Application of predictive models for estimation of health care workers exposure to sevoflurane

Occupational inhalation exposure during surface disinfection-exposure assessment based on exposure models compared with measurement data

BACKGROUND

For healthcare workers, surface disinfections are daily routine tasks. An assessment of the inhalation exposure to hazardous substances, in this case the disinfectant´s active ingredients, is necessary to ensure workers safety. However, deciding which exposure model is best for exposure assessment remains difficult.

OBJECTIVE

The aim of the study was to evaluate the applicability of different exposure models for disinfection of small surfaces in healthcare settings.

METHODS

Measurements of the air concentration of active ingredients in disinfectants (ethanol, formaldehyde, glutaraldehyde, hydrogen peroxide, peroxyacetic acid) together with other exposure parameters were recorded in a test chamber. The measurements were performed using personal and stationary air sampling. In addition, exposure modelling was performed using three deterministic models (unsteady 1-zone, ConsExpo and 2-component) and one modifying-factor model (Stoffenmanager®). Their estimates were compared with the measured values using various methods to assess model quality (like accuracy and level of conservatism).

RESULTS

The deterministic models showed overestimation predominantly in the range of two- to fivefold relative to the measured data and high conservatism for all active ingredients of disinfectants with the exception of ethanol. With Stoffenmanager® an exposure distribution was estimated for ethanol, which was in good accordance with the measured data.

IMPACT STATEMENT

To date, workplace exposure assessments often involve expensive and time consuming air measurements. Reliable exposure models can be used to assess occupational inhalation exposure to hazardous substances, in this case surface disinfectants. This study describes the applicability of three deterministic and one modifying-factor model for disinfection of small surfaces in healthcare settings, in direct comparison to measurements performed and will facilitate future exposure assessments at these workplaces.

Understanding the limitations and application of occupational exposure models in a REACH context

Exposure modeling plays a significant role for regulatory organizations, companies, and professionals involved in assessing and managing occupational health risks in workplaces. One context in which occupational exposure models are particularly relevant is the REACH Regulation in the European Union (Regulation (EC) No 1907/2006). This commentary describes the models for the occupational inhalation exposure assessment of chemicals within the REACH framework, their theoretical background, applications, and limitations, as well as the latest developments and priorities for model improvement. Summing up the debate, despite its relevance and importance in the context of REACH not being in question, occupational exposure modeling needs to be improved in many respects. There is a need to reach a wide consensus on several key issues (e.g., the theoretical background and the reliability of modeling tools), to consolidate and monitor model performance and regulatory acceptance, and to align practices and policies regarding exposure modeling.

The ECETOC-Targeted Risk Assessment Tool for Worker Exposure Estimation in REACH Registration Dossiers of Chemical Substances-Current Developments

(1) Background: The ECETOC Targeted Risk Assessment (TRA) tool is widely used for estimation of worker exposure levels in the development of dossiers for REACH registration of manufactured or imported chemical substances in Europe. A number of studies have been published since 2010 in which the exposure estimates of the tool are compared with workplace exposure measurement results and in some instances an underestimation of exposure was reported. The quality and results of these studies are being reviewed by ECETOC. (2) Methods: Original exposure measurement data from published comparison studies for which six or more data points were available for each workplace scenario and a TRA estimate had been developed to create a curated database to examine under what conditions and for which applications the tool is valid or may need adaptation. (3) Results: The published studies have been reviewed for completeness and clarity and TRA estimates have been constructed based on the available information, following a set of rules. The full review findings are expected to be available in the course of 2021. (4) Conclusions: The ECETOC TRA tool developers periodically review the validity and limitations of their tool, in line with international recommendations.

How to Obtain a Reliable Estimate of Occupational Exposure? Review and Discussion of Models' Reliability

Evaluation and validation studies of quantitative exposure models for occupational exposure assessment are still scarce and generally only consider a limited number of exposure scenarios. The aim of this review was to report the current state of knowledge of models’ reliability in terms of precision, accuracy, and robustness. A systematic review was performed through searches of major scientific databases (Web of Science, Scopus, and PubMed), concerning reliability of Tier1 (“ECETOC TRA”-European Centre for Ecotoxicology and Toxicology of Chemicals Targeted Risk Assessment, MEASE, and EMKG-Expo-Tool) and Tier2 models (STOFFENMANAGER^® and “ART”-Advanced Registration, Evaluation, Authorization and Restriction of Chemicals (REACH) Tool). Forty-five studies were identified, and we report the complete information concerning model performance in different exposure scenarios, as well as between-user reliability. Different studies describe the ECETOC TRA model as insufficient conservative to be a Tier1 model, in different exposure scenarios. Contrariwise, MEASE and EMKG-Expo-Tool seem to be conservative enough, even if these models have not been deeply evaluated. STOFFENMANAGER^® resulted the most balanced and robust model. Finally, ART was generally found to be the most accurate and precise model, with a medium level of conservatism. Overall, the results showed that no complete evaluation of the models has been conducted, suggesting the need for correct and harmonized validation of these tools.