Pharmaceutical dust exposure at pharmacies using automatic dispensing machines: a preliminary study.

Automatic dispensing machines (ADMs) used in pharmacies concentrate and dispense large volumes of pharmaceuticals, including uncoated tablets that can shed dust. We evaluated 43 employees' exposures to pharmaceutical dust at three pharmacies where ADMs were used. We used an optical particle counter to identify tasks that generated pharmaceutical dust. We collected 72 inhalable dust air samples in or near the employees' breathing zones. In addition to gravimetric analysis, our contract laboratory used internal methods involving liquid chromatography to analyze these samples for active pharmaceutical ingredients (APIs) and/or lactose, an inactive filler in tablets. We had to choose samples for these additional analyses because many methods used different extraction solvents. We selected 57 samples for analysis of lactose. We used real-time particle monitoring results, observations, and information from employees on the dustiness of pharmaceuticals to select 28 samples (including 13 samples that were analyzed for lactose) for analysis of specific APIs. Pharmaceutical dust was generated during a variety of tasks like emptying and refilling of ADM canisters. Using compressed air to clean canisters and manual count machines produced the overall highest peak number concentrations (19,000-580,000 particles/L) of smallest particles (count median aerodynamic diameter ≤ 2 µm). Employees who refilled, cleaned, or repaired ADM canisters, or hand filled prescriptions were exposed to higher median air concentrations of lactose (5.0-12 µg/m(3)) than employees who did other jobs (0.04-1.3 µg/m(3)), such as administrative/office work, labeling/packaging, and verifying prescriptions. We detected 10 APIs in air, including lisinopril, a drug prescribed for high blood pressure, levothyroxine, a drug prescribed for hypothyroidism, and methotrexate, a hazardous drug prescribed for cancer and other disorders. Three air concentrations of lisinopril (1.8-2.7 µg/m(3)) exceeded the lower bound of the manufacturer's hazard control band (1-10 µg/m(3)). All other API air concentrations were below applicable occupational exposure limits. Our findings indicate that some pharmacy employees are exposed to multiple APIs and that measures are needed to control those exposures.

The identification of a sensitizing component used in the manufacturing of an ink ribbon.

Skin diseases including dermatitis constitute ≈ 30% of all occupational illnesses, with a high incidence in the printing industry. An outbreak of contact dermatitis among employees at an ink ribbon manufacturing plant was investigated by scientists from the National Institute for Occupational Safety and Health (NIOSH). Employees in the process areas of the plant were exposed to numerous chemicals and many had experienced skin rashes, especially after the introduction of a new ink ribbon product. To identify the causative agent(s) of the occupational dermatitis, the murine local lymph node assay (LLNA) was used to identify the potential of the chemicals used in the manufacture of the ink ribbon to induce allergic contact dermatitis. Follow-up patch testing with the suspected allergens was conducted on exposed employees. Polyvinyl butyral, a chemical component used in the manufacture of the ink ribbon in question and other products, tested positive in the LLNA, with an EC3 of 3.6%, which identifies it as a potential sensitizer; however, no employees tested positive to this chemical during skin patch testing. This finding has implications beyond those described in this report because of occupational exposure to polyvinyl butyral outside of the printing industry.

A health hazard evaluation of antimony exposure in fire fighters.

OBJECTIVES: Some firefighter station uniforms contain the flame-retardant, antimony trioxide. National Institute for Occupational Safety and Health investigated a possible outbreak of antimony toxicity wherein 30 firefighters reported elevated antimony levels on hair analyses. METHODS: We surveyed and collected urine samples from firefighters not wearing (Fire Department A) and wearing (Fire Department B) antimony-containing pants. Urine antimony concentrations were measured and adjusted for creatinine. RESULTS: All 20 participating firefighters from Fire Department A and 41 (97.6%) of 42 participating firefighters from Fire Department B had urine antimony concentrations below or within the national reference range. No differences in urine antimony levels between departments were detected. CONCLUSIONS: Wearing antimony-containing uniforms does not pose a risk for antimony toxicity. This investigation highlights the importance of using validated methods for toxicity determination and of accurate, timely risk communication.