WORK HEALTH ☆ lastyeuv .

wntHen paper
Lecture 2
questiong
Chemical Health Hazards in the
Workplace
Shelly Tse
JC School of Public Health and Primary Care
The Chinese University of Hong Kong

Public Health Students Lecture, 2024

1
 Learning objectives of “Lecture 2”
• Discuss GHS and the classification, chemical label, storage and
handling of hazardous chemical substances, as well as the disposal.
• Recognize material safety data sheet (MSDS) and safety data sheet
(SDS)
• Realize major hazardous chemicals (lead, benzene,
trichloroethylene, and silica) and the adverse health effects;
legislation and compensation ordinance for silicosis.
• Gain knowledge of prevention and control strategies for major
chemical health hazards

2
 Chemical
classification, label,
effects and disposal
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 Purpose of classification
• To identify the properties of substances and
preparations that may constitute a hazard during
normal handling and use.

4
 Classification of chemicals
• The classification of hazardous chemical substances and
preparation of hazardous for supply is based on their

Physicochemical properties: Effects on health & environment:

i.e. corrosive, explosive, i.e. very toxic, harmful, corrosive,
oxidizing, toxic, harmful / irritant, irritant, sensitizing, carcinogenic,
extremely flammable / highly mutagenic, toxic for reproduction and
flammable / flammable dangerous for the environment

Also the criteria for choice of symbols, indication of

danger and choice of risk phrase, GHS ☆ 5
 What the GHS stands for?
• The Globally Harmonized System of Classification and Labelling of
Chemicals - a system of hazard communication for chemical hazards
that can be adopted by countries around the world.
• GHS was developed by a United Nations (UN) international team of
hazard communication experts who established the following two major
standardized elements -
1. rules for classifying the hazards of chemical products (i.e.,
substances, materials, or mixtures)
2. hazard communication tools (e.g., format for safety data sheets
(SDSs), content for label and SDSs with hazard and precautionary
statements, symbols, signal word)
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 What is the scope of GHS?
• GHS covers all hazardous chemicals products, such as those used for the
following purposes:
– industrial chemicals
– consumer chemical products
– pesticides
– agricultural chemicals
– pharmaceuticals
• The target audiences for GHS include workers in many different
industries (e.g., warehouses, construction, chemical manufacturing,
transportation), emergency responders, and consumers.
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 How is GHS organized ?
GHS consists of three major hazard groups :
– Physical hazards.
– Health hazards.
– Environmental hazards.

Within each of these hazard groups there are classes and

categories.

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 What are the classes within the Health hazard group?
☆
Criteria of GHS for classifying chemicals into 10 health hazard classes:
1. Acute toxicity.
2. Skin corrosion/irritation.
3. Serious eye damage/eye irritation.
4. Respiratory or skin sensitization.
5. Germ cell mutagenicity.
6. Carcinogenicity.
7. Reproductive toxicity.
8. Specific target organ toxicity - single exposure.
9. Specific target organ toxicity - repeated exposure.
10.Aspiration hazard.
9
Tiny ←
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Source: A Guide to The Globally Harmonized System of Classification and Labeling of Chemicals (GHS)
10
 Inconsisfent ersdence from drfferertsfudis

IARcGmud 1 2 ARcawrprA
,

YARCGroup 2 b

Source: A Guide to The Globally Harmonized System of Classification and Labeling of Chemicals (GHS)

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 List of classification of carcinogens
Agents Classified by the IARC Monographs, Volumes 1–132

IARC (International Agency for Research on Cancer) classifies each

agent or exposure into one of five groups according to the strength of
scientific evidence for carcinogenicity (human, animal, other lab
polralr
吃 t evidence) 1
7 tenstingoy
-

mos
Group 1 Carcinogenic to humans ⼆ swbcateyorles IA 122 agents
Group 2A Probably carcinogenic to humans =
Subcateguis 1 B 93 agents
Group 2B Possibly carcinogenic to humans = Subcutegorls 2 319 agents
Group 3 Not classifiable as to its carcinogenicity to humans 501 agents
Group 4 Probably not carcinogenic to humans

A list is available at https://monographs.iarc.who.int/agents-classified-by-the-iarc/

Last available: 06 Jan 2023
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13
14
业 GHS hazard warning symbols

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https://www.dr-software.com/en/
 Chemical labels
☆
Classified substances must
display a supply label which is The chemical label should take
intended to provide a primary account of all potential
means by which people at hazards that are likely to arise
work and the general public in normal handling and the
use of a dangerous substance
are given essential information
or preparation in the form in
about hazardous substances which it is supplied
and preparations.

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 Information on the label
• The name, full address and telephone number of
a person in a member state who is responsible
for supplying the substances or preparation.
• The indication(s) of danger and the
corresponding symbol(s)
• The risk phrase (set out in full)
• The safety phrase (set out in full)

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Risk phrase(s) and Safety phrase(s): set out in full
(Trichloroethylene, TCE)

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 Storage and handling of hazardous
chemicals
• General precautions (e.g., standards of housekeeping)

• Precautions with specific substances (e.g., flammable

liquids, carcinogens, poisons, solids)

• Bulk storage of hazardous chemical substances (e.g.,

segregation, structural requirements, general
requirements, storage system)

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 Disposal of hazardous substances
⽤
• Procedures for the safe disposal of dangerous substances
depend largely on the type and quantity of material involved
• Only trained and authorized staff should be permitted to
disposal of dangerous substances (e.g., asbestos)
• Necessary information that contractors should know to provide
disposal services - location, procedure, whether formal
licensing is required, the mode of transport.
? Waste disposal department
5
depends on the amonnt
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 Major routes of chemicals to the body
• Inhalation is a critical route (airborne)
– May cause acute or chronic effects
– Inhalation allows rapid entry to blood
• Absorption through skin (liquid)
– Systemic toxic effect
– Result in allergic or irritant type effects causing acute or chronic
dermatitis
– Even rapid through the broken skin
• Ingestion, injection?
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OEL: Occupational Exposure Limit

Adverse health
effect
If > OEL
a. Inhalation via air
Reversible or
irreversible

b. Ingestion or absorption
The source

Risk assessment to chemicals’ health effects 22

 Material Safety Data Sheet (MSDS)

• An MSDS is a document that contains information on the

potential hazards (health, fire, reactivity and environment) and
how to work safely with the chemical product. MSDSs are
prepared by the supplier or manufacturer of the material.
Employers must ensure that MSDSs are readily accessible to
employees.

- OSHA

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Source: 24
http://www.iosh.gov.tw/Msds.aspx
 Important information on the MSDS
• Product Information - product identifier (name), manufacturer and
suppliers names, addresses, and emergency phone numbers
• Hazardous Ingredients
• Physical Data
• Fire or Explosion Hazard Data
• Reactivity Data - information on the chemical instability of a product
and the substances it may react with
• Toxicological Properties - health effects
• Preventive Measures
• First Aid Measures
• Preparation Information - who is responsible for preparation and date
of preparation of MSDS 25
 MSDS
– TCE as a case
study

Source:
https://www.mathesongas.com/pdfs/msds/MAT238
50.pdf
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GHS Brings Big Changes to Safety Data Sheets in
HazCom 2012

• Transition: HazCom1994 to HazCom2012

？
• Is an SDS an MSDS?
– GHS 16 section SDS
– OSHA 8 section MSDS
– ANSI standard 16 section MSDS
-OSHA
Globally Harmonized System of Classification and Labelling of Chemicals (GHS)
American National Standard Institute (ANSI) 27
Source: http://www.osha.gov/Publications/HazComm_QuickCard_SafetyData.html
Source:
http://www.labour.gov.hk/eng/public/oh/AirImpure.pdf 28
•Lead
•Benzene
•Trichloroethylene (TCE)
•Silica 29
Lead
• Perhaps, the oldest known metal, its use being common in
the Roman age and thereafter
• Lead is mined principally as lead sulphide (galena)
• A compound of electric batteries, cables, lead sheet and
pipe, an anti-detonate in petrol, in solders and alloys,
constituent of paints, glass and pottery.

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 Routes of body entry - lead
• Inhalation (fumes, dust)

• Ingestion (contaminated food)

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• Pervasion of the unbroken skin (in the form of

organic compounds, such as, tetraethyl lead)四乙鉛

The use, handling of, or exposure to the fumes, dust or

vapor of, lead or a compound of lead, or a substance
containing lead, is a prescribed occupational disease.
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 Inorganic lead poisoning
• In acute cases of inorganic lead poisoning, usually caused by
exposure to fumes, the initial symptoms are a sweetish taste in
the mouth.

• In more chronic poisoning, the classical symptoms and signs are

headache, pallor, a blue line at the gum margins, anemia and
palsy (wrist and foot drop), mental dullness, inability to
concentration, faulty memory, tremors, deafness, convulsion and
coma.

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 Organic lead poisoning
• Tetraethyl lead (C8H20Pb) is a colorless, poisonous, oily
liquid used in gasoline for internal-combustion engines
as an antiknock agent
- the major cause of organic lead poisoning
- volatile at room temperature and is readily inhaled
• Central nervous system - startling, progression
to talkativeness, excitement and muscular
twitchings, with insomnia, delusions,
hallucinations, and even acute and violent
mania.
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 Common control strategies for lead
Follow the principles of hierarchy of prevention, specifically

• Substitution • Containment
• Change in form • LEV systems
• Temperature control • Wet methods

These strategies should be accompanied by training and

supported by meticulous levels of cleaning and housekeeping,
with a regular air monitoring and medical surveillance, in
addition to PPE.
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 Benzene

• A freely volatile solvent with a distinctive odor and narcotic

action
• Crude benzene, such as ‘benzol’ or ‘benzole’, frequently
contains as impurities varying amount of the homologues of
benzene (toluene, xylene)
• Benzene family: benzene (benzole), nitrobenzene and
aniline.

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Benzene poisoning
• Poisoning by benzene or a homologue of benzene through the
use or handling of, or exposure to the fumes of, or vapour
containing benzene or any of its homologues, is a prescribed
occupational disease.

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 High-risk benzene exposure jobs
☆
• Adhesive production • Offshore workers
• Aircraft engine and fuel workers • Painters (marine, industrial and auto)
• Automotive mechanics • Paper and pulp
• Barge / tug workers • Pesticide manufacturing
• Boat and vessel seamen • Pipefitters
• Brake technicians • Printers and print shop employees
• Chemical plant workers • Railroad workers
• Dock workers • Refinery workers
• Engine and turbine workers • Rubber workers
• Gasoline distribution workers • Shoe / leather workers
• House painters • Solvent workers
• Industrial plant workers (solvents) • Synthetic rubber production
• Maritime workers • Tanker men
• Newspaper press workers • Truck drivers
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 Acute benzene poisoning
D
• Occurs: accidental exposure to high concentrations of
fumes, perhaps following a spillage.
• In its initial stages: a feeling of euphoria, or merely to
headache, giddiness, nausea and vomiting.
• In the more serious cases: excitement with a sensation of
constriction in the chest, convulsive movements and
paralysis may give way, as intoxication increases, to
delirium, coma and death due to respiratory failure.
• Toluene and xylene have a similar but less toxic effect.
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Chronic benzene poisoning
• Occurs: more common, affects the bone marrow causing
anemia.

• Early symptoms: lassitude, muscular weakness, mild digestive

disturbances, pallor and giddiness.

• Subsequent symptoms: severe anemia, with extreme pallor,

muscular weakness, hemorrhages from the mucous
membranes and skin hemorrhages. Death may result from
aplastic anemia
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 Control strategies for benzene
P Follow the Principles of hierarchy of prevention

• Benzene is virtually been banned from use in

industry, other than for use in specific research
operations.

• The principal control strategies is that of

substitution of benzene by the safer toluene.

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Trichloroethylene (TCE) - as a case study

A nonflammable (at most conditions), colorless liquid, volatile

organic chemical (VOC), with a somewhat sweet odor and a
sweet, burning taste. It is used mainly as a solvent to remove
grease from metal parts, but it is also an ingredient in
adhesives, paint removers, typewriter correction fluids, and
spot removers.

- Agency for Toxic Substance and Disease Registry (ATSDR)

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http://image.baidu.com/i?ct=201326592&cl=2&lm=-1&tn=baiduimage&fr=&pv=&word=%C9%EE%DB%DA%20%B5%E7%D7%D3%20%C5%AE%B9%A4&istype=2&z=0&fm=rs10#pn=0

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 Trichloroethylene (TCE) – the effects
• Inhalation of the TCE vapor can produce drowsiness, giddiness,
unconsciousness and death.
• TCE vapor may cause eye irritation and blistering of the skin.

• The effects of exposure can be cumulative: repeated exposure,

particularly where people handle the substance on a regular basis, can
further result in dermatitis (eczema), particularly of the hands, due to
the degreasing effect on the skin.

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 Common control strategies of TCE
D Following the principles of hierarchy of prevention
• In addition to formal instructions to staff on the hazards
of exposure and on the operation of formal safe working
procedures, LEV should be provided around the lips of
degreasing tanks (lip extraction).

• TCE should be used in well-ventilated areas

and its use in confined spaces is prohibited.

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 Silica –
Single exposure
Multiple outcomes http://www.flickr.com/photos/nlcnet/4399719964/

Gemstone worker
•Stone cutting
•Grinding
•Polishing

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Incident cases of silicosis by year (LD), 2000-2021
Calendar year No. of silicotics Ranking
2000 105 2
2001 122 1
2002 110 2
2003 74 1
2004 69 2
2005 68 1
2006 109 1
2007 67 1
2008 65 1
2009 86 1
2010 61 2
2011 63 3
2012 44 3
2013 51 2
2014 68 2
2015 56 2
2016 43 3
2017 54 2
2018 59 2
2019 52 2
2020 88 1
2021 67 2
46
2022 79 2
 Free silica dust
• Causative agent:
– Crystalline silicon dioxide
(SiO2): quartz, tridymite,
cristobalite
– Amorphous free silica (kaolin) http://thorax.bmj.com/content/64/1/74.full

• Hazardous occupations:
http://www.selectstoneohio.com/images/SelectSilicaSM.jpg
construction, quarry, caisson,
tunnelling, pottery rock drilling,
jewellery, mining, sand
blasting.
http://www.made-in-china.com/image/2f0j00qCETovshHfgZM/Silica-Bricks-Preform-Silex-Blocks-Oblong-Stone.jpg
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Inhaled particulates deposit in different
parts of our respiratory system
Particles removed by: • Inhalable dusts
1. Impaction • <100 um
2. Sedimentation • Particles > 10 um are removed in
3. Diffusion mouth and nasal passages
4. Electrostatic
• Thoracic dusts
• <10 um
• Produce health effects in the
tracheobronchial region
• Respirable dusts
• <4 um
• Deposit deep in alveolar region
- ACGIH 48
Particulate matter – PM10, PM2.5

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 Silica dust and multiple adverse health
outcomes
业 • Non-malignancies
– Silicosis
– Chronic bronchitis, emphysema
– Silicotuberculosis
– Pulmonary heart diseases
– Ischemic heart disease?
– Renal diseases?
• Malignancies
– Lung cancer (Group 1 carcinogen, IARC, 1997)
50
Figure 3. Spline curve: log lung cancer rate ratio vs. log
cumulative dust exposure 15-year lag. - Steenland et al., Cancer
Cause and Control. 2001;12:773-784 - Park et al., Occup Environ Med 2002;59:36-43

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- Chen WH, PLOS Medicine 2011
Silicosis
• Silicosis is a fibrotic disease of the lungs caused by
the inhalation, retention and pulmonary reaction to
crystalline silica.

http://www.google.com/search?hl=en&safe=active&biw=1243&bih=904&gbv=2&tbm=isch&sa=1&q=silicosis&aq=f&aqi=g10&aql=&oq=#q=silicosis&hl=en&safe=act
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 Forms of silicosis
• Chronic (or classic) silicosis: 15 or more years of exposure
• Accelerated silicosis: more intense exposure for 5-10
years
• Acute silicosis: a few months to 2 years of massive silica
exposure
• Progressive massive fibrosis (PMF): nodular opacities >
1cm of CR [complications are common]

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 Assessment of silicosis
• The diagnosis of silicosis in Hong Kong depends on a
lifetime occupational history of silica dust exposure,
abnormalities on chest X-rays, and the absence of medical
conditions that could produce similar chest radiographic
findings.

• The presence of silicosis was defined as the code of

profusion of 1/0 or higher according to the definition
proposed by ILO.
(ILO: International Labor Organization)
54
 Diagnosis of
Silicosis
- standard radiograph
ILO, 1980

Simple silicosis

Progressive Massive
Normal Fibrosis (PMF) 55
 •A small-scale goldmine in Jiangxi, China

•574 Chinese male gold miners, rock-drillers

•Age at first exposure: 24.2 years old

•Age at diagnosis of silicosis: 29.7 years old

•Respirable silica dust: 89.5 mg/m3 (ranged:

70.2–108.8) – far exceed the OEL

After an average of 5.6 years of dust exposure, the rate of

accelerated silicosis was 29.1% (95% CI: 24.8–33.4%, 167 cases),
and with a tendency of an increased risk of TB.
Source: Tse LA et al., Am J Ind Med 50:876–880 (2007) 56
Standards of crystalline silica dust
• The National Institution for Occupational Safety and Health
(NIOSH) - recommended exposure limit (REL) of 0.05mg/m3 for
all forms of crystalline silica.

• Occupational Safety and Health Administration (OSHA) -

standard of about 0.05mg/m3 for respirable cristobalite dust

• OSHA and Mine Safety and Health Administration (MSHA) -

standards (permissible exposure limits) of 0.1mg/m3 100%
respirable crystalline silica dust.

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Code of practice, LD
Source:
https://www.labour.gov.hk/eng/public/oh/AirImpure.pdf

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 Therapy of silicosis
• No successful treatment. To date, the search for a
specific therapy for silicosis has been unrewarding.
• Silicosis is irreversible and sometimes
fatal, it may progress even without
further silica exposure.

• Prevention remains the cornerstone

of eliminating this occupational lung
diseases Source of photo: Center for Community Health

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 Prevention of silicosis
• The use of improved ventilation and local exhaust, process
enclosure, wet techniques, personal protection including
the proper selection of respirators, and where possible
industrial substitution of agents less hazardous than silica
can reduce the exposure.
• Education of workers
• Screening and medical surveillance

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 Pneumoconiosis and Mesothelioma
(Compensation) Ordinance
Compensation items:
• Monthly compensation for pain, suffering and loss of amenities
• Monthly compensation for incapacity
• Compensation for period prior to date of diagnosis
• Compensation for care and attention
• Expenses for medical treatment
• Expenses for medical appliances
• Compensation for death resulting from Pneumoconiosis or Mesothelioma (or both)
• Compensation for bereavement
• Funeral expenses

Source: http://www.pcfb.org.hk/compensate/compensate.html
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 Entitlement to compensation
- pneumoconiosis or mesothelioma

Compensation shall be payable to:

• any person suffering from pneumoconiosis or mesothelioma (or both), in respect of
any incapacity resulting from the above disease or diseases and any pain, suffering
and loss of amenities arising from the above disease or diseases
• for a person suffering from pneumoconiosis (whether or not he is also suffering
from mesothelioma), compensation in respect of his pneumoconiosis shall be
payable only where the date of diagnosis of his pneumoconiosis occurs on or after
1 January 1981
• for a person suffering from mesothelioma (whether or not he is also suffering from
pneumoconiosis), compensation in respect of his mesothelioma shall be payable
only where the date of diagnosis of his mesothelioma occurs on or after 18 April
2008
AND
• a person resident in Hong Kong for 5 years or more at the date of the notification of
the claim, or resident in Hong Kong for less than 5 years at such date if he
contracted pneumoconiosis or mesothelioma (or both) in Hong Kong 62
 References
• A Guide to The Globally Harmonized System of Classification and
Labeling of Chemicals (GHS)
https://www.osha.gov/dsg/hazcom/ghs.html
• Code Of Practice On Control Of Air Impurities In The Workplace
http://www.labour.gov.hk/eng/public/oh/AirImpure.pdf
• Hazard Communication Safety Data Sheets
http://www.osha.gov/Publications/HazComm_QuickCard_SafetyData.ht
ml

63
 Tutorial (Lecture 2)
• What is the typical clinical presentation for the acute case of
lead poisoning?
• Why is trichloroethylene prohibited using in confined space?
• What are the major adverse health effects of silicosis?

64