Document ExR33kRLnpRv9zz0VdzGy54n0

FILENAME: Flintkote (FLK) DATE: 1971 DOC#: FLK061 DOCUMENT DESCRIPTION: Journal Article - Floor Tile Installation as a Source of Asbestos Exposure - American Review of Respiratory Diseases ft* OCO'3& t u Case Reports Car li i ol . Volf ami Floor Tile Installation as a Source of Asbestos Exposure' * ii I <1(01 * an .1 S' RAYMOND L MURPHY, BARRY W. LEVINE, FAIQ J. A L BAZZAZ,* Jl JOHN J. LYNCH, and WILLIAM A. BURGESS PLAINTIFF'S K '", EXHIBIT mIoo1 ill . r ami tal. In o |,.v. hell. SUM M ARY________________________________________________________ ____________ Asphalt or Tinyl-aslx-tto flour tile contain fifteen to twcntv-live |wr em t aUwvi.*, tiot the numotal A lim arc firmly embedded in ilw binding mati-iial. Inw albtion nf tin-,- tile m ild, theicforc. seem to be an unlikely Hirer of a hatardnuv d in t o ;]omm t a w trpoit of io n imiallci <A Hour tile, one with lMojvptov<sl mcvmhrlioma am! antHhet with r\im tvi. ph-tnal c a ln lu 31M*m are presented. Both wanker* hail frrapim tly u n d i d aplvali and vinyl tile H n o prior to im talbtion of new floot covTring. An investigation of the work p e m r irvcaled tliat iiimIit im ubicd umdition* of woik. asbestm dust otnccntrationv a* Urge at I J fiber* per mi weie (mind in aii ample* pawed through membrane filtrrt w orn hy a jvrsn m gac'al in vamliug im l a>Jvio. (.haraiterfrtic asix-Mtv filicrt w-etc vn in dev Iron photnmii ingraph. id lliive ample 1 hew (Hiding sug gest tiiat txdoir tin- tile u n d in e p rousluie i )vi formed ad.tpiate tiv p iiato n proteciion hould be provided nr altem atc, available iiiu a lb iin n method hmitd he nnl. ag... I l. 0(11 1 W.( I d o n i A jug (Ills 1 - I ( |.|.t< I ' elm ( ( II .id ". I M I i. Introduction Atpitalt or vinyl-adiesins floor tile contains 15 to 25 per erttt atlsestov. however, the mineral fillers are firmly emlntliletl in the binding material (1). Installation of these tiles would, lliCTriorv. aeent to be an unlike ly source of hazardous dust exposure. Re cently the writers studied two itistallers of (Kerrnrrt for pnbbrafmtt S'nrrmliri i t , J97<i) floor tile, one with liio|i*y-pimrd mesotheli oma and the oilier with e\trwivc pleural calriiiiation who had no oilier known ex|nimiu' to avlKwlm. I l-w wotki 1 had Iretjuemly sanded asphalt and vinyl tile floors I>cioiv inciallniinii ol tievv door coveting In this rr|*on. these tases and the results of an investigation o( c\(Htsinc to atlKStn* during tile sanding are pievnivd. From lire M edial S c n iio . M aK lium i> General Hospital ami Uepartm int of M cdirinr. H arsartl U cthiat Sthonl: and the IV-partmettt of Environmental Health Vrvicrv and Phyviotegy, K arranl Srhtml of Public Health. Boston. U aiuchuvrttt. I Supported in pail hv l*A. rn h lii llealih Servile (.ram FW! AI VWil ami Environmental Cenicr Gram ES-00UO3. * Requests for tvptim Imidd be addrtsvsl to D i. Ravmnnd I . II. M m phy. Ih-pannw-ni of rhysioh-py. Harvard School of puhlic Health, **;, llioKiiigioti Avenue, ltoinn. Mavvarhlocvtv - 2115. a R i-w au h Fellow in M oliiine. Ma*af htiwtt* (H-neral Ilm piU l and lluivaitl Mtsliial Stltool. Supportisl hv Natitwial InMilutr* nf H ralth tonn a n I'H -IM n -H . 576 AMLR1CAN RtVItvv Of RtSPIRATORV DISIASI. VOU'Mt IW. 1*71 of ic. 11 1. < .1 f. IK. HIM IIHII I I, IIOl.ll' fli.I.X t 111"n! (IH|. Hie!* low*.I I . I. (ih M ri. *r . i di.ll. vail, j . il. line. I V C u t Reports C ur /: A ffyrar-old n a n a t admitted beauscd chest pain of one weei's duration. He lu d led hum ItHS to l% 7 at a ikxtr tile installer and MMUiiK.lv t i n l o l old tile before m m fating U. Tlu-rt- K jt nu ititloiy of exlier utenpaticMul dust rxpvxuir. He lu d worked in a mutditxty area of a shipyard fioni I'.Mj tu l!H7 rvpaiiiitg gytovopcs. I'ntm 17 lo Sd ycat of age. itc lu d smoked one (tallage of tigaietlet pet day. Four an toilit brfnrc hit preteni ad mixtion an Alness developed k it it left a met tor elK-it pain and henntjMvtiv On admisxiem to anoUier boxpiUl. a left ((rural eduiion wax noted. He a t m ated k ith petiidllin and k-ax dixebarged imVrovvd. One week befote Itix curre-ttt admission, -Moptvxis anti xetete. pleuritic. left ehcst pain gain developed. There k e tc dultuexx and decreased breath totrndv over the left lover chcxl. No friction n th wax Itcatd. A citexl roeuigcmyjram revealed a left pleural effusion without calvihealivMtt. A lltoiaunievu yielded 2.000 ml of xcrolattguimvms fluid that contained 3.-KAI Icukocytet pet turn*. ptc-ckxnmjtcly uhmkhiiicIcji eellx. lSfjlIUO etythrueyicx per mm3, and no polymerphunueicar le-ulntyiex. T h e glucose ewterntratiou wax S i g per 100 ml; the concurrent blood glutnxe ka* SO mg per 100 ml. T otal protein conCeturation of the ttuid wav iJ t g per 100 ml. No asbestos bodies r a r tern, and cytologic e-leatuianon ol the trllx iu the llniil suggested m alig nancy. Histologic examination of a uevdle biopsy of the ph-uia showed tuaiigiuni papillary ntevtibcliuma. Carr 2; A til-year-old Soor tile Utttallcr a t re ferred to the pulmonary d iu ic became of an ahmaul th ru lonngmogram u le u during a routine pertod u OM-dital evaluatinn. T he patietii lu d wot kid (or tlte paxl 30 yeatx installing asphalt and vinyl ale-. 11 v ie wax tut htvtory of other o u upatiuual duxt exposute. dirxt traum a, poeum onu. oi iH-moptvvix. He cuntplaiitul of mild ilyxpuca on climbing iwii flight* of xtairt. hut dciiiid orthopnea. patitcvcmal iiovtinual dypua. ami a n ile edt-ma. lie had xix itiil mm- (tat kjgc nl ( igai Ills ytet day (ot tin- paxl la yeatx. Physical cxatumaiKwi trvcaicd a wctl develp rd . plcihorit k h ite man. T h e anteiopoxteTtcir Him u lc t 'J the th ru wax iucrc-avsl. and bite, wain red. etvpitaui htspitatmy ralex k ite notetl at the l o w hilatetallv. Marked dubbing of the tingt-Tx kas |iiivlll. Fig. I. Poster(anterior then roentgenogram re vealing extensive pleural calcification. pleural thiekctiing, and pulmonary fibrosis. denvr platque of caldfiaiiott in tlte left pleural spare anti xhcctlikt- u leilia tio tiv in (Ik- pleura on the right, Derive calcifications were xerti on both diaphiagnutic pleural turfacei. Tin- diaphiagitix kcrc Uattrned. Tlte vital a parity at M per cent of predicted with a one-second forced expiratory volume of 65 per tent of the total. Arterial oxygen tension at ra t was 71 mm Hg. The single breath pulmo nary dilluxing a parity wax 6U per unit nf pre dicted. UrnI x potior To simulate normal work practice, ample of vinyl tile ere laid an a plywood beet utittg tile cement. This xin-rt ax plaavl insilk- a rootn ippitnuoatrly 10 fret wide. 12 fed king, and 7 feet high that wa exhausted at a rate of tour air efuttge-x per lutur. An operator wearing a n-tpitatut xamU-d tin- tile ft ap|iioxiouirly 20 minutes using a rumcntiaiial belt under with a coarse grit. During the w ort period, air sam pling wax o r - rirvl out tu de-te-rmine tlte rxposute- tn axltettot bbe-tx. Tw o |iersuttal um pleix worn Ivy the opera tor collet ted ait samples m i uK-tubraiii- Him at ait average sampling rate ol 3.(1 liter per mitt, fibers longer tlu n i a whit an aspect ratto great er titan I wcic counted under pltavc rnm iaxt uioxcopy by live lrcluiM|ite of Edveanlv ami l.vm li <21 Duxt titiue-tinalUMis lot tlnse two pjialU-l samples were 1.2 filters atul I J bbcTs per ml of air. tesyavtivrlv. 1 Im-v . oueniitaliou ate i. i.- . . 1... .................................. *i..* .............i.. I S78 I M l'R r t lV . U A 1NK. A l B W A / . 1.VV.11. A N D .I . 1. i-i'l"l ` ft. Fig. Z Eltiiron photomicrograph of a replicated membrane filter iltwing achertoc hbetr. of S fiben per mi (S) hut d o rrp rtiertt ignifictm crtpoitim . Under o th er *eotk conditione, th threcliohl litttit calur cottiti In- e artn le d . The ficidt of thtK membrane filtrn esaminai under pitale microeftipv rere ctjtuietrnt hit tbocc cren in aamplre cvllmed in other atbretoc operaitoni auch ai marine ineubiion imialbtimt and traroui. Detrete filiere ere evHh-nt and rere racilv esumai. Cliarattrrniic ebreim filurr are hoern in the decimo pfiotomitrograph o( a replicateti metnbram- filtrr campir (hginr2). Durine th undiug opcration. a point-to-pbnc eietiroctatic precipitator rat in n i to tn ilrrt a enee oi ampie no gride fin elettrott micronopy. Theee filler met lite r t it r r b pntpocnl for adiretoc I (linee ami acMuijtee (Il (tiglio- -11. 'I Ite m d i of the filtrn Itati mitiIre t b a ra n ti irci! Ite atcplikr in trm iptioni. and filini bundlre e n r caiile tern, fiber ere cltimptri togi-ther thin (lie matrix of the tile material. Diseuaaion Both of tlir tile im u llc n hail ili'tare known to t>r aevxiatcd with c\|toeuic 10 aditiiov T h e firit |iaticttt had typical clinical, men tpetrographic ami patltolngic finding o( pleural tncvrthcliuma. Epidemiologic inves tigation ol taect of tneeotltelioma have lioirn adieetcn nqxwurc in mort than -fn per cent (5. ti). T h e im idenre of nicvnhelionu in the general populatiott i* Irotn 1 in 1.000 to I in MUttHI deathe (7|. Hctanec the pur trtt itiidiec m e a le d that aii-U uur adtcsitn particles are generated during winding ol ru m * tux j\ iA iix n o .\ x m u . n r x u u i m r x H h n u I $79 Fig. 3. Air.lwrssc aUjt-u> blicis collected by ckrtrasutic precipitator. tile, asbestos must lie strongly considered as a cause of die patient' illness. Because his employment in gyroscope repair did not in volve work in engineering spates, it is un likely that be v at exposed to asbestos dust. Nonocrupational cx|toturc to aslicstot or tetUtlieUooia unrelated to asbestu* cannot be excluded. Significant asliestut exposure vas also im plicated in the scrum! patient wito had ex tensive bilateral pleural cakifications. Sellkofl found 150 rates of pleural calcification in 1,"II7 iiistallatioti workers and concluded that in the absence uf a history <ti chest inletlion or trauma. bilateral pleural calcification can usually Ik- tutisiilerctl to lit due to as bestos exposure (8). Tile causal relationship seems clear because die patient had no his tory of pulmonary iufettion or trauma anti bad a known cx| mimuc tu asliestos. It was wore tllQiruh, howeter, li assess the extent Ol umletlyiug pulmonary asltcstosts in this worker. Tlte commonly described clinical manifestations of this disease include dysp nea. basilar rales, dubbing of die fingers, de creased vital capacity, abnormal tliilusing capacity, decreased compliance, hypoxemia, and characteristic radiographic changes in tlte lungs (9k T he patient exhibited most of these findings and had no evidence of heart disease, other systemic disorder, or oc cupational exposure. It is likely, tlterefore, dial he hail at least minimal pulmonary as bestos! as well at pleural disease. Asliestos tile has been installed on count less Hums during the last SO years. Because this industry is the sriunil largest consumer uf this in im u l in the 1'luted States, the po tential hazard is signiheant if the current metliod ol sanding these Moon continues (1). Tlte clinical (hidings In these subjects and tin* results of ait sampling in a simulated stork intiiiiiiUK-iii suggest that lieiorc the tile sjii.line pnut-diiie is |K-rlonnril ade- 580 MURPHY. LEVINE. AL RA2/A/- LYNCH. ANII R U R fir quite rtspiratnry proiection or tn altrnate snstailatioti tncthod should be usetl. T he ataociation lietween installation o lile and sbcstoa-rtlatecl disease lu m n a that epidemtologic. cm ironm enuL and dinical inve*tigaiion o tile inttallers he conducted. In addition, practidng phytians hould be atened lo the ponibiliiy o aibcaoa-relatctl Ulnas in m occupation. Jcin ou-lfdfm rnu T he r o m are grateful lo Mr. Uoyd Shocnbaeh (or ibe extensive electrn niaotcopy a r ded out dunng this ttudy and lo Dr. Heinrich Brugxch for reriewinf lite manusaipc K E SU U E X --------------------------------------------------- Instalacin de baldosas para el piio como una fuente de exposirin a asbestos 1 asfalto o la baldosa para d pito de vinilo-aibcw contiene de 15 a 23 por esento de asbesto*, pero U> fibras numerales estn firmamente in crustadas en el material de ligamiento. La inatalanta de o t n baldosas, por consiguiente, no pare a ra ser una fuente peligrosa de exposib ta al polvo. Se presenun los osos de 2 instala dores de baldosa para el piso, uno con un mesotelioma comprobado por biopsia y d otro ron calcificacioiK? pleurales extemas. Estos trabaja dores haban lijado frecuentemente baUltras el piso de asfalto y de Tinilo antes de insular lo* nuevos pisos. La ocurrencia de estos casos llev a una investigacin del proceso de trabajo. Bajo condiciones de trabajo simuladas, te encontraron concrstradooes de polvo de asbestos tan alus conso 1J fibras por mi en muestras de aire en filtros de membrana que llevaba poesu una permna cnruelu en lijar las asbestos de rinilo. Fibras de asbestos araoerfstkas de esas mues tras fueron visus en forouiitsgn fos electrni cos. Estos hallarlo sugieren que antes del proctso de lijar se lleve a ab o . te debera usar una proteccin respiratoria adecuada o mar otros mtodos de instalacin al alance. JU S U U E ----------------------------------------------- L'in tu lla (ion des earreUges: u rce d'expositon fi I'amiante Le* a rre tn s d'aspiuhe ou done eombinaison de vinvl s d'ashestr nnticnnrnt le IS i 23 pourcent d'aniiantc. ntais Ir* tihm rom inlimenictit lices l'agssu agglutmanl. I.'iustallation le crs arrraux parail dmc une snurce improbable de troubles pm-umn<mhotK|ucv Its rap|K>n milia u x de deux oustcts msulleur* 1e carrt-Ugc. l un mufirant de msothliome confirme U biqrsir. et l'autre riant porteur de calcification pleurales sont prsent ici te* deux ouvrier* avaient musent table des arrcbgcs d'aqrhahe nu de vinyl-asbeste au papier de verre, avant d'installer des nouveltrx a n a u x . L'inrUlmct ( e m a i l incit fi tme imestiption du pro cd. En recrant les condition* de travail, les concernrations de -poutbriv ,d'amiante d'un niveau aussi eiev que 1J fibre* par ml ont pu este mesure dans l'air ambiant. Le* mesures furent dtermine en fatum passer des nehantillons d'air sur un papier filtr fix sur un travailleur en train de tabler des tuiles de vins!sbestc. Ds photomicrographies de ces prlve ment ont montr qu'il s'agissait rie libres amiante aractnstiqucs. En consquence, nous devons appliquer une protection respiratoire suffisante lors du sablagr Je tuiles ei choisir un autre pro cd d'installation. Rofortncos 1. Hendry, N. VVj The geology, occurrences, and major tacs of asbestos. Ann. N. Y. Acad. Sri 1963, fJ2.20. 2. Edwards. J. H-, and Lynch J. Rj The meth od used by the U. S. Public Health Service for enumeration of asbestos dust on mem brane filler. Amer. Occup. Hvg.. 1968. if. I. 8. Committee on Threshold Limit Values: Threshold Limit Values for 197(1, Am. Coni. o l Gov. ind. Hyg.. Ciiidntmi, 1967. (. Cross, P,, de Trcville. R. T. P- and Hal- let, M. Asbestos versus nonasbestos fibers, ultra-microscopic criteria. Arch. Environ. Health (Chicago), 1970.20, S71. 5. Newbonsc. M. L . and Thompson. H- Mcsothclioma of the pleura and peritoneum following exposure to asbestos in the London i r a . Brit. J. Industr. Med- 1963.22,261. 6. Elmers. P. C.. McCaughcy, 3V. T. E.. and Made, O. 1_: Diffuse mesothelioma of the pleura and asbestos. Brit. Med. J . 1963. f, 830. 7. Sclifcnff, j. J,, Churg. J - and Hammond. E. C.: Relation between aabettos exposure and neoplasia. New Eng. J. Med- 1963. 272, CO. a. Selikon, J. J.: The nccunmrr o( pleural raid- fitation among asbestos insulation worker*. Ann. N. Y. A nd. Sd.. 1965. fi2. 851. 9. Thompson. M. I--rd m r. A-M.. and Smiihcr. \V. J.: Tlie discriminant-value of pulmonary functicm tests in atbctiosis. Ann. X. Y. Acad. S d - 19G5.fi:. 121. -