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      Changes in Work Practices for Safe Use of Formaldehyde in a University-Based Anatomy Teaching and Research Facility

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          Abstract

          Anatomy teaching and research relies on the use of formaldehyde (FA) as a preservation agent for human and animal tissues. Due to the recent classification of FA as a carcinogen, university hospitals are facing a challenge to (further) reduce exposure to FA. The aim of this study was to reduce exposure to FA in the anatomy teaching and research facility. Workers participated in the development of improved work practices, both technical and organizational solutions. Over a period of 6 years mitigating measures were introduced, including improvement of a down-flow ventilation system, introduction of local exhaust ventilation, collection of drain liquid from displayed specimens in closed containers and leak prevention. Furthermore, some organizational changes were made to reduce the number of FA peak exposures. Stationary and personal air sampling was performed in three different campaigns to assess the effect of these new work practices on inhalation exposure to FA. Samples were collected over 8 h (full shift) and 15 min (task-based) to support mitigation of exposure and improvement of work practices. Air was collected on an adsorbent coated with 2,4-dinitrophenylhydrazine (DNPH) and analyzed by HPLC-UV. Geometric mean (GM) concentrations of FA in the breathing zone over a work-shift were 123 µg/m 3 in 2012 and 114 µg/m 3 in 2014, exceeding the workplace standard of 150 µg/m 3 (8 h time-weighted average, TWA) on 46% of the workdays in 2012 and 38% of the workdays in 2014. This exposure was reduced to an average of 28.8 µg/m 3 in 2017 with an estimated probability of exceeding the OEL of 0.6%. Task-based measurements resulted in a mean peak exposures of 291 µg/m 3 in 2012 ( n = 19) and a mean of 272 µg/m 3 in 2014 ( n = 21), occasionally exceeding the standard of 500 µg/m 3 (15 min TWA), and were reduced to a mean of 88.7 µg/m 3 in 2017 ( n = 12) with an estimated probability of exceeding the OEL of 1.6%.

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          Mortality from lymphohematopoietic malignancies and brain cancer among embalmers exposed to formaldehyde.

          Christine Stewart, Jay H. Lubin, Laura Freeman … (2009)
          Excess mortality from lymphohematopoietic malignancies, in particular myeloid leukemia, and brain cancer has been found in surveys of anatomists, pathologists, and funeral industry workers, all of whom may have worked with formaldehyde. We investigated the relation of mortality to work practices and formaldehyde exposure levels among these professionals to address cancer risk in the funeral industry. Professionals employed in the funeral industry who died between January 1, 1960, and January 1, 1986, from lymphohematopoietic malignancies (n = 168) or brain tumors (n = 48) (ie, case subjects) were compared with deceased matched control subjects (n = 265) with regard to lifetime work practices and exposures in the funeral industry, which were obtained by interviews with next of kin and coworkers, and to estimated levels of formaldehyde exposure. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by use of logistic regression. All statistical tests were two-sided. Mortality from myeloid leukemia increased statistically significantly with increasing number of years of embalming (P for trend = .020) and with increasing peak formaldehyde exposure (P for trend = .036). Compared with subjects who performed fewer than 500 lifetime embalmings, mortality from myeloid leukemia was elevated among those who performed embalmings for more than 34 years (OR = 3.9, 95% CI = 1.2 to 12.5, P = .024), who performed more than 3068 embalmings (OR = 3.0, 95% CI = 1.0 to 9.2, P = .057), and those whose estimated cumulative formaldehyde exposure exceeded 9253 parts per million-hours (OR = 3.1; 95% CI = 1.0 to 9.6, P = .047). These exposures were not related to other lymphohematopoietic malignancies or to brain cancer. Duration of embalming practice and related formaldehyde exposures in the funeral industry were associated with statistically significantly increased risk for mortality from myeloid leukemia.
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            Re-evaluation of the WHO (2010) formaldehyde indoor air quality guideline for cancer risk assessment

            Gunnar Nielsen, Søren Larsen, Peder Wolkoff (2016)
            In 2010, the World Health Organization (WHO) established an indoor air quality guideline for short- and long-term exposures to formaldehyde (FA) of 0.1 mg/m3 (0.08 ppm) for all 30-min periods at lifelong exposure. This guideline was supported by studies from 2010 to 2013. Since 2013, new key studies have been published and key cancer cohorts have been updated, which we have evaluated and compared with the WHO guideline. FA is genotoxic, causing DNA adduct formation, and has a clastogenic effect; exposure–response relationships were nonlinear. Relevant genetic polymorphisms were not identified. Normal indoor air FA concentrations do not pass beyond the respiratory epithelium, and therefore FA’s direct effects are limited to portal-of-entry effects. However, systemic effects have been observed in rats and mice, which may be due to secondary effects as airway inflammation and (sensory) irritation of eyes and the upper airways, which inter alia decreases respiratory ventilation. Both secondary effects are prevented at the guideline level. Nasopharyngeal cancer and leukaemia were observed inconsistently among studies; new updates of the US National Cancer Institute (NCI) cohort confirmed that the relative risk was not increased with mean FA exposures below 1 ppm and peak exposures below 4 ppm. Hodgkin’s lymphoma, not observed in the other studies reviewed and not considered FA dependent, was increased in the NCI cohort at a mean concentration ≥0.6 mg/m3 and at peak exposures ≥2.5 mg/m3; both levels are above the WHO guideline. Overall, the credibility of the WHO guideline has not been challenged by new studies.
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              Occupational exposure to formaldehyde, hematotoxicity, and leukemia-specific chromosome changes in cultured myeloid progenitor cells.

              L. Zhang, X. Tang, N Rothman … (2010)
              There are concerns about the health effects of formaldehyde exposure, including carcinogenicity, in light of elevated indoor air levels in new homes and occupational exposures experienced by workers in health care, embalming, manufacturing, and other industries. Epidemiologic studies suggest that formaldehyde exposure is associated with an increased risk of leukemia. However, the biological plausibility of these findings has been questioned because limited information is available on the ability of formaldehyde to disrupt hematopoietic function. Our objective was to determine if formaldehyde exposure disrupts hematopoietic function and produces leukemia-related chromosome changes in exposed humans. We examined the ability of formaldehyde to disrupt hematopoiesis in a study of 94 workers in China (43 exposed to formaldehyde and 51 frequency-matched controls) by measuring complete blood counts and peripheral stem/progenitor cell colony formation. Further, myeloid progenitor cells, the target for leukemogenesis, were cultured from the workers to quantify the level of leukemia-specific chromosome changes, including monosomy 7 and trisomy 8, in metaphase spreads of these cells. Among exposed workers, peripheral blood cell counts were significantly lowered in a manner consistent with toxic effects on the bone marrow and leukemia-specific chromosome changes were significantly elevated in myeloid blood progenitor cells. These findings suggest that formaldehyde exposure can have an adverse effect on the hematopoietic system and that leukemia induction by formaldehyde is biologically plausible, which heightens concerns about its leukemogenic potential from occupational and environmental exposures.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Environ Res Public Health
                Journal ID (iso-abbrev): Int J Environ Res Public Health
                Journal ID (publisher-id): ijerph
                Title: International Journal of Environmental Research and Public Health
                Publisher: MDPI
                ISSN (Print): 1661-7827
                ISSN (Electronic): 1660-4601
                Publication date (Electronic): 19 September 2018
                Publication date (Print): September 2018
                Volume: 15
                Issue: 9
                Electronic Location Identifier: 2049
                Affiliations
                [1 ]Research Lab Molecular Epidemiology, Radboud Institute for Health Sciences, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; martien.graumans@ 123456radboudumc.nl (M.H.F.G.); gwbeckmann@ 123456gmail.com (G.B.); Maurice.vandael@ 123456radboudumc.nl (M.v.D.); Rob.anzion@ 123456radboudumc.nl (R.B.M.A.); Maarten.melissen@ 123456digireg.nl (M.M.); nicole_pinckaers@ 123456hotmail.com (N.P.); L.vanwel@ 123456uu.nl (L.v.W.); laurie.de.werdt@ 123456arbounie.nl (L.M.A.d.W.)
                [2 ]Yacht, High Tech Campus 32, 5656 AE Eindhoven, The Netherlands
                [3 ]Digireg, Kranestraat 37, 5961 GX Horst, The Netherlands
                [4 ]WUR-RIKILT, Akkermaalsbos 2, 6708 WB Wageningen, The Netherlands
                [5 ]Institute for Risk Assessment Sciences (IRAS), Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
                [6 ]Arbo Unie, Europalaan 40, 3526 KS Utrecht, The Netherlands
                [7 ]Department of Anatomy, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; vera.gelsing@ 123456radboudumc.nl (V.G.); Albert.vanlinge@ 123456radboudumc.nl (A.v.L.)
                Author notes
                [* ]Correspondence: paul.scheepers@ 123456radboudumc.nl ; Tel.: +31-24-36-16878
                Author information
                https://orcid.org/0000-0002-8546-2161
                https://orcid.org/0000-0002-3003-6632
                Article
                Publisher ID: ijerph-15-02049
                DOI: 10.3390/ijerph15092049
                PMC ID: 6164304
                PubMed ID: 30235815
                SO-VID: 43bb1941-ce22-42b6-8814-d85873bc6f32
                Copyright © © 2018 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 03 August 2018
                Date accepted : 12 September 2018
                Categories
                Subject: Article

                ScienceOpen disciplines: Public health
                Keywords: occupational hygiene,carcinogenicity,exposure assessment,risk assessment,risk management
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: occupational hygiene, carcinogenicity, exposure assessment, risk assessment, risk management

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