Iran Occupational Health

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Introduction: Breathing is the most common way of entering chemicals, especially detergents, into work places. Most acute and chronic pneumoconiosis can caused by inhalation of occupational pollutants. Occupational aerosol pollutants, especially gases and chemical vapors, can cause various pulmonary diseases due to individual difference. Chronic and acute poisoning by detergents is a major problem in developing countries and poisoning with some detergent compounds is common in these countries more than developed countries. The toxic effects of exposure by detergent on various organs had been studied. However the major route of exposure to these compounds is the inhalation, it have not been studied comprehensively acute and chronic respiratory effects of occupational exposure to these compounds. Or results for respiratory effects contradictory have been reported. Hydrogen peroxide is a toxic and irritating liquid that has antiseptic, antiviral and antifungal properties due to oxidizing. Hydrogen peroxide used to clean packaging equipment of dairy and fruit juice. The procedure of these equipment is immersion to the hydrogen peroxide. Hydrogen peroxide can stimulate the respiratory system. Repeated exposure by this combination may lead to bronchitis, cough, sputum and dyspnea. Long-term exposure sometimes cause disappear pigmentation and burning sensation in skin. Higher concentrations of hydrogen peroxide can cause red rash and blisters. Inhalation of this substance may cause sore throat, abdominal pain, nausea and vomiting. Hydrogen peroxide released into the environment initially vaporizes and gradually decomposes into water and oxygen. Cleaning workers at the dairy Industry use hydrogen peroxide to clean the salon. Dairy workers have reported occupational disorders such as asthma, chronic obstructive pulmonary disease, hypertensive pneumonia, chronic bronchitis, and cancer. It is not found comprehensive study on effective exposure and exposure conditions, individual parameters and other confounding factors, that show what proportion of exposure can lead to respiratory disorder in exposed workers. The purpose of this study is finding amount and type of workers exposure to hydrogen peroxide, also long time effect of pollutants exposure and the adverse effects on the respiratory system of cleaning workers in the dairy industry.
Methods: Study was planned as a case-control study. Statistical population is workers in a dairy factory. 10 workers was considered as case group exposed to hydrogen peroxide and 20 workers as control group. All sample subjects had a minimum of 4 years working experience in their work places. Exclusion criteria were low work experience, smoking, respiratory disease, and age less than 30 and more than 50 years. Hydrogen peroxide was sampled by OSHA VI-6 standard methods. In this method the sample is collected using a midget fritted-glass bubbler containing 15mL TiOSO4. Used an air sampling pump at flow rate of 1.0 L/min. The pump properly calibrated so that the volume of air sampled determined accurately from the flow rate and time. After sampling for analyte extraction samples transferred to the spectrophotometer vials. Absorption measured at 410 nm by spectrophotometer.  And measured using a spectrophotometer. From the calibration curve of the standard samples, the amount of contaminants in the sampled analytes determined. Demographic questionnaire used to collect information such as age, work experience, underlying disease, hereditary disease and smoking. To obtain the disorder of respiratory system used a Vitalograph Compact spirometer. All subjects evaluated by spirometric tests under the assistance of a physician. This test determined the respiratory ability of the subjects. Performance respiratory system evaluated by pulmonary volumes and capacities according to the physician opinion. The investigations performed in this study determined lung force vital capacity (FVC) and the forced expiratory vital capacity in the first second (FEV1). The FEV1 / FVC ratio measured and determined for all subjects in case and control groups. If this ratio was above 75%, respiratory function was correct. If the ratio is less than 75% the subject had a respiratory complication. If the ratio was above 75% but FVC was less than 80 % the subject had a respiratory complication. The results of questionnaire, spirometry and medical examinations analyzed by statistical tests. Comparisons between means and nonparametric tests were performed to compare the differences between the means of the case and control groups. Oddchr('39')s ratio calculated and analyzed for both groups, respiratory health and disease in both groups to make sure the confidence interval results.
Results: The case group mean age was 46.6±6.9 and control group 42±5. Comparison of age mean in two groups with definite variance test, it concluded that the mean age of both groups was equal (95% Confidence). Interfering factors were ineffective according to exclusion criteria, because the underlying and hereditary diseases eliminated in both case and control groups. By measuring the exposure levels, if exposure exceeds the 8-hour limit (1ppm) it was identified as exposed sample and otherwise unexposed. Spirometery test showed 6 workers of case group and 8 workers of control group had disorder. The ratio of disorder workers and without disorder in case and control group was 1.5, 0.67. By statistical analysis and calculating Odds Ratio, the chance ofcomplicating in this workplace by H2O2 exposure workers were 2.25 times greater than unexposed. Considering to confidence interval 2.12-10.76 and OR, it could be said that hydrogen peroxide exposure in the population issignificantly caused respiratory disorder (95% confidence). According to the results in the 4-13 year work experience category, the relationship between exposure and respiratory system disorder was significant and strong. In other words, more work experience would had fewer side effects. In the category 13-21 years, this relationship was not detected. There was a significant relationship in the categorization of the age group of 21 to 30 years, but due to the extent of trust gap, this result cannot be generalized to society. There is also a significant relationship between smokings in study groups, but due to the wide range of confidence intervals, this result is not generalizable to the society and only in case group as a positive factor affecting deliberate pulmonary disorder
Discussion: According to the results of this study, the incidence of restricted respiratory symptoms in exposed workers has increased compared to unexposed workers. Result of this study is similar to other studies which conducted in the field of chronic respiratory symptoms. Respiratory system is primary target organism for all inhalable toxins, function of respiratory system was affected by exposure to hydrogen peroxide by inhalation.  Long-term exposure to lower levels of pollutants in the workplace may result in chronic disorders such as chronic bronchitis, fibrosis, and lung cancer. Exposure to high concentration of hydrogen peroxide (7 ppm) stimulates the upper respiratory system. Other symptoms, such as headaches, nausea and diarrhea have been observed among exposed workers. No other respiratory symptoms have been studied in workers in this study. Workers exposed constantly higher concentrations of hydrogen peroxide in work place. The concentration of other pollutants in this plant has not been studied, but it can predicted that exposure to this substance alone in different ways will lead to respiratory disorder. The results also show that workers exposed to hydrogen peroxide are at risk of respiratory disorder. According to the findings of this study, the cause of lung function defects is unclear when exposed to hydrogen peroxide. Different studies have shown that exposure increases production of anionic superoxide in pulmonary arteries. However, it can partially stated that the lung diseases are caused by parenchymal lung disease or neuromuscular disorders. The workers in this study did not use appropriate personal protective equipment at work place. Therefore, hydrogen peroxide uptake may occur by any of the inhalation, dermal or even oral ingestion pathways, and cannot be presented the role of either of these pathways in respiratory disorder. Presence of smokers in the study, it is not possible to comment correctly on the extent to which each of these variables has an impact on development of pulmonary morbidity. One of the limitations of this study was simultaneous exposure to several factors such as hydrogen peroxide and smoking in workers, the respiratory disorder deficits cannot be attributed to exposure to one or a combination of several factors.Another limitation of the study was that the respiratory disease in workers diagnosed by spirometry. According to the studies, the last diagnosis of respiratory disorders will be made by plethysmography that was not possible in this study. It was recommended to determine respiratory disorder in exposed workers, that respiratory function tests be performed, especially when workerschr('39') respiratory disorders was increased or when expose with high concentration contamination.

Keywords: Hydrogen peroxide, occupational disease, pulmonary disease

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