A discourse on the issues and challenges that face Environmental Health Professionals everyday.

By: Rosemary Stephen, Elements: Environmental Health Intelligence

The reason I ask myself this question is because my CTO sent me a link to an article from the New Scientist Online News that addresses this topic.

According to the Public Health Agency of Canada Business Continuity Plan, it is appropriate to expect an absenteeism rate of around 20 to 25 % for all workers during a pandemic over a two week peak period (1). Absenteeism, however, is predicted to be higher for health care workers. In the New Scientist article, entitled “Health workers may flee in pandemic panic”, studies done in different countries predicted different absenteeism rates (2); for instance, in the UK, 85 % of their health care workers would not report to work, while in Australia, this percentage is a lot better with 60 to 80 % of their health care workers reporting for work. In Hong Kong, the absenteeism rate would be 15%, in the US, absenteeism rate would possibly be 50% (3) and in Canada around 39% (4). Why are health care workers unwilling to report to work during a pandemic? They are, after all, trained to handle these situations and care for people affected by them. Are these workers simply ’selfish’?

Numerous studies have been done on human behaviour in extreme events, including many studies on human reaction to war. We all have heard of ‘post traumatic stress syndrome’, but we do not hear very much about desertion from battle field because it is considered a war crime and deserters are branded as “cowards”. But we have to ask two questions - Why would a well trained soldier suddenly leave the war front ? And what does this have to do with health care workers ?

Let’s start with the military. Having been in the military, I remember being part of a gathering after an afternoon of sports activity. We were outside enjoying the sunshine and discussing nuclear war. All of us were trained in nuclear warfare and knew what to expect. Suddenly, a husky Master Corporal said…

“well if there is a nuclear war, I’m gone.”

What? Where would you go?

“To my wife and kids”

Why?

“Because I need to protect them…”

I was surprised by his comment. Was it common to think this way? Refusing to do our duty is a punishable crime. Is this person selfish to think this way?

Military psychiatrists are well aware of this phenomenon. All known war records list a certain percentage of deserters. Through careful examination of these records, military psychiatrists have discovered that, aside from poor pay, brutal treatment and poor living conditions, another stimulus motivates soldiers to desert - their sense of personal honor and of personal duty.

Mark A.Weitz, in his book entitled A Higher Duty: Desertion among Georgia Troops during the Civil War discusses the high desertion rate amongst soldiers during the invasion of Georgia (USA) (5). The author studied letters and diaries written by the soldiers, discovering what honor meant to them personally and ultimately why they deserted. Mr. Weitz mentions that “Despite the importance attached to honor,”… “it eventually gave way to the duty soldiers felt for their wives and families. Whether a soldier deserted also depended on the ideas of honor held by the women in his life (6).”

What does this have to do with health care workers absenteeism? Interestingly, Dr.Sarah Damery of the University of Birmingham, UK suggested that health workers may flee in a pandemic not because they are selfish, but because “the biggest factor (affecting their decision) was their safety and that of their families” (7).

During the Severe Acute Respiratory Syndrome (SARS) outbreak in the fall of 2002 in China and in February 2003 in Toronto, Ontario, Canada, a working group from the University of Toronto Joint Centre for Bioethics created a framework based on the SARS outbreak experience. This framework addressed five ethical issues found during the outbreak. Four of these issues dealt with patient care: freedom of movement of SARS and non-SARS patients, public diffusion of medical information, lack of contact with family members of quarantined SARS and non-SARS patients admitted at different Toronto hospitals and the increased emergence and rapid spread of infectious diseases (8).

The fifth issue, however, dealt with health care workers themselves. In a paper entitled Health care workers’ duty to care, and the duty of institutions to support them, the University of Toronto working group acknowledged that health care workers feared being infected. Generally, they perceived an increased risk of dying from SARS resulting from caring for sick patients. Nurses in particular, and especially younger nurses, were the most fearful. This feeling was enough to make 34% of nurses think about a change in occupation or possible resignation (9). Health care workers also feared being “shunned by others in case they were infectious“. But above all, the reason most frequently cited, was their “concern for the safety of their family and themselves” (10). These fears were less predominant when: workers had management or supervisory roles, when they believed in the effectiveness of environmental and administrative controls within the care facility and when workers were 50 years of age and older.

The working group also discovered that health care workers felt guilty about their children and /or pets because they knew they could not care for them if they were to become sick. In the article The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital victims of SARS (both patient and staff) felt stigmatized. There was a feeling of personal danger within the hospital caused by frequent changes in control procedures and public health recommendations, the known lethality of SARS and the intense media coverage about the effects of the outbreak (11).

What, then, are the solutions ? How do we motivate health care personnel to work throughout a pandemic?

One of the recommendations from the University of Toronto working group suggested that “professionals have a duty to care for the sick, this must be tempered by a duty to care for themselves in order to remain well enough to be able to carry out their duties“. Health care institutions therefore must support their employees by creating plans and guidelines that addressed the reaction of fear when health care workers are confronted with an outbreak (12).

What should these plans and guidelines include to influence health care worker in deciding to report to work? Would these plans and guidelines condemn fear or acknowledge it? MDs Koelemay and Duchin have proposed a valuable readiness training program (13). In the form of a power point presentation this program is based on what health care workers experienced during the SARS outbreak. The presentation outlines what can be done to increase peoples’ willingness to work.

This readiness training covers risk perception (fears) that interferes with reporting to work. Health concerns, along with the addition of transportation, childcare and other issues, are also components of their readiness guidelines. The presentation stresses that to reduce fear, methods such has education of health care workers, provisions of appropriate PPE and assurance of environmental controls should be part of all plans and guidelines. Above all, the authors stress “the single most influential construct associated with willingness to report to duty - the perception of the importance of one’s role in the agency’s overall response.”(14)

Conclusion

Numerous studies have been done to understand why individuals may decide to refuse to work or simply desert their posts. Through the study of military records and of the SARS outbreak, we have identified that one of the most often cited reasons is concerns over the safety of our family and ourselves. When studying SARS, The University of Toronto, Ontario, Canada and MDs Koelemay and Duchin were better able to understand the reason why health care workers’ did not to report to work and tried to find ways to alleviate their fears. It appears that readiness training which addresses the roots of these fears may have a positive influence on employee willingness to work.

Rosemary Stephen (2009). Why are a percentage of health workers unwilling to work during a pandemic ? Elements: Environmental Health Intelligence

References

(1) Infectious Disease, Business Continuity Plan, Pandemic Planing (2007) Canadian Centre for Occupational Health and Safety. (On-line) Available: http://www.ccohs.ca/pandemic/pdf/Business_continuity.pdf. Cited 2009 Jun 18.

(2) Nowak, R. Health workers may flee in pandemic panic (2009) New Scientist Online News. (On-line) Available: www.newscientist.com/article/mg20227104.200-health-workers-may-flee-in-pandemic-panic.html. Cited 2009 04 Jun.

(3) Mackler, N. Wilkerson, W. Cinti, S. Will First-Responders Show Up for Work During a Pandemic?(2009) Disaster Management & Response, Elsevier. (On-line) Available: http://linkinghub.elsevier.com/retrieve/pii/S1540248707000272. Cited 2009 Jun 18.

(4) Nowak, R. Health workers may flee in pandemic panic (2009) New Scientist Online News. (On-line) Available: www.newscientist.com/article/mg20227104.200-health-workers-may-flee-in-pandemic-panic.html. Cited 2009 04 Jun.

(5) Weitz, M.A. A Higher Duty: Desertion among Georgia Troops during the Civil War (2000) University of Nebraska Press. (On-line), 8. Available: http://www.questiaschool.com/read/9897920?title=A%20Higher%20Duty%3a%20Desertion%20among%20Georgia%20Troops%20during%20the%20Civil%20War. Cited 2009 Jun 04.

(6) Weitz, M.A. A Higher Duty: Desertion among Georgia Troops during the Civil War (2000) University of Nebraska Press. (On-line), 8. Available: http://www.questiaschool.com/read/9897920?title=A%20Higher%20Duty%3a%20Desertion%20among%20Georgia%20Troops%20during%20the%20Civil%20War. Cited 2009 Jun 04.

(7) Nowak, R. Health workers may flee in pandemic panic (2009) New Scientist Online News. (On-line) Available: www.newscientist.com/article/mg20227104.200-health-workers-may-flee-in-pandemic-panic.html. Cited 2009 04 Jun.

(8) Ethics and SARS: Learning Lessons from the Toronto Experience (2009) Working Group, University of Toronto Joint Centre for Bioethics. (On-line) Available: http://www.yorku.ca/igreene/sars.html. cited 2009 Jun 04.

(9) Koelemay, K. MD and Duchin, D. MD Healthcare Worker Ability and Willingness to Work During Pandemic Flu, Risk perception and attitudes (intended audience: managers) (2006) Public Health - Seattle & King County, University of Washington and National Institutes of Health Region X Center of Excellence for Biodefense and Emerging Infectious Diseases
www.kingcounty.gov/healthservices/health/preparedness/pandemicflu/~/media/health/publichealth/documents/…/willingness_to_work. Cited 2009 Jun 04.

(10) Maunder, R. and al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital (2003) Departments of Psychiatry, Nursing, Social Work, University of Toronto, Toronto, Ont. Canada. (On-line) Available: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=154178. Cited 2009 Jun 19.

(11) Koelemay, K. MD and Duchin, D. MD Healthcare Worker Ability and Willingness to Work During Pandemic Flu, Risk perception and attitudes (intended audience: managers) (2006) Public Health - Seattle & King County, University of Washington and National Institutes of Health Region X Center of Excellence for Biodefense and Emerging Infectious Diseases
www.kingcounty.gov/healthservices/health/preparedness/pandemicflu/~/media/health/publichealth/documents/…/willingness_to_work. Cited 2009 Jun 04.

(12) Ethics and SARS: Learning Lessons from the Toronto Experience (2009) Working Group, University of Toronto Joint Centre for Bioethics. (On-line) Available: http://www.yorku.ca/igreene/sars.html. Cited 2009 Jun 04.

(13) Koelemay, K. MD and Duchin, D. MD Healthcare Worker Ability and Willingness to Work During Pandemic Flu, Risk perception and attitudes (intended audience: managers) (2006) Public Health - Seattle & King County, University of Washington and National Institutes of Health Region X Center of Excellence for Biodefense and Emerging Infectious Diseases
www.kingcounty.gov/healthservices/health/preparedness/pandemicflu/~/media/health/publichealth/documents/…/willingness_to_work. Cited 2009 Jun 04.

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By: Rosemary Stephen, Elements: Environmental Health Intelligence

News briefs about Influenza A (H1N1) always show people in public places wearing face masks. Some people wear them correctly but many individuals have the mask covering only their mouth. If you choose to wear a mask, how effective is it, especially if not worn properly ? With this question in mind, I decided to have a look at what a selection of Health Agencies had to say about face masks…

The United Kingdom

The United Kingdom’s Health Protection Agency (HPA) shares the same opinion about face masks as the US Center for Disease Control. Currently, there are no proven advantages for healthy people to wear face masks during daily activity [1]. The HPA also stresses that wearing and disposing of masks incorrectly may actually expose other people to infection. Health Care workers are trained in the proper ways to wear and to remove face masks; the general population is not. Once a mask is dampened by breath, it is damaged or becomes soiled, it should be changed. Touching the external surface of the mask upon removal, may infect the wearer as well as other people especially when masks are not disposed of properly – first bagged and then placed in covered garbage cans. In the UK, good personal hygiene — such as hand washing and covering the nose and mouth when sneezing – is considered the most effective method of protection [2].

California

In “Masks keep you from spreading illness” Dr. Arthur Reingold, head of the epidemiology division at the University of California, Berkeley, School of Public Health presents a positive view on mask wearing. Dr. Reingold says that face masks serve as a “reminder to people that they should avoid close contact with other persons,” and “They (face masks) also have this effect of isolating people and reminding them that they should not be kissing people, shaking hands, things like that”[3]. His comments made me smile because we, as humans, react to visual input. It is true that when we see someone wearing a face mask we tend to shy away from them.

The USA

The U.S. Department of Health and Human Services (HHS) feels that it is difficult to assess the potential effectiveness of face masks in a community setting due to a lack of scientific evidence. They mention that “ operational and policy questions regarding the manufacturing, supply, and distribution of face masks and respirators, and public education about their use, (in a influenza pandemic) remain unresolved” [4]. The HHS states that people are most infectious during the early stage of sickness, at the onset of coughing and sneezing. They encourage the public to adopt very similar actions as those listed above for the UK; the United Kingdom’s Health Protection Agency and the U.S. Department of Health and Human Services both encourage frequent hand washing and covering the mouth and nose when sneezing. They also note that keeping a distance of 6 feet (1.83m) away from people who are sick or, appear sick, as well as avoiding crowded public places are also effective means for preventing contamination by the H1N1 Influenza [5].

Australia

The Australian Government, in concert with other agencies, recommends that sick people wear a mask as well as wash their hands regularly. They agree with the UK and the United States and feel that the general public do not gain any protection from wearing masks during daily activities because it gives a false sense of security. People in general forget, or do not even realize, that H1N1 flu can be picked up from surfaces contaminated from droplets expelled while sneezing and again a mask may not stop small particles. Professor Peter Leggat of James Cook University’s School of Public Health and Tropical Medicine concurs and warns that “Some face masks are better than others at filtering out small particles - those that fit more snuggly and/or have better filtering capabilities, such as the N95/P2 masks, may be more useful than common medical and surgical masks, but research is limited.” [6] The Australian Government also notes that face masks only slow down swine flu and are only a means of reducing the transmission of the virus [7].

The Center for Disease Control in Atlanta USA (CDC)

If most health agencies do not recommend face mask usage for daily activity then when should masks be worn? CDC web site answers that question in two concise tables. Table 1 “CDC Interim Recommendations for Face mask and Respirator Use for Home, Community, and Occupational Settings for Non-Ill Persons to Prevent Infection with Novel H1N1” tells readers exactly when face mask are recommended for non-ill individuals [8]. Table 2 called “CDC Interim Recommendations For Face mask Use For Persons Ill With Confirmed, Probable, Or Suspected Novel Influenza A (H1N1)1 To Prevent Transmission Of Novel H1”, provides very helpful recommendations on wearing face masks for ill people at home, in health care or non-health care settings and for mothers who are breastfeeding. These two tables are definitely a “must have” if you are responsible for providing guidance to the general public or to health care facilities [9].

Canada

The SARS outbreak which occurred in 2003 in Canada had a strong impact in the public health sector. In the current swine flu outbreak, the Public Health Agency of Canada decided to seek the opinion of medical experts so they could provide appropriate guidance for avoiding Influenza A H1N1 virus. Scientific evidence suggests that “the flu viruses are mainly transmitted over short distances and that more people become infected by inhaling viruses than by touching contaminated surfaces”. [10] Dr. Donald Low, microbiologist in chief at Mount Sinai Hospital in Toronto and who chaired the Council of Canadian Academies, looked at the question of face mask usage during a pandemic [11]. He considers face masks to be the final layer of protection when exposure to an infected person is “required, or unavoidable”. The Council of Canadian Academies recommended instead the implementation of “Administrative and Engineering controls” [12].

Administrative controls are specific hygiene policies and procedures as well as reminders for people to wash their hands frequently, cover their mouth and nose when sneezing or coughing and seek medical attention when they feel sick. Engineering controls are more sophisticated. They suggest the manipulation of our indoor environment by setting relative humidity, temperature and ventilation rates inside buildings in ways that will disrupt Influenza A H1N1 spread. Since influenza prefer dry air and cool temperatures [13], we can set HAVC systems to release more humidity and maintain higher room temperatures.

But – should we or shouldn’t we increase the temperature and humidity?

Most will say that changing the relative humidity and the temperature to affect swine flu virus is a bit ‘far fetched’ and may trigger other problems such as mold. In 2007, however, a group of researchers from Mount Sinai School of Medicine in New York studied how the influenza virus spread. Their study indicated that this virus prefers cool and dry air. When these parameters were changed, the flu did not spread to test animals, in this case guinea pigs. Ambient temperatures above 86°F [a temperature setting between 20°C (68°F) and 30°C (86 °F) is effective] and a relative humidity at 80% and above [ 14, 15, 16] showed a marked decrease in the transmission of the virus. In an environment where the relative humidity is high, exhaled respiratory droplets take on water. This action increases the virus droplet size and therefore decreases the virus’ ability to stay airborne for extended periods of time. Engineering controls could be quite effective in large public areas and office towers.

Conclusion

Should face masks be worn daily? The general consensus is that face masks are not necessary when it comes to Influenza A H1N1. They do not necessarily filter out small particles and they give a false sense of security. Unless the general public is aware how to wear and to dispose of masks, the original wearer or anyone coming in contact with used masks may become infected. I agree with Dr. Reingold that the visual message people send when wearing face masks warns others to avoid close contact but this argument is not strong enough to favor the general public wearing face masks. It is only in specific situations that masks should be worn; other times usual Administrative precautionary measures should be strongly encouraged. We should also control the spread of Influenza A H1N1 by controlling our environment. Ambient temperature above 86°F (30°C) and a relative humidity at 80% are forms of Engineering control that have been proven to be effective.

Rosemary Stephen (2009). Face Masks and Environmental control: are they really effective for H1N1? Elements: Environmental Health Intelligence

References:

[1] Swine Flu: Question and Answers. (2009) NHS Plymouth. (On-line) Available: http://www.plymouthpct.nhs.uk/Documents/Swine%20Flu%20QA.pdf Cited 2009 May 25.

[2] Swine Flu: Question and Answers. (2009) NHS Plymouth. (On-line) Available: http://www.plymouthpct.nhs.uk/Documents/Swine%20Flu%20QA.pdf Cited 2009 May 25.

[3] Landau, E., Masks keep you from spreading illness (2009) CNNhealth.com (On-line) Available:http://www.cnn.com/2009/HEALTH/04/28/swine.flu.masks/. Cited 2009 May 25.

[4] Interim Public Health Guidance for the Use of Facemasks and Respirators in Non-Occupational Community Settings during an Influenza Pandemic (2009) PandemicFlu.gov. (On-line) Available: http://www.pandemicflu.gov/plan/community/maskguidancecommunity.html. Cited 2009 June 01.

[5] Interim Public Health Guidance for the Use of Facemasks and Respirators in Non-Occupational Community Settings during an Influenza Pandemic (2009) PandemicFlu.gov. (On-line) Available: http://www.pandemicflu.gov/plan/community/maskguidancecommunity.html. Cited 2009 June 01.

[6] Kwek, G. Face masks: do they work? (2009) WAtoday.com.au. (On-line) Available: http://www.watoday.com.au/national/face-masks-do-they-work-20090430-aogg.html?page=2. Cited 2009 May 25.

[7] Kwek, G. Face masks: do they work? (2009) WAtoday.com.au. (On-line) Available: http://www.watoday.com.au/national/face-masks-do-they-work-20090430-aogg.html?page=2. Cited 2009 May 25.

[8] Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission (2009) Centers for Disease Control and Prevention. (On-line) Available: http://www.cdc.gov/h1n1flu/masks.htm. Cited 2009 May 25.

[9] Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission (2009) Centers for Disease Control and Prevention. (On-line) Available: http://www.cdc.gov/h1n1flu/masks.htm. Cited 2009 Jun 01.

[10] The Flu Personal respiratory masks. Will face masks protect you from the flu? (2009) CBCnews.ca (On-line) Available: http://www.cbc.ca/health/story/2009/04/28/f-flumasks.html. Cited 2009 May 26.

[11] The Flu Personal respiratory masks. Will face masks protect you from the flu? (2009) CBCnews.ca (On-line) Available: http://www.cbc.ca/health/story/2009/04/28/f-flumasks.html. Cited 2009 May 26.

[12] The Flu Personal respiratory masks. Will face masks protect you from the flu? (2009) CBCnews.ca (On-line) Available: http://www.cbc.ca/health/story/2009/04/28/f-flumasks.html. Cited 2009 May 26.

[13] Lowen, A.C., Mubareka, S., Steel, J., Palese, P. Influenza Virus Transmission Is Dependent on Relative Humidity and Temperature. (2007) Plos Pathogens. (On-line) Available: http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.0030151. Cited 2009 May 26.

[14]Temte, J.L. MD, PhD. Basic Rules of Influenza: How to Combat the H1N1 Influenza (Swine Flu) Virus (2009) American Family Physician, American Academy of Family Physicians. (On-line) Available: http://www.aafp.org/online/en/home/publications/journals/afp/preprint/combat-h1n1.html. Cited 2009 May 26.

[15] Lowen, A.C., Mubareka, S., Steel, J., Palese, P. Influenza Virus Transmission Is Dependent on Relative Humidity and Temperature. (2007) Plos Pathogens. (On-line) Available: http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.0030151. Cited 2009 May 26.

[16] Will Summer Weather Suppress Swine Flu? (2009) Capital Weather Gang, Washing Post. (On-line) Available: http://voices.washingtonpost.com/capitalweathergang/2009/05/will_summer_suppress_swine_flu.html. Cited 2009 May 26.

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By: Rosemary Stephen, Elements: Environmental Health Intelligence

Once in a while our work involves giving recommendations that are outside the scope of our expertise. Back in the early 1980’s, I was involved in something that I never dreamed would become my responsibility. At that time I was posted in a Military Base as a Preventive Medicine Technician. My Superior was away, so he allowed me to ‘man the fort’ (so to speak). One morning, the Base Surgeon brought a Captain to my office. The Base Surgeon explained that the Capt. needed our help; the military police had just informed him that one of his Non-Commissioned Officers (NCO’s) as well as the NCO’s wife had been murdered. This terrible event had taken place in rented, military housing, called the PMQs. Base Housing, the department responsible for the upkeep of PMQs, had requested that the Capt. have all traces of the crime removed within a week.

The bodies of the NCO and his wife were discovered earlier in the morning when a newly posted Private on his first week on the job after graduating from the Military Police, was ordered by his superior to see if the NCO was home. Oddly, the NCO had not reported for work two mornings in a row! The young Private drove to PMQ and saw the NCO’s car was parked in the driveway.

The Private radioed in and asked his supervisor what to do next — “Well, knock at the door. Maybe he’s still sleeping…”

The Private knocked but there was no answer. He then went around the back and found the back door slightly ajar. Stepping inside the PMQ, he was overcome by a strong smell.

The Private radioed in again — “ Sir, I found the back door unlocked and open and there is an awful smell coming from inside. I called the NCO’s name, but I got no answer”.

“Check the house” he was instructed. “Also go upstairs; maybe he’s still sleeping and simply hasn’t heard you...”

The Private found no one on the first floor. Climbing to the second floor, he looked into the master bedroom; from the hall doorway, he could see two people laying in bed, possibly asleep…. Carefully entering the bedroom, he called the NCO’s name. Once inside the bedroom, however, it was clear the occupants were not asleep. The Private found two bodies — a man’s and woman’s – lying in the bed and, kneeling on the carpet beside the bed, the body of a young man.

The Private screamed in to his walky-talky. Another police car was dispatched to the scene. A full murder investigation followed. The events were very sad; it was the outcome of a father banning an obsessive young man from seeing his daughter. Revenge came in the form of a murder–suicide…

The Base Surgeon asked me to inspect the PMQ and give recommendations on how to clean the residence. When I arrived at the scene, the PMQ was surround by military police. Before I could enter, I was told the scene was pretty gruesome and that I could refuse to enter if I felt it would upset me too much. Having worked in hospitals before, I felt this would not be an issue. What I saw, however, made me realize how fragile the human body truly is. The bodies had been removed but what was left was overwhelming and required my immediate attention. But where, exactly, should I start ? I phoned the Command Preventive Medicine Technician and asked him for his advice. He came to the PMQ, had a look at the situation, and told me how to proceed….

That was then….

Under his guidance, the first step we took was to gather appropriate PPEs (personal protective equipment) – cotton coveralls, surgical gloves and medical masks — as anyone involved with the cleaning may become exposed to pathogens from blood and body fluids. We then returned to the PMQ and asked everyone who had volunteered to dress in the protective gear and wait to be assigned a task. Volunteers from the Military police were responsible for removing items such as the carpet, bed frame, mattress and box spring and any furniture stained by blood. The Command P Med and myself bagged and removed all bedding, curtains, cloths and personal items from the room. After some phone calls, we were able to get the service of two hospital janitors. They were assigned to clean and disinfect the ceiling, the walls and the floors using medical grade disinfectant to remove all traces of blood and any lingering smell.

At the time we assumed that we could dispose the waste at the local land fill. We, however, were refused. They explained that the amount of waste would exceed their limited capacity. Now, we had to find a suitable landfill. The Master Warrant Officer’s Superior officer, after numerous calls, finally found a disposal site that was willing to take the large quantity of waste. This landfill agreed to receive our waste on the condition that everything would be properly and securely packaged. Proper packaging involved double-bagging small items and placing large items into cardboard boxes. The landfill operators feared that because this murder-suicide had gathered a lot of publicity, people may try to locate the landfill and steal clothes and other small items for resale. They were also concerned that wild life could be attracted by the scent of blood and then dig out soiled items.

We disposed of everything into the crime scene waste, including our PPEs. The packed waste was put into a military truck and driven to the landfill. This event was before hazardous waste classification hence none of the bags or cardboard boxes carried biohazard waste symbols to identify the type of waste being transported.

This is now….

Today, looking back at the event with my current knowledge, I would have told the Base Surgeon and the Capt to hire the services of a company that specializes in crime scene clean-up. Crime Scene Cleaning companies belong to an emerging niche market in England, Australia, Canada and in the United States. These companies are regulated under federal, state or provincial and local environmental regulations. In the United States, they are governed by state health departments, the EPA or the OSHA and the CDC because the job involves working in a blood soiled environment. In Canada, guidelines are issued by the Ministry of Labour (Health and Safety), the Ministry of the Environment under the Management of Biomedical Waste, the Public Health Agency of Canada for the inactivation of the Hepatitis B and C virus and Provincial Workplace Safety. Biohazardous Infectious materials fall under the Workplace Hazardous Materials Information Systems (WHMIS) Classification D, Division 3 which consider these materials toxic. (1).

Crime scene clean-up companies train their employees how to clean sites properly using the appropriate disinfectants and how to dispose of human wastes of all types properly, always recognizing the hazards. But why are these scenes potentially so hazardous ? Victims may be carriers of communicable diseases (2) and crime scenes are not necessarily clean. The presence of mold, bacteria, fungus and vermin in the area where the body lay may cause sickness months or years after exposure (3). In the situation of a violent death or when a decomposing body is found, human waste must be disposed of in a manner that prevents environmental contamination (4). The US Medical Waste Management Act, defines human wastes as biohazardous and, therefore, cannot be put with regular garbage (5). Human wastes includes: human anatomical wastes (pieces of body parts, matter or organs), sharps (razors and broken glass) which have contacted human blood, biological fluids or tissues or microbial cultures, contaminated material, containers, debris or materials saturated with any blood or body fluids (found on furniture, bedding and clothing) (6). On an international level, the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), consider that all human blood and fluid wastes should be treated as infectious and be handled accordingly (7).

Crime scene clean-up is not a job for the untrained person. I would not recommend that anyone do a clean-up themselves. This job is best left to a professional.

Health and Environmental Safety Risks

In the United States, the Occupational Safety and Health Administration (OSHA) is responsible for employee safety. All companies that deal in any way with human blood and fluid wastes must comply with occupational standards laid out in General Industry Regulation 29CFR1910.1030. This regulation specifies that “no employee can be placed in a position to be exposed to blood spills without first:

• receiving blood borne pathogen (BBP) training and certification through an accredited organization

• having a written exposure control plan (ECP)

• having been provided with Personal Protective Equipment (PPE)

• training in the proper way of cleaning and disposing of crime scene waste

• training on how to identify Critical Incident Stress Syndrome (CISS) or Post Traumatic Stress Disorder (PTSD) symptoms

• training in the transportation of biohazardous waste

Receiving Blood Borne Pathogen (BBP) training: The World Health Organization (as of 2004) considers biohazardous infectious materials to fall into 4 risk groups. Each group categorizes pathogens according to their risk; the higher the group number, the higher the risks. This concept has been adopted by Australian/New Zealand (Standard 2002), Canadian Laboratory Safety Guidelines (2004), European Economic Community (2000), NIH Recombinant DNA Guidelines (USA, 2002) and CDC/NIH Guidelines (1999).

The WHO risk groups are defined as:

• WHO Risk Group 1 - no or low individual and community risk. A microorganism that is unlikely to cause human or animal disease .

• WHO Risk Group 2 - moderate individual risk, low community risk. A pathogen that can cause human or animal disease but is unlikely to be a serious hazard to laboratory workers, the community, livestock or the environment. Laboratory exposure may cause serious infection, but effective treatment and preventative measures are available and the risk of spread of infection is limited. (8). Hepatitis type A, B, C, D, E and G can be included in this group (9), however, depending on the country, Hepatitis may also be classified as Group 3 (10).

• WHO Risk Group 3 - high individual risk, low community risk. A pathogen that usually causes serious human or animal disease but does not ordinarily spread from one infected individual to another. Effective treatment and preventive measures are available (11). These pathogens include, but are not limited to, HIV, TB and Hantavirous Pulmonary Syndrome (HPS) (12, 13, 14). HPS is found in Canada and in the United States as well as a number of countries in South America (15). Workers are at risk of contracting HPS through aerosolization of dried or fresh contaminated rodents excreta, saliva or nesting materials. Homes, or areas with visible rodent infestation, (16) pose a health risk for employees because the virus can survive in the environment for approximately one week (17).

• WHO Risk Group 4 - high individual and community risk. A pathogen that usually causes serious human or animal disease and that can be readily transmitted from one individual to another, directly or indirectly. Effective treatment and preventive measures are not usually available.

The written exposure control plan (ECP) : An ECP is an effective way to protect employees by ensuring appropriate working guidelines are issued and then followed.

The ECP should include the following:

• The establishment of exposure controls including:

  • Universal precautions (part of initial and refresher training);

  • Engineering and work practice controls (sharps disposal containers);

  • Personal protective equipment; and

  • Housekeeping (regulated waste placed in appropriate color-coded containers, laundry, etc)

• Hepatitis B vaccinations (at initial employee training and within 10 days of initial assignment); Hepatitis A (2 doses) and Hepatitis B (3 doses) vaccines are required for all employees working in crime scene cleanup (18) . The advantage of the HBV vaccine is that it also protects against HDV (which only infects people who already have active HBV infection). People are infected with HAV by eating food or drinking water contaminated with the virus. Hepatitis G is another infection transmitted via blood and blood products. It can co-infect people infected by HBV, HCV and HIV. Hepatitis E is transmitted through contact by fecal-oral route and Hepatitis C is transmitted via needle sharing or other drug-related equipment. (19). These pathogens may be present at the site. There are no vaccines at the moment to protect against HCV and HGV. Research is currently being done for an HEV vaccine, but it is not commercially available yet (20, 21).

• Post-exposure evaluations and follow-up (routes and circumstances of exposure, blood test for HIV, HCV and HBV infections);

• Communication of hazards to employees (hazardous chemicals MSDS, confined space protective and safety measures) and training (epidemiology, symptoms, transmission of blood borne pathogen diseases);

• Dangerous chemicals and drugs may be present at a crime scene. These may not necessarily leave an odor or they may affect the odor threshold to the point where people can no longer smell the offending agent. In this situation, employees may be overcome by chemical concentrations that could have serious or disastrous health effects.

• Crime scene clean-up in clandestine drug labs presents other issues. In the process of making drugs, there might be highly toxic and flammable solvents. The risks of explosion in such environments exposes employees to serious safety risks. Proper training and testing of these environment prior to entry are essential (22).

• Another area of concern is working in a confined space. Confined spaces are characterized by: small size, not being designed for human occupancy, having a single access point, lacking a means of ventilation and/or a level of oxygen below 19.5% (23). Examples include: sewers, oven pits, tanker cars, underground electrical passages, cold storage, sub-cellars, culvert, silos, or vaults, etc. In a crime scene, confined space may also include closets, a small bathrooms and tool sheds (24). Employers must train their employees in such areas as: entry/exit strategies, emergency requirements and procedures, equipment maintenance and how to work in warm, stuffy environments(25).

• Record keeping (training records, medical records, exposure evaluation, sharps injury log, Hepatitis vaccination records;

and

• Procedures for evaluating circumstances surrounding exposure incidents (engineering controls in use at the time, was work practice followed, PPEs worn, where and in what circumstances did the incident occur, training level of employee etc (26).

Having been provided with Personal Protective Equipment (PPE) and instruction in their use: PPEs consists of a non-porous, fluid resistant clothing such as one-time-use suits, non-latex gloves (e.g. nitrile or other barrier material), filtered respirators with either N95 or N100 cartridge and (27) heavy-duty industrial or chemical-spill protective boots (28). Cleaners must be instructed on how to dunn and duff gowns, masks and gloves as well as how, and when, to wash their hands in order to minimize the contamination of skin and cloths (29).

Training in the Proper way to clean and dispose of crime scene waste: Items that are blood soaked and dripping must be placed in biohazard bags, with a biohazardous symbol clearly visible on its surface. Biohazardous material cannot be disposed in regular garbage.

Not all crime scene waste is considered to be biohazardous. Wipes and disposable towels used to clean surfaces contaminated with blood such as walls, floors, horizontal surfaces or other objects such as picture frames, lamps and decorations must be placed into plastic bags and then they may be disposed of in regular garbage. Uncontaminated surfaces can be cleaned with just detergent and the waste disposed into regular garbage.

Surfaces more heavily contaminated with blood, must be disinfected with appropriate disinfectants (30,31). There are three levels of disinfection: high, intermediate and low. Each level targets different type of microorganisms. In the case of a crime scene, intermediate disinfectant kills mycobacteria (Tuberculosis), most viruses and bacteria (32). Agents used for intermediate disinfection include iodophors (chlorine solutions), alcohol (isopropyl, ethyl), phenolic compounds and quaternary ammonium compounds, Wescodyne (an iodophor) and sodium hypochlorite (bleach) (33). Bleach (Chlorine) is the most often recommended disinfectant for its low cost and its ability to decontaminate numerous biological organisms. A concentration of 10% chlorine solution and contact time of usually from 20 to 30 minutes or longer is very effective in killing microorganisms (34).

Any clothing contaminated with blood and/or body fluids can be washed in a washing machine. Care must be taken to transport soiled clothing to the washing machine into plastic bags to prevent contamination of other items or surfaces (35). Appropriate PPEs (gloves, mask, gown etc.) should be worn while loading the washing machine. Clothing should be washed in hot (160° F / 71°C), soapy water for 25 minutes. A cup of bleach may be added to the water if cloths are colour fast. If washing at low temperature (less than 150° F / 65°C), the recommended concentration of detergents made to work at low temperature should be followed (36).

There will be a strong odour present at the crime scene caused by bodily fluids that are released by the body as soon as decomposition begins. This odor may be absorbed into floor coverings and furniture. If this has happened, these items may have to be removed because body fluids do not evaporate and can take months to years before they dry. (37). Stains may also be found in rooms located below that of the crime scene. These areas must be cleaned as well.

Employee Mental Health or training on how to identify Critical Incident Stress Syndrome (CISS) and Post Traumatic Stress Disorder (PTSD) : Employees hired for crime scene cleanup must receive training on how to identify Critical Incident Stress Syndrome (CISS) or Post Traumatic Stress Disorder (PTSD) (38). This is very important because the reality of a crime scene is totally different from what is portrayed on TV. If an employee becomes affected by these disorders often only the help of a mental health specialist can relieve their symptoms.

Disposal and Transportation of Biohazardous Waste : In the United States, the OSHA and the U.S. Department of Transport require that people be trained in moving biohazardous materials. The EPA also stresses that it is up to individual states and to local governments to follow statutes on biohazardous wastes (39).

In Canada, the transportation of biohazardous waste falls under national Transportation of Dangerous Goods Regulations. In Canada, the group or person who produced the hazardous waste is “responsible for the handling, storage and safe disposal of the hazardous waste they produce”(40). Part 2 of the Transport Canada regulations specifies that biohazardous wastes belong to Class 6, Toxic and Infectious Substances. This class is divided into two divisions: 6.1 for Toxic Substances and 6.2 for Infectious Substances. Infectious Substances are defined as “ substances which are known or are reasonably expected to contain pathogens. These are defined as micro-organisms (including bacteria, viruses, rickettsiae, parasites, fungi) and other agents such as prions, which can cause diseases in humans or animals” (41).

Division 6.2 is then divided into two further categories – Cat. A and Cat. B – that define the waste type more precisely. Category A is for viruses and bacteria such as Hantavirous causing pulmonary syndrome or hemorrhagic fever with renal syndrome, HIV and HBV. Category B is for viruses, bacteria and fungi such as Hantavirus not causing pulmonary syndrome or hemorrhagic fever with renal syndrome, HCV and HDV (42).

Canadian regulations state that biohazardous waste must be put into packaging that is made from material appropriate for that specific type of waste and that is strong enough to hold up during handling, transportation and disposal so that it is leak-proof and prevents any spills or injuries (43). Sharp objects must be disposed of in puncture-resistant, hard-shell yellow biohazard containers with a lid that can be tightly secured. The containers must also be clearly labeled with a biohazard symbol. The container should not be filled more than three quarters to prevent injuries caused by overfilling. Any plastic bags used in waste disposal should be sturdy enough to prevent punctures under work conditions. They must also be color coded and labeled. Cardboard containers must be rigid, have a sealable lid and be leak resistant. Boxes must also labeled with the biohazard symbol.

Human anatomical waste is disposed of in red bags or containers. Human blood and body fluid waste is disposed of in yellow bags or containers. Contaminated linen and blood soiled rags must first be placed in to plastic bags and then in labeled yellow biohazard bags. Once waste is assembled and either stored or transported, it must be segregated by color coding (44).

Biohazardous waste that must be stored before disposal, must be placed in an enclosed room and separated from any other rooms. The room must be lockable and entry must be restricted to authorized personnel. A biohazard symbol must be displayed outside the room and no other type of waste can be stored there. The interior walls, ceiling and floors of the storage area must be properly cleaned once the waste is removed for disposal.

The person or company shipping biohazardous wastes is responsible for identifying, packaging and labeling all waste as well as completing a transport manifest according to EPA (USA) or to Transportation of Dangerous Goods Regulation and / or provincial regulation and standards (Canada). A biohazardous waste manifest must be completed and given to the carrier along with the appropriate plates or placards. A copy of the manifest must be sent to the appropriate authorities. The manifest must contain the following information:

• The name or identification number of the generator;

• The number of pages;

• An emergency response phone number;

• A tracking number;

• The address and phone number of the generator as well as the site address;

• The transporter company name and other ID number;

• The name and address of the facility that will receive the waste;

• Shipping name, the hazard class or division;

• The type and number of containers;

• The weight and volume;

• Handling instructions and any additional information;

• Shipper certification (45)

Records of biohazardous waste must be kept for a period of five years. The records must list the waste categories, the quantity, the storage site and any comments or observations (46). Biohazardous waste, once transported to its final disposal site, can be steam autoclaved, chemically decontaminated or disposed with new technology such as irradiation using Gamma irradiation (60 Co), Microwave and Ultraviolet irradiation (47, 48 and 49).

Drivers of biohazardous waste vehicles must be trained in its operation and maintenance, loading, unloading and cleaning procedures as well as being knowledgeable about the legislations that governs the transportation of biohazardous waste.

Conclusions

In the past, cleaning up crime scenes were not regulated, today it is a different story. In view of the above requirements, I would not recommend that untrained people be involved even if it is a family member; simple washing and disinfecting of soiled items does not provide protection from exposure to health, safety and environmental risks.

The emergence of specialized Crime Scene Cleanup companies is, in my opinion, welcome. These companies know how to handle a crime scene. Through proper training, the use of regulated, written Exposure Control Plans, the use of appropriate PPEs and the proper disposal of biohazardous waste, these companies know how to mitigate environmental risks. They are trained in the proper way to clean crime scene sites so that other people do not inherit someone else’s issues.

Rosemary Stephen (2009). CSI : Crime Scene Inspection Elements: Environmental Health Intelligence

References:

(1) Frequently Asked Questions (2009) Infection Control Specialist, Crime and Trauma Scene Cleaners. (On-line) Available: http://crimescenecleaners.ca/faq.htm. Cited 2009 Apr 20.

(2) Baldwin, H.B. M/ Sgt Retired. Bio-hazardous waste: a Crime Scene Perspective (2009) Illinios State Police. (On-line) Available; http://www.feinc.net/biowaste.htm. Cited 2009 Apr 07.

(3) Layton, J. How Crime-scene Clean-up Works(2009) howstuffworks. (On-line) Available:http://science.howstuffworks.com/crime-scene-clean-up1.htm. Cited 2009 Apr 07.

(4) Layton, J. How Crime-scene Clean-up Works(2009) howstuffworks. (On-line) Available:http://science.howstuffworks.com/crime-scene-clean-up1.htm. Cited 2009 Apr 07.

(5) Baldwin, H.B. M/ Sgt Retired. Bio-hazardous waste: a Crime Scene Perspective (2009) Illinios State Police. (On-line) Available; http://www.feinc.net/biowaste.htm. Cited 2009 Apr 07.

(6)) American Regulations (2006) A Team Master’s scene (On-line) Available : http://www.ateammasters.com/regs.html. Cited 2009 Apr 16

(7) Layton, J. How Crime-scene Clean-up Works(2009) howstuffworks. (On-line) Available:http://science.howstuffworks.com/crime-scene-clean-up1.htm. Cited 2009 Apr 07.

(8) Risk Classification Criteria for World Health Organization, Australia, Canada, European Union (EU), USA CDC/NIH and NIH for RDNA, Risk Group Classification for Infectious Agents. (2009)

American Biological Safety Association. (On-line) Available: http://www.absa.org/riskgroups/index.html. Cited 2009 Apr 30.

(9) Heymann, D.L. (2004) Hepatitis, Control of Communicable Diseases Manual. Washington: American Public Health Association.

(8) Model Plans and Programs for the OSHA, Bloodborne Pathogens and Hazard Communications Standards (2003) Occupational Safety and Health Administration. (On-line) Available: http://www.osha.gov/Publications/osha3186.pdf. Cited 2009 Apr 15.

(9) Model Plans and Programs for the OSHA, Bloodborne Pathogens and Hazard Communications Standards (2003) Occupational Safety and Health Administration. (On-line) Available: http://www.osha.gov/Publications/osha3186.pdf. Cited 2009 Apr 15.

(10) Viruses Search Results, Risk Group Classification for Infectious Agents (2009) American Biological Safety Association. (On-line) Available: http://www.absa.org/riskgroups/virusessearch.php?viralgroup=Hepadnaviridae. Cited 2009 Apr 30.

(12) CPR Section 64 Division 3: Biohazardous Infectious Material (Class D) (2007) Environmental and Workplace Health, Health Canada. (On-line) Available: http://www.hc-sc.gc.ca/ewh-semt/pubs/occup-travail/ref_man/cpr-rpc_64-eng.php. Cited 2009 Apr 14.

(13) WHO Risk Group, Hazard-specific Issues: Biohazards (2008) Environmental and Workplace Health, Health Canada. (On-line) Available:

http://www.hc-sc.gc.ca/ewh-semt/occup-travail/whmis-simdut/biohazards-matieres_infectieuses-eng.php. Cited 2009 Apr 23.

(14) Crime and Trauma Scene Safety for Apartment Managers (2009) Amdecon (On-line) Available: http://www.amdecon.com/aptmanagers.html. Cited 2009 Apr 14.

(15) Heymann, D. L. Hantavirous Pulmonary Syndrome (2004) 18^th Edition, Control of Communicable Diseases Manual, American Public Health Association.

(16) Crime and Trauma, Janitorial, Remediation, Restoration (2009) Information Services, Alert Worldwide, LLC (On-line) Available: http://www.cleanupdirectory.com./. Cited 2009 Apr 14.

(17) Guide on respiratory protection against bioaerosols Recommendations on its selection and use (2007) Studies and Research Projects, Technical Guide RG-501, Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST) (On-line) Available: http://www.irsst.qc.ca/files/documents/PubIRSST/RG-501.pdf. Cited 2009 Apr 23.

(18) Recommended Adult Immunization Schedule — United States (2009) Quick Guide, MMWR Vol.57, No. 53 (On-line) Available:

http://www.cdc.gov/mmwr/PDF/wk/mm5753-Immunization.pdf. Cited 2009 Apr 24.

(19) Recommended Adult Immunization Schedule — United States (2009) Quick Guide, MMWR Vol.57, No. 53 (On-line) Available:

http://www.cdc.gov/mmwr/PDF/wk/mm5753-Immunization.pdf. Cited 2009 Apr 24.

(20) Hepatitis A to G (2008) New York Access to Health (On-line) Available: http://www.noah-health.org/en/kidver/liver/diseases/hepatitis/what/atog/. Cited 2009 Apr 24.

(21) Hepatitis E, (2009) World Health Organization (On-line) Available: http://www.who.int/mediacentre/factsheets/fs280/en/. Cited 2009 Apr 2.

(22) Dr. Hanson, Doug. Safety Issues at a Crime Scene, Don’t become a victim of a crime scene (2008) On the Street, Officer.com. (On-line) Available: http://www.officer.com/web/online/On-the-Street/Safety-Issues-at-a-Crime-Scene/21$41948. Cited 2009 Apr 24.

(23) Magyar, S. V. MBA, CSP. Confined Space Entry, Part 4 (2006) Occupational Health and Safety.(On-line) Available:http://www.ohsonline.com/Articles/2006/05/Confined-Space-Entry-Part-4.aspx?Page=. Cited 2009 Apr 24.

(24) Dr. Hanson, Doug. Safety Issues at a Crime Scene, Don’t become a victim of a crime scene (2008) On the Street, Officer.com. (On-line) Available: http://www.officer.com/web/online/On-the-Street/Safety-Issues-at-a-Crime-Scene/21$41948. Cited 2009 Apr 24.

(25) Confined Spaces, Definitions, Part 9 (2008) Occupational Health and Safety Directive, Treasury board of Canada Secretariat. (On-line) Available: http://www.tbs-sct.gc.ca/pubs_pol/hrpubs/tbm_119/oshd-dsst/oshd-dsst04-eng.asp. Cited Apr 30.

(26) Model Plans and Programs for the OSHA, Bloodborne Pathogens and Hazard Communications Standards (2003) Occupational Safety and Health Administration. (On-line) Available: http://www.osha.gov/Publications/osha3186.pdf. Cited 2009 Apr 15.

(27) Layton, J. How Crime-scene Clean-up Works(2009) howstuffworks. (On-line) Available:http://science.howstuffworks.com/crime-scene-clean-up1.htm. Cited 2009 Apr 07.

(28) Crime Scene Clean Up (2008) AussiePage. (On-line) Available:http://www.aussiepages.com.au/CRIME-SCENE-CLEAN-UP.html. Cited 2009 Apr 14.

(29) Cleaning Blood and / or Other Body Fluids Spills, Commissioner’s Guidelines (2007) Correctional Service Canada. (On-line) Available: http://www.csc-scc.gc.ca/text/plcy/cdshtm/821-3-gl-eng.shtml. Cited 2009 Apr 14.

(30) Part 2, Classification, (2008) Transport Canada (On-line) Available: http://www.tc.gc.ca/tdg/clear/part2.htm#sec226. Cited 2009 Apr 15.

(31) Part 5, Means of Containment (2008) Transport Canada (On-line) Available:http://www.tc.gc.ca/tdg/clear/part5.htm#sec516. Cited 2009 Apr 15.

(32) Sterilization or Disinfection of Medical Devices (2002) Department of Health and Human Services, Centers for Disease Control and Prevention. (On-line) Available: http://www.cdc.gov/ncidod/dhqp/bp_sterilization_medDevices.html. Cited 2009 Apr 20.

(33) Decontamination and Sterilization, Division of Occupational Health and Safety(2009) Office of Research Services (On-line) Available: http://dohs.ors.od.nih.gov/decontamination.htm. Cited 2009 Apr 20.

(34) Decontamination and Sterilization, Division of Occupational Health and Safety(2009) Office of Research Services (On-line) Available: http://dohs.ors.od.nih.gov/decontamination.htm. Cited 2009 Apr 20..

(35) Cleaning Blood and `or Other Body Fluids Spills, Commissioner’s Guidelines (2007) Correctional Service Canada. (On-line) Available: http://www.csc-scc.gc.ca/text/plcy/cdshtm/821-3-gl-eng.shtml. Cited 2009 Apr 14.

(36) Infection Control – Standard Precautions, Policy Number: PC.I50 (2009) Hope Hospice and Palliative Care Patient Care Policy and Procedure. (On-line) Available: hhospice.com/policies/infection_control_standard_precautions.doc. Cited 2009 May 19.

(37) Crime and Trauma Scene Safety for Apartment Managers (2009) Amdecon (On-line) Available: http://www.amdecon.com/aptmanagers.html. Cited 2009 Apr 20.

(38) Crime and Trauma Scene Safety for Apartment Managers (2009) Amdecon (On-line) Available: http://www.amdecon.com/aptmanagers.html. Cited 2009 Apr 20.

(39) Wilson, M.R. Rules for Hospital Waste Often Skip Over Crime Scene Cleanup Companies (2009) InfoZine Kansas City. (On-line) Available: http://www.infozine.com/news/stories/op/storiesView/sid/35400/. Cited 2009 Apr 23.

(40) Hazardous Waste Management, Environmental Guidelines (2003) Correctional Service Canada. (On

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By: Rosemary Stephen, Elements: Environmental Health Intelligence

Swine raising his a very touchy subject, especially these days. We tend to imagine worst case scenarios: too many animals per pen, odor and fly problems, a possible link to diseases and even public disagreement over the ethics of pig raising. In the web article called “Critics question self-inspections for flu in pigs”(http://www.google.com/hostednews/ap/article/ALeqM5hnnj7U0vgUZFv_KY46utcS-jdv7wD9804HG81), Chistopher Leonard presents very interesting information on pig farming and poses the question — should public health officials inspect farms or should the industry rely on self-inspection?

Before I could answer this question, I needed to be more versed in pig farming. I had a look at the US Industry Profile on Hogs (http://www.answers.com/topic/hogs-sic-0213) which supplies a good synopsis of what challenges the industry faces. After reading this article, in my opinion, self-inspection is definitely a start in the right direction for health protection, but the question is - should, or can, producers go further? I think this is possible.

Hog management programs already exist where HACCP principles have been adapted to hog raising. The Canadian Hog Producers have done just this and presented their program on the web (http://www.cqa-aqc.ca/home_e.cfm). The program has been recognized by the Canadian Food Inspection Agency (CFIA) and the technical content of their program has been reviewed and approved by government health experts. The beauty, too, of this web site is the list of excellent resources. I had a look at “Animal Care Assessment”. It addresses issues such has stockmanship, as well as care of animals and equipment.

If you are an inspector who may need to inspect hog farms but need more information on what to look for — the Canadian Hog Producers site is for you. If, on the other hand, farmers ask you for information about self inspection, this is also a good resource. I hope you enjoy the site.

###

References:

(1) Leonard, C. Critics question self-inspections for flu in pigs (2009) AP Associated Press (On-line) Available: http://www.google.com/hostednews/ap/article/ALeqM5hnnj7U0vgUZFv_KY46utcS-jdv7wD9804HG81. Cited 2009 May 06.

(2) US Industry Profile : Hogs (2009) Answers.com. (On-line) Available: http://www.answers.com/topic/hogs-sic-0213. Cited 2009 May 06.

(3) Food safety at work. (2209) CQA For Canadian Producers, Canadian Pork Council. (On-line) Available: http://www.cqa-aqc.ca/home_e.cfm .Cited 2009 May 08

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By: Rosemary Stephen, Elements: Environmental Health Intelligence

At the moment we are being inundated with information about the H1N1 flu - some of this information is valuable and informative while some of it is less so…

I came across three articles that are valuable, informative and worth reading. The first one is entitled “Germ Sleuths Stalk Origin of Killer Flu”(http://online.wsj.com/article/SB124113876438075685.html) written by By David Luhnow, Jose De Cordoba and Gautam Naik. These three authors have provided a time line of events since the beginning of the outbreak. I assumed that in the early stages of the outbreak the virus only affected people in Mexico, but I found that in late March, two children living in California became sick just before the two cases in Mexico. Through this article, I also became aware how quickly Mexico’s Health Minister reacted. This quick action has prevented thousands of people from contracting the disease and /or spreading it.

The second article called “Expert Says Farm Isn’t Flu Origin” written by Ana Campoy and Lauren Etter (http://online.wsj.com/article/SB124105320874371313.html) made me realize how quickly we tend to reach conclusions. I know I did. It is not, however, always the most obvious cause — in this case a pork-processing giant in the village of Perote — that is necessarily the culprit. It has not yet been confirmed that this mega farm is the source of the virus. At the moment, no one knows for sure where H1N1 originated….

The third article “Employers prepare for the worst” is written by Sarah Dobson (http://www.hrreporter.com/ArticleView.aspx?l=1&articleid=6854). Ms. Dobson presents three examples of companies, including Blake’s Law Firm, Scotiabank and L’Oréal, who have taken a pro-active role in creating a pandemic action plan for their employees. The last section of the article, Swine influenza: Advice for employers preparing for pandemic, was, to me, very informative. I would suggest that employers who are looking to create such a plan for their company read this section carefully. It gives very sound advice and a blue print from which to build a workable plan.

References:

(1) Luhnow, D. De Cordoba ,J.and Naik, G. Germ Sleuths Stalk Origin of Killer Flu Germ (2009) Health, The Wall Street Journal. (On-line) Available: http://online.wsj.com/article/SB124113876438075685.html. Cited 2009 May 04.

(2) Campoy, A. and Etter, L. Expert Says Farm Isn’t Flu Origin (2009) Health, The Wall Street Journal.(On-line) Available: http://online.wsj.com/article/SB124105320874371313.html. Cited 2009 May 04.

(3) Dobson, S. Employers prepare for the worst (2009) Canadian HRReporter, Thomson Reuters Canada Ltd. (On-line) Available: http://www.hrreporter.com/ArticleView.aspx?l=1&articleid=6854. Cited 2009 May 04.

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By Rosemary Stephen, Elements: Environmental Health Intelligence

I clearly remember a particular grade 7 Science class when our teacher did a lecture on mercury. He described this amazing silvery liquid as being “unwettable” meaning it did not bind to anything. He than gave us a demonstration of this peculiar property; he poured a small amount of mercury on a student’s desk and pushed it around with his finger. Yes indeed, the liquid did not leave any trace on the desk. Once the demonstration was complete, he pushed the mercury back into a small bottle which was also full of mercury.

Many years later, during my training as an inspector, I became aware of the negative health effects of mercury on humans. Students attending a course in aircraft engineering were becoming ill. The history of the building was the cause; the classroom was located in an old building that originally was used during WWII as an aircraft dial production shop. Investigation uncovered the presence of mercury bubbles in the spaces between floor tiles — the students were being affected by mercury vapours !

I assumed these types of situations no longer existed, but I was wrong. I was shocked when I came across a web article from Environmental Health News that describes similar stories. I recommend reading Special Report: Thousands of kids exposed to dangerous liquid mercury in schools, homes. Contamination can last years, and cleanups are costly written by Jessica A. Knoblauch (excerpt and link below). It really opened my eyes as to how easily our environment can become contaminated and in such unexpected ways.

####

Special Report:

Thousands of kids exposed to dangerous liquid mercury in schools, homes. Contamination can last years, and cleanups are costly

When children encounter long-forgotten stashes of liquid mercury, schools have to shut down for days or weeks and the toxic trail left in classrooms, buses, homes and communities costs hundreds of thousands of dollars to clean up. Found in many old science labs and used in some cultural ceremonies, mercury triggered more than 37,000 calls to U.S. poison control centers in a five-year period. One specialist found traces in 40% of schools tested.

By Jessica A. Knoblauch
Environmental Health News
May 5, 2009

One night in February, high school principal Matthew Smith got a frightening wake-up call.

The local fire department alerted him that the home of a student at Agua Fria High School was contaminated with liquid mercury that apparently had been taken from a science classroom. The next day, emergency crews descended on the school in haz-mat suits, discovering a toxic trail of mercury vapors in classrooms, locker rooms, and buses.

The high school, in Avondale, Ariz., was shut down for a week so it could be decontaminated. The homes of six students were tainted with mercury, two so severely that the families had to be relocated for 11 days, according to the Environmental Protection Agency. The total cleanup is expected to reach hundreds of thousands of dollars.

The mercury mess in Arizona was only the latest in thousands of incidents where children are exposed to elemental mercury, a poison that can damage the brain, trigger respiratory failure and cause other serious health problems.

Power plants are typically cast as the usual suspects of mercury contamination, since they emit mercury into the air, where it spreads globally. But many children are exposed to toxic levels of mercury much closer to home. Mercury spills inside schools and houses, often unreported, can release vapors into the air for weeks, even years.

Elemental mercury, or quicksilver, is a shiny, silvery liquid metal found in thermometers, thermostats, light bulbs, barometers and LCD screens. Though mercury inside these items poses little risk, once broken, they release mercury that vaporizes as an invisible, odorless gas.

Children are most frequently exposed to mercury when it is mishandled or improperly cleaned up after a spill. Broken thermometers, filled with tiny blobs of mercury, are the most common culprits.

From 2002 to 2006, more than 37,000 calls were made to U.S. poison control centers about children exposed to mercury. Of those, 30,891 concerned broken thermometers and 6,396 were caused by other sources, such as old science laboratories and religious or cultural ceremonies, according to a new report by the Agency for Toxic Substances and Disease Registry, part of the U.S. Centers for Disease Control and Prevention….

Read the full article by Jessica A. Knoblauch of Environmental Health News: http://www.environmentalhealthnews.org/ehs/news/mercury-in-schools-and-homes

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Via: Pan North America, Pesticide Action Network, http://www.panna.org/newsroom/20090422

Contact:
Medha Chandra, 650-283-4887
Karl Tupper, 415-981-1771

Washington DC - In a Capitol Hill briefing today marking the upcoming World Malaria Day (April 25th), experts called for increased U.S. support for safe and sustainable malaria control solutions.

“This preventable disease is devastating families around the world,” said moderator Dr. Andrea Kidd Taylor of the Morgan State University School of Community Health and Policy, and the American Public Health Association (APHA). “We are here to share good news from programs that are winning the battle against malaria with the safest tools available.”

The briefing, co-sponsored by Senator Edward Kennedy, APHA and other organizations, highlighted malaria control programs that have achieved strong results in Africa and Latin America. Experts from Kenya, Mexico and the United States emphasized the benefits of community-based approaches to malaria control, including use of bednets, environmental management and other integrated vector management techniques.

“Safer strategies that don’t involve spraying the inside of people’s homes with pesticides exist, and are already being used in communities throughout Africa to combat this terrible disease” said Dr. John Githure, Head of the Human Health Division at the International Center for Insect Physiology and Ecology (ICIPE) in Kenya.

Dr. Githure, who traveled to Washington DC for the briefing, presented examples of larval control and other effective biological vector control strategies to reduce the risk of malaria transmission by mosquitoes. According to research by ICIPE scientists, these measures are often more effective than “indoor residual spraying” with pesticides, and don’t pose any additional health risks.

Dr. Medha Chandra of Pesticide Action Network presented the findings of a gathering of African researchers and NGO experts from in Dar es Salaam, Tanzania earlier this month. A Declaration released by meeting participants expressed “serious concern” about the growing use of DDT for malaria control in Africa, despite a specific mandate from the global Stockholm Convention on Persistent Organic Pollutants to reduce reliance on DDT for malaria control and work toward its ultimate elimination.

“Our colleagues in Africa are calling for a significant shift of resources away from the spraying of pesticides like DDT inside people’s homes,” said Dr. Chandra. “We ask that members of Congress direct U.S. funds to support safe and sustainable malaria control efforts that are in line with public health goals of the Stockholm Convention.”

As a persistent pesticide, DDT is targeted for a global ban by the 163 governments that have ratified the Stockholm Convention because it is toxic, accumulates in the bodies of humans and other animals, and lasts for decades in the environment. The treaty allows short-term use of DDT for malaria control, and urges the international community to help countries battling malaria quickly find and adopt safer alternatives.

Other organizations sponsoring the briefing include Pesticide Action Network North America, Advocates for Environmental Human Rights and Beyond Pesticides.

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Resources
New Report - DDT and the Stockholm Convention: States on the Edge of Non-Compliance, Pesticide Action Network, Germany (see http://www.pan-germany.org/download/ddt/PAN_G_DDT_study_EN.pdf)
Dar es Salaam Declaration on Alternative Approaches to DDT Use for Vector Control (see spotlight box at http://www.panna.org/ddt)
Stockholm Convention official site: http://www.pops.int

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Via: Eureka Alert, http://www.eurekalert.org/pub_releases/2009-04/ncsu-nss041709.php

Contact: Dr. Rich McLaughlin
rich_mclaughlin@ncsu.edu
919-515-7306
North Carolina State University

Researchers at North Carolina State University have found an exponentially better way to protect streams and lakes from the muddy runoff associated with stormwater around road and other construction projects.

The alternative is lower or comparable in cost to commonly used best management practices (BMPs) around construction sites, yet much more effective at keeping streams and lakes free of runoff sediment that pollutes water and harms aquatic life.

In a study comparing BMPs against alternatives on road stormwater runoff in western North Carolina, the NC State researchers found the alternative method kept local streams that received the runoff cleaner, and helped reduce the amount of sediment loss inside ditches near roads. Sediment and muddy water are among the most common pollutants of streams and lakes.

Dr. Rich McLaughlin, associate professor of soil science at NC State and one of the researchers involved in the project, says that the current BMPs used in controlling erosion and sediment involve using so-called “sediment traps” along with rock check dams in ditches. Sediment traps collect water with the heavier sediment - like dirt and other larger, heavier particles - settling to the bottom and the “cleansed” water moving through rock check dams, or piles of rock that are intended to slow the flow of water through the ditch. Water then travels out of the ditch through a pipe to streams, rivers or lakes.

In the study, McLaughlin and NC State colleagues Scott King, extension associate in soil science, and Dr. Greg Jennings, professor and extension specialist in biological and agricultural engineering, found that the BMPs don’t hold a candle to the alternative - natural fiber check dams (FCDs) enhanced with polyacrylamide (PAM), a chemical that causes sediment to clump together. FCDs use natural fibers instead of rocks as a type of dam to slow the flow of water in ditches.

The researchers found, in a measure of the “muddiness” of road runoff, that the BMPs yielded 3,813 nephelometric turbidity units (NTUs) in testing, equating to some rather muddy water, McLaughlin says. Fiber check dams with PAM yielded averages of 34 NTUs, a veritable drink of Perrier in comparison, McLaughlin adds.

Further, the study showed that after a storm, sites that used standard BMPs lost an average of 944 pounds of sediment compared with only 1.8 pounds of sediment lost at sites utilizing FCDs with PAM.

McLaughlin says that these results are so convincing that North Carolina’s Department of Transportation is in the process of making FCDs with PAM the new best management practice around road and construction sites. McLaughlin’s group is also training engineers and installers around the state and nationally in the use of this system.

A paper showing the study results appears in the March/April edition of the Journal of Soil and Water Conservation.

###

Note: An abstract of the paper follows.

“Improving construction site runoff quality with fiber check dams and polyacrylamide”

Authors: Richard A. McLaughlin, Scott E. King and Greg D. Jennings, North Carolina State University

Published: March/April 2009 edition of the Journal of Soil and Water Conservation

Abstract: Sediment and turbidity are among the most common pollutants affecting surface waters, resulting in reduced reservoir capacity, degradation of aquatic organism habitat, and decreased aesthetic value. Construction activities, including roadway projects, can be significant contributors to sediment loading in streams and lakes. We studied water quality in stormwater runoff from three systems for erosion and sediment control on two roadway projects in the North Carolina mountains. The first roadway project was divided into three experimental sections, each with one the following treatments installed in the adjacent drainage ditch: (1) the standard best management practice (BMP) consisting of narrow sediment traps in the ditch along with rock check dams, (2) fiber check dams (FCDs) consisting of a mix of straw wattles and coir logs, or (3) FCDs with granulated, anionic polyacrylamide (PAM) added to each. The second project was smaller and included only two of the experimental sections described above: (1) the standard BMPs and (2) FCDs with PAM. Significant reductions in turbidity and total suspended solids were obtained using the FCDs, particularly those with PAM added. At site 1, from June 2006 to March 2007, the average turbidity values for the stormwater runoff were 3,813 nephelometric turbidity units (NTU) for the standard BMPs, 202 NTU for the FCDs-only, and 34 NTU for the FCDs with PAM. Average turbidity in discharges at site 2 was reduced from 867 NTU for the standard BMPs to 115 NTU for the FCDs with PAM. Sediment loading at both sites was similarly reduced with the use of FCDs. At site 1, the standard BMPs lost an average of 428 kg (944 lb) of sediment per storm event compared to just 2.1 kg (4.6 lb) for the FCDs-only and 0.9 kg (2.0 lb) for the FCDs with PAM. At site 2, the standard BMPs lost an average of 3.3 kg (7.3 lb) per storm event compared with 0.8 kg (1.8 lb) for the FCDs with PAM. A conservative economic analysis suggests that the costs of the FCDs are lower than the standard BMPs. This study suggests that the use of FCDs with PAM can bring discharges from similar linear construction projects much closer to the regulatory guidelines for non-point source discharges than the current standard practices.

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By: Rosemary Stephen

I am amazed at how many countries are affected by groundwater contamination from Trichloroethylene C2HCl3 (TCE). This chemical is used worldwide as a solvent, and its foot print is felt in occupational and non-occupational settings alike. Recently, two cases of non-occupational exposure to Trichloroethylene caught my attention; one in Canada and one in the United States. Though published via two different media — television and web newspaper - each covered stories about people who were exposed to TCE by means of contaminated groundwater.

The first report was broadcast on 29 January 2009 during Enquète, a weekly show on the CBC French TV channel in Canada. This documentary discussed ‘Shannon’, a small town in Québec, Canada. Residents of Shannon pump their water from private wells located on their own properties as the municipality does not have a public water system. They share the same aquifer as CFB Valcartier, a Canadian Forces Military Base. In 2000, the residents of the small town became aware that the water they were drinking was contaminated with TCE. Currently, within the population of Shannon, there is a high incidence of cancers — colon, prostate, kidney, brain and skin - possibly linked to this TCE exposure [1].

The second case was published in Cascade Connection web site on 28 Jan 2009 (http://connectionnewspapers.com/). This case involves TCE groundwater contamination in Sterling, Loudoun County Health Department Virginia USA. This was traced to an abandoned landfill; TCE migrated from the landfill to residential wells within a 1 mile (1.61km) radius. There was also a strong possibility that TCE vapours may have penetrated homes through cracks in basements or in crawl spaces. Currently, within the population of Sterling, information on any possible link between cancer and TCE exposure is lacking due to the very small number of people exposed and the strong possibility that other contaminants may also be present in the ground water [2].”

Case Study: Shannon, Province of Québec, Canada

Prior to 1980, SNC Lavalin, CFB Valcartier R&D and the Military Research Centre used TCE extensively. When the TCE lost its effectiveness through repeated use and could no longer be used as a degreaser, it was dumped into open, man-made lagoons to allow the TCE to evaporate (e.g. Lagoon C and Sector 214) [3]. Over time, TCE seeped from the lagoons, percolating through the sandy, porous soil of the area and contaminated the aquifer [4]. In 1997, base officials became aware that TCE had contaminated the aquifer serving the base and had migrated, contaminating private wells used by the community of Shannon [5]. Residents from Shannon, however, only became aware of the contamination in 2000, after water samples from one private well identified the presence of a chemical (TCE) registering 200 times above accepted safe levels [6]. Québec Public Health officials immediately took emergency measures; they told the residents to drink only bottled water and to shower with their windows open. In 2002, the Military also responded to the problem by drilling another well, but this new well only serviced about one third of Shannon’s homes. The residents, however, were outraged at the contamination and no longer trusted the base; they wanted an independent water source that was not connected to the base [7, 8].

In 2002, CFB Valcartier connected Shannon to a new, closely monitored well located on base property. Unfortunatly, it only served a third of the population of Shannon. In 2004, the town of Shannon successfully sued the Canadian Government and the Department of National Defense and received $19 million settlement. The residents, still distrustful of the Military, decided to use this money to find an independent water source not under military control. So far, Shannon has not been successful as exploratory wells failed to find a source of potable water that met the Canadian Water Standards. Very recently, however, (March 26 2009), the Canadian Government announced the provision of more than 13 million dollars to complete a water supply system for the municipality [9].

It is not known if any of the military personnel stationed on the Base prior to 1997 suffer from increased rates of cancers, but residents of Shannon who once lived, and who are currently living in 55 homes located within the most contaminated area — the ” Red Triangle”– suffer from a high incidence of cancer [10]. Residents named TCE as the cause of their high cancer rates, and they want compensation; a group of them have launched a class-action lawsuit against the Canadian government as well as against a subsidiary of SNC-Lavalin Group Inc. that owned the property where the TCE was used in an ammunition factory.

Case Study: Sterling, Loudoun County, Virginia, USA

In Sterling, the source TCE contamination was traced to an abandoned landfill called Hidden Lane. This landfill was in operation from 1971 through 1984 when it was then closed by the county of Loudoun for multiple violations of the zoning ordinance. In March 2008, Hidden Lane was designated a ‘Superfund site’ and put on the National Priorities list. Under the Comprehensive Environmental Response, Compensation, and Liabilities Act of 1980, a site becomes eligible for ‘Superfund’ when abandoned hazardous wastes represent a potential health risk to human population.

In 1988, Loudoun County Department of Health and the EPA started studies on the land fill, testing for hazardous substances. In three residential wells located close to the landfill, they found traces of TCE, its biodegradation products (see below for a list) and pesticides. In 2005, Loudoun County Health Department carried out testing on 68 more wells in the area of the landfill. Forty-five wells tested positive for TCE; 17 of these wells contained concentrations of TCE above the maximum contaminant level (MCL) of 5 micrograms per liter (mcg/L) while 28 other wells contained TCE, but below the MCL. Three years ago, the Agency for Toxic Substances and Disease Registry (ATSDR) visited the site and recommended that a proper filtration system be installed in homes which had contaminated wells. They selected carbon filters because they have the ability to separate TCE from water. These were installed by the Virginia Department of Environmental Quality (DEQ) and are maintained semiannually to ensure they function properly [11].

There is, however, also a possibility that vapor may seep into homes when the levels of volotile organic compounds (VOCs) are high in groundwater. Evaporation may take place through the soil above the water table or when the groundwater itself is in close proximity to the surface. There is, hence, no guarantee that homes in the vicinity of the contaminated site are still in good condition; TCE vapor may be entering the homes through cracks in the basement or through crawl spaces. This vapor can accumulate in living quarters; it will reach concentration levels above the 1.0 micrograms per cubic metre, the maximum for vapor concentration indoors set by EPA, unless windows are open [12]. Since the Hidden Valley landfill is now part of the Superfund List, the ATSDR felt that a well-defined health risks assessment was required to determine if vapor intrusion was indeed present inside 26 homes located closed to the landfill area. If this was the case, the ATSDR would request that the EPA take appropriate action through remediation [13]. This can be achieved by installing an abatement system similar to that for radon affected homes, which creates a negative pressure beneath the building slab and exhausts the TCE vapours to the outside [14].

The County Health Department has not confirmed if any residents have been affected directly by water contaminated with TCE, but because filtration systems were installed three years ago, the County Health department did not pursue medical testing [15].

What is Trichloroethylene?

Trichloroethylene is a man made, liquid chemical that is nonflammable, colorless with a sweet odor, belonging to the family of chlorinated volatile organic compounds (VOCs). It is widely used as an industrial solvent in military, commercial, and industrial applications. TCE is present in consumer products such as spot and paint remover, adhesives, type writer correction fluid and rug cleaning fluids [16] and it has been identified as a groundwater contaminant coming from numerous hazardous waste dumps and industrial sites [17]. It is among the most frequently detected organic contaminants in groundwater at waste sites in the USA, Japan, Canada, Europe and Australia [18].

According to the World Health Organisation (WHO), TCE is also present in the air we breath. In 2000, concentrations of TCE measured in urban areas worldwide showed background levels between <17 and 109 ng/m3 (actual guidelines recommend 5 ng/m3) [19]. In rural areas, levels between 0.10 and 0.68 μg/m3 have been reported [20]. Basically, we all inhale a certain amount of TCE and there is little we can do to avoid it. Peter Montague [21] says it very well when he wrote ” we industrial humans have managed to spread TCE everywhere”

The International Agency for Research on Cancer (IARC) considers Trichloroethylene a Group 2A carcinogen meaning that it has the potential of causing cancer in humans [22].

How humans are exposed to TCE

Activities such as drinking water (ingestion), swimming (ingestion and dermal absorption), showering (inhalation and dermal absorption) and handling contaminated soil (dermal absorption) are cited as the most frequent sources of exposure in non-occupational settings. In a domestic setting, long, hot showers allows TCE to volatilize from the hot water into the air. TCE will then accumulate and circulate easily inside the home especially if the home is well insulated [23]. In foods, TCE is believed to come from contaminated water used in food processing or from food processing equipment cleaned with TCE. In occupational settings, workers are exposed to TCE either through metal degreasing or via Tetrachloroethylene (PCE) or perchloroethylene (Perc) when working in a dry cleaning facilities.

How TCE behaves in the environment

In the past, no one considered the consequences of dumping TCE into the environment. No regulations existed prior to 1989 in the United States and prior to 1995 in Canada [24] to control dumping and use. Trichloroethylene does not affect the ozone layer, is not directly responsible for acid rain [25], and there is also no current data to suggest TCE affects the climate [26] but in 2001, the World Health Organization recognized the large distribution of TCE in surface water, rainwater and wells (bore water) [27].
In the atmosphere, the estimated half-life for trichloroethylene depends upon latitude, season and the concentration of photochemically produced hydroxyl radicals. These hydroxyl radicals will break down TCE into phosgene, dichloroacetyl chloride, formyl chloride and other degradation products in 6 to 40 days. Eventually, these sub-products create hydrochloric acid, a component of acid rain [28, 29, 30]. In Canada, the TCE atmospheric half-life during summer months ranges from 1 day in the south to 3 days in the north In winter, this reaction can extend to approximately 2 1/2 weeks in the south, to several months in the far north. TCE can move short to medium distances in the atmosphere depending on the wind speed and cloud cover [31]. In surface water the TCE half-life may take days to weeks to break down. It takes 11 days for TCE to volatize from a pond, 4-12 days to volatize from a lake and 1-12 days to volatize from a river. Particles of TCE may be found in bottom sediments in standing water if the organic content of the sediment is high.

How TCE contaminates groundwater

A large part of Trichloroethylene will volatilize in the air, but a small quantity will break down in the soil. TCE has the particularity of percolating unaltered into underground water and, being heavier than water, will sink below the groundwater strata. This behavior creates pools of contaminant which will be released over time. When released, TCE will eventually dissolve and spread as a plume, initially narrow and concentrated at its origin then spreading out further away from the source of contamination and decreasing in concentration. As it spreads in water, TCE will slowly evaporate. Through the activity of anaerobic bacteria, biodegradation will break down TCE into three sub products: 1,1,1-tricholorethane (DCA), 1,2-dichloroethene.(DCE), and vinyl chloride (VC) [32, 33].VC is considered to be more toxic than TCE and it should be investigated whenever TCE is present. Biodegradation will occur in an half life of months to years [34].

TCE will be present as a groundwater contaminant for decades unless adequate remediation is done [35]. The size of the contamination plume can be quite extensive, spreading under buildings and surface water. In 2001, the Shannon TCE plume was estimated between 4.5 to 5 km long (2.8 to 3.10 miles) by 650 m wide (0.40 miles) This plume is now beneath the town and and will eventually reach the Jacques-Cartier River [36, 37] at a migration velocity ranging between 13m to 68m per year (43 ft to 223 ft) [38]. The Sterling plume is smaller, measuring a mile long (1.6 km) and half a mile (804 m) wide. In 2007, geological reports indicated that the plume was moving toward the Potomac River [39].

How TCE behaves inside the body

Both the ATSDR and the International Agency for Research on Cancer (IARC) have labeled TCE as a probable human carcinogen based on epidemiological studies done on mice and rats. Under the International Union of Pure and Applied Chemistry (IUPAC), TCE is classified as a Group B agent because of proven evidence of carcinogenicity in experimental animals [40]. In Europe, the European Union Commission Expert Groups classified TCE as a human carcinogen in 2001 [41].

When inhaled, between one-third and two-thirds of TCE is rapidly absorbed into the lungs. The rest is exhaled. In the case of dermal contact, TCE removes fat from the skin thus increasing its own absorption. Once in the blood, TCE will be distributed to most tissues, but it metabolizes in the liver where it is broken down further and will eventually be excreted in the urine within a day [42]. Small quantities may be stored in body fat for a brief period. Chronic exposure allows TCE to build up in the body. Two medical tests can detect the presence of TCE in humans: a breath sample taken soon after exposure, and a blood or a urine sample taken after larger exposure. A study done by toxicologist Dr. Forkert indicated that in mice and in humans, TCE and its by products are metabolized in the human reproductive tract, and can adversely affect the normal development of sperm [43]. This could mean that a sperm test could also be used as another option in detecting TCE in the body.

In 2001, the EPA produced a draft risk assessment based on the most up-to-date informations, which explains that TCE may induce neurotoxicity, immunotoxicity and developmental toxicity (TCE crosses the placenta in animals and humans and can accumulate in the fetus) [44]. The Agency for Toxic Substances and Disease Registry (ATSDR) agrees with EPA and states that long term exposure to small amounts of TCE in water may “cause liver and kidney damage, impaired immune system function, and impaired fetal development in pregnant women” [45]. The EPA concluded that TCE “posed a more significant human health risk than previous studies had indicated”[46]. The EPA has also “considered the potential for cumulative exposure to not only TCE, but also to its metabolites DCA and/or TCA, and VC regardless of their source” [47].

Chronic (long-term) exposure to TCE induces: nausea, intolerance to fatty foods, respiratory irritation, renal (kidney) toxicity, and immune system depression. If alcohol is consumed, TCE’s toxic effects in the body will increase [48]. Cases of ‘degreaser’s flush’ (transient redness and itching of the back, neck, and face) have been reported after the ingestion of alcohol [49].

Dr. Claude Juneau stated that there are at the moment, 240 cases of various cancers in Shannon, 12 of which are brain cancers [50]. This is important because brain cancer is not on the list of the usual cancers related to TCE exposure. Brain cancers, however, are known to occur when people are exposed to vinyl chloride which, according to the EPA (2000), is a known human carcinigen [51, 52]; VC is one of the sub-products of TCE. Most of these cancer cases are within an area called the “Red Triangle” which was mentioned earlier [53]. The number of cancers within the population may increase as more past and present residents from Shannon and from the Base are diagnosed with cancer.

What epidemiological studies say about TCE

Numerous occupational and non-occupational studies have been done on TCE and its effect on humans; the results are not definitive.

One study carried out by the Agency for Toxic Substances and Disease Registry (ATSDR) compiled data on 4,280 residents from Michigan, Illinois and Indiana. Here the results found no evidence to link increased cancer rates to TCE exposure [54].

Another ATSDR study looked at participants who had been exposed to TCE concentration in drinking water between 2ppm to 19.380 ppm for18 years (the WHO recommends no more than 5 ppb). The results here indicated an increase in health complaints in people who were exposed to higher TCE concentrations with an increase in the rate of strokes. Still, no clear cause and effect could be established between the TCE and health issues [55].

Other studies carried out by the National Toxicology Program on animals noted that tumors in the lungs, liver and testes were present in rats and mice exposed to massive doses of TCE. In the rodents, however, problems developed when they were exposed to much higher levels of TCE than encountered by human populations.

Epidemiological studies have looked at specific characteristics which define cancer clusters in different locations affected by TCE groundwater contamination. For a cancer cluster to be considered, it must show characteristics which take in consideration the occurrence of a greater than expected number of cases of a particular disease within a group of people, the geographic area, or the period of time. There are four characteristics inherent to cancer cluster that we do not see in Shannon. They are: 1) a large number of cases of one type of cancer; in Shannon there are numerous types of cancer, 2) a rare type of cancer rather than common types, 3) an increased number of cases of a certain type of cancer in an age group that is not usually affected by that type of cancer, e.g. in children and 4) unmetastatized primary cancer cases [56]. According to these defining characteristics, the residents of Shannon do not have a cancer cluster within their population.

As for the residents of Sterling, no information on cancer rates are available at this time. ATSDR has opted not to perform a review of health outcome, because of the relatively short period of time from the discovery of the contamination and the installation of carbon filters. Other reasons, which are similar to Shannon’s are the small number of people being exposed makes it impossible to detect statistical differences in cancer rates [57].

Establishing cause and effect between TCE and cancers

Researchers are aware that, when looking at TCE , people are exposed to a complex mixture of metabolites. This, coupled with other environmental pollutants, may enhance carcinogenicity by creating a synergistic effect. Now, where do we turn to prove that people from Shannon and Sterling as well as others in the world, who are in the same situation, suffer from TCE induced cancers?

Well we could use the ATSDR highest cancer slope factor of 0.02 to 0.4 mg/kg/day, which is the risk associated with a unit dose of a carcinogen. In the Public Health Assessment for Hidden Lane Landfill, ATSDR is quite specific. They state that “Lifetime excess cancer risk is estimated by assuming the maximum daily adult dose (a person weighing 70 kilograms drinking 2 liters of water containing TCE at the maximum concentration) continues for a 70-year lifetime. (The potential exposure is also doubled to account for inhalation and dermal exposures associated with use of the well water.) Using an oral cancer slope factor of 0.4 (mg/kg/day)-1, the predicted increased risk of cancer would be moderate to high” [58]. This cancer slope factor would require public health departments to follow exposed people for a long period of time, so do we have any other more precise means to prove that TCE induces cancer in chronic exposure? Well we might…..

A coalition of Shannon residents have decided they can prove, via a new approach, that TCE is responsible for the different cancers found in their population. They will present this evidence in an upcoming lawsuit scheduled for this fall. According to Dr. Sidney Finkelstein who works for RedPath Integrated Pathology in Pittsburgh, the results of molecular toxicology done on cancerous tissue samples from victims is showing promising results. TCE has a specific signature in the form of an identical genetic mutation on chromosome 3.

People who have been exposed to TCE for an unknown period of time may show characteristic changes on this chromosome. This causes mutations which are forerunners to tumor formation and eventually to cancer [59]. It must, however, first be proven that TCE induces DNA or chromosomal damage to cells and their daughters before this specific signature can be accepted. If this new technique is shown to prove the mutagenic mode of action of TCE, and that human tumors are a result of exposure, this will be very exciting to the research community. I sincerely hope that this “new approach” will work and will pave the way for new brands of studies.

Is it possible to decontaminate groundwater affected by TCE?

Yes. In the past, contaminated soils were incinerated and groundwater was pumped through carbon adsorption/absorption filters. Decontamination processes have evolved into Bioremediation, where microbes such as methanotropic bacteria are used to break down TCE within groundwater [60] and Phytoremediation which uses plants.These two have gained attention as relatively inexpensive methods of TCE break down or removal. Trees such as hybrid poplars (Populus trichocarpa x Populus) and Eastern cottonwoods (Populus deltoides) planted over contaminated soils and groundwaters, are showing signs of being very effective. They are both fast growing and can uptake TCE in their roots. These trees are also aethetically pleasing giving a contaminated site, especially in an urban area, a park-like look. Trees root systems, however, cannot grow deeper than 10m and thus are only suitable for shallow aquifers [61].

Other decontamination methods include using products such as molasses, whey, vegetable oil, fertilizer and calcium peroxide. Molasses or whey can be applied directly to the soil or molasses and vegetable oil can be injected into the aquefer. The electron exchange between donors and receptors encourages bacteria to feed on contaminated soils and groundwater [62]. This ‘feeding frenzy’ is said to render TCE less toxic and potentiolly harmless.

Conclusion

TCE is a world-wide contaminant. TCE, being tasteless, cannot be detected by physically drinking water. The only way to detect TCE is through well water analysis. TCE also degrades over time producing by-products, such as vinyl chloride, that may have more cancer causing potential than just TCE. TCE can be detected in the blood and urine soon after exposure, but when people are exposed to TCE repeatedly, it will accumulate in body fat. We also learned, however, that numerous epidemiological studies have been carried out on the potential effects of TCE, but they estabalished no specific link between cause and effects. Rats and mice show adverse health effects when exposed to TCE, but only when they are subjected to greatly higher dosages than human populations ever find.

In the United States and in Canada, people have been exposed by ingestion, inhalation and or dermal contact. The residents of Shannon and Sterling were exposed specifically via ingestion and inhalation. Although we do not know exactly how long residents of Shannon have been drinking contaminated water, we know that in Sterling, residents were exposed from 1971 until three years ago when carbon filtration systems were installed. We now know that in Shannon at least 240 residents were diagnosed with cancer and the residents blame TCE. Here, however, the cancers do not meet the characteristics of cancer clusters. In Sterling, because carbon filtration was installed on affected wells, no health follow-ups were deemed necessary.

There is a possibility that, thanks to molecular toxicology, specific chromosome signatures in cancerous tissues may identify the culprit agent, similar to TCE’s specific signature on chromosome 3. If chromosomal signatures can be identified, conclusions as to cause and effect could potentially be reached more quickly.

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Rosemary Stephen (2009). Trichloroethylene (TCE) Water Contamination Elements: Environmental Health Intelligence; http://elements.healthspace.com/

References:

[1] Gendron, C., Cancers à Shannon: une histoire d’eau (2009) Enquète, Radio-Canada.ca. (On-line) Available:http://www.radio-canada.ca/emissions/enquete/2008-2009/reportages.asp. Cited 2009 Jan 29.

[2] Potential Impact of TCE Exposure, Hidden Lane Landfill Sterling, Loudoun County, Virginia (2009) Public Health Assessment Agency for Toxic Substances and disease Registry. (on-line) Available:http://www.atsdr.cdc.gov/HAC/pha/HiddenLaneLandfill/HiddenLaneLandfillPublicHealthAssessment(PublicComment)1-12-09.pdf. Cited 2009 Mar 09.

[3] Montpetit, J. Toxic water haunts Quebec town (2008) Canadian Press, theStar.com. (On-line) Available:http://www.thestar.com/News/Canada/article/350399. Cited 2009Mar 18.

[4] The Education of Shannon (2007) The Fifth Estate, CBC News. (On-line) Available:http://www.cbc.ca/fifth/educationofshannon.html. Cited 2009 Mar 17.

[5] Potential Impact of TCE Exposure, Hidden Lane Landfill Sterling, Loudoun County, Virginia (2009) Public Health Assessment Agency for Toxic Substances and disease Registry. (on-line) Available:http://www.atsdr.cdc.gov/HAC/pha/HiddenLaneLandfill/HiddenLaneLandfillPublicHealthAssessment(PublicComment)1-12-09.pdf. Cited 2009 Mar 09.

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