Outils pratiques et orientations concernant les substances dangereuses

Un certain nombre d'outils et de documents d'orientation ont été mis au point par les États membres, les institutions européennes, les associations d'entreprises, les partenaires sociaux et d'autres acteurs pour aider les entreprises à effectuer des analyses de risque complètes et efficaces. Ces outils illustrent une grande variété d'approches destinées à gérer efficacement les substances dangereuses. Ils couvrent souvent des opérations de travail spécifiques, telles que le remplissage ou le pompage de liquides, ou les procédés de soudure. D'autres sources donnent un aperçu complet de certains groupes de substances, comme les substances sensibilisantes, ou mettent en avant les risques typiques dans certains secteurs.
En outre, en plus de contribuer à une évaluation des risque de haute qualité, la plupart de ces outils proposent de bonnes pratiques, expliquant comment réduire les risques dans des contextes professionnels courants comportant une exposition aux substances dangereuses. Il existe également des outils destiné à aider des acteurs spécifiques, comme les inspecteurs du travail, les petites et moyennes entreprises et les représentants des travailleurs, pour ne citer qu'eux. Il vaut donc vraiment la peine d'explorer le site pour découvrir l'aide à votre disposition.

Source: https://osha.europa.eu/fr/themes/dangerous-substances/practical-tools-dangerous-substances

Mission relative à la prévention et à la prise en compte de l’exposition des travailleurs aux agents chimiques dangereux

Rapport remis à la ministre du Travail, Muriel Pénicaud, le 29 août 2018.
Mission sur l'exposition aux agents chimiques dangereux confiée au Professeur Frimat, professeur des universités et praticien hospitalier de l'université de Lille, spécialiste de la santé au travail, avec l'appui et le soutien logistique de la direction générale du travail et de la direction de la sécurité sociale.

Source: https://travail-emploi.gouv.fr/IMG/pdf/rapport_professeur_frimat.pdf

Le risque chimique

Présent dans tous les secteurs d'activité, le risque chimique reste une préoccupation majeure en matière de risques professionnels. Les produits chimiques peuvent en effet induire de graves effets sur la santé, immédiats ou différés. Parmi les multiples substances employées, les produits classés cancérogènes, mutagènes ou toxiques pour la reproduction (CMR) exposent de nombreux salariés à moyen ou long terme : près de 10 % de la population active est en contact avec au moins un CMR sur le lieu de travail. Du fait de leur nocivité, ces produits nécessitent d'être substitués par d'autres agents moins dangereux, lorsque cela est possible.

Source: (2018). Travail & sécurité, (797).
http://www.travail-et-securite.fr/ts/dossier/Le%20risque%20chimique.html

A Review of Workplace Risk Management Measures for Nanomaterials to Mitigate Inhalation and Dermal Exposure

This review describes an evaluation of the effectiveness of Risk Management Measures (RMM) for nanomaterials in the workplace. Our aim was to review the effectiveness of workplace RMM for nanomaterials and to determine whether established effectiveness values of conventional chemical substances applied for modelling purposes should be adopted or revised based on available evidence. A literature review was conducted to collate nano-specific data on workplace RMM. Besides the quantitative efficacy values, the library was populated with important covariables such as the study design, measurement type, size of particles or agglomerates/aggregates, and metrics applied. In total 770 records were retrieved from 41 studies for three general types of RMM (engineering controls, respiratory equipment and skin protective equipment: gloves and clothing). Records were found for various sub-categories of the different types of RMM although the number of records for each was generally limited. Significant variation in efficacy values was observed within RMM categories while also considering the respective covariables. Based on a comparative evaluation with efficacy values applied for conventional substances, adapted efficacy values are proposed for various RMM sub-categories (e.g. containment, fume cupboards, FFP2 respirators). It is concluded that RMM efficacy data for nanomaterials are limited and often inconclusive to propose effectiveness values. This review also shed some light on the current knowledge gaps for nanomaterials related to RMM effectiveness (e.g. ventilated walk-in enclosures and clean rooms) and the challenges foreseen to derive reliable RMM efficacy values from aggregated data in the future.

Source: Goede, H., Christopher-de Vries, Y., Kuijpers, E. et Fransman, W. (2018). Annals of work exposures and health.
https://doi.org/10.1093/annweh/wxy032

Development of a bar code-based exposure assessment method to evaluate occupational exposure to disinfectants and cleaning products

A pilot study
Objective: Healthcare workers are highly exposed to various types of disinfectants and cleaning products. Assessment of exposure to these products remains a challenge. We aimed to investigate the feasibility of a method, based on a smartphone application and bar codes, to improve occupational exposure assessment among hospital/cleaning workers in epidemiological studies.
Methods: A database of disinfectants and cleaning products used in French hospitals, including their names, bar codes and composition, was developed using several sources: ProdHyBase (a database of disinfectants managed by hospital hygiene experts), and specific regulatory agencies and industrial websites. A smartphone application has been created to scan bar codes of products and fill a short questionnaire. The application was tested in a French hospital. The ease of use and the ability to record information through this new approach were estimated.
Results: The method was tested in a French hospital (7 units, 14 participants). Through the application, 126 records (one record referred to one product entered by one participant/unit) were registered, majority of which were liquids (55.5%) or sprays (23.8%); 20.6% were used to clean surfaces and 15.9% to clean toilets. Workers used mostly products with alcohol and quaternary ammonium compounds (>90% with weekly use), followed by hypochlorite bleach and hydrogen peroxide (28.6%). For most records, information was available on the name (93.7%) and bar code (77.0%). Information on product compounds was available for all products and recorded in the database.
Conclusion: This innovative and easy-to-use method could help to improve the assessment of occupational exposure to disinfectants/cleaning products in epidemiological studies.

Source: Quinot, C., Amsellem-Dubourget, S., Temam, S., Sevin, E., Barreto, C., Tackin, A., ... et Descatha, A. (2018). Occup Environ Med.
http://dx.doi.org/10.1136/oemed-2017-104793

Surveillance biologique de l’exposition professionnelle (SBEP) aux médicaments anticancéreux au sein d’un hôpital Mauritanien

Contexte: En Mauritanie, l'activité du Centre National d'Oncologie (CNO) n'a cessé de croître, entraînant une augmentation de la manipulation de médicaments anticancéreux (MAC). Dans ce contexte, la contamination des professionnels aux MAC a été évaluée.
Méthodes: L'intervention s'est déroulée en 2015, dans 2 services de soins, et a évalué des infirmiers (IDE) préparant et administrant des MAC et des agents en charge de l'hygiène (AH). Chaque participant a fourni un prélèvement urinaire en fin de poste et fin de semaine. Cinq molécules ont été recherchées à l'aide de méthodes spécifiques, de haute sensibilité (UHPLC-MS/MS) avec des limites de quantification (LQ) très basses (cyclophosphamide [CP], ifosfamide [IF], méthotrexate [MTX] : 2,5 ng/L ; doxorubicine [Doxo] : 10 ng/L ; alpha-fluoro-béta-alanine [FBAL, métabolite du 5-fluoro-uracile] : 20 ng/L). Un sujet était considéré comme « contaminé » dès lors qu'un MAC était détecté à une concentration urinaire ≥ la LQ ou à l'état de traces.
Résultats: Douze personnes ont participé (6 IDE, 6 AH) et 12 échantillons urinaires ont été recueillis et analysés. Le pourcentage de contamination interne était de 66,6 % pour l'ensemble des participants (n = 8/12), 100 % pour les IDE (6/6) et 33 % pour les AH (2/6). Chez 62,5 % (u = 5/8) des sujets contaminés, 2 à 4 des MAC recherchés ont été détectés dans les urines. Le CP a été retrouvé dans les urines de tous les sujets contaminés. Le FBAL a été retrouvé chez 4 sujets, le MTX chez 3, la Doxo chez 1. Seul l'IF n'a pas été détecté dans les échantillons. Les niveaux de concentrations urinaires (toutes molécules confondues) s'étendaient de 3 à 844 ng/L pour les IDE et de 3 à 44 ng/L pour les AH. Les valeurs médianes des concentrations urinaires étaient respectivement de 87 ng/L, 15,1 ng/L et 4,4 ng/L pour le FBAL, le CP et le MTX. La valeur de la Doxo était 218 ng/L.
Discussion: Il n'existe pas à ce jour de valeur biologique d'interprétation (VBI) mais la contamination de ces personnels est avérée puisqu'un ou plusieurs MAC ont été détectés à l'état de traces dans les urines ou à une concentration urinaire supérieure ou à égale à la LQ de la méthode analytique qui doit être la plus basse possible. Cependant, étant donnée la dangerosité des MAC, la mise en place de mesures correctives est indispensable auprès de ce personnel. La SBEP est l'outil de choix pour tracer les expositions insuffisamment maîtrisées et constitue un signal d'alarme. Ces résultats démontrent la nécessité de sensibiliser les professionnels aux risques liés à la manipulation des MAC.

Source: Villa, A., Mohamedou, M., Pillière, F., Verdun-Esquer, C., Molimard, M., Sidatt, M. et Canal-Raffin, M. (2018). Archives des Maladies Professionnelles et de l'Environnement, 79(3), 392.
https://doi.org/10.1016/j.admp.2018.03.397

In-cab air filtration in plant vehicles to control exposure to hazardous dust

Quarry industry example
Tackling occupational lung disease is a priority for HSE. In-cab air filtration systems are installed on plant vehicles used in a wide range of industries where drivers can potentially breathe in hazardous airborne dust, such as farming, waste management and quarrying. Plant vehicles include tractors, diggers, dumper trucks, excavators and mechanical shovels. However, little is known about the effectiveness of in-cab air filtration as a control measure. This report describes research to develop this evidence; the research was carried out with the support of the quarry industry as a representative sector.br> The research looked at the factors that influence the effectiveness of in-cab air filtration systems throughout their operational lifecycle, including system design, in-service use, and maintenance. The research included developing a new scientific method to evaluate filtration system efficiency whilst a vehicle is being driven.
The research found: penetration of hazardous dust into vehicle cabs; some vehicle cab filters of low efficiency; and that staff had variable knowledge about the effectiveness of in-cab air filtration and the level of protection it afforded. The research identified practical steps that industry can take to improve protection of workers. Improved understanding of good practice for in-cab air filtration systems is needed by vehicle designers and manufacturers and within the sectors using the vehicles – including the importance of filter maintenance and ensuring that drivers are made aware of the actions they need to take.

Source: http://www.hse.gov.uk/research/rrhtm/rr1126.htm

Agreement in Occupational Exposures Between Men and Women Using Retrospective Assessments by Expert Coders

Objectives: To estimate the level of agreement and identify notable differences in occupational exposures (agents) between men and women from retrospective assessments by expert coders.
Methods: Lifetime occupational histories of 1657 men and 2073 women from two case–control studies, were translated into exposure estimates to 243 agents, from data on 13882 jobs. Exposure estimates were summarized as proportions and frequency-weighted intensity of exposure for 59 occupational codes by sex. Agreement between metrics of exposure in men’s and women’s jobs was determined with intraclass correlation coefficients (ICC) and weighted Kappa coefficients, using as unit of analysis (‘cell’) a combination of occupational code and occupational agent. ‘Notable’ differences between men and women were identified for each cell, according to a Bayesian hierarchical model for both proportion and frequency-weighted intensity of exposure.
Results: For cells common to both men and women, the ICC for continuous probability of exposure was 0.84 (95% CI: 0.83–0.84) and 7.4% of cells showed notable differences with jobs held by men being more often exposed. A weighted kappa of 0.67 (95% CI: 0.61–0.73) was calculated for intensity of exposure, and an ICC of 0.67 (95% CI: 0.62–0.71) for frequency-weighted intensity of exposure, with a tendency of higher values of exposure metrics in jobs held by men.
Conclusions: Exposures were generally in agreement between men and women. Some notable differences were identified, most of them explained by differential sub-occupations or industries or dissimilar reported tasks within the studied occupations.

Source: Lacourt, A., Labrèche, F., Goldberg, M. S., Siemiatycki, J. et Lavoué, J. (2018). Annals of Work Exposures and Health.
https://doi.org/10.1093/annweh/wxy074

Welding, Molybdenum Trioxide, and Indium Tin Oxide

IARC Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 118
This volume of the IARC Monographs provides evaluations of the carcinogenicity of welding and welding fumes, molybdenum trioxide, and indium tin oxide.
Worldwide, an estimated 11 million workers have a job title of welder, and around 110 million additional workers probably incur welding-related exposures. Welding can involve exposures to fumes, gases, ultraviolet radiation and electromagnetic fields, and co-exposures to asbestos and solvents. The extent and type of exposure can depend on the process used, the material welded, ventilation, degree of enclosure, and use of personal protection.
Molybdenum trioxide, which occurs rarely naturally, is a chemical with a high production volume that is mainly used in steel manufacture, but also in biocides and in photovoltaic technology. Most occupational exposures occur in mining and metallurgy, steel foundries, welding, and other high-temperature processes using steel.
Indium tin oxide, which does not occur naturally, is a chemical with a low production volume that is a mixture of indium oxide and stannic oxide. It is mainly used in producing transparent conductive films on glass or plastic panels used in electronic devices. Exposure to indium tin oxide occurs mainly in occupational settings, during production and processing, or during recycling of elemental indium. As the use, recycling, and disposal of electronics increases worldwide, exposures to indium in low- and middle-income countries where informal e-recycling occurs are also expected to increase.

Source: http://publications.iarc.fr/569

Occupational exposure to benzene, toluene, xylene and styrene and risk of prostate cancer in a population-based study

Objectives: While several monocyclic aromatic hydrocarbons are classified as definite or possible carcinogens to humans, little data exist on their role in prostate cancer (PCa). We examined occupational exposure to benzene, toluene, xylene (BTX) and styrene and PCa risk in a population-based case–control study in Montreal, Canada.
Methods: Cases aged ≤75 years diagnosed with PCa in 2005–2009 (n=1920) and population controls frequency-matched on age (n=1989) provided detailed work histories. Experts evaluated the certainty, frequency and concentration of exposure to monocyclic aromatic hydrocarbons in each job lasting ≥2 years. Logistic regression estimated OR and 95% CIs for PCa risk, adjusting for potential confounders.
Results: Exposures to BTX were highly intercorrelated, except for durations of exposure at substantial levels. Ever exposure to any BTX was associated with overall PCa (OR 1.27, 95% CI 1.05 to 1.53), while the OR for styrene was 1.19. However, increases in risk were largely confined to low-grade tumours, with ORs of 1.33 (95%CI 1.08 to 1.64) and 1.41 (95% CI 0.85 to 2.31) for ever exposure to any BTX and styrene, respectively, and a duration response pattern for any BTX. Risks for low-grade tumours were elevated among men exposed ≥25 years at substantial levels of benzene (OR 2.32) and styrene (OR 2.44). Some cumulative exposure categories showed increased risks but without clear trends.
Conclusion: Exposure to any BTX was associated with higher risks of overall PCa. Prolonged exposures at the substantial level to benzene and styrene increased risks of low-grade tumours. These novel findings were independent from PCa screening.

Source: Blanc-Lapierre, A., Sauvé, J. F. et Parent, M. E. (2018). Occup Environ Med.
http://dx.doi.org/10.1136/oemed-2018-105058

Development of a Coding and Crosswalk Tool for Occupations and Industries

Introduction: Job coding into a standard occupation or industry classification is commonly performed in occupational epidemiology and occupational health. Sometimes, it is necessary to code jobs into multiple classifications or to convert job codes from one classification to another. We developed a generic tool, called CAPS-Canada (http://www.caps-canada.ca/), that combines a computer-assisted coding tool covering seven International, Canadian and US occupation and industry classifications and an assistant facilitating crosswalks from one classification to another. The objectives of this paper are to present the different functions of the CAPS-Canada tool and to assess their contribution through an inter-rater reliability study.
Method: The crosswalk assistant was built based on a database of >30,000 jobs coded during a previous project. We evaluated to what extent it would allow automatic translation between pairs of classifications. The influence of CAPS-Canada on agreement between coders was assessed through an inter-rater reliability study comparing three approaches: manual coding, coding with CAPS-Canada without the crosswalk assistant, and coding with the complete tool. The material for this trial consisted of a random sample of 1000 jobs extracted from a case–control study and divided into three subgroups of equivalent size.
Results: Across the classification systems, the crosswalk assistant would provide useful information for 83–99% of jobs (median 95%) in a population similar to ours. Eighteen to eighty-one percent of jobs (median 56%) could be entirely automatically recoded. Based on our sample of 1000 jobs, inter-rater reliability in occupation coding ranged from 35.7 to 66.5% (median 53.7%) depending on the combination of classification/resolution. Compared with manual coding, the use of CAPS-Canada substantially improved inter-rater reliability.
Conclusion: CAPS-Canada is an attractive alternative to manual coding and is particularly relevant for coding a job into multiple classifications or for recoding jobs into other classifications.

Source: Rémen, T., Richardson, L., Pilorget, C., Palmer, G., Siemiatycki, J. et Lavoué, J. (2018). Annals of work exposures and health.
https://doi.org/10.1093/annweh/wxy052

Priorisation des zoonoses au Québec dans un contexte d’adaptation aux changements climatiques à l’aide d’un outil d’aide à la décision multicritère

Au Québec comme ailleurs dans le monde, les maladies transmises entre les animaux et les humains (zoonoses) sont en émergence, notamment du fait des changements climatiques. Elles représentent environ 60 % des maladies infectieuses émergentes chez l'humain.
Devant les enjeux zoonotiques qui se multiplient, l'Observatoire multipartite québécois sur les zoonoses et l'adaptation aux changements climatiques (Observatoire) a initié en 2015 une démarche de priorisation des zoonoses, afin d'orienter les besoins en recherche et les actions de surveillance, de prévention et de contrôle au Québec.
Dans le cadre de cette démarche, les membres de l'Observatoire se sont initiés à l'utilisation d'un outil de priorisation des zoonoses basé sur la méthode systématique, rigoureuse et transparente d'aide à la décision multicritères (ADMC).
Ce rapport présente les différentes étapes de cet exercice de priorisation qui ont mené à l'établissement d'une liste consensuelle de 32 zoonoses priorisées, prenant en compte la multiplicité des enjeux présents au Québec notamment leurs impacts en santé publique, en santé animale et environnementale, leurs impacts socio-économiques et leur capacité d'émergence.
De cette liste, neuf zoonoses prioritaires se démarquent : il s'agit du Virus du Nil Occidental, du botulisme, de la rage, de la salmonellose, de la listériose, de l'infection à Escherichia coli, du syndrome pulmonaire à Hantavirus, de l'influenza aviaire et de la maladie de Lyme.
Cette liste de zoonoses priorisées devrait servir de référence pour guider les efforts d'adaptation aux changements climatiques des décideurs (priorisation des actions) et des chercheurs ou organismes subventionnaires (identification de thèmes de recherche).
L'exercice de priorisation à l'aide d'un outil ADMC a également permis de mettre en évidence les manques de connaissances au Québec pour certaines zoonoses. Cela représente bien sûr des défis à relever, mais également de nouvelles opportunités de recherche à exploiter, permettant de façon concrète aux décideurs de cibler où mettre des ressources pour combler ces manques.

Source: https://www.inspq.qc.ca/publications/2432

Exposures to Volatile Organic Compounds among Healthcare Workers

Modeling the Effects of Cleaning Tasks and Product Use
Objectives: Use of cleaning and disinfecting products is associated with work-related asthma among healthcare workers, but the specific levels and factors that affect exposures remain unclear. The objective of this study was to evaluate the determinants of selected volatile organic compound (VOC) exposures in healthcare settings.
Methods: Personal and mobile-area air measurements (n = 143) from 100 healthcare workers at four hospitals were used to model the determinants of ethanol, acetone, 2-propanol, d-limonene, α-pinene, and chloroform exposures. Hierarchical cluster analysis was conducted to partition workers into groups with similar cleaning task/product-use profiles. Linear mixed-effect regression models using log-transformed VOC measurements were applied to evaluate the association of individual VOCs with clusters of task/product use, industrial hygienists' grouping (IH) of tasks, grouping of product application, chemical ingredients of the cleaning products used, amount of product use, and ventilation.
Results: Cluster analysis identified eight task/product-use clusters that were distributed across multiple occupations and hospital units, with the exception of clusters consisting of housekeepers and floor strippers/waxers. Results of the mixed-effect models showed significant associations between selected VOC exposures and several clusters, combinations of IH-generated task groups and chemical ingredients, and product application groups. The patient/personal cleaning task using products containing chlorine was associated with elevated levels of personal chloroform and α-pinene exposures. Tasks associated with instrument sterilizing and disinfecting were significantly associated with personal d-limonene and 2-propanol exposures. Surface and floor cleaning and stripping tasks were predominated by housekeepers and floor strippers/waxers, and use of chlorine-, alcohol-, ethanolamine-, and quaternary ammonium compounds-based products was associated with exposures to chloroform, α-pinene, acetone, 2-propanol, or d-limonene.
Conclusions: Healthcare workers are exposed to a variety of chemicals that vary with tasks and ingredients of products used during cleaning and disinfecting. The combination of product ingredients with cleaning and disinfecting tasks were associated with specific VOCs. Exposure modules for questionnaires used in epidemiologic studies might benefit from seeking information on products used within a task context.

Source: Su, F. C., Friesen, M. C., Stefaniak, A. B., Henneberger, P. K., LeBouf, R. F., Stanton, M. L., ... et Virji, M. A. (2018). Annals of work exposures and health.
https://doi.org/10.1093/annweh/wxy055

Identifying occupational carcinogens: an update from the IARC Monographs

The recognition of occupational carcinogens is important for primary prevention, compensation and surveillance of exposed workers, as well as identifying causes of cancer in the general population. This study updates previously published lists of known occupational carcinogens while providing additional information on cancer type, exposure scenarios and routes, and discussing trends in the identification of carcinogens over time. Data were extracted from International Agency for Research on Cancer (IARC) Monographs covering the years 1971–2017, using specific criteria to ensure occupational relevance and provide high confidence in the causality of observed exposure-disease associations. Selected agents were substances, mixtures or types of radiation classified in IARC Group 1 with ‘sufficient evidence of carcinogenicity' in humans from studies of exposed workers and evidence of occupational exposure documented in the pertinent monograph. The number of known occupational carcinogens has increased over time: 47 agents were identified as known occupational carcinogens in 2017 compared with 28 in 2004. These estimates are conservative and likely underestimate the number of carcinogenic agents present in workplaces. Exposure to these agents causes a wide range of cancers; cancers of the lung and other respiratory sites, followed by skin, account for the largest proportion. The dominant routes of exposure are inhalation and dermal contact. Important progress has been made in identifying occupational carcinogens; nevertheless, there is an ongoing need for research on the causes of work-related cancer. Most workplace exposures have not been evaluated for their carcinogenic potential due to inadequate epidemiologic evidence and a paucity of quantitative exposure data.

Source: Loomis, D., Guha, N., Hall, A. L. et Straif, K. (2018). Occup Environ Med.
http://dx.doi.org/10.1136/oemed-2017-104944

An Integrated Air Monitoring Approach for Assessment of Formaldehyde in the Workplace

The aim of this study is to validate an integrated air monitoring approach for assessing airborne formaldehyde (FA) in the workplace. An active sampling by silica gel impregnated with 2,4-dinitrophenylhydrazine, a passive solid phase microextraction technique using O-(2,3,4,5,6-pentafluorobenzyl)hydroxylamine as on-fiber derivatization reagent, an electrochemical direct-reading monitor, and an enzyme-based badge were evaluated and tested over a range of 0.020–5.12 ppm, using dynamically generated FA air concentrations. Simple linear regression analysis showed the four methods were suitable for evaluating airborne FA. Personal and area samplings in 12 anatomy pathology departments showed that the international occupational exposure limits in the GESTIS database were frequently exceeded. This monitoring approach would allow a fast, easy-to-use, and economical evaluation of both current work practices and eventual changes made to reduce FA vapor concentrations.

Source: Dugheri, S., Bonari, A., Pompilio, I., Colpo, M., Mucci, N. et Arcangeli, G. (2017). Safety and Health at Work.
https://doi.org/10.1016/j.shaw.2018.05.002

Occupational exposures and cancer: a review of agents and relative risk estimates

Objectives: The contribution of occupational exposures to the cancer burden can be estimated using population-attributable fractions, which is of great importance for policy making. This paper reviews occupational carcinogens, and presents the most relevant risk relations to cancer in high-income countries using France as an example, to provide a framework for national estimation of cancer burden attributable to occupational exposure.
Methods: Occupational exposures that should be included in cancer burden studies were evaluated using multiple criteria: classified as carcinogenic or probably carcinogenic by the International Agency for Research on Cancer (IARC) Monographs volumes 1–114, being a primary occupational exposure, historical and current presence of the exposure in France and the availability of exposure and risk relation data. Relative risk estimates were obtained from published systematic reviews and from the IARC Monographs.
Results: Of the 118 group 1 and 75 group 2A carcinogens, 37 exposures and 73 exposure-cancer site pairs were relevant. Lung cancer was associated with the most occupational carcinogenic exposures (namely, 18), followed by bladder cancer and non-Hodgkin's lymphoma. Ionising radiation was associated with the highest number of cancer sites (namely, 20), followed by asbestos and working in the rubber manufacturing industry. Asbestos, bis(chloromethyl)ether, nickel and wood dust had the strongest effect on cancer, with relative risks above 5.
Conclusions: A large number of occupational exposures continues to impact the burden of cancer in high-income countries such as France. Information on types of exposures, affected jobs, industries and cancer sites affected is key for prioritising policy and prevention initiatives.

Source: Micallef, C. M., Shield, K. D., Baldi, I., Charbotel, B., Fervers, B., Ilg, A. G. S., ... et Straif, K. (2018). Occup Environ Med.
http://dx.doi.org/10.1136/oemed-2017-104858

Occupational Mercury Exposure at a Fluorescent Lamp Recycling Facility - Wisconsin, 2017

On May 9, 2017, Public Health Madison & Dane County contacted the Wisconsin Division of Public Health for assistance with investigation of mercury exposure among workers at a fluorescent lamp recycling facility. Public Health Madison & Dane County had been contacted by the Wisconsin Department of Natural Resources as part of an investigation of potential environmental contamination at the facility. Fluorescent lamps are composed of a phosphor-coated glass tube containing mercury vapor and argon. During the recycling process, lamps are crushed, releasing mercury vapor and mercury-containing dusts. State and county health officials, in collaboration with Wisconsin Department of Natural Resources, conducted an investigation of mercury exposure of workers and an environmental assessment of the facility, surrounding areas, and worker vehicles. All five workers who were tested had urine mercury levels exceeding the American Conference of Governmental Industrial Hygienists (ACGIH) biologic exposure index of 20.0 μg/g creatinine, and two had tremor on physical exam. Workers wore inadequate personal protective equipment (PPE). Mercury levels in indoor air varied within the building, with a maximum of 207.4 μg/m3 at floor level on the crushing platform, approximately eightfold higher than the ACGIH threshold limit value of 25 μg/m3 (1). Mercury also was found in workers' vehicles, indicating risk for take-home exposure. Workers at risk for mercury exposure need to have access to and consistently wear National Institute of Occupational Safety and Health (NIOSH)-approved respiratory protection for mercury vapor, nitrile or other suitable gloves to prevent contact exposure, and disposable suits with booties and change shoes before leaving the worksite to prevent take-home exposures.

Source: https://www.cdc.gov/mmwr/volumes/67/wr/mm6727a3.htm?s_cid=mm6727a3_e

Incendies dans les activités de compostage des déchets

Le traitement biologique des déchets, et notamment le compostage, est en pleine expansion en France. Cet essor, bénéfique sur le plan environnemental, s'accompagne toutefois d'une augmentation de l'accidentologie ! Le risque d'incendie est particulièrement important dans cette activité impliquant des déchets à potentiel d'auto-échauffement, stockés en quantité importante et sur de longues durées… Et ce surtout quand les prescriptions réglementaires, qui doivent permettre de maîtriser ce risque, ne sont pas appliquées ! Illustrée par des exemples récents, cette synthèse dresse le panorama des situations accidentelles rencontrées et propose des mesures de prévention. Un zoom est également fait sur les stratégies d'intervention et sur les conséquences des accidents.

Source: https://www.aria.developpement-durable.gouv.fr/synthese/syntheses/incendies-dans-les-activites-de-compostage-des-dechets-facteurs-de-risques-et-mesures-de-prevention-les-lecons-tirees-du-rex/?utm_source=Sendinblue&utm_medium=email&utm_campaign=LettreInfo52&utm_term=MaiJuin2018&utm_content=IncendieCompostageDechet

Exposition professionnelle des personnels de santé hospitaliers aux médicaments cytotoxiques

Biométrologie et mesure de la contamination des surfaces
Utilisés dans le traitement des cancers, les médicaments cytotoxiques présentent une toxicité intrinsèque, du fait de leurs propriétés génotoxiques, cancérogènes et tératogènes. Une étude réalisée dans 12 établissements hospitaliers, pour évaluer les expositions à ces substances, a montré que plus de la moitié des professionnels suivis avait des niveaux quantifiables de cytotoxiques dans leurs
urines. Le personnel des services d'oncologie était plus fréquemment exposé que celui des pharmacies. Les mesures de la contamination de l'environnement de travail ont apporté des éléments sur les principales sources d'exposition. Tous les moyens doivent donc être mis en oeuvre pour réduire ces expositions, en identifiant les catégories professionnelles susceptibles d'être exposées afin de leur proposer des mesures de prévention adaptées et efficaces.

Source: Ndaw, S., Denis, F., Marsan, P., Rémy, A., Robert, A. (2018). Références en santé au travail (154), 81-92.
http://www.rst-sante-travail.fr/rst/pages-article/ArticleRST.html?ref=RST.TF 255

Evaluation of Exposure to Metals at an Electronics Recycling Facility

The Health Hazard Evaluation Program received a request from managers at an electronics recycling company. The request concerned possible employee exposures to flame retardants and metals associated with electronics. We first visited the facility in February 2017. We held an opening meeting and toured the facility to observe operations, work practices, and working conditions. We returned in July 2017 to collect air, hand wipe, and blood samples for metals. The National Institute for Occupational Safety and Health (NIOSH) Industrywide Studies Branch evaluated employees' exposure to flame retardants in July 2017 and will provide the results to the company and employee representatives in a separate report. We provided preliminary observations and recommendations to the employer and the employee representatives in February 2017 and July 2017.

Source: https://www.cdc.gov/niosh/hhe/reports/pdfs/2016-0242-3315.pdf?s_cid=102015-HETAB-RSS-001

Potential Health Risk of Endocrine Disruptors in Construction Sector and Plastics Industry

A New Paradigm in Occupational Health
Endocrine disruptors (EDs) belong to large and diverse groups of agents that may cause multiple biological effects associated with, for example, hormone imbalance and infertility, chronic diseases such as diabetes, genome damage and cancer. The health risks related with the exposure to EDs are typically underestimated, less well characterized, and not regulated to the same extent as, for example, carcinogens. The increased production and utilization of identified or suspected EDs in many different technological processes raises new challenges with respect to occupational exposure settings and associated health risks. Due to the specific profile of health risk, occupational exposure to EDs demands a new paradigm in health risk assessment, redefinition of exposure assessment, new effects biomarkers for occupational health surveillance and definition of limit values. The construction and plastics industries are among the strongest economic sectors, employing millions of workers globally. They also use large quantities of chemicals that are known or suspected EDs. Focusing on these two industries, this short communication discusses: (a) why occupational exposure to EDs needs a more specific approach to occupational health risk assessments, (b) identifies the current knowledge gaps, and (c) identifies and gives a rationale for a future occupational health paradigm, which will include ED biomarkers as a relevant parameter in occupational health risk assessment, surveillance and exposure prevention.

Source: Fucic, A., Galea, K. S., Duca, R. C., El Yamani, M., Frery, N., Godderis, L., ... et Viegas, S. (2018). International journal of environmental research and public health, 15(6).
https://doi.org/10.3390/ijerph15061229

Risque d'accident exposant au sang lors des prélèvements veineux dans les laboratoires de biologie médicale de ville en 2015

Dix ans après une première étude sur le risque d'accidents exposant au sang (AES) lié aux prélèvements veineux dans les laboratoires de biologie médicale (LBM) de ville, une nouvelle enquête a été réalisée, utilisant la même méthodologie. Ont été inclus 22 LBM totalisant 337 sites. L'incidence des piqûres lors des prélèvements est de 3,5/100 équivalents temps plein préleveurs/an. Tous les matériels utilisés sont des systèmes de prélèvement sous vide et 22 % d'entre eux sont des matériels de sécurité. Le risque d'AES est deux fois plus faible et le pourcentage de matériels de sécurité deux fois plus important que dans l'enquête conduite en 2005.

Source: Pellissier, G., Lolom, I., L'Hériteau, F., Lebascle, K., Suiro, A., Touche, S., ... et Bouvet, E. (2018). Références en santé au travail (154), 65-80.
http://www.rst-sante-travail.fr/rst/pages-article/ArticleRST.html?ref=RST.TF 254

A Systematic Review of the Routes and Forms of Exposure to Engineered Nanomaterials

Background: Establishing the routes of exposure is a fundamental component of the risk assessment process for every dangerous substance. The present study systematically reviews the available literature to assess the relevance of the different routes and forms of exposure that are of concern for the protection of workers during the manufacture, handling, or end-use of engineered nanomaterials (ENMs).
Methods: A systematic review of the peer-reviewed literature published between 2000 and 2015 was completed. Only studies including measurements of inhalation or dermal exposure were selected and used to identify the exposure situations for which the measurements were collected. The identified exposure situations were grouped based on the type of ENM (i.e. carbon nanotubes and fibres, silicon-based, titanium dioxide, other metal oxides, pure elemental metals, and other ENMs) and activity involved. The grouped exposure situations were assessed to provide a conclusion regarding the likelihood, form, and route of exposure. Assessment of the likelihood of exposure was based on well-defined criteria using a previously established decision logic for inhalation exposure and the outputs from measurements and/or conceptual models for dermal/ingestion exposure. For each combination of nano-activity and type of ENM, the aggregated likelihood across all relevant individual assessments was used to draw conclusions about the relevance of both the inhalation and dermal/ingestion routes. Based on the quality of the data, the strength of the evidence was also evaluated.
Results: One hundred and seven studies were identified during the review process, reporting 424 individual exposure assessments. Measurement data were limited for dermal/ingestion exposure and for inhalation exposure for downstream use and end-of-life. However, the data provided high-quality evidence that in occupational settings all three routes can be of relevance for exposure to ENMs. In general, whenever inhalation exposure occurs then dermal and inadvertent ingestion exposure may occur due to surface deposition and transfer due to the ENMs release. However, for some forms of exposure (e.g. suspension/liquids), dermal exposure can occur even when inhalation exposure is unlikely. An increased likelihood of exposure was observed for manual activities such as cleaning and maintenance, collection/harvesting, spraying, and finishing as well as those involving feeding into a process and handling of powders outside enclosures. The likelihood of exposure was affected by the presence of risk management measures and the scale of the production involved.
Conclusion: This literature review provides evidence that for ENMs, as found for other materials, the likelihood of the exposure depends largely on the physical form of the substance as well as the applied process and operational conditions. These results can be used to provide first indications of the likelihood of exposure and guidance for exposure controls in workplaces. However, there is a clear lack of high-quality exposure data, in particular for downstream use and end-of-life scenarios and in low- and medium-income countries.

Source: Basinas, I., Jiménez, A. S., Galea, K. S., Tongeren, M. V. et Hurley, F. (2018). Annals of work exposures and health, 62(6), 639-662.
https://doi.org/10.1093/annweh/wxy048

Cartographie des expositions aux hydrocarbures aromatiques polycycliques (HAP) par secteur d'activité

Focus sur la surveillance biologique des expositions professionnelles
L'analyse des données de surveillance biologique des expositions professionnelles (SBEP) aux hydrocarbures aromatiques polycycliques (HAP) publiées au cours de la dernière décennie permet de dresser une cartographie des expositions par secteur d'activité. La stratégie de SBEP, notamment le choix du ou des biomarqueurs pertinents, est discutée pour certains secteurs d'activité pouvant exposer à des HAP dont certains cancérogènes comme la cokerie, l'électrométallurgie et la cémentation gazeuse basse pression, ainsi que d'autres secteurs comme les travaux de pose de revêtement routier bitumineux où l'exposition aux HAP est significativement moins importante. Les données biométrologiques disponibles par secteur d'activité, voire par tâche ou poste de travail, peuvent être utiles au médecin du travail pour l'interprétation des résultats de campagnes de SBEP chez des salariés dans des secteurs similaires.

Source: Nikolova-Pavageau, N., Pillière, F. (2018). Références en santé au travail (154), 41-63.
http://www.rst-sante-travail.fr/rst/pages-article/ArticleRST.html?ref=RST.TC 162

Évolution de l’exposition professionnelle aux solvants oxygénés, pétroliers et chlorés en France entre 1999 et 2013

Résultats du programme Matgéné
L'évolution de l'exposition professionnelle aux solvants oxygénés, pétroliers et chlorés entre 1999 et 2013 en France est présentée selon le sexe et le secteur d'activité. Les expositions sont évaluées par les matrices emplois-expositions du programme Matgéné. Les données de population issues des recensements de 1999, 2007 et 2013 sont croisées avec les matrices pour estimer les prévalences d'exposition sur les trois années.
Les solvants les plus fréquemment utilisés en milieu professionnel en 2013 étaient les solvants oxygénés (11,4% des travailleurs), devant les solvants pétroliers (5,3%) et les solvants chlorés (0,2%). Les femmes étaient plus exposées aux solvants oxygénés (15,4% des femmes vs 7,7% des hommes), alors que les hommes étaient plus souvent concernés par les solvants pétroliers (9,1% vs 1,1%) et chlorés (0,3% vs 0,1%). L'exposition professionnelle a diminué pour chacune des familles de solvants sur la période d'étude, de même que l'exposition à au moins un solvant de chacune des familles.
Cette étude est la première à présenter l'évolution de l'exposition professionnelle à trois grandes familles de solvants sur une période de 14 ans pour l'ensemble des travailleurs en France, quels que soient leur statut et leur activité. La baisse globale observée pour l'ensemble des solvants est positive compte tenu du fait que certains de ces solvants présentent un caractère cancérogène, mutagène ou reprotoxique. Cependant, cette baisse est à étudier selon les secteurs et le sexe afin d'orienter et cibler au mieux les actions de prévention à mettre en place pour les groupes professionnels restant les plus exposés en 2013.

Source: Pilorget C, Lagarrigue R, Houot M. (2018) Bull Epidémiol Hebd. (12-13), 234-240.?
http://invs.santepubliquefrance.fr/beh/2018/12-13/2018_12-13_4.html

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