WORK HEALTH

Lecture 5
Toxicological Assessment and
Occupational Exposure Limits

Shelly Tse
JC School of Public Health and Primary Care
The Chinese University of Hong Kong

Public Health Students Lecture, 2024

1
 Case Study
Mr. Fung is a 25-year-old men who had worked
in a foundry plant for 5 years with a job nature
of melting lead. Recently Mr. Fung had
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complained of headache, pallor, a blue line at

the gum margins, and anemia. His co-workers
also found Mr. Fung had poor memory and was
not easy to concentrate. Lab report revealed
that Mr. Fung’s blood lead level was 35 µg/dL
(CDC upper reference value: <10 µg/dL).

Comment on forms of exposure, routes of entry, risk of health

lead fumes nhalaton acutelchronic
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 Learning objectives of “Lecture 5”
• Understand the principles of industrial toxicology of toxic
substances
• Know mechanisms of establishments of occupational
exposure limits
• Gain knowledge of environmental and biological monitoring
• Describe the main methods of recognizing health hazards
• In-class exercises and tutorial

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Toxicological
Assessment

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Terminology
• Toxicology is the study of the • Intoxication is the general state
body’s responses to toxic of harm caused by the effects of
substances toxic substances

• Toxicity is the intrinsic ability • Detoxication is the process in

of a chemical molecule to the body when decomposition of
produce injury once it reaches a toxic substances occurs to
susceptible site in or on the produce harmless substances
body; it is the quantitative which are eliminated from the
study of the body’s responses body
to toxic substances
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Toxic substances – Routes of Entry
• Inhalation
• Ingestion
• Injection
• Absorption / pervasion

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Inhalation
• Dust, gas, mist, fog, fumes or vapor: about 90% of all ill
health

– Acute (immediate): gassing accidents, e.g., chlorine, carbon

monoxide

– Chronic (prolonged, cumulative): e.g., TCE, benzene, lead,

silica dust, asbestos fiber, welding fumes

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Absorption /pervasion
• Primary irritants are substances which will cause
dermatitis at the site of contact if permitted to act for a
sufficient level (e.g. strong alkalis, acids and solvents)

• Primary irritation from contact

ACID
• Sensitization from repeated exposure
• Systemic poisoning from absorption

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 Absorption /pervasion
• Secondary cutaneous sensitizers are substances which do not
necessarily cause skin changes on first contact but produce a
specific sensitization of the skin. If further contact occurs after a
certain interval, dermatitis will develop at the site of the second
contact.

• Typical skin sensitizers are plants, rubber, nickel (occupational

6
dermatitis).
fulskiy
Red swollen itchy pain
,
,
,

sTfe of
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lwith irrifants
or

wnfat

allergens ,

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Ingestion

• Ingestion - certain substances

are carried into the gut from
which some will pass into the
body by absorption

•Eating/smoking
•Nature cleaning of the lungs to be swallowed

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Injection
• Injection/implantation - a forceful
reach of the skin, frequently as a
cause of injury, can carry substances
through the skin barrier
http://photo-dictionary.com/phrase/2353/injection.html

•Sharp needle injuries, a hazardous process of

health professionals

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Certain substances have direct
or indirect effects BRAIN
TOXIN
RESPIRATORY
•The most common target SYSTEMS
organs - lungs, liver, brain, skin,
bladder
HEART

•The most common target STOMACH

systems - central nervous
LIVER
system, circulatory system,
INTESTINE
reproductive system, urinogenital
system

Target organs & target systems

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 Effects of exposure to toxic substances
Tunk
T
never experiene
acute ,

• Acute effect - a rapidly produced effect following a single exposure to an

offending agent (e.g., acute silicosis) most approprinte latency
pesiod
• Chronic effect - an effect produced as a result of prolonged exposure or from
repeated exposures of long duration (e.g., silicosis). first
diagnok
• Sub-acute effect - a reduced form of acute effect (e.g., accelerated → 15
silicosis) years ,

• Progressive chronic effect - an effect which continues to develop after

exposure ceases (e.g., PMF)
• Local effect - an effect usually confined to the initial point contact, e.g.,
skin/mucous membranes of eyes, liver, bladder.
• Systemic effect - such effects occur in parts of the body other than at the
initial point of contact, and are associated with a particular body system , e.g.
respiratory system, center nervous system.
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Physical state of hazardous substances

“dusts, mists, fumes, gases, vapors, smoke, and fog”

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Protective mechanisms
The efficacy of protective mechanisms is largely according to the
shape and size of particulate matter which may be inhaled
– Nose
– Ciliary escalator
– Macrophages/phagocytes
– Lymphatic system
– Tissue response

http://www.healingdaily.com/exercise/rebounding-for-detoxification-and-health.htm

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 Respiratory Mucosa
Respiratory epithelium plus
supporting connective tissue
with mucous glands

http://facstaff.bloomu.edu/gwassmer/ap2summer2003/lecturenotes/respiratoryanatomy.ppt

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Physical state and
the toxicology
•Dusts
•Mists
•Fumes
•Gases
•Vapours
•Smoke
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Dusts

• Dusts are solid airborne particles, often created by

operations such as grinding, crushing, milling, sanding
and demolition.
• Fibrogenic and toxic
• Two principle dusts in industry: asbestos and silica

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Mists

• Airborne liquid droplets, a finely dispersed liquid

suspended in air.
• Mainly released by spraying, foaming, pickling and
electroplating.
• Danger arises most frequently from acid mist produced in
industrial treatment processes e.g. oil mist, chromic acid
mist.

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http://www.cdc.gov/niosh/topics/skin/occderm-slides/ocderm8.html
Fumes

• Fine solid particulates

http://www.international-welder.com/?p=55

• Formed from the gaseous state usually by vaporization or

oxidation of metals (e.g., lead fumes)
• Created by industrial processes which involve the heating
and melting of metals (e.g., welding, smelting and arc air
gouging).
• Lead poisoning associated with the inhalation of lead
fumes is a common fume danger.

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Gases

• Formless fluids usually produced by chemical processes

involving combustion or by the interaction of chemical
substances
• A classic gas encountered in industry is carbon monoxide
(CO)
• Certain gases such as acetylene, hydrogen and methane are
particularly flammable

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 High methane concentration underground

Source: https://news.now.com/home/local/player?newsId=457106

Health Risk Assessment for Confined

Space Work Environment (F&IU, Cap 59)
• When to test?
Pre-entry, continuous, re-entry test
• What to test?
1. Flammable atmosphere (enriched O2, methane)
2. Toxic atmosphere (CO, HS)
3. Asphyxiating atmosphere (O2<19.5%?)的
• Where to test?
g genby
pipenot
Different level/ location if S. Tse Source: https://hk.on.cc/hk/bkn/cnt/news/20211222/bkn- 22
你 na
20211222100015093-1222_00822_001.html
Vapors

• Gaseous form

• Normally encountered in a solid or liquid state at normal room

temperature and pressure

• Typical example are solvents (TCE), which release vapors when the
container is opened.

• Other liquids produce a vapor on heating, the amount being directly

related to the boiling point of that particular liquid

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Smoke

• A product of incomplete combustion

• Mainly of organic materials
• May include fine particles of carbon in the form of ash,
soot and grit that are visibly suspended in air.
• Irritation, inflammation
of the lung, bronchi,
heart; malignancy.

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http://www.smashingmagazine.com/2008/10/05/celebration-of-smoke-photography-and-smoke-art/
 Aerosol and PM
• Aerosol: an all embracing term including all airborne
particles small enough to float in the air

• Particulate matter (PM): the term for a mixture of solid

particles and liquid droplets suspended in the air and
move with the air

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 OELs
Establishments

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A basic principle of occupational disease
prevention rests upon the reality of
threshold levels of exposure for the
various hazardous agents, below
which, Man can cope successfully
without significant threat to his health.

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 Dose-response relationship

Diagram A Diagram B [TLV]

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 Dose = Level of environmental contaminant
x
Duration of exposure

• Once the concentration of a toxic substance in

air is reached (threshold dose), some form of
body response will result. This concept is most
important in the correct use and interpretation
of occupational exposure limits ( i.e., threshold
limit values, TLVs)
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 Threshold limit values (TLVs)
• TLVs refer to time-weighted average (TWA) concentrations for a 7-
or 8-hour work day and a 40-hour working week.

• TLVs refer to airborne concentrations of substances and represent

conditions under which it is believed that nearly all workers may
be repeatedly exposed, day after day without adverse effects.

• Published by the American Conference of Government Industrial

Hygienists (ACGIH) and adopted for use in the UK.

TWA = 1/8 C(t) dt (t: 0 → tw), where

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Units of measurement
• Concentrations of gases and vapors in air (volume): parts per million
(ppm)

• Concentrations of gases and vapors in air (mass): milligrams per cubit

meter of air (mg/m3)

• Concentrations of airborne particles (e.g., fumes, dust): milligrams per

cubic meter (mg/m3), with the exception of mineral fibres (fibers/mL,
fibers per milliliter of air)

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 Occupational exposure standard (OES)
STEL: short-term exposure limits; LTEL: long-term exposure limits; MEL:
maximum exposure limits

• STEL and LTEL are time-weighted average concentrations

– STEL: averaged over 10 minutes (scarcely deviation)*
– LTEL: averaged over 8 hours (excursions)

• MELs: must not be exceeded at any time

* 10’ average in UK, 15’ average in HK (<4 times)

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Mixtures of substances

Additive effects

C1 C2 C3 Cn
+ + ... 1
L1 L2 L3 Ln
Where C= the observed and L= the permitted concentrations.

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 Exceeding STEL or LTEL
• Adverse effects:
– irritation of skin, eyes and lungs, narcosis or even death after
short-term exposure, or
– via long-term exposure through accumulation of substances in
the body or through the gradual development of increased risk
of disease with each contact.

• It is important to control exposure so as to avoid both

short-term and long-term effects (two types of exposure
limit)

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Some occupational exposure standards (OES)
• Threshold Limit Value (TLV) ‐ ACGIH/ USA
• Permissible Exposure Limit (PEL) – OSHA/ USA
• Occupational exposure limits (OEL) – OSHA/ EU
• Recommended exposure limit (REL) – NOISH/ USA
• Occupational exposure standard (OES)/ Workplace
exposure limit (WEL) – HSE/ UK
• Occupational exposure limits (OEL) – Labour Dept/HK
• GB Z2.1: OEL for hazardous agents – NHFPC(MoH)/ PRC

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 Factors influencing toxic action
 Rate of entry Toxic
Dose Action
 Previous exposure levels
 Route of exposure
Form
 Workplace environmental factors
 Age of individual
Individual  State of health
susceptibility
 Individual susceptibility and heredity
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 Toxicological assessment and investigation

• Toxicological assessment refers to the collection,

assembly and evaluation of data on a potentially toxic
substance and the conditions of its use, in order to
determine the danger to human health, systems for
preventing or control the danger, the detection and
treatment of overexposure and, where such information
is insufficient, the need for further investigation.

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Monitoring
•Environmental monitoring
•Biological monitoring

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 Environmental monitoring - the principles
• Is an important aspect of occupational hygiene practice

• Is concerned with the identification of these physical,

chemical, and biological stressors (such as noise, dust, toxic
gases and harmful bacteria) in the working environment, to
ensure compliance with the regulations.

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 Environmental monitoring - the philosophy
• A potential harmful substance is kept below some
predetermined level*, then no harm will come to exposed
workers.

* Predetermined exposure levels: OES, TLVs, PEL, OEL, REL, etc.

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Air sampling Noise sampling
• Sound pressure level meter
Short-term sampling
• Dosimeter
• Grab sampling / snap sampling
• Using hand pump and bellows Radiation sampling
device (multi-gas detector) • Geiger-Muller counter
Long-term sampling • Scintillation counter
• Personal sampling (personal • Airborne sampler
dosimeters, e.g., gas monitoring • Film badges
badges, UPAS) • Thermoluminescent personal
• Static sampling systems dosimeter (TLD)
• Quartz fibre detector (packet
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electrometer) 41
 Portable
Multi-gas
Detector
(e.g., H2S, CO)

UPAS*
• 48h Static monitoring
• 48h personal sampling
with GPS (armband,
harness)
* Ultrasonic personal aerosol sampler

https://www.a1-cbiss.com/ultrasonic-personal-air-sampler-upas.html 42
www.thelancet.com/planetary-health Vol 4 October 2020
Gas and vapour detector tubes and sampling pump
43
EPA Air Sampling Stations

44
 noise

OSHA

SOUND PRESSURE LEVEL METER

- Measurement of "A" weighted sound levels
45
 noise

OSHA

CEL-360 Logging Noise Dosimeter

46
Air Geiger Counter Kit blueGeiger PG-15 Geiger
Counter with Bluetooth

radiation
Re-Metered CDV-700
Classic Geiger Counter 47
http://www.ndt-
ed.org/EducationResources/CommunityCollege/RadiationSafety http://www.stanforddosimetry.com/images/badge.jpg
/Graphics/FilmBadge.jpg

Personnel dosimetry film badges ( particles,  rays, x-rays)

radiation

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Biological monitoring
• A regular measuring activity to select validated indicators
of the uptake of toxic substances in the human body are
determined in order to prevent health impairment.

• This form of monitoring could entail examination of, for

example, blood, urine, saliva and expired air.

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Biological thresholds
• Biological threshold values are based on the assumption
that below some given concentration, toxic substances
will not produce clinical poisoning even though there may
be some degree of metabolic abnormality which is
considered tolerable.

• How much deviation from normal is tolerable?

e.g., urinary cadmium: normal value <2 ug/g; suggested
maximum 10 ug/g

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 Methods
of recognizing
health hazards

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Main methods of recognizing health
hazards
• Experimental toxicological data
• Epidemiological studies
• Information from government data, etc.

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Experimental toxicological data

• Experimental toxicology is concerned with the study of the

effects of exposure to toxic substances.
• This may entail exposure to laboratory animals, such as
rabbits and rats, to controlled doses of toxic substances,
measuring the effects on target organs and systems, and
comparing same with control animals who have not
received these doses.
• The terms LD50 and LC50 are commonly used.
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 LD50 and LC50
LD50
“This is the lethal dose for 50 per cent of the test population
usually expressed as mg/kg. It is measured of acute toxicity being the
dose of a substance expected to kill 50 per cent of a population of test
animals.”

LC50
“This is a lethal concentration for 50 per cent of the test
population expressed as mg/l or mg/m3. It is a measure of acute
toxicity being the concentration of a substance in air expected to kill
50 per cent of a population of test animals exposed for a specified
period.”

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Epidemiological studies
riskof cancr
devedopiy
Hill’s criteria 时
• Strength of assoviathon
• Biological gradient
• Consistency.
• Specificity
• Biological plausibility
• Analogy
• Preventive action
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 Exposure model

LC50
LD50
Response
TLV

Safe
exposure

0 Dose

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Information from government data

• Various forms of data are produced by organizations, such as, the

Department of Health and local authorities: such as, the number
of diagnosed cases per year of particular diseases, the incidence
rate.

• Such information may also be presented as bar charts showing

the number of cases on a year to year basis, or as pie charts
showing the percentage of occupational diseases of various types
diagnosed.

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https://www.labour.gov.hk/common/osh/pdf/Bulletin2020_issue21_en.pdf
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https://www.labour.gov.hk/common/osh/pdf/Bulletin2020_issue21_en.pdf
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Key references
Stranks, Jeremy W. Occupational health and hygiene / Jeremy Stranks.
London: Pitman Pub., 1995.
Waldron, H. A. Lecture notes on occupational medicine / H.A. Waldron.
Oxford; Boston: Blackwell Scientific Publications, 1990. 4th ed.
Occupational health practice / [edited by] H.A. Waldron, C. Edling. Oxford;
Boston: Butterworth-Heinemann, 1997. 4th ed.

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 What we have learned?
• The most common target organs and target systems of toxic
substances
• Effects of exposure to toxic substances
• TLVs and OELs establishment
• Adverse effects after exceeding STEL or LETL
• Environmental monitoring
• Main methods of recognizing health hazards

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Tutorial

64
 5 ml,
shutquesthe
_

MCQ fonnt
Midterm MCQ: Which of the following statement is CORRECT?
(2
wir
-
3
foreamm)
A. Mixtures of substances are present in the atmosphere they are generally considered
to have additive effects and the sum of the ratio of observed to permitted
concentrations should not exceed unity.
B. Mixtures of substances are present in the atmosphere they are generally considered
to have biological effects and the sum of the observed risk should not exceed unity.
⑧ C. Mixtures of substances are present in the atmosphere they are generally considered
to have additive effects and the sum of the ratio of observed to permitted
concentrations should not exceed unity. refer to stlde 3了
D. Mixtures of substances are present in the atmosphere they are generally considered
to have effects and the sum of the ratio of observed to permitted concentrations
should exceed unity.
E. Mixtures of substances are present in the atmosphere they are generally considered
to have additive effects and the product of the observed and permitted
concentrations should not exceed unity.
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Haviy a scenarlo ,

PMF
dinmeter
Short questions
1. What are the major types of adverse health effects
of exposure to toxic substances?
2. What are the common target organs and systems of
toxic effects (name 3 each)? ind abbubpten stm unfanti
dianeter
3. For a construction worker potentially exposed to 4
µm
respIatable
silica – what is(are) the major form(s) of exposure, dust
routes of entry, and major health effects?hemc 4

inhalation elated to respintony

PD immunodisene
,

( ancer
ω ,
siillos
'
lung
s
,

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Leture
 Revision and preparation for mid-term exam on
26 February, 2024 (Monday), 2:30-3:30pm
• Duration: 1.0h
• Mode: physical face-to-face mode, close book questions
• Venue: MMW 704
• Scopes: from lecture 1 to lecture 5
• Format of assessment: short questions and/or MCQs
110
shusins
2 me

• Requirements
⼀ calcalator
– Prepare a proper calculation
– Turn off mobile and any device for communication
– No talk, no discussion
– Invigilation S. Tse 67