a potential risk of exposure to toxic metals. Therefore, we assessed the occupational exposure of recycling workers to toxic metals to identify potential health risks and insufficient protective measures. METHODS: We used a combined air- and bio-monitoring approach to determine exposure of recycling workers to toxic metals. Air and urine samples were collected in five sheltered workshops in Germany and were analysed for their content of aluminium, antimony, arsenic, beryllium, cadmium, chromium, cobalt, mercury and nickel. Results were compared to German and international occupational limit values and to metal exposures of workers in conventional e-waste recycling firms. RESULTS: Exposure of recycling workers in five German sheltered workshops to the studied metals and their compounds was below German and international occupational limit values across all facilities studied considering both air and urine samples. Workers in the present study were not exposed to higher amounts of toxic metals than workers in conventional e-waste recycling firms. CONCLUSION: This is the first study on toxic metal exposure of recycling workers in sheltered workshops. The results of this study revealed a low occupational exposure of e-waste recycling workers to toxic metals in this type of enterprises. Current work methods and safety measures provide the workers with adequate protection.

Comparison of established systems for measuring the dustiness of powders with the UNC Dustiness Tester developed especially for pharmaceutical substances.

Four methods for evaluating the dustiness of powders have been compared. The relatively new UNC Dustiness Tester first described by Boundy et al. (2006) in the Annals of Occupational Hygiene, which was developed specifically for the measurement of hazardous and/or highly potent substances, a single-drop device, a rotating-drum method, and a continuous drop-down apparatus. The four methods show four different ratings of dustiness for nine reference materials. This article describes the differences, explores reasons for the deviations, identifies a need for distinct dustiness test methods, and highlights the significance for occupational health and safety.

Application and assessment of a regular environmental monitoring of the antineoplastic drug contamination level in pharmacies - the MEWIP project.

A large-scale study was carried out in order to determine the contamination level of antineoplastic drugs in pharmacies and to investigate the suitability and effects of wipe sample monitoring at regular intervals. A specific study design was developed. The 130 participating pharmacies were divided into a study and a control group, carrying out five and two wipe sampling cycles, respectively. The work practice was analyzed using questionnaires to identify factors that influence the contamination level. From 1269 wipe samples, 774 (61%) were contaminated with at least one of the analyzed cytotoxic drugs: cyclophosphamide, docetaxel, etoposide, 5-fluorouracil, gemcitabine, ifosfamide, methotrexate, and paclitaxel. A significant decrease of the contamination with cyclophosphamide and 5-fluorouracil was observed in the study group. The Monitoring-Effect Study of Wipe Sampling in Pharmacies method has proven to be a reliable and affordable tool for contamination control. Based on the 90th percentile of the contamination values, a substance-independent performance-based guidance value of 0.1ng cm(-2) has been derived.

A simple approach to assess the cancer risk of occupational exposure to genotoxic drugs in healthcare settings.

BACKGROUND: Several drugs for human use possess genotoxic properties as a necessary consequence of their intended therapeutic effect (e.g. antineoplastics). Health workers may be exposed to these chemicals in various occupational settings such as dose preparation and administration. To date, there are no quantitative risk assessment models to estimate the cancer risk of health workers due to the handling of genotoxic drugs. We therefore developed a quantitative risk assessment model to assess the cancer risk of occupational exposure to genotoxic drugs in healthcare settings based on the threshold of toxicological concern (TTC) concept. This model was used to evaluate the cancer risk of health workers due to the handling of genotoxic drugs in modern health care facilities. METHODS: We modified the threshold of toxicological concern (TTC) concept to fit the purpose of occupational cancer risk assessment. The risk model underlying ICH guideline M7 (R1): "assessment and control of DNA reactive (mutagenic) impurities in pharmaceuticals to limit potential carcinogenic risk" was used as a starting point for our model. We conducted a short review of studies on the occupational exposure of health workers to genotoxic drugs. These occupational exposure data were compared to the acceptable exposure levels resulting from our TTC based risk model. RESULTS: Based on the threshold of toxicological concern (TTC) concept, we defined an acceptable daily intake (ADI) of 4 µg/day as threshold of no concern for the exposure of health workers to genotoxic drugs. Regarding the dermal exposure of health workers to genotoxic drugs, we derived a corresponding acceptable surface contamination level (ASCL) of 20 ng/cm2. Both ADI and ASCL are usually not exceeded in modern healthcare settings. Current safety precautions provide sufficient protection to health workers. CONCLUSIONS: The application of our model indicates that workers in modern healthcare facilities are not at risk of developing work related cancer above widely accepted cancer risk levels due to the occupational exposure to genotoxic drugs. Hence, the present study may assist employers and public authorities to make informed decisions concerning the need for (further) protective measures and during risk communication to health workers.

Surgical Smoke-Hazard Perceptions and Protective Measures in German Operating Rooms.

(1) Background: Hazardous substances in surgical smoke that is generated during laser or electrosurgery pose a potential health hazard. In Germany, the Technical Rules for Hazardous Substances (TRGS 525) have included recommendations for appropriate protective measures since 2014. Up to now, no empirical data has been available on the extent to which recommendations have been implemented in practice. (2) Methods: In 2018, 7089 surgeons in hospitals and outpatient practices were invited by email to participate in an online survey. In addition, 219 technical assistants were interviewed. The questionnaire dealt with knowledge of, and attitudes toward, the hazard potential of surgical smoke, as well as the availability and actual use of protective measures. Furthermore, manufacturers and distributors of smoke extraction devices were asked to give their assessment of the development of prevention in recent years. (3) Results: The survey response rate was 5% (surgeons) and 65% (technical assistant staff). Half of all surgeons assumed that there were high health hazards of surgical smoke without taking protective measures. Operating room nurses were more often concerned (88%). Only a few felt properly informed about the topic. The TRGS recommendations had been read by a minority of the respondents. In total, 52% of hospital respondents and 65% of the respondents in outpatient facilities reported any type of special suction system to capture surgical smoke. One-fifth of respondents from hospitals reported that technical measures had improved since the introduction of the TRGS 525. Fifty-one percent of the surgeons in hospitals and 70% of the surgeons in outpatient facilities "mostly" or "always" paid attention to avoiding surgical smoke. The most important reason for non-compliance with recommendations was a lack of problem awareness or thoughtlessness. Twelve industrial interviewees who assessed the situation and the development of prevention in practice largely confirmed the prevention gaps observed; only slight developments were observed in recent years. (4) Conclusions: The low response rate among surgeons and the survey results both indicate a major lack of interest and knowledge. Among other measures, team interventions with advanced training are needed in the future.