Formaldehyde exposure in gross anatomy laboratory of Suranaree University of Technology: a comparison of area and personal sampling

Bangkok school indoor air quality: monitoring and intervention by positive pressure fresh air system

A PM2.5 crisis in Thailand has caused the Thai government and public to be increasingly concerned about children's exposure to PM2.5 during time in school. This study is a part of a project to create a modeled effective school indoor air quality management for the Bangkok Metropolitan Administration (BMA). We measured air quality and environment in 10 Bangkok school rooms, including CO2, CO, O3, PM2.5, PM10, TVOCPID, formaldehyde, airborne bacteria and fungi, and gaseous organic contaminants. The indoor-to-outdoor concentration ratios indicated that either outdoor sources or indoor + outdoor sources were the predominant contributors to PM in naturally ventilated classrooms. Meanwhile, PM levels in air-conditioned classrooms strongly depended on class activities. CO2 measurements showed that the air-conditioned classrooms had a low 0.4 per hour air change rate and total fungal counts also reached 800 CFU m-3. Analysis of gaseous organic compounds showed that the two most abundant were aliphatic and aromatic hydrocarbons, accounting for 60% by mass concentration. Interestingly, 2-ethyl-1-hexanol, a mucous membrane irritant, was detected in all study rooms. In one naturally ventilated classroom, we implemented a positive pressure fresh air system to mitigate in-class PM levels; it kept PM levels below 20 μg m-3 throughout the class day. Students reported a 20-37% increase in satisfaction with the perceived indoor environmental quality and reported reduced rates in all symptoms of the sick building syndrome after implementing the positive pressure system.

The effects of enhanced formaldehyde clearance in a gross anatomy laboratory by floor plan redesign and dissection table adjustment

Formaldehyde has carcinogenic properties. It is associated with nasopharyngeal cancer and causes irritation of the eyes, nose, throat, and respiratory system. Formaldehyde exposure is a significant health concern for those participating in the gross anatomy laboratory, but no learning method can substitute cadaver dissection. We performed a formaldehyde level study in 2018, which found that most of the breathing zone (S-level) and environment (R-level) formaldehyde levels during laboratory sessions at the Faculty of Medicine Siriraj Hospital exceeded international ceiling standards. In the academic year 2019, we adapted the engineering rationale of the NIOSH hierarchy of controls to facilitate formaldehyde clearance by opening the dissection table covers and increasing the area per dissection table, then measured formaldehyde ceiling levels by formaldehyde detector tube with a gas-piston hand pump during (1) body wall, (2) upper limb, (3) head-neck, (4) thorax, (5) spinal cord removal, (6) lower limb, (7) abdomen, and (8) organs of special senses dissection sessions and comparing the results with the 2018 study. The perineum region data were excluded from analyses due to the laboratory closure in 2019 from the COVID-19 outbreak. There were statistically significant differences between the 2018 and 2019 S-levels (p < 0.001) and R-levels (p < 0.001). The mean S-level decreased by 64.18% from 1.34 ± 0.71 to 0.48 ± 0.26 ppm, and the mean R-level decreased by 70.18% from 0.57 ± 0.27 to 0.17 ± 0.09 ppm. The highest formaldehyde level in 2019 was the S-level in the body wall region (1.04 ± 0.3 ppm), followed by the S-level in the abdomen region (0.56 ± 0.08 ppm) and the spinal cord removal region (0.51 ± 0.29 ppm). All 2019 formaldehyde levels passed the OSHA 15-min STEL standard (2 ppm). The R-level in the special sense region (0.06 ± 0.02 ppm) passed the NIOSH 15-min ceiling limit (0.1 ppm). Three levels for 2019 were very close: the R-level in the head-neck region (0.11 ± 0.08 ppm), the abdomen region (0.11 ± 0.08), the body wall region (0.14 ± 0.12 ppm), and the S-level in the special sense region (0.12 ± 0.04 ppm). In summary, extensive analysis and removal of factors impeding formaldehyde clearance can improve the general ventilation system and achieve the OSHA 15-min STEL standard.

Evaluation of formaldehyde exposure among gross dissection after modified embalming solution and health assessment

Mainly embalming fixative contains formaldehyde which is classified as a carcinogen. People who work with cadavers have been at higher risk of cancer after formaldehyde exposure. We have formulated a less-formalin fixative (contained 3.6% formaldehyde,23.8% ethanol, 15% glycerin, and 0.2% phenol in the water) for preserving cadavers. Therefore, the objective of the present study was to evaluate the level of atmospheric formaldehyde indoors and the breathing exposure of medical students during dissection classes. We also analyzed the pulmonary parameters and effects of formaldehyde. The levels of atmospheric formaldehyde indoors and personal breathing exposure were sampled during anatomy dissection classes (musculoskeletal system, respiratory system, and abdominopelvic organ system) using sorbent tubes with air sampling pumps. Samples were then analyzed using Gas Chromatography with Flame Ionization Detector (GC-FID). The mean level of formaldehyde indoor air among the three classes was 0.518 ± 0.156 ppm whereas the formaldehyde level in the personal breathing zone was 0.956±0.408 ppm, which exceeded the recommended exposure standards of international agencies, including NIOSH agency and PEL of Thailand legislation. The laboratory had high humidity, high room temperature, and poor air ventilation. There was a significant difference in FVC, FEV1, and PEF (p < 0.05) between the sexes of students. Comparison pulmonary parameters between students and instructors showed that all parameters of the pulmonary function test had no significant differences. General fatigue and burnings of eyes and nose associated with strong odor were the most common symptoms reported during the dissection classes. The modified embalming fixative was used less formalin with ethanol-glycerin mixture, and it was suitable for the study of medical students, with few side effects of respiratory problems. However, the modified exhaust ventilation with local table-exhaust ventilation and heating-ventilation-air conditioning system performance were urgent issues for reducing levels of formaldehyde indoor air in the dissection room.

Occupational scenarios and exposure assessment to formaldehyde: A systematic review

The objectives of the systematic review were to: identify the work sectors at risk for exposure to formaldehyde; investigate the procedures applied to assess occupational exposure; evaluate the reported exposure levels among the different settings. An electronic search of Pubmed, Scopus, Web of Science and ToxNet was carried out for collecting all the articles on the investigated issue published from January 1, 2004 to September 30, 2019. Forty-three papers were included in the review, and evidenced a great number of occupational scenarios at risk for formaldehyde exposure. All the included studies collected data on formaldehyde exposure levels by a similar approach: environmental and personal sampling followed by chromatographic analyses. Results ranged from not detectable values until to some mg m^-3 of airborne formaldehyde. The riskiest occupational settings for formaldehyde exposure were the gross anatomy and pathology laboratories, the hairdressing salons and some specific productive settings, such as wooden furniture factories, dairy facilities and fish hatcheries. Notice that formaldehyde, a well-known carcinogen, was recovered in air at levels higher than outdoor in almost all the studied scenarios/activities; thus, when formaldehyde cannot be removed or substituted, targeted strategies for exposure elimination or mitigation must be adopted.

Formaldehyde exposure and atmospheric biomonitoring with lichen Cladonia verticillaris in an anatomy laboratory

Formaldehyde is one of the most toxic contaminants of indoor environments and very common in the anatomy laboratory. In this work, we investigated the level of formaldehyde exposure to staff and students who attended an anatomy lab and in nearby environments in the same university building. We also performed atmospheric biomonitoring of the sites with the lichen Cladonia verticillaris. Quantification samplings were performed over four weeks, on 7 days with and 7 days without practical classes, totaling 70 samples. The samples were collected in five different locations, three points inside the laboratory and two points outside the laboratory, representing nearby and susceptible environments to contamination. The results showed CHOH concentrations from 0.20-3.76 ppmv for days with practical courses and 0.17-3.06 ppmv for days without practical classes. Although the laboratory was more contaminated than the surrounding environments, the concentration of formaldehyde in these areas is not negligible, showing a dispersion of formaldehyde from the laboratory. Potential dose (PD) and cancer risk (CR) were calculated for an individual exposed to the same levels analyzed for 8 h daily and 30 years of work. The study on C. verticillaris lasted 90 days and evaluated the variation of chlorophyll and pheophytin (photosynthetic pigments). The results showed a significant difference in the production of chlorophylls a and b and total chlorophyll when compared to control, and there was also a progressive increase of the total pheophytin/total chlorophyll ratio. The results also showed the correlation between the increase in chlorophylls and the studied environments with less ventilation since these places provided greater accumulation of formaldehyde in the long run. Thus, measurable evidence was obtained of biological disorders in a living organism caused by exposure to formaldehyde.

First-year health degree students in the dissection room: Analysis of adaptation to practical classes

Human anatomy is a core subject that students of all health degrees are required to pass. Practical classes with human cadavers are a widely used educational resource in medicine, but are less frequent in other health degrees. Determining how first-year podiatry, nursing, and physiotherapy students cope with human anatomy practical classes and identifying the presence of physical reactions and possible causes of distress they experience in the dissection room are essential steps in designing a guidance plan to address students' needs. A questionnaire was distributed to 172 first-year students in non-medical health degrees immediately after their first visit to the dissection room. The questionnaire comprised 29 Yes/No questions to determine students' physical reactions, causes of distress and coping methods. The most frequent physical reactions were disgust, uneasiness and nausea. The main causes of distress were the smell of the cadavers, the smell of the dissection room and the sight of the cadavers. The coping methods used were being with friends, eating before the practical class and practicing beforehand with anatomical atlases and CDs. No significant differences were found between gender and the three variables analyzed (number of physical reactions, number of causes of distress and number of coping methods) (p-value >0.216), although differences were found between the type of health degree and the number of physical reactions and causes of distress (p-values = 0.028 and 0.001, respectively).

The relationship between impaired lung functions and cytokine levels in formaldehyde exposure

Exposure to formaldehyde (FA) causes detrimental effects on respiratory system. Inflammation is one of the mechanisms responsible for these effects. Our aim is to demonstrate the possible effect of formaldehyde on inflammation biomarkers and pulmonary function tests. One hundred ninety-eight male workers in a fiber production factory are included. Eighty two of them were not exposed to FA. Thirty nine workers were exposed to FA for 4 h or more in a work shift and 77 workers were exposed less than 4 h. Statistically significant differences were found for FA, TNF-α, and IL-6 levels and pulmonary function test parameters (FEV1 and FVC) between no exposure and exposure groups. The results revealed a correlation between decrement in pulmonary function tests and an increase in cytokine levels concordant with the duration of FA exposure. The results may emphasize that FA exposure shows its effect on pulmonary system via inflammatory pathways.

Formaldehído en ambientes laborales: revisión de la literatura y propuesta de vigilancia ocupacional

Introducción. El formaldehído es una sustancia ampliamente usada a nivel industrial; sin embargo, es considerada un agente mutagénico y carcinógeno para los humanos. Para determinar el grado de riesgo de los trabajadores ocupacionalmente expuestos (TOE) al formaldehído, debe hacerse un seguimiento de sus niveles de concentración ambiental y de los biomarcadores que permiten identificar su daño potencial para la salud. En Colombia, lamentablemente, no existen lineamientos respecto a la exposición ocupacional a esta sustancia.Objetivo.Revisar estudios recientes sobre exposición ocupacional a formaldehído para diseñar una estrategia de seguimiento y vigilancia de los TOE a esta sustancia en Colombia.Materiales y métodos. Se realizó una revisión de la literatura en PubMed, MedLine, ScienceDirect y Embase mediante la siguiente estrategia de búsqueda: artículos sobre exposición ocupacional a formaldehído publicados en inglés o español entre 2013 y 2017. Los términos de búsqueda fueron “occupational exposure”, “formaldehyde” “mutagenicity test” y “DNA adducts” y sus equivalentes en español.Resultados. La búsqueda inicial arrojó 103 registros, sin embargo solo 36 artículos cumplieron los criterios de inclusión establecidos.Conclusiones. La gestión adecuada del riesgo derivado de la exposición ocupacional a formaldehido, así como el seguimiento médico apropiado de estos trabajadores, requiere la implementación de una serie de acciones interdisciplinarias que permitan la creación de un sistema de vigilancia ocupacional integral de los TOE a esta sustancia. 

One academic year laboratory and student breathing zone formaldehyde level, measured by gas-piston hand pump at gross anatomy laboratory, Siriraj Hospital, Thailand

This study used a formaldehyde detector tube with a gas-piston hand pump to assess ceiling levels of student breathing zone and gross laboratory environment across the 2018 academic year. The room dimension was 28.6 × 55.48 × 5.5 m. It contained 90 cadavers, each placed on a hinged cover table. We measured before and during nine body region dissections. There was a significant difference (p < 0.01) between student exposure and laboratory environment levels. The highest level was student exposure during body wall dissection (2.7 ppm), the first laboratory; students may accidentally enter body cavities. The latter two were in abdominal (1.85 ppm) and lower limb dissections (1.49 ppm). The three highest environment levels were in different regions; spinal cord removal (1.13 ppm), lower limb (0.72 ppm), and thorax (0.71 ppm) dissection. Only the perineum environment level (0.09 ppm) was below the NIOSH ceiling level (0.1 ppm), which may result from the table covers that had been opened for 2 weeks before measurement. This study finding signified the importance of student personal exposure monitoring and encouraged the academic year measurement. Because each laboratory has unique factors, those affect formaldehyde levels; dissection steps, dissection table design, cadaver storage protocol, and heating-ventilation-air conditioning system performance, for instance.

Estimation of occupational formaldehyde exposure in cadaver dissection laboratory and its implications

The formaldehyde (FA) is a universally used chemical for preservation of cadavers in dissection halls. The adverse effects of formalin exposure are health concern to faculty, workers, and students. The benefits of using formalin, its cost effectiveness, and its proper fixation and efficient preservation of tissue, have to outweigh its adverse effects on the health of those working with it. The best way to ensure the benefits outweigh the risks are providing adequate ventilation, using personal protective equipment, and developing awareness of FA's adverse effects. This study observed that both government and private colleges had better ventilation when more windows and doors were present, but active ventilation strategies like powerful exhaust, along with monitoring of FA level (personal or dissection hall), were needed. Students exposed to FA suffered eye and nose mucosal irritation. But faculty and workers with prolonged exposure to FA had more severe respiratory symptoms and suffered migraines. Hence personal FA monitoring and personal protective equipment must be made mandatory for those with prolonged exposure to FA. In addition, proper ventilation should be in place to reduce formalin vapours levels in workspaces.

Improvement in histology, enzymatic activity, and redox state of the liver following administration of Cinnamomum zeylanicum bark oil in rats with established hepatotoxicity

Formaldehyde (FA) is an environmentally-available pollutant. Since the liver acts as a detoxifier in the human body, it is the first and most affected organ in individuals exposed to higher-than-normal amounts of FA. FA mainly alters oxidant/antioxidant status and initiates oxidative stress, and by means, causes functional damage to the liver. Thus, it is important to identify natural bioactive compounds with antioxidant properties in order to be used as food additives. Cinnamon (Cinnamomum zeylanicum) is a popular flavor and also a medicinal plant with a variety of beneficial effects. In the present original study, cinnamon essential oil (CEO) has been administrated at doses of 10, 20, and 100 mg/kg, orally, to hepatotoxicity rat models caused by FA (10 mg/kg, intraperitoneally). Liver enzymes and its histology were assessed and oxidative stress biomarkers in the liver tissue were also examined. CEO administration caused a significant increase in superoxide dismutase, glutathione peroxidase, and catalase and a prominent decrease in nitric oxide levels in the liver tissue. Also, in serum samples, CEO significantly reduced the elevated amounts of alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase. When assessed histologically, portal area and central vein fibrosis alongside with the hepatocytes' hypereosinophilia and swelling, focal inflammation, and necrotic areas were found to be prominently decreased in the CEO group. In conclusion, our study suggested that the CEO may have the potential for being used against FA-induced hepatotoxicity.

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

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/m³ in 2012 and 114 µg/m³ in 2014, exceeding the workplace standard of 150 µg/m³ (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/m³ 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/m³ in 2012 (n = 19) and a mean of 272 µg/m³ in 2014 (n = 21), occasionally exceeding the standard of 500 µg/m³ (15 min TWA), and were reduced to a mean of 88.7 µg/m³ in 2017 (n = 12) with an estimated probability of exceeding the OEL of 1.6%.

Is it possible to use biomonitoring for the quantitative assessment of formaldehyde occupational exposure?

The European classification, labeling and packaging classified formaldehyde as human carcinogen Group 1B and mutagen 2, fostering the re-evaluation of the exposure risk in occupational settings. Although formaldehyde exposure is traditionally measured in air, many efforts were made to identify specific exposure biomarkers: urinary formaldehyde, formic acid and DNA damage indicators. Though used in combination, none of these seems satisfactory. The influence of the metabolism on exogenous formaldehyde levels, the exposure to other xenobiotics, the difference in genetic background and metabolism efficiency, misled the relationship between genotoxicity and exposure data. Nevertheless, the limitation of adverse effects to the local contact sites hampers biomonitoring. Here we discuss the feasibility of formaldehyde biomonitoring and the use of DNA, DNA-protein cross-links and protein adducts as potential biomarkers.