Exposure and Management of the Health Risk for the Use of Formaldehyde and Xylene in a Large Pathology Laboratory

Human exposure to formaldehyde and health risk assessment: a 46-year systematic literature review

After confirming that formaldehyde (FA) is carcinogenic, many studies were conducted in different countries to investigate this finding. Therefore, according to the dispersion of related studies, a bibliometric review of the current literature was performed with the aim of better understanding the exposure to FA and the resulting health risk, for the first time, using the Scopus database and the two open-source software packages, Bibliometrix R package. After screening the documents in Excel, the data was analyzed based on three aspects including performance analysis, conceptual structure, and intellectual structure, and the results were presented in tables and diagrams. A total of 468 documents were analyzed over period 1977-2023, in which 1956 authors from 56 countries participated. The number of scientific publications has grown significantly from 1977 (n = 1) to 2022 (n = 19). Zhang Y., from the Yale School of Public Health (USA), was identified as the most impactful author in this field. The Science of the Total Environment journal was identified as the main source of articles related to exposure to formaldehyde by publishing 25 studies. The United States and China were the most active countries with the most international collaboration. The main topics investigated during these 46 years included "formaldehyde" and "health risk assessment", which have taken new directions in recent years with the emergence of the keyword "asthma". The present study provides a comprehensive view of the growth and evolution of studies related to formaldehyde and the resulting health risks, which can provide a better understanding of existing research gaps and new and emerging issues.

Inhalational exposure to formaldehyde, carcinogenic, and non-carcinogenic risk assessment: A systematic review

Formaldehyde is one of the most widely used substances in a variety of industries, although it was classified as a human carcinogen by the International Agency for Research on Cancer (IARC). The present systematic review was conducted to retrieve studies related to occupational exposure to formaldehyde until November 2, 2022. Aims of the study were to identify workplaces exposed to formaldehyde, to investigate the formaldehyde concentrations in various occupations and to evaluate carcinogenic and non-carcinogenic risks caused by respiratory exposure to this chemical among workers. A systematic search was done in Scopus, PubMed and Web of Science databases to find the studies done in this field. In this review, studies that did not meet the criteria specified by Population, Exposure, Comparator, and Outcomes (PECO) approach were excluded. In addition, the inclusion of studies dealing with the biological monitoring of FA in the body and review studies, conference articles, books, and letters to the editors were avoided. The quality of the selected studies was also evaluated using the Joanna Briggs Institute (JBI) checklist for analytic-cross-sectional studies. Finally, 828 studies were found, and after the investigations, 35 articles were included in this study. The results revealed that the highest formaldehyde concentrations were observed in waterpipe cafes (1,620,000 μg/m³) and anatomy and pathology laboratories (4237.5 μg/m³). Carcinogenic and non-carcinogenic risk indicated the potential health effects for employees due to respiratory exposure as acceptable levels of CR = 1.00 × 10^-4 and HQ = 1, respectively were reported to be exceeded in more than 71% and 28.57% of the investigated studies. Therefore, according to the confirmation of formaldehyde's adverse health effects, it is necessary to adopt targeted strategies to reduce or eliminate exposure to this compound from the occupational usage.

Occupational health risk assessment of airborne formaldehyde in medical laboratories

The professional use of formaldehyde is a major occupational health concern in medical laboratory operations. Quantification of various risks associated with chronic exposure to formaldehyde may help in understanding the related hazards. This study designed to assess the health risks associated with inhalation exposure to formaldehyde involving biological, cancer, and non-cancer risks in medical laboratories. This study was performed in the hospital laboratories at Semnan Medical Sciences University. Risk assessment was performed in pathology, bacteriology, hematology, biochemistry, and serology laboratories with 30 employees, using formaldehyde in their daily routine operations. We determined area and personal exposures to airborne contaminant, applied standard air sampling, and analytical method recommended by National Institute of Occupational Safety and Health (NIOSH). We addressed formaldehyde-specific hazard by estimating peak blood level, life cancer risk, and the hazard quotient of non-cancer risks, adapted from Environmental Protection Agency (EPA) assessment method. The airborne formaldehyde concentrations in the laboratory personal samples ranged 0.0156-0.5940 ppm (mean = 0.195 ppm, SD = 0.048) and area exposure ranged 0.0285-1.0810 ppm (mean = 0.462 ppm, SD = 0.087). Based on workplace exposure, peak blood levels of formaldehyde were estimated at minimum 0.0026 mg/l to maximum 0.152 mg/l (mean = 0.015 mg/l, SD = 0.016). The mean cancer risk levels in terms of area and personal exposures were estimated respectively at 3.93 E - 8 μg/m³ and 1.84 E - 4 μg/m³, and for the non-cancer risk levels of the same exposures measured respectively at 0.03 μg/m³ and 0.07 μg/m³. Formaldehyde levels were significantly higher among laboratory employees, especially bacteriology workers. Exposure and risk could be minimized by strengthening control measures including the use of management controls, engineering controls, and respiratory protection equipment to reduce exposure levels of all workers to less than the allowed exposure limits and improve indoor air quality in the workplace.

Formaldehyde in Hospitals Induces Oxidative Stress: The Role of GSTT1 and GSTM1 Polymorphisms

Despite the toxicity and health risk characteristics of formaldehyde (FA), it is currently used as a cytological fixative and the definition of safe exposure levels is still a matter of debate. Our aim was to investigate the alterations in both oxidative and inflammatory status in a hospital working population. The 68 workers recruited wore a personal air-FA passive sampler, provided a urine sample to measure 15-F_2t-Isoprostane (15-F_2t-IsoP) and malondialdehyde (MDA) and a blood specimen to measure tumour necrosis factor α (TNFα). Subjects were also genotyped for GSTT1 (Presence/Absence), GSTM1 (Presence/Absence), CYP1A1 exon 7 (A > G), and IL6 (−174, G > C). Workers were ex post split into formalin-employers (57.3 μg/m³) and non-employers (13.5 μg/m³). In the formalin-employers group we assessed significantly higher levels of 15-F_2t-IsoP, MDA and TNFα (<0.001) in comparison to the non-employers group. The air-FA levels turned out to be positively correlated with 15-F_2t-IsoP (p = 0.027) and MDA (p < 0.001). In the formalin-employers group the MDA level was significantly higher in GSTT1 Null (p = 0.038), GSTM1 Null (p = 0.031), and CYP1A1 exon 7 mutation carrier (p = 0.008) workers, compared to the wild type subjects. This study confirms the role of FA in biomolecular profiles alterations, highlighting how low occupational exposure can also result in measurable biological outcomes.