A comprehensive review of the literature on exposure to metalworking fluids

Characterization of occupational inhalation exposures to particulate and gaseous straight and water-based metalworking fluids

Exposure assessments to metalworking fluids (MWF) is difficult considering the complex nature of MWF. This study describes a comprehensive exposure assessment to straight and water-based MWFs among workers from 20 workshops. Metal and organic carbon (OC) content in new and used MWF were determined. Full-shift air samples of inhalable particulate and gaseous fraction were collected and analysed gravimetrically and for metals, OC, and aldehydes. Exposure determinants were ascertained through observations and interviews with workers. Determinants associated with personal inhalable particulate and gaseous fractions were systematically identified using mixed models. Similar inhalable particle exposure was observed for straight and water-based MWFs (64-386 µg/m3). The gaseous fraction was the most important contributor to the total mass fraction for both straight (322-2362 µg/m3) and water-based MWFs (101-699 µg/m3). The aerosolized particles exhibited low metal content irrespective of the MWF type; however, notable concentrations were observed in the sumps potentially reaching hazardous concentrations. Job activity clusters were important determinants for both exposure to particulate and gaseous fractions from straight MWF. Current machine enclosures remain an efficient determinant to reduce particulate MWF but were inefficient for the gaseous fraction. Properly managed water-based MWF meaning no recycling and no contamination from hydraulic fluids minimizes gaseous exposure. Workshop temperature also influenced the mass fractions. These findings suggest that exposures may be improved with control measures that reduce the gaseous fraction and proper management of MWF.

Adapting Decision Rules to Estimate Occupational Metalworking Fluid Exposure in a Case-Control Study of Bladder Cancer in Spain

OBJECTIVES

We adapted previously developed decision rules from the New England Bladder Cancer Study (NEBCS) to assign occupational exposure to straight, soluble, and synthetic metalworking fluids (MWFs) to participants of the Spanish Bladder Cancer Study (SBCS).

METHODS

The SBCS and NEBCS are case-control studies that used the same lifetime occupational history and job module questionnaires. We adapted published decision rules from the NEBCS that linked questionnaire responses to estimates of the probability (<5, ≥5 to <50, ≥50 to <100, and 100%), frequency (in h week-1), and intensity (in mg m-3) of exposure to each of the three broad classes of MWFs to assign exposure to 10 182 reported jobs in the SBCS. The decision rules used the participant's module responses to MWF questions wherever possible. We then used these SBCS module responses to calculate job-, industry-, and time-specific patterns in the prevalence and frequency of MWF exposure. These estimates replaced the NEBCS-specific estimates in decision rules applied to jobs without MWF module responses. Intensity estimates were predicted using a previously developed statistical model that used the decade, industry (three categories), operation (grinding versus machining), and MWF type extracted from the SBCS questionnaire responses. We also developed new decision rules to assess mineral oil exposure from non-machining sources (possibly exposed versus not exposed). The decision rules for MWF and mineral oil identified questionnaire response patterns that required job-by-job expert review.

RESULTS

To assign MWF exposure, we applied decision rules that incorporated participant's responses and job group patterns for 99% of the jobs and conducted expert review of the remaining 1% (145) jobs. Overall, 14% of the jobs were assessed as having ≥5% probability of exposure to at least one of the three MWFs. Probability of exposure of ≥50% to soluble, straight, and synthetic MWFs was identified in 2.5, 1.7, and 0.5% of the jobs, respectively. To assign mineral oil from non-machining sources, we used module responses for 49% of jobs, a job-exposure matrix for 41% of jobs, and expert review for the remaining 10%. We identified 24% of jobs as possibly exposed to mineral oil from non-machining sources.

CONCLUSIONS

We demonstrated that we could adapt existing decision rules to assess exposure in a new population by deriving population-specific job group patterns.

Interventions to Reduce Exposures in the Workplace: A Systematic Review of Intervention Studies Over Six Decades, 1960-2019

Background: Reducing occupational ill-health from chemical and biological agents is realized primarily through the mitigation and elimination of hazardous exposures. Despite evidence of declining exposure in European and North-American workplaces, comprehensive studies of the effectiveness of workplace interventions for reducing hazardous exposure and associated work-related ill-health seem rare. We reviewed occupational intervention studies targeting exposure to chemical and biological agents, and determined trends in frequency and quality of such studies. Methods: We searched Embase, Medline, and Web of Science for peer-reviewed original articles on occupational intervention studies published 1960-2019, aimed at reducing workers' exposure to dusts, gases, fumes, or liquids of chemical, biological, or mineral nature, or workers' risks for associated health outcomes. The frequency of articles, intervention types, intervention endpoints, and study quality of published intervention studies between 1960 and 2019 and according to 10-year intervals were analyzed. Results: Of 3,663 retrieved articles, 146 intervention studies were identified and reviewed, of which 63 concerned control measures, 43 behavioral change, 28 use of personal protective equipment, and 12 workplace policies. Intervention endpoints were occupational exposures (73%), health outcomes (22%), and a combination of both (5%). Of reviewed studies, 38% involved a control group, 16% randomized the intervention, 86% were planned interventions, and 86% compared exposure or health outcomes pre and post intervention. Over time the number of intervention studies identified in this search increased from none during 1960-1969 to ~60 during 2000-2009 and 2010-2019, respectively. The study quality improved over time, with no studies during 1960-1989 that complied with the highest quality criteria. During 2000-2009 and 2010-2019 16 and 12% of studies, respectively, were judged to be of highest quality. Conclusion: Despite an improvement over the last six decades in the frequency and quality of intervention studies targeting exposure to chemicals and biological agents, the absolute number of intervention studies remains low, particularly when considering only high quality studies. Occupational exposure to chemical and biological agents is still causing excessive disease in workforces worldwide. To reduce occupational ill-health caused by these exposures, it is important to expand the evidence on (cost-)effectiveness and transferability of interventions to reduce exposure and health effects.

New Opportunities in Exposure Assessment of Occupational Epidemiology: Use of Measurements to Aid Exposure Reconstruction in Population-Based Studies

PURPOSE OF REVIEW

Exposure assessment efforts in population-based studies are increasingly incorporating measurements. The published literature was reviewed to identify the measurement sources and the approaches used to incorporate measurements into these efforts.

RECENT FINDINGS

The variety of occupations and industries in these studies made collecting participant-specific measurements impractical. Thus, the starting point was often the compilation of large databases of measurements from inspections, published literature, and other exposure surveys. These measurements usually represented multiple occupations, industries, and worksites, and spanned multiple decades. Measurements were used both qualitatively and quantitatively, dependent on the coverage and quality of the data. Increasingly, statistical models were used to derive job-, industry-, time period-, and other determinant-specific exposure concentrations. Quantitative measurement-based approaches are increasingly replacing expert judgment, which facilitates the development of quantitative exposure-response associations. Evaluations of potential biases in these measurement sources, and their representativeness of typical exposure situations, warrant additional examination.

Flow Cytometry Is a Powerful Tool for Assessment of the Viability of Fungal Conidia in Metalworking Fluids

Fungal contamination of metalworking fluids (MWF) is a dual problem in automated processing plants because resulting fungal biofilms obstruct cutting, drilling, and polishing machines. Moreover, some fungal species of MWF comprise pathogens such as Fusarium solani Therefore, the development of an accurate analytical tool to evaluate conidial viability in MWF is important. We developed a flow cytometric method to measure fungal viability in MWF using F. solani as the model organism. To validate this method, viable and dead conidia were mixed in several proportions and flow was cytometrically analyzed. Subsequently, we assessed the fungicidal activity of two commercial MWF using flow cytometry (FCM) and compared it with microscopic analyses and plating experiments. We evaluated the fungal growth in both MWF after 7 days using quantitative PCR (qPCR) to assess the predictive value of FCM. Our results showed that FCM distinguishes live from dead conidia as early as 5 h after exposure to MWF, whereas the microscopic germination approach detected conidial viability much later and less accurately. At 24 h, microscopic analyses of germinating conidia and live/dead analyses by FCM correlated well, although the former consistently underestimated the proportion of viable conidia. In addition, the reproducibility and sensitivity of the flow cytometric method were high and allowed assessment of the fungicidal properties of two commercial MWF. Importantly, the obtained flow cytometric results on viability of F. solani conidia at both early time points (5 h and 24 h) correlated well with fungal biomass measurements assessed via a qPCR methodology 7 days after the start of the experiment.IMPORTANCE This result shows the predictive power of flow cytometry (FCM) in assessing the fungicidal capacity of MWF formulations. It also implies that FCM can be implemented as a rapid detection tool to estimate the viable fungal load in an industrial processing matrix (MWF).

Developing Asbestos Job Exposure Matrix Using Occupation and Industry Specific Exposure Data (1984-2008) in Republic of Korea

Background

The goal of this study is to develop a general population job-exposure matrix (GPJEM) on asbestos to estimate occupational asbestos exposure levels in the Republic of Korea.

Methods

Three Korean domestic quantitative exposure datasets collected from 1984 to 2008 were used to build the GPJEM. Exposure groups in collected data were reclassified based on the current Korean Standard Industrial Classification (9^th edition) and the Korean Standard Classification of Occupations code (6^th edition) that is in accordance to international standards. All of the exposure levels were expressed by weighted arithmetic mean (WAM) and minimum and maximum concentrations.

Results

Based on the established GPJEM, the 112 exposure groups could be reclassified into 86 industries and 74 occupations. In the 1980s, the highest exposure levels were estimated in “knitting and weaving machine operators” with a WAM concentration of 7.48 fibers/mL (f/mL); in the 1990s, “plastic products production machine operators” with 5.12 f/mL, and in the 2000s “detergents production machine operators” handling talc containing asbestos with 2.45 f/mL. Of the 112 exposure groups, 44 groups had higher WAM concentrations than the Korean occupational exposure limit of 0.1 f/mL.

Conclusion

The newly constructed GPJEM which is generated from actual domestic quantitative exposure data could be useful in evaluating historical exposure levels to asbestos and could contribute to improved prediction of asbestos-related diseases among Koreans.

Occupational diseases in individuals exposed to metal working fluids

PURPOSE OF REVIEW

To examine the current occurrence of respiratory and skin disease in workers who do metal machining with metal working fluids (MWFs), a common work process in manufacturing.

RECENT FINDINGS

A summary of the 27 recognized outbreaks of respiratory disease in workers exposed to MWFs was published. New studies have identified irritative symptoms among workers with low-level exposures. There were review articles discussing the content, measurement and control of microbial agents in MWFs.

SUMMARY

The occurrence of work-related asthma and hypersensitivity pneumonitis appears to have diminished in the last 10 years. This is presumed to be secondary to lower air levels from the use of newer machining equipment, which are enclosed and have local ventilation as well as better control of microbial contaminants. However, clinicians need to be aware that at the minimum irritative symptoms of the upper respiratory tract are still being reported at these lower exposure levels and there remains the possibility of the development of asthma and hypersensitivity pneumonitis. Given the widespread use of MWFs in manufacturing facilities, clinicians need to consider the possibility that MWFs are the cause or are aggravating the respiratory and dermatologic conditions of their patients.

Estimating Benzene Exposure Level over Time and by Industry Type through a Review of Literature on Korea

The major purpose of this study is to construct a retrospective exposure assessment for benzene through a review of literature on Korea. Airborne benzene measurements reported in 34 articles were reviewed. A total of 15,729 individual measurements were compiled. Weighted arithmetic means [AM(w)] and their variance calculated across studies were summarized according to 5-year period intervals (prior to the 1970s through the 2010s) and industry type. Industries were classified according to Korea Standard Industrial Classification (KSIC) using information provided in the literature. We estimated quantitative retrospective exposure to benzene for each cell in the matrix through a combination of time and KSIC. Analysis of the AM(w) indicated reductions in exposure levels over time, regardless of industry, with mean levels prior to the 1980-1984 period of 50.4 ppm (n = 2,289), which dropped to 2.8 ppm (n = 305) in the 1990-1994 period, and to 0.1 ppm (n = 294) in the 1995-1999 period. There has been no improvement since the 2000s, when the AM(w) of 4.3 ppm (n = 6,211) for the 2005-2009 period and 4.5 ppm (n = 3,358) for the 2010-2013 period were estimated. A comparison by industry found no consistent patterns in the measurement results. Our estimated benzene measurements can be used to determine not only the possibility of retrospective exposure to benzene, but also to estimate the level of quantitative or semiquantitative retrospective exposure to benzene.

Reliability and validity of expert assessment based on airborne and urinary measures of nickel and chromium exposure in the electroplating industry

The reliability and validity of six experts' exposure ratings were evaluated for 64 nickel-exposed and 72 chromium-exposed workers from six Shanghai electroplating plants based on airborne and urinary nickel and chromium measurements. Three industrial hygienists and three occupational physicians independently ranked the exposure intensity of each metal on an ordinal scale (1-4) for each worker's job in two rounds: the first round was based on responses to an occupational history questionnaire and the second round also included responses to an electroplating industry-specific questionnaire. The Spearman correlation (r(s)) was used to compare each rating's validity to its corresponding subject-specific arithmetic mean of four airborne or four urinary measurements. Reliability was moderately high (weighted kappa range=0.60-0.64). Validity was poor to moderate (r(s)=-0.37-0.46) for both airborne and urinary concentrations of both metals. For airborne nickel concentrations, validity differed by plant. For dichotomized metrics, sensitivity and specificity were higher based on urinary measurements (47-78%) than airborne measurements (16-50%). Few patterns were observed by metal, assessment round, or expert type. These results suggest that, for electroplating exposures, experts can achieve moderately high agreement and (reasonably) distinguish between low and high exposures when reviewing responses to in-depth questionnaires used in population-based case-control studies.

A case-control study of occupational exposure to metalworking fluids and bladder cancer risk among men

OBJECTIVES

Metalworking has been associated with an excess risk of bladder cancer in over 20 studies. Metalworking fluids (MWFs) are suspected as the responsible exposure, but epidemiological data are limited. We investigated this association among men in the New England Bladder Cancer Study using state-of-the-art, quantitative exposure assessment methods.

METHODS

Cases (n=895) and population controls (n=1031) provided occupational histories during personal interviews. For selected jobs, exposure-oriented modules were administered to collect information on use of three MWF types: (1) straight (mineral oil, additives), (2) soluble (mineral oil, water, additives) and (3) synthetic (water, organics, additives) or semisynthetic (hybrid of soluble and synthetic). We computed ORs and 95% CIs relating bladder cancer risk to a variety of exposure metrics, adjusting for smoking and other factors. Non-metalworkers who had held jobs with possible exposure to mineral oil were analysed separately.

RESULTS

Bladder cancer risk was elevated among men who reported using straight MWFs (OR=1.7, 95% CI 1.1 to 2.8); risk increased monotonically with increasing cumulative exposure (p=0.041). Use of soluble MWFs was associated with a 50% increased risk (95% CI 0.96 to 2.5). ORs were non-significantly elevated for synthetic/semisynthetic MWFs based on a small number of exposed men. Non-metalworkers holding jobs with possible exposure to mineral oil had a 40% increased risk (95% CI 1.1 to 1.8).

CONCLUSIONS

Exposure to straight MWFs was associated with a significantly increased bladder cancer risk, as was employment in non-metalworking jobs with possible exposure to mineral oil. These findings strengthen prior evidence for mineral oil as a bladder carcinogen.

Skin absorption of six performance amines used in metalworking fluids

Every year, 10 million workers are exposed to metalworking fluids (MWFs) that may be toxic. There are four types of MWFs: neat oils and three water-based MWFs (soluble oil, semisynthetic and synthetic), which are diluted with water and whose composition varies according to the mineral oils ratio. MWFs also contain various additives. To determine the absorption of six amines used as corrosion inhibitors and biocides in MWFs, porcine skin flow-through diffusion cell experiments were conducted with hydrophilic ethanolamines (mono-, di- and triethanolamine, MEA, DEA and TEA respectively) and a mixture of lipophilic amines (dibutylethanolamine, dicyclohexylamine and diphenylamine). The six amines were dosed in four vehicles (water and three generic water-based MWF formulations) and analyzed using a scintillation counter or gas chromatography/mass spectrometry. These 24 h studies showed that dermal absorption significantly (P < 0.05) increased from water for the six amines (e.g. 1.15 ± 0.29% dose; DEA in water) compared to other formulations (e.g. 0.13 ± 0.01% dose; DEA in semisynthetic MWF) and absorption was greatest for dibutylethanolamine in all the formulations. The soluble oil formulation tended to increase the dermal absorption of the hydrophilic amines. The permeability coefficient was significantly higher (P < 0.05) with TEA relative to the other hydrophilic amines (e.g. 4.22 × 10(-4) ± 0.53 × 10(-4) cm h(-1) [TEA in synthetic MWF] vs. 1.23 × 10(-4) ± 0.10 × 10(-4) cm h(-1) [MEA in synthetic MWF]), except for MEA in soluble oil formulation. Future research will confirm these findings in an in vivo pig model along with dermatotoxicity studies. These results should help MWF industries choose safer additives for their formulations to protect the health of metalworkers.

Developing estimates of frequency and intensity of exposure to three types of metalworking fluids in a population-based case-control study of bladder cancer

BACKGROUND

A systematic, transparent, and data-driven approach was developed to estimate frequency and intensity of exposure to straight, soluble, and synthetic/semi-synthetic metalworking fluids (MWFs) within a case-control study of bladder cancer in New England.

METHODS

We assessed frequency using individual-level information from job-specific questionnaires wherever possible, then derived and applied job group-level patterns to likely exposed jobs with less information. Intensity estimates were calculated using a statistical model developed from measurements and determinants extracted from the published literature.

RESULTS

For jobs with probabilities of exposure≥0.5, median frequencies were 8-10 hr/week, depending on MWF type. Median intensities for these jobs were 2.5, 2.1, and 1.0 mg/m3 for soluble, straight, and synthetic/semi-synthetic MWFs, respectively.

CONCLUSIONS

Compared to case-by-case assessment, these data-driven decision rules are transparent and reproducible and may result in less biased estimates. These rules can also aid future exposure assessments of MWFs in population-based studies.

Estimation of the probability of exposure to machining fluids in a population-based case-control study

We describe an approach for estimating the probability that study subjects were exposed to metalworking fluids (MWFs) in a population-based case-control study of bladder cancer. Study subject reports on the frequency of machining and use of specific MWFs (straight, soluble, and synthetic/semi-synthetic) were used to estimate exposure probability when available. Those reports also were used to develop estimates for job groups, which were then applied to jobs without MWF reports. Estimates using both cases and controls and controls only were developed. The prevalence of machining varied substantially across job groups (0.1->0.9%), with the greatest percentage of jobs that machined being reported by machinists and tool and die workers. Reports of straight and soluble MWF use were fairly consistent across job groups (generally 50-70%). Synthetic MWF use was lower (13-45%). There was little difference in reports by cases and controls vs. controls only. Approximately, 1% of the entire study population was assessed as definitely exposed to straight or soluble fluids in contrast to 0.2% definitely exposed to synthetic/semi-synthetics. A comparison between the reported use of the MWFs and U.S. production levels found high correlations (r generally >0.7). Overall, the method described here is likely to have provided a systematic and reliable ranking that better reflects the variability of exposure to three types of MWFs than approaches applied in the past. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resources: a list of keywords in the occupational histories that were used to link study subjects to the metalworking fluids (MWFs) modules; recommendations from the literature on selection of MWFs based on type of machining operation, the metal being machined and decade; popular additives to MWFs; the number and proportion of controls who reported various MWF responses by job group; the number and proportion of controls assigned to the MWF types by job group and exposure category; and the distribution of cases and controls assigned various levels of probability by MWF type.].

Essential Occupational Safety and Health Interventions for Low- and Middle-income Countries: An Overview of the Evidence

There is still a considerable burden of occupational diseases and injuries in the world. It is not well known which interventions can effectively reduce the exposures at work that cause this burden. The objective of this article is to summarize evidence from systematic reviews of interventions to prevent occupational diseases and injuries. We included systematic reviews of interventions to reduce the incidence of work-related cancer, dust-related diseases, occupational asthma, chronic obstructive pulmonary disease, noiseinduced hearing loss, back pain, and occupational injuries. We searched Medline and Embase with predefined search strategies to locate systematic reviews of these interventions. We found 23 systematic reviews of which the results are also applicable to low- and middle income countries. Effective measures to reduce exposure leading to work-related cancer, dust-related diseases, asthma, chronic obstructive pulmonary disease, noise, and injuries are available. However, better implementation of these measures is needed. Regulation, enforcement of regulation, and incentives for employers are effective interventions to achieve this goal. There is evidence that feedback and rewards for workers help in reducing occupational injuries. There is no evidence in many studies that back pain can be prevented. Personal protective equipment technically has the potential to reduce exposure but this is difficult to put into effect. There is no evidence in the studies regarding the effectiveness of education and training, preventive drugs, or health examinations. There is evidence that the implementation of technical measures enforced by regulation can prevent occupational diseases and injuries. For other interventions such as education or health examinations, there is no evidence that supports their effectiveness. More systematic reviews are needed in the area of injury prevention.

The occupational exposure limit for fluid aerosol generated in metalworking operations: limitations and recommendations

The aim of this review was to assess current knowledge related to the occupational exposure limit (OEL) for fluid aerosols including either mineral or chemical oil that are generated in metalworking operations, and to discuss whether their OEL can be appropriately used to prevent several health risks that may vary among metalworking fluid (MWF) types. The OEL (time-weighted average; 5 mg/m(3), short-term exposure limit ; 15 mg/m(3)) has been applied to MWF aerosols without consideration of different fluid aerosol-size fractions. The OEL, is also based on the assumption that there are no significant differences in risk among fluid types, which may be contentious. Particularly, the health risks from exposure to water-soluble fluids may not have been sufficiently considered. Although adoption of The National Institute for Occupational Safety and Health's recommended exposure limit for MWF aerosol (0.5 mg/m(3)) would be an effective step towards minimizing and evaluating the upper respiratory irritation that may be caused by neat or diluted MWF, this would fail to address the hazards (e.g., asthma and hypersensitivity pneumonitis) caused by microbial contaminants generated only by the use of water-soluble fluids. The absence of an OEL for the water-soluble fluids used in approximately 80-90 % of all applicants may result in limitations of the protection from health risks caused by exposure to those fluids.

Determinants of exposure to metalworking fluid aerosols: a literature review and analysis of reported measurements

An extensive literature review of published metalworking fluid (MWF) aerosol measurement data was conducted to identify the major determinants that may affect exposure to aerosol fractions (total or inhalable, thoracic and respirable) and mass median diameters (MMDs). The identification of determinants was conducted through published studies and analysis of published measurement levels. For the latter, weighted arithmetic means (WAMs) by number of measurements were calculated and compared using analysis of variance and t-tests. The literature review found that the major factors affecting aerosol exposure levels were, primarily, decade, type of industry, operation and fluid and engineering control measures. Our analysis of total aerosol levels found a significant decline in measured levels from an average of 5.36 mg m(-3) prior to the 1970s and 2.52 mg m(-3) in the 1970s to 1.21 mg m(-3) in the 1980s, 0.50 mg m(-3) in the 1990s and 0.55 mg m(-3) in the 2000s. Significant declines from the 1990s to the 2000s also were found in thoracic fraction levels (0.48 versus 0.40 mg m(-3)), but not for the respirable fraction. The WAMs for the auto (1.47 mg m(-3)) and auto parts manufacturing industry (1.83 mg m(-3)) were significantly higher than that for small-job machine shops (0.68 mg m(-3)). In addition, a significant difference in the thoracic WAM was found between the automotive industry (0.46 mg m(-3)) and small-job machine shops (0.32 mg m(-3)). Operation type, in particular, grinding, was a significant factor affecting the total aerosol fraction [grinding operations (1.75 mg m(-3)) versus other machining (0.95 mg m(-3))], but the levels associated with these operations were not statistically different for either the thoracic or the respirable fractions. Across all decades, the total aerosol fraction for straight oils (1.49 mg m(-3)) was higher than for other fluid types (soluble = 1.08 mg m(-3), synthetic = 0.52 mg m(-3) and semisynthetic = 0.50 mg m(-3)). Fluid type was also found to be partly associated with differences in the respirable fraction level. We found that the total aerosols were measured by a variety of sampling media, devices and analytical methods. This diversity of approaches makes interpretation of the study results difficult. In conclusion, both the literature review and the measurement data analyzed found that decade and type of industry, operation and fluid were important determinants of total aerosol exposure. Industry type and fluid type were associated with differences in exposure to the thoracic and respirable fraction levels, respectively.