In recent years, cleaning has been identified as an occupational risk because of an increased incidence of reported respiratory effects, such as asthma and asthma-like symptoms among cleaning workers. Due to the lack of systematic occupational hygiene analyses and workplace exposure data, it is not clear which cleaning-related exposures induce or aggravate asthma and other respiratory effects. Currently, there is a need for systematic evaluation of cleaning products ingredients and their exposures in the workplace. The objectives of this work were to: a) identify cleaning products' ingredients of concern with respect to respiratory and skin irritation and sensitization; and b) assess the potential for inhalation and dermal exposures to these ingredients during common cleaning tasks. We prioritized ingredients of concern in cleaning products commonly used in several hospitals in Massachusetts. Methods included workplace interviews, reviews of product Materials Safety Data Sheets and the scientific literature on adverse health effects to humans, reviews of physico-chemical properties of cleaning ingredients, and occupational hygiene observational analyses. Furthermore, the potential for exposure in the workplace was assessed by conducting qualitative assessment of airborne exposures and semi-quantitative assessment of dermal exposures. Cleaning products used for common cleaning tasks were mixtures of many chemicals, including respiratory and dermal irritants and sensitizers. Examples of ingredients of concern include quaternary ammonium compounds, 2-butoxyethanol, and ethanolamines. Cleaning workers are at risk of acute and chronic inhalation exposures to volatile organic compounds (VOC) vapors and aerosols generated from product spraying, and dermal exposures mostly through hands. Cleaning products are mixtures of many chemical ingredients that may impact workers' health through air and dermal exposures. Because cleaning exposures are a function of product formulations and product application procedures, a combination of product evaluation with workplace exposure assessment is critical in developing strategies for protecting workers from cleaning hazards. Our task based assessment methods allowed classification of tasks in different exposure categories, a strategy that can be employed by epidemiological investigations related to cleaning. The methods presented here can be used by occupational and environmental health practitioners to identify intervention strategies.

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Characterization of occupational exposures to cleaning products used for common cleaning tasks-a pilot study of hospital cleaners

Background 
The study of human exposure to environmental toxicants has evolved as a scientific field over the past 30 years.

Exposure science: a view of the past and milestones for the future.

In The Netherlands, the web-based tool called 'Stoffenmanager' was initially developed to assist small- and medium-sized enterprises to prioritize and control risks of handling chemical products in their workplaces. The aim of the present study was to explore the accuracy of the Stoffenmanager exposure algorithm. This was done by comparing its semi-quantitative exposure rankings for specific substances with exposure measurements collected from several occupational settings to derive a quantitative exposure algorithm. Exposure data were collected using two strategies. First, we conducted seven surveys specifically for validation of the Stoffenmanager. Second, existing occupational exposure data sets were collected from various sources. This resulted in 378 and 320 measurements for solid and liquid scenarios, respectively. The Spearman correlation coefficients between Stoffenmanager scores and exposure measurements appeared to be good for handling solids (rs = 0.80, N = 378, P 10 Pa (rs = 0.56, N = 104, P < 0.0001) and non-volatile substances with a vapour pressure ≤10 Pa (rs = 0.53, N = 216, P < 0.0001). The mixed-effect regression models with natural log-transformed Stoffenmanager scores as independent parameter explained a substantial part of the total exposure variability (52% for solid scenarios and 76% for liquid scenarios). Notwithstanding the good correlation, the data show substantial variability in exposure measurements given a certain Stoffenmanager score. The overall performance increases our confidence in the use of the Stoffenmanager as a generic tool for risk assessment. The mixed-effect regression models presented in this paper may be used for assessment of so-called reasonable worst case exposures. This evaluation is considered as an ongoing process and when more good quality data become available, the analyses described in this paper will be expanded. Based on these analyses, the algorithm will be refined in the near future. © The Author 2008. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

Stoffenmanager exposure model: development of a quantitative algorithm.

The present paper proposes a source-receptor model to schematically describe inhalation exposure to help understand the complex processes leading to inhalation of hazardous substances. The model considers a stepwise transfer of a contaminant from the source to the receptor. The conceptual model is constructed using three components, i.e. (i) the source, (ii) various transmission compartments and (iii) the receptor, and describes the contaminant's emission and its pattern of transport. Based on this conceptual model, a list of nine mutually independent principal modifying factors (MFs) is proposed: activity emission potential, substance emission potential, localized control, separation, segregation, dilution, worker behavior, surface contamination and respiratory protection. These MFs describe the exposure process at a high level of abstraction so that the model can be generically applicable. A list of exposure determinants underlying each of these principal MFs is proposed to describe the exposure process at a more detailed level. The presented conceptual model is developed in conjunction with an activity taxonomy as described in a separate paper. The proposed conceptual model and MFs should be seen as 'building blocks' for development of higher tier exposure models. © The Author 2008. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

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Conceptual model for assessment of inhalation exposure: Defining modifying factors

The Inter-Organization Programme for the Sound Management of Chemicals was established to foster increased collaboration between international organizations in the area of sound chemicals management as a follow-up to the Rio Conference in 1992. The eight participating organizations and the observers have attempted to coordinate their policies and work, including programs in which they support multilateral environmental agreements and their implementation in countries and regions around the world.

Inter-Organization Programme for Sound Management of Chemicals

Valid and reliable semi-quantitative dermal exposure assessment methods for epidemiological research and for occupational hygiene practice, applicable for different chemical agents, are practically nonexistent. The aim of this study was to assess the reliability of a recently developed semi-quantitative dermal exposure assessment method (DREAM) by (i) studying inter-observer agreement, (ii) assessing the effect of individual observers on dermal exposure estimates for different tasks, and (iii) comparing inter-observer agreement for ranking of body parts according to their exposure level. Four studies were performed in which a total of 29 observers (mainly occupational hygienists) were asked to fill in DREAM while performing side-by-side observations for different tasks, comprising dermal exposures to liquids, solids, and vapors. Intra-class correlation coefficients ranged from 0.68 to 0.87 for total dermal exposure estimates, indicating good to excellent inter-observer agreement. The effects of individual observers on task estimates were estimated using a linear mixed effect model with logged DREAM estimates as explanatory variable; "task", "company/department", and the interaction of "task" and "company/department" as fixed effects; and "observer" as a random effect. Geometric mean (GM) dermal exposure estimates for different tasks were estimated by taking the exponent of the predicted betas for the tasks. By taking the exponent of the predicted observer's intercept (expωi), a multiplier (MO) was estimated for each observer. The effects of individual observers on task estimates were relatively small, as the maximum predicted mean observers' multiplier was only a factor 2, while predicted GMs of dermal exposure estimates for tasks ranged from 0 to 1226, and none of the predicted individual observers' multipliers differed significantly from 1 (t-test α = 0.05). Inter-observer agreement for ranking of dermal exposure of nine body parts was moderate to good, as median values of Spearman correlation coefficients for pairs of observers ranged from 0.29 to 0.93. DREAM provides reproducible results for a broad range of tasks with dermal exposures to liquids, solids, as well as vapors. DREAM appears to offer a useful advance for estimations of dermal exposure both for epidemiological research and for occupational hygiene practice.

Berna van Wender de Joode

Papers

Reliability of a semi-quantitative method for dermal exposure assessment (DREAM)