Occupational Exposure to Carbon Nanotubes and Nanofibers

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B.1 Key Terms Related toMedical SurveillanceOccupational health surveillance involves theongoing systematic collection, analysis, and disseminationof exposure and health data on groupsof workers for the purpose of preventing illness andinjury. Occupational health surveillance, which includeshazard and medical surveillance, is an essentialcomponent of an effective occupational safetyand health program [Harber et al. 2003; Baker andMatte 2005; NIOSH 2006; Wagner and Fine 2008;Trout and Schulte 2009], and NIOSH continues torecommend occupational health surveillance asan important part of an effective risk managementprogram.Hazard surveillance includes elements of hazardand exposure assessment••The hazard assessment involves reviewingthe best available information concerningtoxicity of materials. Such an assessment maycome from databases, texts, and publishedliterature or available regulations or guidelines(e.g., from NIOSH or the OccupationalSafety and Health Administration [OSHA]).Human studies, such as epidemiologic investigationsand case series or reports, andanimal studies may also provide valuable information.In most instances involving CNTthere are limited toxicological data and a lackof epidemiologic data with which to make acomplete hazard assessment.••The exposure assessment involves evaluatingrelevant exposure routes (inhalation, ingestion,dermal, and/or injection), amount, duration,and frequency (i.e., dose), as well as whetherexposure controls are in place and how protectivethey are. When data are not available,this will be a qualitative process.B.2 Medical SurveillanceMedical surveillance targets actual health eventsor a change in a biologic function of an exposedperson or persons. Medical surveillance involvesthe ongoing evaluation of the health status of agroup of workers through the collection and aggregateanalysis of health data for the purpose ofpreventing disease and evaluating the effectivenessof intervention programs (primary prevention).NIOSH recommends the medical surveillance ofworkers when they are exposed to hazardous materials,and therefore are at risk of adverse healtheffects from such exposures. Medical screening isone form of medical surveillance that is designedto detect early signs of work-related illness in individualworkers by administering tests to apparentlyhealthy persons to detect those with early stages ofdisease or risk of disease. Medical screening generallyrepresents secondary prevention.Medical surveillance is a second line of defensebehind the implementation of engineering, administrative,and work practice controls (includingpersonal protective equipment). Integrationof hazard and medical surveillance is important toan effective occupational health surveillance program,and surveillance of disease or illness shouldnot proceed without having a hazard surveillanceprogram in place.B.2.1 Planning and ConductingMedical SurveillanceImportant factors when considering medical surveillanceinclude the following:1. A clearly defined purpose or objective.2. A clearly defined target population.3. The availability of testing modalities to accomplishthe defined objective. Testing modalitiesmay include such tools as questionnaires, physicalexaminations, and medical testing.A clear plan should be established before beginninga medical surveillance program. The plan shouldinclude the following:1. A rationale for the type of medical surveillance.2. Provisions for interpreting the results.146 NIOSH CIB 65 • Carbon Nanotubes and Nanofibers
3. Presentation of the findings to workers andmanagement of the affected workplace.4. Implementation of all the other steps of a completemedical surveillance program [Harber et al. 2003].The elements for conducting a medical surveillanceprogram generally include the following:1. An initial medical examination and collection ofmedical and occupational histories.2. Periodic medical examinations at regularly scheduledintervals, including specific medical screeningtests when warranted.3. More frequent and detailed medical examinationsas indicated, based on findings from theseexaminations.4. Post-incident examinations and medical screeningfollowing uncontrolled or nonroutine increasesin exposures such as spills.5. Worker training to recognize symptoms of exposureto a given hazard.6. A written report of medical findings.7. Employer actions in response to identification ofpotential hazards.NIOSH CIB 65 • Carbon Nanotubes and Nanofibers147
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CURRENT INTELLIGENCE BULLETIN 65Occ
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Current Intelligence Bulletin 65Occ
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ForewordThe Occupational Safety and
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Executive SummaryOverviewCarbon nan
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2009; Pauluhn 2010a; Porter et al.
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neurogenic sig nals from sensory ir
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possible. Until the results from an
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••Follow exposure and hazard as
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Periodic Evaluations••Evaluatio
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ContentsForeword ..................
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A.3.2 Comparison of Short-term and
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ESPFeFMPSFPSSgGMGSDHCLHECHEPAhrISOI
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AcknowledgementsThis Current Intell
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1 IntroductionMany nanomaterial-bas
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2 Potential for ExposureThe novel a
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CNMs, with MWCNT agglomerates obser
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composite materials with local exha
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information on air contaminants. Sa
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3 Evidence for Potential Adverse He
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decreasing agglomerate size increas
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examined up to 60 days post-exposur
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3.3 SWCNT and MWCNTIntraperitoneal
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The same potency sequence was obser
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Table 3-3. Findings from published
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Table 3-7 (Continued). Findings fro
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length, respectively) [Muller et al
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5 CNT Risk Assessment and Recommend
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A-6). Risk estimates derived from o
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Table 5-4. Factors, assumptions, an
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and analytical methods. NIOSH is re
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Table 5-5. Recommended occupational
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deficits in animals or clinically s
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(3) Rat lung dose estimationIn the
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tasks where worker exposures exceed
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As part of the evaluation of worker
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Table 6-1. EC LODs and LOQs for 25-
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6.2 Engineering ControlsOne of the
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Table 6-6 (Continued). Examples of
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Table 6-7 (Continued). Engineering
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exposure estimates for SWCNT on ind
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Table 6-8. Respiratory protection f
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••Workers in areas or in jobs w
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7 Research NeedsAdditional data and
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ReferencesACGIH [1984]. Particle si
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Bolton RE, Vincent HJ, Jones AD, Ad
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eport issued on July 22, 2011. NEDO
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Kobayashi N, Naya M, Mizuno K, Yama
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Methner M, Hodson L, Geraci C [2010
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Human Services, Centers for Disease
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Piegorsch WW, Bailer AF [2005]. Qua
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AD, Baron PA [2003]. Exposure to ca
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Varga C, Szendi K [2010]. Carbon na
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ContentsA.1 Introduction ..........
Page 121 and 122: A.1 IntroductionThe increasing prod
Page 123 and 124: provide an informal check on the es
Page 125 and 126: these same dose groups; this effect
Page 127 and 128: Table A-1. Rodent study information
Page 129 and 130: the deposited (no clearance) and th
Page 131 and 132: The other BMDS models failed to con
Page 133 and 134: Figure A-2. Benchmark dose model (m
Page 135 and 136: Figure A-3 (continued). Benchmark d
Page 137 and 138: Table A-3. Benchmark dose estimates
Page 139 and 140: Table A-5. Benchmark dose estimates
Page 141 and 142: histopathology grade 2 or higher lu
Page 143 and 144: Table A-8. Working lifetime percent
Page 145 and 146: developing early-stage adverse lung
Page 147 and 148: Figure A-4. Dose-response relations
Page 149 and 150: cell surface area). However, the wo
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Page 153 and 154: Table A-9. Comparison of rat or hum
Page 155 and 156: A.6.1.3 Pulmonary Ventilation RateT
Page 157 and 158: used as the effect levels in evalua
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Page 161 and 162: or overloading, of particle clearan
Page 163 and 164: Table A-13. Human-equivalent retain
Page 165 and 166: A.7.1 Particle CharacteristicsBoth
Page 167 and 168: and density. The following MMAD and
Page 169: Table A-15. CNT lung dose normalize
Page 175 and 176: APPENDIX CNIOSH Method 5040
Page 177 and 178: filter. In the method evaluation, d
Page 179 and 180: Most of the studies on sampling art
Page 181 and 182: e analyzed to determine the onset o
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