Changes in respiratory function after one and three hours of exposure to formaldehyde in non-smoking subjects

Comparison of Haptic and Biometric Properties, Bacterial Load, and Student Perception of Fixative Solutions: Formaldehyde Versus Chilean Conservative Fixative Solution with and without Formaldehyde in Pig Kidneys

One of the most widely used solutions to fix and preserve organic tissues is formaldehyde, despite reservations regarding its toxicity and the fact that formaldehyde-embalmed bodies lose their original characteristics. Anatomy laboratories have been replacing formaldehyde with solutions that retain the characteristics of fresh tissue. For this purpose, alternative solutions with a very low concentration of formaldehyde or without any formaldehyde have been analyzed. The objective of this study was to compare biometry, coloration, haptic properties, and bacterial load on animal specimens (pig kidneys) embalmed with formaldehyde, and with Chilean Conservative Fixative Solution with and without formaldehyde (formaldehyde chCFS and formaldehyde-free chCFS). Also, the perception of health and biological science students toward specimens treated with different solutions was assessed. The results indicated that there were no significant differences in specimens' retraction, or bacterial load. Students showed a preference for organs embalmed in formaldehyde chCFS and formaldehyde-free chCFS; indicating that with these treatments they could better visualize structures and that the prosections had greater flexibility and the colors were more similar to those of fresh tissue. Additionally, students recommended the material embalmed in formaldehyde chCFS and formaldehyde-free chCFS for anatomy learning. In contrast, students indicated that formaldehyde-fixation negatively affected their practical experience. In conclusion, embalming with formaldehyde chCFS or formaldehyde-free chCFS provides an advantageous practical experience over the use of formaldehyde and may be an alternative to replace the use of formaldehyde in anatomy laboratories.

Personal formaldehyde exposure during the transportation of embalmed cadavers

Occupational exposure to the known carcinogen formaldehyde during embalming (the preservation of cadavers) has been well documented. Cadavers may be transported to universities on loan for training medical professionals in human anatomy courses. However, occupational formaldehyde exposure levels associated with the transportation of cadavers have not previously been published. Therefore, the current pilot study examined formaldehyde exposure during this process. Preserved intact cadavers (room temperature or cooled) were loaded into cargo vans at the source (lending) lab, driven to the destination (borrowing) lab, and unloaded. Dissected cadavers (room temperature) were picked up and loaded into the cargo vans at the destination lab and driven to and unloaded at the source lab. Formaldehyde samples were collected in the breathing zone of employees engaged in cadaver transportation and handling. The number of intact cadavers or dissected cadavers in each cargo van ranged from 4 to 13 bodies. Sample collection times associated with cadaver transportation and handling tasks ranged from 15 to 216 min per sample with formaldehyde concentrations up to 1.6 ppm. Median exposure levels during cadaver transportation tasks were (1) 1.4 ppm (intact room temperature cadavers); (2) 0.13 ppm (dissected room temperature cadavers); and (3) 0.018 ppm (intact cooled cadavers). The median exposure during cadaver handling (loading/unloading) was 0.05 ppm. The 8-hr time-weighted averages during cadaver transportation and handling ranged from 0.030 ppm (intact cooled cadavers and dissected room temperature cadavers) to 0.51 ppm (intact room temperature cadavers, and dissected room temperature cadavers), the latter of which exceeded the American Conference of Governmental Industrial Hygienists recommended time-weighted average threshold limit value of 0.1 ppm. It is recommended that cadavers be transported cooled, however not all facilities may have access to or utilize specialized cadaver storage such as a walk-in cooler. Therefore, alternate exposure prevention approaches should also be identified and implemented.

Does acute exposure to aldehydes impair pulmonary function and structure?

Mixtures of anhydrous ethyl alcohol and gasoline substituted for pure gasoline as a fuel in many Brazilian vehicles. Consequently, the concentrations of volatile organic compounds (VOCs) such as ketones, other organic compounds, and particularly aldehydes increased in many Brazilian cities. The current study aims to investigate whether formaldehyde, acetaldehyde, or mixtures of both impair lung function, morphology, inflammatory and redox responses at environmentally relevant concentrations. For such purpose, C57BL/6 mice were exposed to either medical compressed air or to 4 different mixtures of formaldehyde and acetaldehyde. Eight hours later animals were anesthetized, paralyzed and lung mechanics and morphology, inflammatory cells and IL-1β, KC, TNF-α, IL-6, CCL2, MCP-1 contents, superoxide dismutase and catalalase activities were determined. The extra pulmonary respiratory tract was also analyzed. No differences could be detected between any exposed and control groups. In conclusion, no morpho-functional alterations were detected in exposed mice in relation to the control group.

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

Cadavers are usually preserved by embalming solution which is composed of formaldehyde (FA), phenol, and glycerol. Therefore, medical students and instructors have a higher risk of exposure to FA inhalation from cadavers during dissection. Therefore, the objective of this study was to evaluate the FA exposure in indoor air and breathing zone of medical students and instructors during dissection classes in order to investigate the relationship between them. The indoor air and personal air samples in breathing zone were collected three times during anatomy dissection classes (in January, August, and October of 2014) with sorbent tubes, which were analyzed by high-performance liquid chromatography (HPLC). The air cleaner machines were determined by weight measurement. Pulmonary function tests and irritation effects were also investigated. The mean of FA concentrations ranged from 0.117 to 0.415 ppm in the indoor air and from 0.126 to 1.176 ppm in the breathing zone of students and instructors. All the personal exposure data obtained exceeded the threshold limit of NIOSH and WHO agencies. The air cleaner machines were not significant difference. The pulmonary function of instructors showed a decrease during attention of classes and statistically significant decreasing in the instructors more than those of the students. Clinical symptoms that were observed in nose and eyes were irritations with general fatigue. We suggested that the modified exhaust ventilation and a locally ventilated dissection work table were considered for reducing FA levels in the gross anatomy dissection room.

Aldehydes in Relation to Air Pollution Sources: A Case Study around the Beijing Olympics

This study was carried out to characterize three aldehydes of health concern (formaldehyde, acetaldehyde, and acrolein) at a central Beijing site in the summer and early fall of 2008 (from June to October). Aldehydes in polluted atmospheres come from both primary and secondary sources, which limits the control strategies for these reactive compounds. Measurements were made before, during, and after the Beijing Olympics to examine whether the dramatic air pollution control measures implemented during the Olympics had an impact on concentrations of the three aldehydes and their underlying primary and secondary sources. Average concentrations of formaldehyde, acetaldehyde and acrolein were 29.3±15.1 μg/m3, 27.1±15.7 μg/m3 and 2.3±1.0 μg/m3, respectively, for the entire period of measurements, all being at the high end of concentration ranges measured in cities around the world in photochemical smog seasons. Formaldehyde and acrolein increased during the pollution control period compared to the pre-Olympic Games, followed the changing pattern of temperature, and were significantly correlated with ozone and with a secondary formation factor identified by principal component analysis (PCA). In contrast, acetaldehyde had a reduction in mean concentration during the Olympic air pollution control period compared to the pre-Olympic period and was significantly correlated with several pollutants emitted from local emission sources (e.g., NO2, CO, and PM2.5). Acetaldehyde was also more strongly associated with primary emission sources including vegetative burning and oil combustion factors identified through the PCA. All three aldehydes were lower during the post-Olympic sampling period compared to the before and during Olympic periods, likely due to seasonal and regional effects. Our findings point to the complexity of source control strategies for secondary pollutants.

Comparison of modified Thiel embalming and ethanol-glycerin fixation in an anatomy environment: Potentials and limitations of two complementary techniques

Thiel-fixed specimens have outstandingly lifelike visual and haptic properties. However, the original Thiel method is expensive and requires an elaborate setup. It is therefore of principal interest to modify the Thiel method in order to make it available to a broader user group. A modified Thiel embalming method will be described in detail and compared to ethanol-glycerin fixation with the help of illustrative examples. The visual properties, haptic properties, the usability for performing histological investigations, costs and potential health aspects will be considered. Tissues fixed with the modified Thiel technique gave results similar to the original method, providing more realistic visual and haptic properties than ethanol-glycerin embalming. However, Thiel fixation is significantly more expensive and requires more precautions to minimize potential health hazards than ethanol-glycerin-fixed tissues. In contrast to ethanol-glycerin-fixed specimens, the Thiel-fixed specimens are not suitable for histological investigations. Both modes of fixation are inappropriate for biomechanical testing. Modified Thiel embalming simplifies the availability of body donors with lifelike properties and has cost-saving advantages to the original technique. Thiel-embalmed body donors are ideally suited for clinical workshops but have restrictions for student dissection courses in facilities with limited storage space, air circulation or technical staff. Vice versa, ethanol-glycerin-fixed body donors are well suited for student dissection courses in such an environment but are limited in their use for clinical workshops. Modified Thiel embalming therefore ideally complements ethanol-glycerin fixation in order to provide customized solutions for clinical workshops and student dissection courses in a wide range of applications.

Student perceptions of an upper-level, undergraduate human anatomy laboratory course without cadavers

Several programs in health professional education require or are considering requiring upper-level human anatomy as prerequisite for their applicants. Undergraduate students are confronted with few institutions offering such a course, in part because of the expense and logistical issues associated with a cadaver-based human anatomy course. This study describes the development of and student reactions to an upper-level human anatomy laboratory course for undergraduate students that used a regional approach and contemporary, alternative teaching methods to a cadaver-based course. The alternative pedagogy to deliver the curriculum included use of commercially available, three-dimensional anatomical virtual dissection software, anatomical models coupled with a learning management system to offer Web-based learning, and a new laboratory manual with collaborative exercises designed to develop the student's anatomical skills and collaborative team skills. A Likert-scale survey with open-ended questions was used to ascertain student perceptions of the course and its various aspects. Students perceived that the noncadaver-based, upper-level human anatomy course with an engaging, regional approach is highly valuable in their learning of anatomy. anatomy.

Preliminary study: Formaldehyde exposure in laboratories of Sharjah university in UAE

Objectives

Laboratory technicians, students, and instructors are at high risk, because they deal with chemicals including formaldehyde. Thus, this preliminary study was conducted to measure the concentration of formaldehyde in the laboratories of the University of Sharjah in UAE.

Materials and Methods:

Thirty-two air samples were collected and analyzed for formaldehyde using National Institute for Occupational Safety and Health (NIOSH) method 3500. In this method, formaldehyde reacts with chromotropic acid in the presence of sulfuric acid to form a colored solution. The absorbance of the colored solution is read in spectrophotometer at wavelength 580 nm and is proportional to the quantity of the formaldehyde in the solution.

Results:

For the anatomy laboratory and in the presence of the covered cadaver, the mean concentration of formaldehyde was found to be 0.100 ppm with a range of 0.095–0.105 ppm. Whereas for the other laboratories, the highest mean concentration of formaldehyde was 0.024 ppm in the general microbiology laboratory and the lowest mean concentration of formaldehyde was 0.001 ppm in the environmental health laboratory. The 8-hour (time-weighted average) concentration of formaldehyde was found to be ranging between 0.0003 ppm in environmental health laboratory and 0.026 ppm in the anatomy laboratory.

Conclusions:

The highest level of concentration of formaldehyde in the presence of the covered cadaver in anatomy laboratory exceeded the recommended ceiling standard established by USA-NIOSH which is 0.1 ppm, but below the ceiling standard established by American Conference of Governmental Industrial Hygienists which is 0.3 ppm. Thus, it is recommended that formaldehyde levels should be measured periodically specially during the dissection in the anatomy laboratory, and local exhaust ventilation system should be installed and personal protective equipment such as safety glass and gloves should be available and be used to prevent direct skin or eye contact.

Exposure to formaldehyde and its potential human health hazards

A widely used chemical, formaldehyde is normally present in both indoor and outdoor air. The rapid growth of formaldehyde-related industries in the past two decades reflects the result of its increased use in building materials and other commercial sectors. Consequently, formaldehyde is encountered almost every day from large segments of society due to its various sources. Many governments and agencies around the world have thus issued a series of standards to regulate its exposure in homes, office buildings, workshops, public places, and food. In light of the deleterious properties of formaldehyde, this article provides an overview of its market, regulation standards, and human health effects.

Non-cancer effects of formaldehyde and relevance for setting an indoor air guideline

There is considerable recent focus and concern about formaldehyde (FA). We have reviewed the literature on FA with focus on chemosensory perception in the airways and lung effects in indoor environments. Concentrations of FA, both personal and stationary, are on average in the order of 0.05 mg/m(3) or less in Europe and North America with the exception of new housing or buildings with extensive wooden surfaces, where the concentration may exceed 0.1 mg/m(3). With the eye the most sensitive organ, subjective irritation is reported at 0.3-0.5 mg/m(3), which is somewhat higher than reported odour thresholds. Objective effects in the eyes and airways occur around 0.6-1 mg/m(3). Dose-response relationships between FA and lung function effects have not been found in controlled human exposure studies below 1 mg/m(3), and epidemiological associations between FA concentrations and exacerbation of asthma in children and adults are encumbered by complex exposures. Neither experimental nor epidemiological studies point to major differences in susceptibility to FA among children, elderly, and asthmatics. People with personal trait of negative affectivity may report more symptoms. An air quality guideline of 0.1 mg/m(3) (0.08 ppm) is considered protective against both acute and chronic sensory irritation in the airways in the general population assuming a log normal distribution of nasal sensory irritation.

Formaldehyde and chemosensory irritation in humans: a controlled human exposure study

OBJECTIVES

The objective of this study was to examine the possible occurrence of sensory irritation and subjective symptoms in human volunteers exposed to formaldehyde concentrations relevant to the workplace. The set up of the study included formaldehyde exposures with and without peaks, the presence and absence of a masking agent, and evaluation of the influence of personality factors.

METHODS

Testing was conducted in 21 healthy volunteers (11 males and 10 females) over a 10-week period using a repeated measures design. Each subject was exposed for 4h to each of the 10 exposure conditions on 10 consecutive working days. The 2-week exposure sequences were randomized, and the exposure to formaldehyde and the effect measurements were conducted in a double-blind fashion. During 4 of the 10 exposure sessions, 12-16 ppm ethyl acetate (EA) was used as a 'masking agent' for formaldehyde exposure. Measurements consisted of conjunctival redness, blinking frequency, nasal flow and resistance, pulmonary function, and reaction times. Also subjective ratings of discomfort as well as the influence of personality factors on the subjective scoring were examined. These were carried out pre-, during and/or post-exposure, and were used to evaluate the possible irritating effects of formaldehyde at these concentrations.

RESULTS

The results indicated no significant treatment effects on nasal flow and resistance, pulmonary function, and reaction times. Blinking frequency and conjunctival redness, ranging from slight to moderate, were significantly increased by short-term peak exposures of 1.0 ppm that occurred at a baseline exposure of 0.5 ppm formaldehyde. Results of the subjective ratings indicated eye and olfactory symptoms at concentrations as low as 0.3 ppm. Nasal irritation was reported at concentration levels of 0.5 ppm plus peaks of 1.0 ppm as well as at levels of 0.3 and 0.5 ppm with co-exposure to EA. However, exposure to EA only was also perceived as irritating. In addition, volunteers who rated their personality as 'anxious' tended to report complaints at a higher intensity. When 'negative affectivity' was used as covariate, the level of 0.3 ppm was no longer an effect level but 0.5 ppm with peaks of 1.0 ppm was. Increased symptom scores were reversed 16 h after the end of the exposures.

CONCLUSIONS

The results of the present study indicated eye irritation as the most sensitive parameter. Minimal objective eye irritation was observed at a level of 0.5 ppm with peaks of 1 ppm. The subjective complaints of ocular and nasal irritation noted at lower levels were not paralleled by objective measurements of eye and nasal irritation and were strongly influenced by personality factors and smell. It was concluded that the no-observed-effect level for subjective and objective eye irritation due to formaldehyde exposure was 0.5 ppm in case of a constant exposure level and 0.3 ppm with peaks of 0.6 ppm in case of short-term peak exposures.

Occupational risk in health care and research

BACKGROUND

Working in the health care and research sectors has been linked to various hazards.

METHODS

Studies published in the peer-reviewed literature that are pertinent to the exposures or diseases relevant to these fields were reviewed.

RESULTS

The most important exposures include infectious agents, formaldehyde, anesthetic agents, antineoplastic drugs, and ethylene oxide. The best-documented evidence is that of infectious risk primarily among clinical personnel. Monitoring studies of persons occupationally exposed to anesthetics clearly demonstrate behavioral effects, possible risk of reproductive problems, as well as cytogenetic effects of unknown significance. The latter two impairments are also observed among those exposed to antineoplastic drugs and ethylene oxide. Exposure to formaldehyde appears to be associated with nasopharyngeal tumors. Whereas increased risk of cancer of certain sites, particularly the brain and lymphohematopoietic system, is found among research and health care personnel, no specific exposure has been linked to these neoplasms.

CONCLUSIONS

Although some results are inconsistent, continued environmental and biological monitoring will allow better assessment of exposures and of implemented protection measures.

Using respirators and goggles to control exposure to air pollutants in an anatomy laboratory

BACKGROUND

Engineering or administrative methods are often insufficient or impractical to control exposure to chemicals in anatomy laboratories. This study explored the feasibility of wearing one or a combination of respirators and goggles used as personal protective equipment (PPE) to control exposure in one such laboratory.

METHODS

A group of 28 subjects were briefly trained in wearing PPE, fit-tested, and asked to complete a questionnaire regarding their subjective reaction after wearing the assigned PPE ensemble while working in the laboratory. The subjects' exposure to formaldehyde was also measured and generally exceeded the recommended limits.

RESULTS

When a full-face respirator or the combination of a half-mask respirator and goggles was worn, a majority of subjects reported no odor problem and no irritation to eyes or upper respiratory system. Subjects accepted the PPE to certain degrees, but those using respirators encountered difficulties communicating with others.

CONCLUSIONS

The combination of a half-mask respirator and goggles was the most feasible ensemble to control exposure to air pollutants in an anatomy laboratory.

Assessing exposure to air toxics relative to asthma

Asthma is a respiratory disease whose prevalence has been increasing since the mid 1970s and that affects more than 14.6 million residents of the United States. Environmental triggers of asthma include air pollutants that are respiratory irritants. Air toxics emitted into the ambient air are listed in the 1990 Clean Air Act Amendments as hazardous air pollutants (HAPs) if they can adversely affect human health, including the respiratory tract. HAPs include particulate and gaseous-phase pollutants, individual organic compounds and metals, and mixtures. Associations between asthma exacerbation and both particles and indoor volatile organic compounds (VOCs), often referred to as indoor air quality, have been reported. Studies conducted in the United States, Canada, and Europe over the past two decades have shown that most people living in the developed countries spend the majority of their time indoors and that the air concentrations of many air toxics or HAPs are higher indoors than in the ambient air in urban, suburban, and rural settings. Elevated indoor air concentrations result from emissions of air toxics from consumer products, household furnishings, and personal activities. The Relationship of Indoor, Outdoor and Personal Air (RIOPA) study was designed to oversample homes in close proximity to ambient sources, excluding residences where smokers lived, to determine the contribution of ambient emissions to air toxics exposure. The ratios of indoor to outdoor air concentrations of some VOCs in homes measured during RIOPA were much greater than one, and for most other VOCs that had indoor-to-outdoor ratios close to unity in the majority of homes, elevated ratios were found in the paired samples with the highest concentration. Thus, although ambient emissions contribute to exposure of some air toxics indoors as well as outdoors, this was not true for all of the air toxics and especially for the higher end of exposures to most volatile organic air toxics examined. It is therefore critical, when evaluating potential effects of air toxics on asthma or other adverse health end points, to determine where the exposure occurs and the source contributions for each air toxic and target population separately and not to rely solely on ambient air concentration measurements.

Hazardous air pollutants and asthma

Asthma has a high prevalence in the United States, and persons with asthma may be at added risk from the adverse effects of hazardous air pollutants (HAPs). Complex mixtures (fine particulate matter and tobacco smoke) have been associated with respiratory symptoms and hospital admissions for asthma. The toxic ingredients of these mixtures are HAPs, but whether ambient HAP exposures can induce asthma remains unclear. Certain HAPs are occupational asthmagens, whereas others may act as adjuncts during sensitization. HAPs may exacerbate asthma because, once sensitized, individuals can respond to remarkably low concentrations, and irritants lower the bronchoconstrictive threshold to respiratory antigens. Adverse responses after ambient exposures to complex mixtures often occur at concentrations below those producing effects in controlled human exposures to a single compound. In addition, certain HAPs that have been associated with asthma in occupational settings may interact with criteria pollutants in ambient air to exacerbate asthma. Based on these observations and past experience with 188 HAPs, a list of 19 compounds that could have the highest impact on the induction or exacerbation of asthma was developed. Nine additional compounds were identified that might exacerbate asthma based on their irritancy, respirability, or ability to react with biological macromolecules. Although the ambient levels of these 28 compounds are largely unknown, estimated exposures from emissions inventories and limited air monitoring suggest that aldehydes (especially acrolein and formaldehyde) and metals (especially nickel and chromium compounds) may have possible health risk indices sufficient for additional attention. Recommendations for research are presented regarding exposure monitoring and evaluation of biologic mechanisms controlling how these substances induce and exacerbate asthma.

The use of noncancer endpoints as a basis for establishing a reference concentration for formaldehyde

Published studies involving formaldehyde were selected for quality and relevance for determining whether noncancer endpoints could be used to derive a reference concentration for formaldehyde. Chamber studies provided the highest quality data for determining the presence of eye, nose, or throat irritation at a known level of formaldehyde. Some individuals begin to sense irritation at about 0.5 ppm, 5-20% report eye irritation at 0.5 to 1 ppm, and greater certainty for sensory irritation appears at 1 ppm or greater. These levels of formaldehyde do not appear to impact asthmatics even though these individuals are thought to be more sensitive to irritants. Mild, reversible changes in pulmonary function (forced expiratory volume at 1 s and midexpiratory flow) can occur in sensitized individuals at levels approaching 2 ppm. Studies in the manufacturing setting, while confounded by multiple exposures, provide useful information for setting boundaries for sensory irritation or changes in pulmonary function. Community surveys do not provide the specificity nor sensitivity needed to establish a reference concentration. Histological studies of the nasal mucosa suffer significant methodological and technological shortcomings in addition to issues commonly associated with the design of residential and workplace studies. Based on the review of chamber, community, and workplace studies of human exposures to formaldehyde, it is not possible to identify a specific no observed adverse effect level or lowest observed adverse effect level for formaldehyde. Ranges of exposures associated with acute sensory irritation can be derived and do include sensitive subpopulations. However, given the quality and variability of the data, human studies alone, especially those involving sensory irritation, are not adequate to serve as a reference concentration for estimating risk, or lack thereof, for a lifetime of exposure to formaldehyde. Alternative approaches, such as modeling cellular changes observed in animal studies, may be more useful for quantitative risk assessment of noncancer endpoints and should be used as an adjunct to interpreting human sensory studies.

Chemicals and gases

This article covers the major chemicals and gases that are considered to be of the most clinical relevance to the primary care provider. The reader is referred to other comprehensive textbooks of toxicology and occupational medicine for a complete discussion of the numerous additional products found in the workplace that may result in occupational exposure.

Field precision of formaldehyde sampling and analysis using NIOSH method 3500

This study examined the field precision of National Institute for Occupational Safety and Health (NIOSH) Method 3500, also known as chromotropic acid method, in the range of exposure limit covers the Occupational Safety and Health Administration (OSHA) permissible exposure limit of 0.75 ppm and the OSHA action level of 0.5 ppm airborne formaldehyde. Using this method, 78 area samples (25 sets of replicate samples) were collected in a workplace and analyzed. The concentrations of formaldehyde ranged from 0.05 to 1.72 ppm with a mean +/- standard deviation of 0.95 +/- 0.31 ppm. The precision (coefficient of variation, CV) of 25 sets of replicated samples ranged from 0.03 to 0.24 with an overall (pooled) precision of 0.09, which is in agreement with that stated in NIOSH Method 3500. In 68% of replicate samples the precision was equal to or less than 0.09. The relative accuracy of the sampling and analytical procedure used in this study was evaluated by collecting 12 sets of side-by-side replicate samples using both NIOSH Method 3500 and OSHA Method 5.2 Method 53 was used to determine whether the concentrations of formaldehyde were within the desired range. The overall mean concentrations were 0.98 +/- 0.42 for Method 3500 and 0.78 +/- 0.28 ppm for Method 5.2. These were no statistically different. The pooled CVs were 0.114 and 0.076 for Method 3500 and Method 52, respectively.