Acrylates in artificial nails-Results of product analyses and glove penetration studies.

BACKGROUND: Artificial nail materials are mixtures that are prone to contain several sensitizing (meth)acrylates. It is not known whether the listing of (meth)acrylates is correct in these products' packages. Protective gloves suited for nail work are needed. OBJECTIVES: To analyse (meth)acrylates in gel nail and acrylic nail products chemically and to compare the results with the information in the product labels, and to study penetration of artificial nail materials through selected disposable gloves. METHODS: We analysed 31 gel nail products and 6 acrylic nail products for their (meth)acrylate content by gas chromatography-mass spectrometry (GC-MS). We tested the penetration of two nail products through three disposable gloves: nitrile rubber, neoprene rubber and polyvinyl chloride (PVC). RESULTS: Altogether 32/37 products contained (meth)acrylates. In all of them, there was discrepancy between the listed (meth)acrylates and those discovered in the analysis. The commonest (meth)acrylates were hydroxyethyl methacrylate (HEMA, 20/37 samples) and hydroxypropyl methacrylate (HPMA, 9/37 samples), but many of the product packages failed to declare them. Isobornyl acrylate (IBA) was discovered in nine gel nail products. The neoprene glove could withstand nail gel for 20 min and thin nitrile glove and PVC glove for 5 min. Acrylic nail liquid penetrated through disposable gloves quickly. CONCLUSIONS: Labelling of artificial nail products was notably incorrect on most products. Requirements for product labelling must be updated so that the risk of sensitization associated with artificial nail products is clearly indicated. Disposable gloves can probably be used short-term in gel nail work, whereas disposable gloves do not protect the user from acrylic nail liquids.

Large-scale decontamination of disposable FFP2 and FFP3 respirators by hydrogen peroxide vapour, Finland, April to June 2020.

BackgroundThe shortage of FFP2 and FFP3 respirators posed a serious threat to the operation of the healthcare system at the onset of the COVID-19 pandemic.AimOur aim was to develop and validate a large-scale facility that uses hydrogen peroxide vapour for the decontamination of used respirators.MethodsA multidisciplinary and multisectoral ad hoc group of experts representing various organisations was assembled to implement the collection and transport of used FFP2 and FFP3 respirators from hospitals covering 86% of the Finnish population. A large-scale decontamination facility using hydrogen peroxide vapour was designed and constructed. Microbiological tests were used to confirm efficacy of hydrogen peroxide vapour decontamination together with a test to assess the effect of decontamination on the filtering efficacy and fit of respirators. Bacterial and fungal growth in stored respirators was determined by standard methods.ResultsLarge-scale hydrogen peroxide vapour decontamination of a range of FFP2 and FFP3 respirator models effectively reduced the recovery of biological indicators: Geobacillus stearothermophilus and Bacillus atrophaeus spores, as well as model virus bacteriophage MS2. The filtering efficacy and facial fit after hydrogen peroxide vapour decontamination were not affected by the process. Microbial growth in the hydrogen peroxide vapour-treated respirators indicated appropriate microbial cleanliness.ConclusionsLarge-scale hydrogen peroxide vapour decontamination was validated. After effective decontamination, no significant changes in the key properties of the respirators were detected. European Union regulations should incorporate a facilitated pathway to allow reuse of appropriately decontaminated respirators in a severe pandemic when unused respirators are not available.

Skin exposure to epoxy chemicals in construction coating, assessed by observation, interviews, and measurements.

BACKGROUND: Epoxy resin systems (ERSs) are among the leading causes of occupational allergic contact dermatitis. OBJECTIVES: To identify riskful exposures and sources of skin exposure, and to quantify skin exposure to diglycidyl ether of bisphenol A (DGEBA) epoxy monomer, in construction coating work. METHODS: Skin exposure to epoxy chemicals was studied in 5 coating companies through (a) interviews and visual observation, (b) quantifying DGEBA on 12 workers' skin by tape-stripping, (c) measuring DGEBA on 23 surfaces by wipe-sampling, and (d) quantifying DGEBA in new sewage pipe. Acetone extracts of the tapes, wipes and sawdust from a newly hardened sewage pipe were analysed by gas chromatography/mass spectrometry. RESULTS: Identified riskful exposures were, for example, mixing ERSs, handling coating pots, and working above shoulder level. Epoxy stains on, for example, tools, equipment and clothing were seen in all workplaces. Protective gloves were of varying quality, and were not always suitable for chemicals. The amount of DGEBA on the workers' skin varied considerably. All screened tool handles were contaminated. Two-day-old epoxy sewage pipe contained 3.2% DGEBA. CONCLUSIONS: Construction coating entails skin contact with ERSs directly and via contaminated surfaces, personal protective equipment, and recently hardened epoxy materials. Observation is a useful method for assessing skin exposure in coating work.

Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff.

BACKGROUND: In epidemics of highly infectious diseases, such as Ebola Virus Disease (EVD) or SARS, healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Contact precautions by means of personal protective equipment (PPE) can reduce the risk. It is unclear which type of PPE protects best, what is the best way to remove PPE, and how to make sure HCWs use PPE as instructed. OBJECTIVES: To evaluate which type or component of full-body PPE and which method of donning or removing (doffing) PPE have the least risk of self-contamination or infection for HCWs, and which training methods most increase compliance with PPE protocols. SEARCH METHODS: We searched MEDLINE (PubMed up to 8 January 2016), Cochrane Central Register of Trials (CENTRAL up to 20 January 2016), EMBASE (embase.com up to 8 January 2016), CINAHL (EBSCOhost up to 20 January 2016), and OSH-Update up to 8 January 2016. We also screened reference lists of included trials and relevant reviews, and contacted NGOs and manufacturers of PPE. SELECTION CRITERIA: We included all eligible controlled studies that compared the effect of types or components of PPE in HCWs exposed to highly infectious diseases with serious consequences, such as EVD and SARS, on the risk of infection, contamination, or noncompliance with protocols. This included studies that simulated contamination with fluorescent markers or a non-pathogenic virus.We also included studies that compared the effect of various ways of donning or removing PPE, and the effects of various types of training in PPE use on the same outcomes. DATA COLLECTION AND ANALYSIS: Two authors independently selected studies, extracted data and assessed risk of bias in included trials. We intended to perform meta-analyses but we did not find sufficiently similar studies to combine their results. MAIN RESULTS: We included nine studies with 1200 participants evaluating ten interventions. Of these, eight trials simulated the exposure with a fluorescent marker or virus or bacteria containing fluids. Five studies evaluated different types of PPE against each other but two did not report sufficient data. Another two studies compared different types of donning and doffing and three studies evaluated the effect of different types of training.None of the included studies reported a standardised classification of the protective properties against viral penetration of the PPE, and only one reported the brand of PPE used. None of the studies were conducted with HCWs exposed to EVD but in one study participants were exposed to SARS. Different types of PPE versus each otherIn simulation studies, contamination rates varied from 25% to 100% of participants for all types of PPE. In one study, PPE made of more breathable material did not lead to a statistically significantly different number of spots with contamination but did have greater user satisfaction (Mean Difference (MD) -0.46 (95% Confidence Interval (CI) -0.84 to -0.08, range 1 to 5, very low quality evidence). In another study, gowns protected better than aprons. In yet another study, the use of a powered air-purifying respirator protected better than a now outdated form of PPE. There were no studies on goggles versus face shields, on long- versus short-sleeved gloves, or on the use of taping PPE parts together. Different methods of donning and doffing procedures versus each otherTwo cross-over simulation studies (one RCT, one CCT) compared different methods for donning and doffing against each other. Double gloving led to less contamination compared to single gloving (Relative Risk (RR) 0.36; 95% CI 0.16 to 0.78, very low quality evidence) in one simulation study, but not to more noncompliance with guidance (RR 1.08; 95% CI 0.70 to 1.67, very low quality evidence). Following CDC recommendations for doffing led to less contamination in another study (very low quality evidence). There were no studies on the use of disinfectants while doffing. Different types of training versus each otherIn one study, the use of additional computer simulation led to less errors in doffing (MD -1.2, 95% CI -1.6 to -0.7) and in another study additional spoken instruction led to less errors (MD -0.9, 95% CI -1.4 to -0.4). One retrospective cohort study assessed the effect of active training - defined as face-to-face instruction - versus passive training - defined as folders or videos - on noncompliance with PPE use and on noncompliance with doffing guidance. Active training did not considerably reduce noncompliance in PPE use (Odds Ratio (OR) 0.63; 95% CI 0.31 to 1.30) but reduced noncompliance with doffing procedures (OR 0.45; 95% CI 0.21 to 0.98, very low quality evidence). There were no studies on how to retain the results of training in the long term or on resource use.The quality of the evidence was very low for all comparisons because of high risk of bias in studies, indirectness of evidence, and small numbers of participants. This means that it is likely that the true effect can be substantially different from the one reported here. AUTHORS' CONCLUSIONS: We found very low quality evidence that more breathable types of PPE may not lead to more contamination, but may have greater user satisfaction. We also found very low quality evidence that double gloving and CDC doffing guidance appear to decrease the risk of contamination and that more active training in PPE use may reduce PPE and doffing errors more than passive training. However, the data all come from single studies with high risk of bias and we are uncertain about the estimates of effects.We need simulation studies conducted with several dozens of participants, preferably using a non-pathogenic virus, to find out which type and combination of PPE protects best, and what is the best way to remove PPE. We also need randomised controlled studies of the effects of one type of training versus another to find out which training works best in the long term. HCWs exposed to highly infectious diseases should have their use of PPE registered and should be prospectively followed for their risk of infection.

Testing Penetration of Epoxy Resin and Diamine Hardeners through Protective Glove and Clothing Materials.

Efficient, comfortable, yet affordable personal protective equipment (PPE) is needed to decrease the high incidence of allergic contact dermatitis arising from epoxy resin systems (ERSs) in industrial countries. The aim of this study was to find affordable, user-friendly glove and clothing materials that provide adequate skin protection against splashes and during the short contact with ERS that often occurs before full cure. We studied the penetration of epoxy resin and diamine hardeners through 12 glove or clothing materials using a newly developed test method. The tests were carried out with two ERS test mixtures that had a high content of epoxy resin and frequently used diamine hardeners of different molar masses. A drop (50 µl) of test mixture was placed on the outer surface of the glove/clothing material, which had a piece of Fixomull tape or Harmony protection sheet attached to the inner surface as the collection medium. The test times were 10 and 30 min. The collecting material was removed after the test was finished and immersed into acetone. The amounts of diglycidyl ether of bisphenol A (DGEBA), isophorone diamine (IPDA), and m-xylylenediamine (XDA) in the acetone solution were determined by gas chromatography with mass spectrometric detection. The limit for acceptable penetration of XDA, IPDA, and DGEBA through glove materials was set at 2 µg cm(-2). Penetration through the glove materials was 1.4 µg cm(-2) or less. The three tested chemical protective gloves showed no detectable penetration (<0.5 µg cm(-2)). Several affordable glove and clothing materials were found to provide adequate protection during short contact with ERS, in the form of, for example, disposable gloves or clothing materials suitable for aprons and as additional protective layers on the most exposed parts of clothing, such as the front of the legs and thighs and under the forearms. Every ERS combination in use should be tested separately to find the best skin protection material, and this can be done by using this simple test method.

A new penetration test method: protection efficiency of glove and clothing materials against diphenylmethane diisocyanate (MDI).

Reported cases of allergic contact dermatitis caused by methylenediphenyl diisocyanate (MDI) have increased and thereby increased the need for adequate skin protection. Current standardized permeation and penetration test methods give information about efficacy of protective materials against individual components of the polyurethane systems. They do not give information of what kind of clothing materials workers should wear against splashes when handling mixed MDI-polyurethane formulations, which contain MDI, its oligomers, and polyols. The aim of this study was to develop and validate a sensitive penetration test method that can be used to select clothing that is protective enough against uncured splashes of MDI-polyurethane, still easy to use, and also, to find affordable glove materials that provide adequate protection during a short contact. The penetration of MDI through eight representative glove or clothing materials was studied with the developed test procedure. One MDI hardener and two polymeric MDI (PMDI)-polyol formulations representing different curing times were used as test substances. The materials tested included work clothing (woven) fabric, arm shields (nonwoven fabric), old T-shirt, winter gloves, and gloves of nitrile rubber, leather, vinyl (PVC), and natural rubber. A drop (50 µl) of test substance was added to the outer surface of the glove/clothing material, which had Tape Fixomull attached to the inner surface as a collection medium. After penetration times of 5 or 20min, the collecting material was removed and immediately immersed into acetonitrile containing 1-(2-methoxyphenyl)-piperazine for derivatization. The formed urea derivatives of 2,4'-MDI and 4,4'-MDI were analysed using liquid chromatography with mass spectrometric and UV detection. The precision of the test method was good for the material with high penetration (work clothing fabric) of MDI, as the relative standard deviation (RSD) was 14 and 20%. For the arm shield with a low penetration (the nonwoven fabric), the precision was lower with RSDs of 35 and 50%. For two clothing materials, the penetration was high (134-577 µg cm(-2)). Low penetration (<0.5 µg cm(-2)) was shown by the arm shield and the natural rubber glove. Three glove materials showed no detectable MDI penetration (<0.002 µg cm(-2)). Two affordable glove materials (natural rubber and nitrile rubber) and one clothing material (dust proof arm shield) that can provide adequate protection during short contact with solvent free PMDI formulations were found. The new test procedure should be standardized in order to get a new international penetration standard.

Role of dermal exposure in systemic intake of methylenediphenyl diisocyanate (MDI) among construction and boat building workers.

The causal relationship between inhalation exposure to methylenediphenyl diisocyanate (MDI) and the risk of occupational asthma is well known, but the role of dermal exposure and dermal uptake of MDI in this process is still unclear. The aims of this study were to measure dermal exposure to and the dermal uptake of MDI among workers (n=24) who regularly handle MDI-urethanes. Dermal exposure was measured by the tape-strip technique from four sites on the dominant hand and arm. The workers with the highest exposure (n=5) were biomonitored immediately after their work shift, in the evening and the next morning, using urinary 4,4´methylenedianiline (MDA) as a marker. Dermal uptake was evaluated by comparing workers' MDA excretions both when they were equipped with respiratory protective devices (RPDs) and when they did not use them. The measured amounts of MDI on their hands varied from below 0.1 to 17 µg/10 cm(2) during the test. MDI concentrations were in the range of 0.08 to 27 µg m(-3) in the breathing zone outside the RPDs. MDA concentrations varied from 0.1 to 0.2 µmol mol(-1) creatinine during the test period. The decreasing effect of RPDs on inhalation exposure was absent in the next morning urine samples; this excretion pattern might be an indication of dermal uptake of MDI.

Permeation tests of glove and clothing materials against sensitizing chemicals using diphenylmethane diisocyanate as an example.

Diphenylmethane diisocyanate (MDI) is a sensitizing chemical that can cause allergic contact dermatitis and asthma. Protective gloves and clothing are necessary to prevent skin exposure. Breakthrough times are used for the selection of chemical protective gloves and clothing. In the EN 374-3:2003 European standard, breakthrough time is defined as the time in which the permeation reaches the rate of 1.0 µg min(-1) cm(-2) through the material. Such breakthrough times do not necessarily represent safe limits for sensitizing chemicals. We studied the permeation of 4,4'-MDI through eight glove materials and one clothing material. The test method was derived from the EN 374-3 and ASTM F 739 standards. All measured permeation rates were below 0.1 µg min(-1) cm(-2), and thus, the breakthrough times for all the tested materials were over 480min, when the definitions of EN 374-3 and ASTM F 739 for the breakthrough time were used. Based on the sensitizing capacity of MDI, we concluded that a cumulative permeation of 1.0 µg cm(-2) should be used as the end point of the breakthrough time determination for materials used for protection against direct contact with MDI. Using this criterion for the breakthrough time, seven tested materials were permeated in <480min (range: 23-406min). Affordable chemical protective glove materials that had a breakthrough time of over 75min were natural rubber, thick polyvinylchloride, neoprene-natural rubber, and thin and thick nitrile rubber. We suggest that the current definitions of breakthrough times in the standard requirements for protective materials should be critically evaluated as regards MDI and other sensitizing chemicals, or chemicals highly toxic via the skin.

Respiratory symptoms and conditions related to occupational exposures in machine shops.

OBJECTIVES: Since there are few data on the effects of metalworking in populations representing a variety of metal companies or on dose-response relationships concerning metalworking, this study investigated the relationship between occupational exposures in machine shops and the occurrence of upper and lower respiratory symptoms, asthma, and chronic bronchitis. METHODS: A cross-sectional study of 726 male machine workers and 84 male office workers from 64 companies was conducted in southern Finland. All of the participants filled out a questionnaire, and aerosol measurements were performed in 57 companies. RESULTS: Exposure to metalworking fluids (MWF) showed a greater risk [odds ratio (OR)>or=2) for upper-airway symptoms, cough, breathlessness, and current asthma than exposures in office work did. Exposure to aerosol levels above the median (>or=0.17 mg/m3 in the general workshop air) was related to an increased risk (OR>or=2) of nasal and throat symptoms, cough, wheezing, breathlessness, chronic bronchitis, and current asthma. Machine workers with a job history of >or=15 years experienced increased throat symptoms, cough, and chronic bronchitis. CONCLUSIONS: This large study representing machine shops in southern Finland showed that machine workers experience increased nasal and throat symptoms, cough, wheezing, breathlessness, and asthma even in environments with exposure levels below the current occupational exposure limit for oil mists. The study suggests that improving machine shop environments could benefit the health of this workforce. It also suggests that it is time to consider reducing the current Finnish occupational exposure limit for oil mist or introducing the use of other health-relevant indicators of exposure.

Occupational contact allergy to glyoxal.

Glyoxal is a dialdehyde that is used as a disinfectant in health care and dentistry work. Allergic contact dermatitis from glyoxal has been described in these occupations. We analysed our patient data from 1998 to 2004 for allergic reactions to glyoxal. 20 patients had allergic reactions to glyoxal on patch testing. 5 of these patients worked in dentistry and 4 of them had present exposure to glyoxal. 9 patients were machinists without obvious exposure to glyoxal. A grinder with work-related facial dermatitis is described in detail. The chemical analysis of air samples from his workplace revealed 9.4-21 microg/m3 glyoxal. Glyoxal was also present in the used metal-working fluid, and apparently it had been formed during grinding. The remaining 6 patients worked in miscellaneous occupations and had no present exposure to glyoxal. Glyoxal is irritant on patch testing. Especially, solitary reactions to glyoxal 10% in aq. may be false-positive irritant reactions. 9 (45%) of our patients reacted to formaldehyde or glutaraldehyde. Glyoxal is an important allergen in dentistry and medical care, and we recommend it to be added to the antimicrobial patch test series. It also seems to be a 'hidden' allergen in the metal industry.

The permeability of surgical gloves to seven chemicals commonly used in hospitals.

Disinfectants may cause adverse effects directly on the skin or systemically by permeating through the skin. In this study breakthrough times were measured for surgical gloves with chemicals which are commonly used in healthcare. Classical methods of analytical chemistry were tailored for the permeation tests, which were carried out according to the European standard EN 374 and the American standard ASTM F739. An exception to the EN 374 standard was made by using a 4 h testing time instead of 8 h. The gloves did not exhibit permeation of potassium hydroxide (45%), sodium hypochlorite (13%) or hydrogen peroxide (30%). Furthermore, neither glutaraldehyde (2%) nor chlorhexidine digluconate (4%) in the commercial disinfectant solutions studied exhibited permeation. Slight permeation of peracetic acid (0.35%) and acetic acid (4%) from a disinfectant agent was observed through single layered natural rubber materials. Clear evidence of formaldehyde permeation was detected through single layered natural rubber gloves, where the ASTM breakthrough times were 17-67 min, but the permeation rates were not high enough for breakthrough to have occurred according to the EN standard. The gloves in this study which offered most protection from chemical permeation were the chloroprene gloves and the thick double layered natural rubber gloves.

Permeation of 70% isopropyl alcohol through surgical gloves: comparison of the standard methods ASTM F739 and EN 374.

Standard test methods ASTM F739 and EN 374 were compared by assessing the permeation of 70% isopropyl alcohol (2-propanol) through seven brands of surgical gloves. The two standards differ in the flow rates of the collection medium and in the chemical permeation rate at which the breakthrough time (BTT) is detected, the EN detection level being 10 times higher than the permeation rate used by ASTM. In a departure from the EN standard method, a 4 h testing time was used instead of 8 h. All of the tested gloves were from the same manufacturer and were made from either natural rubber (NR) (six brands) or chloroprene rubber (CR) (one brand). Two of the NR glove brands were double layered. For the thin NR gloves (0.22, 0.28 and 0.27 mm) the permeation rates were higher throughout the tests with a flow rate of 474 ml/min (EN) of the collection medium (nitrogen) compared with the permeation rates obtained with a flow rate of 52 ml/min (ASTM). These resulted in BTTs of 4.6, 6.5 and 7.6 min (EN) and 4.8, 6.5 and 9.1 min (ASTM), respectively. No statistical difference could be observed between the BTT values obtained with the two standard methods for any of the thin gloves. Thus, although the ASTM standard has a lower criterion for the detection of permeation, it does not necessarily produce shorter BTTs. For the better barriers the methods yielded more equivalent permeation rate curves and thus the EN BTTs were longer than the ASTM BTTs: the EN results were 21, 80, 122 and >240 min compared with the ASTM results of 12, 32, 38 and 103 min for glove thicknesses of 0.37 (NR), 0.22 + 0.22 (double layered NR), 0.31 + 0.29 (double layered NR) and 0.19 mm (CR), respectively.