Document RyYJ7N9OVLgVa8Y0xGJy39gV

Report to Congress on Workers' Home Contamination Study Conducted Under The Workers' Family Protection Act (29 U.S.C. 671a) U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE CENTERS FOR DISEASE CONTROL AND PREVENTION NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH CINCINNATI, OHIO 45226 SEPTEMBER 1995 DHHS(NIOSH) Publication No. 95-123 DISCLAIMER Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health. FOREWORD In 1992, the U.S. Congress passed the Workers' Family Protection Act (Public Law 102-522,29 U.S.C. 671), which requested that the CDC's National Institute for Occupational Safety and Health (NIOSH) conduct a study to "evaluate the potential for, prevalence of, and issues related to the contamination of workers' homes with hazardous chemicals and substances...transported from the workplaces of such workers." With this request. Congress identified a compelling public health issue, bridging health concerns in the workplace and the home. NIOSH found that contamination of workers' homes is a worldwide problem, with incidents reported from 28 countries and from 36 States in the United States. Such incidents have resulted in a wide range of diseases and, in some cases, death among workers' families. This report represents an important step in addressing the concerns outlined in the Act. It puts us on the road to preventing the exposure of families to potentially harmful substances unknowingly brought home from the job. It also serves as a reminder of the importance of occupational safety and health research to CDC's overall mission of promoting health and quality of life by preventing and controlling disease, injury, and disability. David Satcher, M.D., Ph.D. Director, Centers for Disease Control and Prevention 1U PREFACE The legislative directive (Public Law 102-522, Section 209, the Workers' Family Protection Act, [29 U.S.C. 671a]) to conduct this study of contamination of workers' homes by substances carried home on workers' clothing or bodies was enacted on October 26, 1992. However, this is not a new problem. Holt [1923] cited two early studies of lead-workers' families that were published in 1860 and 1896. Oliver [1914] reported on lead poisoning in wives of house painters who washed their husbands' overalls, observations that resulted in a series of laws in Great Britain to protect the workers' families from lead poisoning. Lead poisoning continues to be a problem; this report cites about 65 incidents of lead poisoning among workers' families. Of these, 35 are from the United States, 24 of which were reported in the last 10 years. Lehmann [1905] reported that the mother and child of a worker exposed to chlorinated hydrocarbons developed chloracne (a condition similar to acne caused by certain chlorinated chemicals) ascribed to the worker's contaminated clothing. Lehmann also wrote of a laundress who developed chloracne as a result of washing the contaminated clothing of workers. Thirty years after Lehmann's report was published in Germany, a similar case was reported by Fulton and Matthews [1936] from the Pennsylvania Department of Labor and Industry. In this case a child's father who was exposed to hexachloronaphthalene and chlorodiphenyl wore his soiled clothing home from work. Additional cases of workers' homes being contaminated with chlorinated hydrocarbons have been reported in the last 10 years. Prior to 1960, beryllium, toxaphene. mercury vapors, and diethylstilbestrol were also identified as hazards to the families of workers. In the last 10 years, 10 additional chemical substances have been identified in incidents of workers' home contamination, as well as allergens, radioactive materials, and infectious agents. This report to Congress and the Workers' Family Protection Task Force summarizes the incidents of home contamination this study has discovered, including the health consequences, the sources, and the levels of contamination. The report contains information on the effectiveness of preventive measures and of decontamination procedures that have been used or studied. The report summarizes the relevant laws and regulations and responses of Federal and State agencies and industry to incidents of workers' home contamination. The report should be useful not only to Congress and the Workers' Family Protection Task Force in deciding future actions, but also to all who have responsibilities and concern for protecting workers and their families from preventable illnesses. Linda Kosenstock, m.d., M.P.H. Director, National Institute for Occupational Safety and Health v EXECUTIVE SUMMARY The Workers' Family Protection Act of 1992 (Public Law 102-522, 29 U.S.C. 671a) directed the National Institute for Occupational Safety and Health (NIOSH) to conduct a study of contamination of workers* homes with hazardous chemicals and substances (including infectious agents) transported from the workplace. NIOSH found that contamination of workers' homes is a worldwide problem; incidents have been reported from 28 countries and from 36 States in the United States. Such incidents have resulted in a wide range of health effects and death among workers' families exposed to toxic substances and infectious agents. About half of the reports of health effects have appeared in the last 10 years, revealing new sources of contamination. In completing the study, NIOSH solicited information from Federal and State health, labor, and environmental agencies, groups with special circumstances such as firefighters, and the public. NIOSH then reviewed and compiled the information received along with information in published reports on contamination of workers' homes by substances brought home from the workplace. The report includes a survey of reported health effects, information on sources and levels of contamination, preventive measures, decontamination procedures, a review of Federal and State laws, and responses of agencies and industry to incidents involving contamination of workers' homes. This report is being considered by the Workers' Family Protection Task Force, which is charged under the Workers' Family Protection Act with evaluating the need for additional research. Health Effects of Workers* Home Contamination Workers can inadvertently carry hazardous materials home from work on their clothes, skin, hair, tools, and in their vehicles. As a result, families of these workers have been exposed to hazardous substances and have developed various health effects. Health effects have also occurred when the home and the workplace are not distinct-such as on farms or in homes that involve cottage industries. For some contaminants, there are other potential sources of home contamination such as air and water pollution and deteriorating lead paint in the home. Only a few of the studies found in the literature used epidemiologic methods to estimate the relative risks of health effects from the contaminant transported home by the worker independent of health risks due to other sources of the contaminant in the home. little is known of the full range of health effects or the extent to which they occur as a result of workers' home contamination. There are no information systems to enable tracking of illnesses and health conditions resulting from these circumstances. Many of the health effects among workers' family members described below were recognized because of their uniqueness their clear relationship to workplace contaminants, or their serious nature. vu Chronic beryllium disease This potentially fatal lung disease has occurred in families of workers exposed to beryllium in the nuclear and aviation industries and workplaces involved in the production of beiyllium and fluorescent lights and gyroscopes. Asbestosis and mesothelioma Fatal lung diseases have occurred among family members of workers engaged in the manufacture of many products containing asbestos, including thermal insulation materials, asbestos cement, automobile mufflers, shingles, textiles, gas masks, floor tiles, boilers, ovens, and brakeshoes and other friction products for automobiles. Families have also been exposed to asbestos when workers were engaged in mining, shipbuilding, insulating (e.g., pipe laggers and railway workers), maintenance and repair of boilers and vehicles, and asbestos removal operations. Lead poisoning, neurological effects, and mental retardation These health effects have occurred in children of workers engaged in mining, smelting, construction, manufacturing (pottery, ceramics, stained glass, ceramic tiles, electrical components, bullets, and lead batteries), repair and reclamation of lead batteries, repair of radiators, recovery of gold and silver, work on firing ranges, and welding, painting, and splicing of cables. Deaths and neurological effects from pesticides Farm families and families of other workers exposed to pesticides have suffered these serious effects. Chemical burns from caustic substances Chemical bums of the mouth and esophagus and fatalities from ingesting caustic substances have occurred in farm families when hazardous substances were improperly used and stored on farms. Chloracne and other effects from chlorinated hydrocarbons Family members have been exposed when these substances were transported home on clothing of workers manufacturing or using these compounds in the production of insulated wire, plastic products, ion exchange resins, and textiles. Family members have been similarly exposed when workers' clothes became contaminated during marine electrical work, transformer maintenance, municipal sewage treatment, rail transportation, wood treatment, and application of herbicides. Neurological effects from mercury Family members have developed various neurological effects as a result of being exposed to mercury carried home on clothing of workers engaged in mining, thermometer manufacture, and cottage-industry gold extraction.  Abnormal development from estrogenic substances Enlarged breasts have occurred in boys and girls and premature menstruation has occurred in girls from estrogenic substances brought home on contaminated clothing of pharmaceutical and farm workers. Asthmatic and allergic reactions from dusts Farm families and others have suffered asthmatic and other allergic effects from animal allergens, mushrooms, grain dust, and platinum salts. Liver angiosarcoma from arsenic Families of workers engaged in mining, smelting, and wood treatment have been exposed to arsenic from contaminated skin and clothing; one child developed liver angiosarcoma. Dermatitis from fibrous glass Family members have developed dermatitis when their clothing was contaminated with fibrous glass during laundering of insulation workers' clothing. Status epilepticus from chemical exposure A child experienced epileptic seizures following ingestion of an explosive compound brought home on the clothing of a worker engaged in the manufacture of explosives. Diseases from infectious agents Family members have contracted infectious diseases such as scabies and Q fever from agents brought borne on contaminated clothing and skin of workers engaged in agriculture, hospital, and laboratory work. As intended by Congress, infectious agents are included as hazardous substances to the extent that pathogens can be transported on a worker's person or clothing. Measures for Preventing Home Contamination Preventive measures that were found to be effective when used in the workplace include: Reducing exposures in the workplace; Changing clothes before going home and leaving the soiled clothing at work to be laundered by the employer, Storing street clothes in separate areas of the workplace to prevent their contamination; Showering before leaving work; and Prohibiting removal of toxic substances or contaminated items from the workplace. Preventive measures that have been used successfully at home include: Separating work areas of cottage industries from living areas; Properly storing and disposing of toxic substances on farms and in cottage industries; ix  Preventing family members from visiting the workplace; Laundering contaminated clothing separately from family laundry when it is necessary to launder contaminated clothing at home; and Informing workers of the risk to family members and of preventive measures. Other preventive measures that need to be used include: Educating physicians and other health professionals to inquire about potential workrelated causes of disease; Developing surveillance programs to track health effects that could be related to home contamination; and Educating children, parents, and teachers about the effects of toxic substances. Procedures for Decontaminating Homes and Clothing Decontamination procedures include air showers, laundering, airing, vacuuming and other methods of surface cleaning, and destruction and disposal of contaminated items. These procedures appear to have widely varying effectiveness, depending on the specific methods employed, the contaminants, and the surfaces. In general, hard surfaces can be far more easily decontaminated than clothes, carpets, and soft furniture. In most cases effective decontamination requires relatively intensive methods. Normal house cleaning and laundry practices appear to be inadequate for decontaminating workers' clothes and homes. Lead, asbestos, pesticides, and beryllium contamination can be especially persistent. In some instances even intensive decontamination procedures may be ineffective. Another serious concern is that decontamination methods can increase the hazard to the person performing the operation and to others in the household. Home laundering of contaminated clothing exposes the launderer. Vacuuming of floors contaminated with mercury can substantially increase air concentrations, and vacuuming of carpets contaminated with lead can increase lead concentrations on the carpet surface. The difficulty of decontaminating work clothing, the prominence of clothing as a source of home contamination, and the potential exposure of the launderer are problems that can be avoided through the use of disposable work clothing. The use, availability, and cost of this alternative need to be assessed. Federal and State Laws Seven statutes provide Federal agencies with some mechanisms for responding to or preventing workers' home contamination. Twenty rules or standards in the Code of Federal Regulations (CFR) address workers' home contamination or have elements that serve to protect workers' families. x Under the Occupational Safety and Health Act of 1970 (Public Law 91-596), NIOSH research assessing the health of workers has also addressed the exposure of their families to workplace contaminants, resulting in recommendations to prevent home contamination. The Occupational Safety and Health Administration (OSHA) regulations and actions intended to protect workers also help assure that families are protected. In addition, OSHA can promulgate standards to protect workers' family members when workers are required to live in housing provided by the employer as a condition of employment Under the Federal Mine Safety and Health Act of 1977 (Public Law 95 164), the Mine Safety and Health Administration (MSHA) has limited regulatory authority to address issues of workers' home contamination. The U.S. Environmental Protection Agency (EPA) has broad authority under the Toxic Substances Control Act (Public Law 94-469) to regulate chemicals and to obtain information about the adverse effects of chemicals. In addition, EPA has specific authority and responsibility regarding the use of asbestos and lead. Under the Federal Insecticide, Fungicide, and Rodenticide Act (Public Law 92-516), EPA also regulates the use and disposal of pesticides (which also helps to protect workers' families). EPA and the Agency for Toxic Substances and Disease Registry (ATSDR) are authorized under the Superfimd Amendments and Reauthorization Act of 1986 (Public Law 99-499) to address hazardous waste and releases of hazardous substances that may relate to identifying contamination of workers' homes and assuring decontamination. Thirty States and Puerto Rico responded to the requests from NIOSH for information about State laws. Most indicated that there were no laws specific to workers' home contamination or protection of workers' family members. Some States identified laws requiring the reporting of cases of elevated blood lead levels and pesticide poisonings to a State agency; other States identified laws related to work at hazardous waste sites and emergency responses to releases of hazardous substances. An examination of occupational safety and health regulations of States with OSHA-approved occupational safety and health programs revealed none more stringent than Federal OSHA regulations - with respect to the protection of workers' families. However, extension of occupational safety and health regulations to State and local government employees in these States also helps protect the families of public employees* in these States. Responses to Incidents of Workers' Home Contamination Several Federal agencies have responded to incidents of workers' home contamination, often working together with State or local government agencies. These responses have resulted in identification of workers' home contamination, decontamination of workers' homes, and recommendations for instituting workplace changes that would prevent further contamination. NIOSH has conducted approximately 40 health hazard evaluations that address potential home contamination. In several cases, Federal agencies have referred incidents to State or local health departments for follow-up actions. XI State agencies have investigated incidents of workers' home contamination, made referrals to Federal agencies for follow-up actions, and recommended workplace improvements to prevent further contamination of workers' homes. Responses to incidents of workers' home contamination include educational materials such as those of the Lead Industries Association, Inc. on preventing workers' home contamination as well as responses of various employers to specific incidents of home contamination. limitations of the Report The health information available for the report, which indudes inddents of illness and home contamination obtained from public agenties and published literature, does not provide a basis for estimating the prevalence of this public health problem. The Workers' Family Protection Act requires NIOSH to evaluate relevant information about indoor air quality as it relates to workers' home contamination and to study the sperial circumstances of firefighters as they relate to contamination of their homes. The only report found on indoor air quality applicable to workers' family protection involved tetracbloroethylene exposures in living quarters located in the same building as dry-cleaning establishments. Indoor air quality studies would be useful to protect family members in cottage industries. Inddents of contamination of firefighters' homes were not identified. However, NIOSH has conducted several studies of contamination and decontamination of protective clothing used by firefighters. These studies are reviewed in this report and NIOSH will continue to pursue the issues related to potential contamination of firefighters' homes. Other limitations of the report indude: Little research has documented the frequency and distribution of health effects among the families of workers in various industries and occupations. NIOSH is undertaking one study addressing lead exposure among families of bridge repair workers. Lead and pestiddes are the only contaminants for which monitoring or reporting programs help to identify and prevent cases of poisoning from workers' home contamination. Despite various case reports, the prevalence of health effects from workers' home contamination is not known because there are no surveillance systems in place for tracking or monitoring such health conditions. Many diseases have long latency periods between exposure and manifestation of the disease, making identification and intervention difficult. Xll  The workplace origin of many common diseases that occur in workers' families (such as asthma, dermatitis, and infectious diseases) is probably unrecognized because physicians and other health professionals fail to inquire about the occupation of family members and to consider whether these diseases are work-related. The literature reviewed in this report contained only nominal information about contamination levels in workers' homes. Most measurements were of surface dust, for which there are no guidelines for acceptable levels of contamination. Recommendations for Research and Education The prevalence of health effects of contaminants transported from the workplace should be determined. One possible approach would be to conduct surveys among occupational and environmental medicine health care providers and clinics. The employment practices and controls that work best in preventing the transport of contaminants from the workplace to the home should be identified. Educational programs to prevent home contamination should be developed for employers, workers, children, teachers, and parents, physicians, and other health professionals. The special needs and problems of individuals who work in home or cottage industries need to be identified. Conclusions Workers' home contamination may pose a serious public health problem. Health effects and deaths from contaminants brought home from the workplace have been reported in 28 countries and 36 States. The extent to which these health effects occur is not known because there are no information systems to track them, and physicians do not always recognize the occupational contribution to various common diseases. About half of the reports of health effects from home contamination are less than 10 years old. The literature on the health effects involved approximately 30 different substances or agents. The potential exists for many of the thousands of other chemicals used in commerce to be transported to workers' homes or to be used in home-centered businesses. Health effects and deaths from contaminants brought home from the workplace are preventable using known effective measures. Educational programs are needed to promote their use. xiii  Normal bouse cleaning and laundry practices are often inadequate for decontaminating workers' homes and clothing and can increase the hazard to the person performing the tasks and others in the household. Only two Federal laws have elements that directly address workers' home contaminatioa However, other laws provide agencies with certain mechanisms for responding to, or preventing workers' home contamination. Operating under existing laws OSHA, MSHA, DOE, ATSDR, EPA and CDC, including NIOSH and the National Center for Environmental Health have responded to incidents of workers' home contamination, made recommendations to prevent such incidents, and conducted relevant research. XIV TABLE OF CONTENTS FOREWORD .......................................................................................................................... iii PREFACE......................................................................................................................................v EXECUTIVE SUMMARY................................................................................................ vii Health Effects of Workers' Home Contamination....................................... vii Measures for Preventing Home Contamination............................................................. ix Procedures for Decontaminating Homes and Clothing.......................................................x Federal and State Laws ..........................................................................................................x Responses to Incidents of Workers' Home Contamination.............................................. xi Limitations of the Report................................................................................................ xii Recommendations for Research and Education...............................................................xiii Conclusions ........................................................................................................................... xiii INTRODUCTION............................................................................................. xxiii CHAPTER 1. HEALTH EFFECTS OF WORKERS' HOME CONTAMINATION . 1 CHAPTER SUMMARY ................................................................................................... 1 BERYLLIUM ..................................................................................................................... 3 Overview........................................................................................................................ 3 Background................................................................................................................... 3 Review of Studies ....................................................................................................... 4 ASBESTOS.......................................................................................................................... 6 Overview........................................................................................................................ 6 Background................................................................................................................... 6 Review of Studies ....................................................................................................... 7 Cohort Studies.......................................................................................................... 8 Community-Based Cohort Studies.......................................................................... 9 Case-Control Studies.............................................................................................. 9 Case Reports.......................................................................................................... 10 Case-Series ............................................................................................................ 11 LEAD................................................................................................................................. 11 Overview..................................................................................................................... 11 Background................................................................................................................. 12 Review of Studies of Blood Lead Levels ............................................................. 13 Cohort Studies....................................................................................................... 14 Community Studies................................................................................................. 15 Case Reports and Case Series ........................................................................... 15 Review of Studies of Other Health Effects........................................................... 15 CAUSTTC FARM PRODUCTS..................................................................................... 16 Overview..................................................................................................................... 16 xv TABLE OF CONTENTS Background................................................................................................................. Review of Studies ..................................................................................................... PESTICIDES..................................................................................................................... Overview..................................................................................................................... Background................................................................................................................. Review of Studies ..................................................................................................... CHLORINATED HYDROCARBONS.................... Overview..................................................................................................................... Background................................................................................................................. Review of Studies .......................................................................... MERCURY........................................................................................................................ Overview..................................................................................................................... Background................................................................................................................. Review of Studies ..................................................................................................... ESTROGENIC SUBSTANCES.................................................................................... Overview..................................................................................................................... Background................................................................................................................ Review of Studies ..................................................................................................... ASTHMATOGENS/ALLERGENS.............................................................................. ARSENIC.......................................................................................................................... CADMIUM....................................................................................................................... FIBROUS GLASS............................................................................................................ OTHER SUBSTANCES ................................................................................................ INFECTIOUS AGENTS ................................................................................................ Overview..................................................................................................................... Background................................................................................................................ Review of Studies ..................................................................................................... RADIOACTIVE SUBSTANCES.................................................................................. 16 16 17 17 18 18 20 20 20 20 22 22 22 22 24 24 24 24 25 26 26 27 27 27 27 28 32 33 CHAPTER 2. SOURCES OF WORKERS' HOME CONTAMINATION................. CHAPTER SUMMARY ................................................................................................ CONTAMINATED CLOTHING.................................................................................. Overview..................................................................................................................... Beryllium................................................................................................................. Asbestos ................................................................................................................. Lead........................................................................................................................ Overview........................................................................................ Reports of clothing and home contamination........................................... Supporting studies......................................................................................... Pesticides................................................................................................................. Chlorinated Hydrocarbons.................................................................................. Mercury................................................................................................................... 34 34 35 35 35 36 37 37 37 38 39 41 41 xvi TABLE OP CONTENTS Estrogens.............................................................................................................. Other Substances................................................................................................ Infectious Agents................................................................................................ Radioactive Substances ..................................................................................... THE WORKER'S BODY ............................................................................................ TOOLS AND EQUIPMENT....................................................................................... TAKING ITEMS HOME FROM WORK ................................................................ Beryllium.................................................................................................................. Asbestos .................................................................................................................. Lead......................................................................................................................... Pesticides ................................................................................................................ Estrogens ................................................................................................................ Radioactive Substances ......................................................................................... COTTAGE INDUSTRIES............................................................................................ Asbestos .................................................................................................................. Lead......................................................................................................................... Pesticides ................................................................................................................ Mercury..................................................................................................................... FARMS........................................................................................................................... FAMILY VISITS TO WORKPLACE......................................................................... 42 43 43 43 43 44 44 44 45 45 45 45 45 45 46 46 47 47 47 48 CHAPTER 3. LEVELS OF CONTAMINATION IN HOMES AND CARS............ CHAPTER SUMMARY .............................................................................................. ASBESTOS..................................................................................................................... LEAD.............................................................................................................................. Concentrations of Lead in Dust............................................................................ Lead Loading ......................................................................................................... MERCURY..................................................................................................................... CHLORINATED HYDROCARBONS....................................................................... PESTICIDES.................................................................................................................. ARSENIC....................................................................................................................... INFECTIOUS AGENTS .............................................................................................. 49 49 50 50 50 51 52 52 52 53 53 CHAPTER 4. PREVENTIVE MEASURES.................................................................. CHAPTER SUMMARY .............................................................................................. BERYLLIUM................................................................................................................ ASBESTOS..................................................................................................................... LEAD.............................................................................................................................. CAUSTIC FARM PRODUCTS.................................................................................. PESTICIDES.................................................................................................................. HORMONES ................................................................................................................ ASTHMATOGENS/ALLERGENS ............................................................................ 54 54 54 55 55 57 57 59 60 xvu TABLE OF CONTENTS CHAPTER 5. DECONTAMINATION PROCEDURES.............................................. CHAPTER SUMMARY ............................................................................................. DECONTAMINATION GUIDELINES.................................................................... REVIEW OF DECONTAMINATION PROCEDURES......................................... BERYLLIUM............................................................................................................... ASBESTOS................................................................................................................... LEAD............................................................................................................................. PESTICIDES................................................................................................................. CHLORINATED HYDROCARBONS....................................................................... MERCURY.................................................................................................................... OTHER SUBSTANCES ............................................................................................. INFECTIOUS AGENTS ............................................................................................. 61 61 61 62 62 62 63 64 68 69 70 70 CHAPTER 6. REVIEW OF EXISTING FEDERAL AND STATES LAWS......... CHAPTER SUMMARY ............................................................................................. FEDERAL LAWS........................................................................................................ STATE LAWS............................................................................................................... BACKGROUND........................................................................................................... REVIEW OF RELEVANT FEDERAL STATUTES AND RULES..................... Occupational Safety and Health Act of 1970 (OSH Act).................................. OSHA................................................................................................................. NIOSH................................................................................................................ Federal Mine Safety and Health Act of 1977 (Mine Act) ................................ Toxic Substances Control Act (TSCA)................................................................ Asbestos Hazard Emergency Response Act of 1986 ......................................... Residential Lead-Based Paint Hazard Reduction Act of 1992 ......................... Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) ....................... Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) and Superfund Amendments and Reauthorization Act (SARA) REVIEW OF STATE LAWS...................................................................................... 72 72 72 73 73 75 75 75 77 77 78 79 79 79 81 82 CHAPTER 7. RESPONSES TO INCIDENTS OF HOME CONTAMINATION ... CHAPTER SUMMARY ............................................................................................. RESPONSES OF FEDERAL AGENCIES................................................................ OVERVIEW................................................................................................................. Centers for Disease Control and Prevention (CDQ......................................... National Center for Environmental Health (NCEH)..................................... National Institute for Occupational Safety and Health (NIOSH)................ Asbestos...................................................................................................... Lead............................................................................................................. Chlorinated Hydrocarbons......................................................................... Mercury ...................................................................................................... Estrogenic Substances................................................................................ 84 84 84 84 85 85 86 86 87 87 87 87 xvin table of contents Agency for Toxic Substances and Disease Registry (ATSDR).......................... Occupational Safety and Health Administration (OSHA) ................................ Mine Safety and Health Administration (MSHA).............................................. Environmental Protection Agency (EPA)....................................... Department of Energy (DOE).............................................................................. Nuclear Regulatory Commission (NRC).............................................................. RESPONSES OF STATE AGENCIES....................................................................... Lead............................................................................. Pesticides ................................................................................................................. Other ....................................................................................................................... RESPONSES OF INDUSTRY..................................................................................... 88 88 89 89 89 91 93 93 96 96 97 CHAPTER 8 - RECOMMENDATIONS AND CONCLUSIONS ................................... 98 Recommendations for Research and Education...............................................................98 Conclusions .......................................................................................................................... 98 REFERENCES................................................................................................................... 99 xix [1957] reported on five persons with beryllium disease who had exposure to clothing of beryllium extraction workers. Other authors [DeNardi et al. 1949; Sussman et al. 1959; Eisenbud and Lisson 1983] discuss varying numbers of contact (household) cases. The cases discussed by these authors are likely included in the Beryllium Case Registry, but it is difficult to be certain of this because detailed descriptions are not always given. According to the literature review, there were no more contact (household) cases added to the registry after Hardy et al. [1967] until the article by Newman and Kreiss [1992] who reported on a 56-year-old woman with chronic beryllium disease who had first been diagnosed with sarcoidosis. When it was determined that her husband was a beryllium worker, she was evaluated for beryllium disease. The clinical picture was compatible with beryllium disease and her blood test showed beryllium sensitization. Because of the long period of time between the prior contact cases and this case, a review of her exposures to beryllium is useful. She was a non-smoker who had always lived in Ohio. She was self-employed and had sold cosmetics, done babysitting, brought up her children, and from 1973 until the time of the article, had done stockroom work for a retailer. Her husband had worked from 1959 to the current time at a beryllium production plant, with daily exposure to beryllium. When working directly with beryllium, he always changed clothing after work, showered before leaving for home, and did not bring his work clothing home. The family had always lived at least 28 miles from his work. She sought medical attention for this illness in November 1988. Her exposures consisted of the following: She took a tour of the plant in the 1960's; She took another tour in the 1970's at a time when it was not operating; During some months in 1976, her husband was an advisor to a new ceramics plant, where be did not do hands-on work and wore street clothes, which his wife cleaned on several occasions. Thus although beryllium was used at the plant, clothes worn to work were not left at work; A hydrogen furnace containing beryllium oxide exploded in her husband's face in February 1979. He was sent to the emergency room in his contaminated work clothes. When he was discharged from the emergency room, she was given the contaminated clothes which she put in a plastic bag at home before returning them to the plant guardhouse. Over the next several months, she scrubbed her husband's face several times daily with a motorized rotating brush to remove embedded metallic debris; and The husband injured his ankle while at work in September 1987. When she picked him up at the hospital, he was still wearing work clothes. He rode home in her car and she placed the dusty clothes in a plastic bag. 5 This case illustrates the need for vigilant application of industrial hygiene controls for beryllium even when exposures do not seem high or consistent Moreover, it is possible that household and community cases of beryllium disease may still he occurring but are unrecognized or misdiagnosed as in this case. ASBESTOS Overview Based on the studies reviewed in this section, families of asbestos-exposed workers have been at increased risk of pleural, pericardial, or peritoneal mesothelioma, lung cancer, cancer of the gastrointestinal tract, and non-malignant pleural and parenchymal abnormalities as well as asbestosis. Four cohort studies (Table 2), one community study (Table 3), seven case-control studies CTable 4), numerous case reports . (Table 5) and case series (Table 6) provide evidence of these adverse effects in family members of asbestos workers. ^ The occupations associated with asbestos-related disease in family members are those where workers were exposed to asbestos dust during: construction and renovation; prospecting and mining; manufacturing textiles, tiles, boilers, and ovens; shipbuilding and associated trades; certain railroad shop trades; welding; insulation; use and manufacture of asbestos products such as cords, seals, and plates; and renovation and demolition projects within the construction industry. Although many past uses of asbestos have been abandoned, and asbestos uses and occupational exposures are now subjected to regulation, potential exposures of family members in the United States may still exist, especially in the construction industry [Sullivan et al. 1995]. Background Asbestos is a generic term for a number of silicate minerals with a fibrous crystalline structure. The asbestiform varieties of silicate minerals can be found in both the amphibole and serpentine mineral groups, in veins or small veinlets within rock containing or composed of the common (non-asbestiform) variety of the same mineral. The major asbestiform varieties of minerals used commercially are chiysotile, tremolite-actinolite asbestos, cummingtonite-grunerite asbestos, anthophyllite asbestos, and crotidolite. Asbestos is marketed by its mineral name (e.g., anthophyllite asbestos), its variety name (e.g., chrysotile, crocidolite), or its trade name (e.g., Amosite). Mesothelioma is a tumor arising from the pleural, pericardial, and peritoneal membranes. When it occurs in asbestos workers' household contacts, it is a sentinel event for exposure to asbestos from home contamination [Gardner and Saracd 1989]. Lung cancer is a malignant tumor of the lung. Cancer of the gastrointestinal tract is a malignant tumor of any part of the gastrointestinal tract including the mouth, pharynx, esophagus, stomach, small intestine, pancreas, colon, rectum, and anus. Asbestosis is a fibrotic disease of the lungs caused by 6 asbestos fibers which results in reduced lung volumes and difficulty in breathing. Pleural and hyaline plaques are localized thickenings which may be evident on radiographs 20 or more years after exposure. Pleural and hyaline plaques generally occur without symptoms but do provide a clinical marker of asbestos exposure. Mesothelioma has occurred following short term asbestos exposures of only a few weeks, and can result from very low levels of exposure. There may be a latency period of 40 years or longer between exposure and clinical disease. Symptoms include chest pain, shortness of breath, and weight loss. Analysis of tissue obtained by biopsy (or at autopsy) is required for a definitive diagnosis (Dement et al. 1986]. Treatment is ineffective, with rapid disease progression and dead [Lilis 1986], . Lung cancer may be associated with a range of symptoms including cough, shortness of breath, bloody sputum, and weight loss. Definitive diagnosis is muu. by tissue biopsy. Metastasis is common, and may present as bone pain or fracture, seizure, or various other syndromes. Progression of lung cancer is generally rapid, and treatments (including surgery, chemotherapy, and radiation) are unlikely to result in long term survival [Hodous and Melius 1986]. Although increased risk of lung cancer among household contacts of asbestos workers has been observed, the high prevalence of cigarette smoking among lung cancer cases frequently makes it difficult to detect cases which may be caused by exposure to asbestos resulting from workers' inadvertent contamination of the home. Review of Studies Information on exposure of family members has been elicited by questioning patients or relatives about the practice of bringing work clothes home and laundering the asbestos contaminated clothing at home. Other identified sources of exposure of workers' family members to asbestos include taking contaminate items home from work and using asbestos in cottage industries [Magee et al. 1986; Bittersohl and Ose 1971], Additional evidence that exposures occurred in the homes of asbestos workers is the finding of asbestos in lungs of asbestos workers' family members who had no known exposures, other than contact with an exposed worker [Whitwell et al. 1977; Ashcroft and Heppleston 1970; Huncharek et al. 1989; Gibbs et al. 1989, 1990; Giarelli et al. 1992]. Most cases of asbestos disease among workers' family members occurred in households where information indicated that asbestos-contaminated work clothing was brought into the home and women were exposed during home laundering of the contaminated work clothing [Ashcroft and Heppleston 1970; Dalquen et al. 1970; Edge and Choudhury 1978; Lander and Viskum 1985; Konetzke et al. 1990]. Children were exposed by playing in areas where asbestos-contaminated shoes and work clothes were located, or where products containing asbestos were used or stored. It is of interest to note that male children of asbestos workers appear to 7 CHAPTER 2. SOURCES OF WORKERS' HOME CONTAMINATION CHAPTER SUMMARY Sources of contamination of workers homes and poisonings of workers' family members reviewed in this chapter include: work clothing; the worker's body; tools and equipment; taking items home from work (such as scrap material); cottage industries (where work is done in or adjacent to the home); farms; and visiting a family member's workplace. Clothing contamination was documented in 18 reports: 1 on beryllium; 7 on lead; 7 on pesticides; and 1 each on PCB's, an estrogenic substance (zeranol), and 3,4benzo(a)pyrene. For lead, measurements of both clothing and home contamination were included in some studies. However, these were inadequate for establishing a quantitative relationship between the two. Other evidence of clothing as a source of home contamination includes: high levels of contamination in areas of homes where soiled clothing is stored and laundered (lead, mercury); contamination of washing machines (mercury) or dryers (3,3'*dichlorbenzidine, MOCA); and poisoning of launderers (beryllium, asbestos, lead, kepone). The workers' body has been considered as a source of home contamination, and showering before leaving work has often been recommended as a preventive measure. However, reports have only documented contamination of workers' hands. Hand tools and other equipment have been found to contribute to home and vehicle contamination by mercury and pesticides. The potential for contamination of homes by tools was also demonstrated for PCB's and radioactive substances. Items taken home from work (beryllium-ore bags, cotton shipping-bags for asbestos, cloths from discarded filters, metal drums, contaminated milk, and radioactive scrap lumber) have resulted in serious, and sometimes fatal, poisonings of workers' family members. Cottage industries, where work is undertaken in the same building or on the property where the family resides have been recognized as a hazard to family members since at least 1914. Cottage industries are the subject of 22 reports of home contamination or family poisonings from asbestos, lead, parathion, and mercury which are reviewed in this chapter. The levels of contamination were often extremely high and the poisonings were severe. Farms are similar to cottage industries in that families live on the property where work is performed. Three types of products used on farms: pesticides; caustic substances; and estrogenic substances have resulted in several cases of poisoning of family members. - 34 Visiting the workplace of a family member has been shown to be a hazard for families of dry cleaners and veterinarians. CONTAMINATED CLOTHING Overview This section reviews reports that provide evidence for clothing worn, or otherwise taken home from work, as a source of home contamination. The reports are summarized in Table 15. In the health effects studies reviewed in Chapter 1, home contamination and family exposures were often attributed to contaminated clothing brought home from the workplace. This attribution was based on: information elicited by questioning household members; descriptions of workplaces and work practices; and the practice of wearing and laundering work clothes at home. Clothing contamination was documented in 18 reports reviewed below. 1 on beryllium; 7 on lead; 7 on pesticides; 1 on chlorinated hydrocarbons (PCBs); 1 on an estrogenic substance (zeranol); and 1 on 3,4-benzo(a)pyrene. Only for lead were measurements of both clothing contamination and home contamination included in the same studies; these few studies are inadequate for establishing any quantitative relationship between clothing contamination and home contamination. Other evidence of clothing as a source of home contamination includes: the findings discussed below of high levels of contamination in laundry areas of workers' homes and in areas where contaminated clothing is stored (lead, mercury); contamination of washing machines (mercury) or dryers (3, 3'dichlorbenzidine, MOCA); and poisoning of home launderers (beryllium, asbestos, lead, kepone). Estimates of exposure levels that could have occurred during home laundering of beryllium and asbestos suggest that such exposures could have exceeded OSHA occupational exposure limits for these substances. Beryllium There were no reports of measurements of home contamination by beryllium, although the case histories and epidemiology studies generally assumed that cases of berylliosis in workers' family members were due to laundering contaminated clothing. In support of this assumption, the following studies on clothing contamination indicate that substantial amounts of beryllium dust could have been brought into the workers' homes by contaminated clothing. Fabrics experimentally exposed at a beryllium production worksite contained beryllium up to 2.8 mg/m1 [Bohne and Cohen 1985]. In a subsequent study Cohen and Positano [1986], found that work shirts contained from 12 to 37 mg/m1 of beryllium. It is likely that inhalation exposures of workers' family members occurred during laundering of the contaminated clothing, since resuspended beryllium dust concentrations in air from unwashed shirts at up to 0.64 ftg/m1 were found. In an earlier laboratory study, Eisenbud et al. [1949] found beryllium concentrations in air at 125-1,200 fig/m* when soiled clothes 35 were shaken and estimated an inhalation dose of 17 /ig during a single home laundiy. The OSHA permissible exposure limit (PEL) for beryllium is 2 jig/m3 as an 8-hr. time-weighted average (TWA) with permissible excursions up to 25 Mg/m3 for up to 30 minutes (29 CFR11910.1000). Asbestos Several studies of asbestos workers' families inferred that asbestos-related diseases were due to home contamination emanating from clothes contaminated at work, especially due to laundering the clothes [Anderson et aL 1979a,b; Bianchi et al. 1987; Giarelli et al. 1992; Gibbs et ah 1990; Huncharek et aL 1989]. However, no studies evaluated the relationships between home contamination by asbestos, contamination of clothing brought home from work, and exposures during home laundering. The few studies reported and reviewed in this section indicate that dothing probably was a source of home contamination by asbestos and support the hypothesis that home laundering of asbestos contaminated dothing could be especially hazardous. One study reported measurements of asbestos contamination in workers' homes; however no measurements of dothing as a source of the contamination were made [Nicholson et al. 1980]. Two studies of workplace clothing contamination by asbestos have been reported [Seixas and Ordin 1986; Driscoll and Elliott 1990]. Chiysotile asbestos was found in all dothing vacuumed as employees left work at a brake shoe manufacturing facility, but neither report provided quantitative data on asbestos recovered from the workers' dothing. No studies of exposure during home laundering were found. However, a study on laundering clothing contaminated by an asbestos removal operation produced an average of 0.4 fibers/cm3 while picking up dothing and loading the washer. A maximum of 12 fibers/cm3 was found during the total laundiy operation [Sawyer 1977]. Although the study was not conducted in a home laundry and measurements of the level of dothing contamination that generated these concentrations were not made, the study is consistent with the hypothesis that home laundering of asbestos-contaminated dothing is hazardous. Another important aspect of laundering asbestos contaminated dothing is that the fibers can transfer to uncontaminated dothing washed with the contaminated clothing, as was found by NIOSH [1971] in a study of dry cleaning a coat made with 8% asbestos fiber. </ ^ ^Code of Federal Regulations. See CFR in references. 36 Asbestos Asbestos-contaminated cotton cloth bags that had been used to transport molded asbestos insulation were taken home by a worker and used as diapers (Li et al. 1989]; three family members died of mesothelioma at an early age. It should be noted that dirty clothes were also brought home. Lead Lead-contaminated cloths from discarded pollution control filters at a lead smelter were taken home by workers for use at home [Carvalho et aL 1984], The children of these lead workers had a mean BLL of 67.5 /ig/dL. In another case, discarded lead battery casings were taken home for fuel by a worker engaged in recovering lead from used batteries [Dolcourt et al. 1981]. The battery casings were burned in the family's wood-burning stove. House dust contained up to 43,281 ppm of lead; one child had a BIX of 220 /xg/100 mL and developed encephalopathy with seizures. Osorio [1994] reported that when lead contaminated telephone poles were taken home for fire wood by a worker, the soil in the yard of the worker's home where the poles were located contained lead at 1,500-1,600 Aig/dX Pesticides Toxaphene-contaminated metal brought home from a processing plant resulted in the death of 2-year-old boy [McGee et aL 1952]. The metal, which consisted of flattened strips made from drums that had contained toxaphene, was used to cover the walls of a tool shed on the day the child, who played in the area, was poisoned. In another case, a loaded company truck was parked in an employees driveway overnight [Barnett 1994]. Part of the load was chloropicrin which leaked from the vehicle, poisoning the next-door neighbors. Estrogens Diethylstilbestrol poisoning of family members was considered by Pacynsld et aL [1971] to be due in part to women bringing home contaminated factory-supplied milk which was consumed by the children. Radioactive Substances Radioactive waste lumber was used to construct a garage at home by a worker engaged in the manufacture of catalysts containing depleted uranium. About 20 years later the garage was found to be contaminated in excess of NRC release criteria [Brockman 1993]. COTTAGE INDUSTRIES Cottage industries, those where work is undertaken in the same building or on the property where the family resides have been recognized as a hazard since at least 1914 [Oliver 1914], Poisonings by asbestos, lead, parathion, and mercury have occurred in cottage industries. 45 Asbestos Asbestos sheets brought home from work were used in a cottage industry to repair burned out mufflers [Epler et aL 1980]. The asbestos sheets were stored in the basement where the children played and were also used to construct a tree house in which the children played. Both children developed asbestos related Hmg disease at about age 30. Asbestos cement was produced in the basement of another home for about 20 years [Otte et ah 1990]. The mother, father and one son died of mesothelioma some 40 years after the beginning of the exposures to asbestos. Lead In addition to the early report by Oliver [1914] of lead poisoning in family members of home pottery manufacture, 14 recent reports on cottage-industry home contamination and poisoning of family members by lead were found, 6 of them involved pottery. In the report by Oliver [1914], lead at up to 10,000 ppm was found in dust of potters' homes where the pottery was dipped in lead glaze in the same room in which the family lived and slept; lead was also found in the clothes of a young boy and a baby. Koplan et ah [1977] reported on six home potters and their families in Barbados and found BLLs up to 71 /ig/mL, and average concentrations of lead in dust for the six households of 2333-88,159 ppm with a maximum value of 325,892 ppm. The State of Alabama [1992] reported finding lead at up to 177,000 /tg/ft2 in a home pottery workshop where children with elevated BLLs spent some time; elevated lead levels were also found on the kitchen floor of the family's dwelling. Other studies of home pottery manufacture did not report levels of contamination, but did report elevated BLLs. BLLs up to 74 /tg/100 mL were found for children of workers engaged in ceramics (plates, cups, vases, etc.) production at home in Italy [Abbritti et ah 1979]. Molina-Ballesteros et ah [1983] found BLLs up to 98 /ig/dL in children of potters working in their homes in Mexico; and in Japan, Katagiri et ah [1983] reported lead in urine of children of home pottery workers up to 793 pg/L compared to 59.9 pg/L in control children; 112% of children of home potters had lead in urine greater than 30 fig/L. vs. 2.7% of control children. More recently in the United States, Fischbein et aL [1992] reported finding a BLL of 48 /ig/dL in a child of a home potter in New York. Manufacture, repair and recycling of lead batteries by cottage industries have also resulted in contamination of living areas and exposure of family members. Lead loadings up to 53,140 /tg/m1 were found in households of cottage industry battery repair shops in Jamaica [Matte and Burr 1989; Matte et al 1989]. Matte and Burr [1989] also found that playing in the area of the battery repair shops was an independent predictor of elevated BLLs in children. Other reports did not measure home contamination but reported lead poisoning or elevated BLLs. 46 CHAPTER 3. LEVELS OF CONTAMINATION IN HOMES AND CARS CHAPTER SUMMARY Measurements of contamination in workers' homes and cars were reported for asbestos, lead, pesticides, mercury, a few chlorinated hydrocarbons, arsenic, and fungi (Table 15). However, for the other substances reviewed as contaminants of workers' homes, data on levels of contamination have not been reported; this is true for beryllium, estrogenic substances, asthmatogens, cadmium, fibrous glass, and radioactive substances. For asbestos, there are no studies of contaminated surfaces, but in one study of the air of workers' homes asbestos concentrations up to one-half of the current 8-hr. time-weighted average OSHA exposure limit for workers were found. There are many studies of workers' home contamination by lead that document the substantial contamination that has occurred. Lead contamination of surfaces is measured either as concentration of lead in dust, expressed as ppm or as the amount of lead covering an area of surface, expressed as weight of lead per unit of area, and referred to as lead loading. When the concentration of lead in household dust was measured, average concentrations in workers' homes ranged from 1,600 ppm to 5,000 ppm with maximum values up to 84,000 ppm. In control homes, concentrations were usually less than 1,000 ppm. When lead contamination was measured as weight/unit area, workers' homes had lead loadings that were greater than 2^00 Mg/m1, ranging up to 109,000 Mg/TM1Control houses had lead loadings that were less than 1,000 Mg/TM1- Lead loadings in workers' cars ranged from 1,000 to 300,000 Mg/TM1- Control cars had lead loadings that were less than 1,000 Mg/TM1- While measurements of lead in control homes provide some basis for evaluating contamination of workers' homes, guidelines for critical levels of contamination are needed. A value of 500 ppm for the concentrations of lead in dust was used in one study as a threshold for cleaning homes. For lead loading after lead-based paint removal, 2,152 Mg/TM1 has been used for floors as a practical, not health-based level. A level of 1,500 Mg/m1 has been stated as a level of concern for children's health. In three studies of workers' homes contaminated with mercury, concentrations of mercury in air ranging from 0.02 Mg/TM3 to 50 Mg/TM3 were found. In one study of control homes, concentrations in air ranged from 0.01-1 Mg/TM3- Mercury concentrations in contaminated automobiles were 8-60 Mg/TM3- The MSHA 49 permissible occupational exposure limit for inorganic mercury vapor is SO /ig/m* as an 8-hr. time-weighted average (30 CFR 57.5001). The few reported measurements of workers' home contamination by pesticides, chlorinated hydrocarbons, arsenic, and fungi also demonstrated high levels of contamination. ASBESTOS Only one report on measurements of asbestos contamination in workers' homes was found. Nicholson et al. [1980] reported that chiysotile asbestos in 13 air samples from homes of miners and millers in California and Newfoundland ranged from less than 50 to somewhere in the range of 2,000ng/m5 to 5,000 ng/m3 (1,000 ng/m3 equates to about 0.01 fiber/cm3 [Cossette 1984]). The OSHA maximum permissible concentrations for workplace exposures are 0.1 fiber/cm5 as an 8-hr. average and 1.0 fiber/cmJ as a 30-minute average (29 CFR 1910.1001; 1915.1001; 1926.1101). LEAD Most of the measurements of lead contamination in workers' homes and cars are of lead concentration in dust expressed as ppm (or the equivalent /ig/g) or of lead loading on surfaces expressed as fig/m1 or ng/ff (1 /ig/ft1 = 10.76 ng/m1)- Similar units are used for expressing measurements of contamination of carpets, furniture, and cars. Concentrations of Lead In Dust. Concentrations of lead in house dust of control homes were reported in several studies. Baker et ah [1977] found lead at an average of 404 ppm in control homes for a study of smelter workers in Tennessee, and Rice et al. [1978] found 1,240 ppm in control homes of secondary smelter workers. In control homes for a study of ceramic workers in Colorado, Kaye et aL [1987] found lead concentrations from non-detectable levels up to 320 ppm. For a study of electric cable splicers, Rinehart and Yanagiswa [1993] found 121-879 ppm, in control homes. Watson et al. [1978] found lead at an average of 718 ppm in housedust of control homes used for a study of battery manufacturing workers in Vermont As a guideline for cleaning lead contaminated homes in Idaho, an action level of 500 ppm was used [CH,M Hill 1991], By contrast to these control measurements, Baker et al. [1977] found an average concentration of lead in house dust of smelter workers of 2,687 ppm. Rice et al. [1978] found 3,310 ppm in homes of secondary lead smelter workers, Kaye et aL [1987] found lead up to 3,400 ppm in homes of the ceramics workers, Rinehart and Yanagiswa [1993] found lead up to 1,600 prpm in homes of electric cable splicers, and Watson et al. [1978] found an average of 2J239 ppm in homes of battery manufacturing workers. High concentrations of lead in house dust were also found in other studies of smelter workers, cable workers, and battery manufacturing workers. Smelter workers' 50 CHAPTER 4. PREVENTIVE MEASURES CHAPTER SUMMARY Several measures that have been taken to prevent contamination of workers' homes and to protect workers* families are identified in the reports reviewed in this Chapter. The measures include: reducing exposures in the workplace; changing dothes before going home and leaving the soiled dothing at work to be laundered by the employer; storing street dothes in separate areas of the workplace to prevent their contamination; showering before leaving work; prohibiting taking toxic substances or contaminated items home; separating work areas from living areas of cottage industries; storing and disposing of toxic substances on farms and in cottage industries properly; preventing family members from visiting the workplace; laundering separately from family laundry when it is necessary to launder contaminated clothing at home; and informing workers of die risk to family members from home contamination and ways to prevent it. The few studies evaluating these measures indicate that they can be effective in reducing or eliminating home contamination. There have also been instances in which home contamination has occurred when one or more of these measures has been omitted. BERYLLIUM Following reports of occupational and non-occupationaJ (community and workers' families) cases of berylliosis, the beryllium industry instituted a number of preventive measures, including: engineering controls to reduce air-borne exposures of workers'; community air pollution controls; and measures to prevent exposure of family members to contaminated dothing [Eisenbud et aL 1949; Metzner and Lieben 1961]. In one plant, a double locker system was installed in 1955 which prevented removal of work dothes, underwear, socks and shoes from the facility [lieben and Metzner 54 1959], Until Newman and Kreiss [1992] reported on a case, there were no new cases of baylliosis in beryllium workers' families reported for more than 30 years. This recent case report demonstrates the dangers of any relaxation of preventive measures as the uses of beryllium, the number of workplaces where it exists, and the number of workers exposed expand. ASBESTOS Although poisoning of asbestos workers' families has been known since the report by Newhouse and Thompson [1965], and has been repeatedly associated with laundering contaminated clothing, no information exists on effectiveness of preventive measures. Belanger et al. [1979] recognized the hazard in evaluation of a factory where asbestos was used in the manufacture of floor coverings. They specifically recommended that work clothes not be taken home because this could expose others at home. Seixas and Qrdin [1986] and Driscoll and Elliott [1990] investigated plants manufacturing brake linings and made recommendations for providing protective clothing, keeping street clothes separate from work clothes, company laundering and showering before leaving work. The OSHA asbestos standards [29 CFR 1910.1001, 29 CFR 1915.1001, and 29 CFR 1926.1101] require these actions when employee exposures exceed 0.1 fiber/cm* averaged over 8 hrs. or 1.0 fiber/cms averaged over 30 minutes. In the absence of information on clothing and personal contamination levels when workers are exposed to asbestos at concentrations below these limits, the i/ adequacy of the OSHA standards for protecting workers' families cannot be judged. LEAD The report of an investigation of a stained glass window-making studio [Donovan 1994a,b], documented that the use of controls by the studio effectively prevented lead contamination of the worker's home that was adjacent to the studio. Preventive measures used at the studio included local exhaust ventilation during soldering, general dilution ventilation equipped with an electrostatic filter, adhesive mats at doorways to decrease the migration of lead dust on shoes, a laundry room located between the studio and the house that was also used as a changing room, designated work clothing that was only worn in the studio, washing work clothes separately from other dothes, prohibiting work shoes from leaving the studio, and prohibiting the child from entering the studio. Based on the results of surface-wipe sampling, which demonstrated elevated lead levels in the studio (1.2 mg/ms to 1,600 mg/mJ) but not in the home (non-detected or trace), the author concluded that the measures used prevented contamination of the home. The Lead Industries Association, Inc. has produced a video tape entitled 'Controlling Lead Exposure for Stained Glass Professionals and Hobbyists' [LLA 1994a], In another cottage industry, a home-pottery operation, the concerned potter and her family were asked to discontinue being exposed in the facility because of their elevated BLLs [Fischbein et al. 1992]. Two years later, the BLLs were normal, indicating that corrective measures, though not described, were effective. Hie Lead 55 For lead loading, the Department of Housing and Urban Development (HUD) has guidelines for floors of 200 jtg/ft* (2,152 jig/m*) and for window silk of 500 jig/ft, (5,380 jig/m*) [Jacobs 1994], The HUD guidelines are not based on health considerations, they are based on levels that can be practically achieved following lead-paint abatement These values were used by the State of Alabama [1992] and Pollock [1994], Matte and Burr [1989] cited 1,500 jig/ni* as a level of concern for children's health. CH2M Hill [1991] used a concentration of lead in dust of 500 ppm as an action level for cleaning residences. Mercury concentrations in air of workers' homes of 0.5 jrg/m3 and 1.0 jtg/m3 were used as decontamination goals in the reports by ATSDR [1990a] and Zirschky and Witherell [1987] respectively. In a recent report on decontamination of homes in Florida, 03 jig/m3 was the level at which families were allowed to return to their homes following decontamination [CDC 1995]. For PCBs, EPA guidelines for indoor solid surfaces and high contact outdoor solid surfaces state that post dean-up levels should not exceed 10 pgf100 cm* (40 CFR 761.125). Based on PCB levels found in non-manufacturing buildings, 0.11 jig/100 cm2 was used as a guideline for decontaminating a school building [Orris and Kominsky 1984], Other guidelines cited by Hartle et al. [1987] were 03 jig/100 cm1 for office buildings; for an aircraft plant, 230 jtg/100 cm* was dted for low contact surfaces, and 1 jtg/100 cm* for high contact surfaces. REVIEW OF DECONTAMINATION PROCEDURES BERYLLIUM Shirts worn for one day in a beryllium plant were studied by Cohen and Positano [1986]. Three shirts were classified as "nearly new" and three were classified as "old." One "nearly new" and one "old" shirt was laundered at the workplace. Beryllium was present at 22 mg/m3 and 30 mg/m* in the "old" washed shirt Beryllium was present at 12 mg/m3 and 20 mg/m* in the "nearly new" unwashed shirts and at 0.2 mg/m* in the "nearly new" washed shirt Although this was a pilot study, it is the only study found that provides information on laundering clothing contaminated with beryllium or similar particulate material. The study indicates that the beryllium was laundered from the "nearly new" shirts, but that beryllium had accumulated and was well entrenched in the "old" shirts. Substantial levels of beryllium dust in air were generated during laundry procedures. The concentrations were up to 13 mg/m* [Eisenbud et al. 1949] compared to the occupational exposure limit of 2 jig/m3 as an 8-hr. time-weighted average [29 CFR 1910.1000]. ASBESTOS There were no studies on the effectiveness of any methods for removal of asbestos from clothing contaminated in the workplace. One study conducted on dry cleaning a coat which contained 8% asbestos in its fabric, indicated that some of the loose fibers were removed [NIOSH 1971]. Concentrations in the air of asbestos fibers 62 longer than 5 /t that were generated by wearing the coat before cleaning were around 2/cc whereas after cleaning the concentrations were about 0.5/cc. Since the fibers were part of the fabric, the study may underestimate the ability of laundry procedures to remove asbestos from contaminated clothing. Asbestos fibers were transferred to sport coats dry cleaned with the coat containing asbestos. In a laboratory study, asbestos-contaminated carpets were cleaned for about 65 minutes by either dry vacuuming or hot water extraction, using vacuum cleaners equipped with high efficiency particulate air (HEPA) filters [Kominsky et al. 1990]. The carpets were artificially contaminated with 93 x 10* and 93 x 10' asbestos structures per meter squared (s/m1), based on levels found in carpets from an asbestos-containing building. Dry vacuuming removed little or no asbestos from the carpets whereas hot water extraction removed about 70%. An important aspect of this study was the effect of the cleaning procedures on airborne asbestos concentrations. During carpet cleaning, by either method and at either level of carpet contamination, average asbestos concentrations in room air of 0.15-0.25 s/cm3 were generated. The OSHA permissible exposure limit for asbestos is 0.1 fiber/cm* as an 8-hr. time-weighted average [29 CFR 1910.1001; 29 CFR 1915.1001; 29 CFR 1926.1101]. Resuspension of asbestos fibers was observed with a fiber aerosol monitor during a daily cleaning period of a classroom by Litzistorf et al. [1985]. Resuspension of dust by cleaning activities is an important consideration not only for the decontamination process, but also for persons living in the home and performing routine cleaning operations. LEAD No studies on laundering of clothes contaminated with lead were found. However, Simonson and Mecham [1983] showed that a workplace airshower removed from 5% to 72% of lead oxide dust from clothing samples contaminated with about 1 mg/cm1, and from 23% to 69% from samples contaminated with about 0.6 - 23 mg/cm2 in laboratory studies. A small amount of lead was blown through the clothing to the underclothing and body of the workers (up to 1% of the dust loading). Ewers et al. [1994b] studied the effectiveness of dry vacuuming for removal of lead from carpets taken from homes of children who had high BLLs. These carpets were highly contaminated with surface lead loadings of 114,000 jrg/m2 to 5,650,000 #tg/m*. The carpets were vacuumed with commercially available vacuum cleaners intended for industrial Use. The vacuum cleaners were equipped with HEPA filters and fitted with a commercial beater bar nozzle. The carpets were vacuumed 10 times for 1 min/m* each time. Surface loadings and amount of lead removed were measured after each vacuuming. After some of the earlier vacuumings, lead loading on the surface increased by up to four times, but by the tenth vacuuming the surface lead loading was reduced to 6%-61% (average 20%) of the initial loading. The 63 T ib lc 2. I leallb WcctM o f T ike-I lone Afbcttoc G iponre (Cohort Studies) T ib le Z (Continued) Health BITccti o f Tote-Home A f x r t n Eepoium (Cohort Studies) Thbk 3. Health H/Tccti o f Tko-l lotne Aabentoa Eapomira (Community Studio) E ..** 5 'B 'B .8 5 Ss|2f=J:r I 3-S-S&5t3Jg3 siSa| J &K ? j g o S g a s^v = So^j-S-s -- e fi|s = S s, 5 Ilillljllal || i |. i* I?<I 3E 1 S ,!, =gs8l|| 5jgu^E^i*-a-sSSjeB^s.=SliSS2v!S'rs~s"i.J5l!? -tg2msS*81Jf;osv's'?fl^!J6cgL,1c&* .icst~S*=g2*-. i|lli = i|1i|S a sjjfsll sl|*'s 1 s-sJr&o|.-g|^g IgllslilslfS j8i5lfi:ls1s 1a-M2 I|8a.a=5Z3sS 4. 1g= I|lsS el|5 llsIHi-| I J1=f|Sf h* i'Sg3* % 5 C---g 2S >2. Iidj"'s3-?8 1 _ s Si ill J<9tf 1zVh9 1<3* BIEge?l. Tkble 4, Health Effeeta o f Tke-Homc Acbcataa Bqnaura (Case-Control Studka) I"! 5I- lf I* a I"Sl|J ill If!},s e Si* sc*.e 85- is s a e s % a. sL i O *s|5? " j( > !? E 3 * S B* ? 5 J5 ell SIJ S I jg it\ 5l| &Sl 8i C 3L e _ $ i If! ea g s |af8rtt 2S"-S JIs ESs-*aill5*o?- |Si3 I S3* X. -O 3 -J f 1a t e S -gg | ^* Jea2-g4a Sp . till ?.s?g3 s & s. e & I-- 5 K S I Iff g-gw e *S*f h:i f;{l! * - O S {L3 & hsi* 1 8.6 1 &S.S.S | jf |-S' 8.1 6 ^ a _ ti f M O w1*; 2cLg> -2o -- ^g 5 - x S.3 S' J ihll I i= * IS llsPfc -S_ |i|*sr <J3*C3eo -Mfitlfcmjl *2&* So*=m ^5 g* l*S!| St., S^i I E J-S | s ,,* ^ g - I 1 f s b 2 8 s * <mo 5ao. (A I* O >* * 1 I4 I* 00 Table 4. (Continued) Health Effecti o f Thke-IIome Aebcttoe Bxpoeure (Gn&Cbnlrol Sludlea) m 'Ov _ ^ i 1 -s " c * * 11I ocEJ|oqcc O^e^p-gii.Cg 8|1 ^" 8| S-sst el Iss5 8K.-1o 5. f 2 I I8 --S 1 fS. rE? S* | -*%= * is e 5 z*& s#s SEi? S- Sa -S -3 g f >.2f |5CEi j6i"r o ji .E til e2 e 1 '=OEs"3ic8EIig|ss!si JasZ.j?S E f_* . g"os. kHf5oj'-iBHSaSEojM* ,'sSOI l?ssei5o-*t&t,a 5S*J "O Bl.lIHMI t 1j s512 Bb c2" u*OO S-Ss I~1,, I3IS. it eSs :; Iist us fUi J3 I r, o.S E 55 ! SS'J0 11 ^-E&a Se*o,, |5|^l" | 5 & ' ii". !w IS, H* EC& c- c.^g3o-s 8 Tf S ,,*r |t Ss iS II ill E< e oME 2*S 4S -s - ES -5s 151!.:J g-gi S5f E|l CtJtb8-. g"e 5-T S 4C W gt* nil!r* SLo. js s 3 "c --eoiae snJ! 1ee = f Q O--a ^e -C3c 'C* ""cE ^ u * 11 .8-e -Sifg3 u 1!I 8 g -m | J * 8 Ts i sui I s3 " O: 5 o2 eE ?|sll 3 8 f 11 1i s X Tbble 4. (OonUnued) Health Effect* o f Tike-Home AibetUM Expocuro {Qaae-Coottol Stwlte*) Table 5. Ile a llb P iltc B of Take-Home Acbesloc Saponin (C ue Reporti) Table S. (Continued) Health Effect* o f Take-Home Aabcttoa Cspocurc (Chae Report*) COMMENTS Brotherdea,d iadersur ivve.d Fa iktchenwhentheywerecihldre.n u c cW9 UK ) I HO' 2s f0ifS* <0 3W*> 1 6 h LI H0 gw ,s1o* c* s% ({Ve || uI- l| I bm Bn S 3V As e9 la3 11 . <*5* _ .-|53Vgs5S Ir^Sef3|l1i""55:f^SEs|-S?El H ^ l'-6 IS 24H cSgu B -- jj j 2 ^5- Ulli l>a. & 12 !?|H s| Illill if 8 8 3 5 soc J4VC-a! 2-_IO.uV2SffiSaCEC8tAL' 2| _sSV E J 2 J3E wI 1 | Eo .3 1 sE s2U o <^IfS0i t'cVE9 fxi 1*gu-e2<>C.o""9e |1 111 I=agBS^t2fisnsEi5Sla- c"el-SEl13 iliii IH hi 5S^J5.vif qli '8 =J I I5 fo g-- 59 8s2g i l lt |1=I8l1 Oh JS 5* 5ET 8* VeVga3 3ho* J&3m"aEl, cm -5. f=8V3 * =ii nE -5 8g 2vE E 3v > i i Asbettoc (foundry) 8 *6j**uJ I j; e S 87 S H8U 1 8 It 1 M \Us "mV l-8 ts? ill *3 X~ IICS.D *VD&5 t^ s ill *ju*3 5tt _ 3 =.3 II Hunc II989 Q USA Cloton lcothaalctiInwihchmlod trainportedhadbeenusedtoma werethedetehaofthemtoher,a livedthereandworkedasinslusti ofssbelsolss. Motherlaundered andwork lc tohes. I- 3zVStu-ow"g '6 1 1T<v=V5 !-Ve l^m*g!9Whvn ufuec t2uSfc ^-*y9 I"8a s|5*f |a8 1|r. ieOs-I-og*.!i g3 v*ei if s 74SS* r1hTok%u9*a2a>i BE. 1 3 .-2 1 SE VC .5 8 8 85 <m S sS-ci 5 Table 5. (Continued) Health IlffecU o r Take-Home Asbestos [Uposure (Case Reports) Table & Health Effect! o f Take-Home Aabeatca Qapawie (C ue Seriei) Hi ill Km JSO Sf 3 J! I = '82-0c si g e n l;iJE io g &E I |Jsgst'iIljfi. SS'Sl^iSg S F*s ?g S I o-S | mo Sla stil* iispia 'St sS.g'Sfr 3 3 a s| :3 o5 g i?:* * If* lliS Sirs If II oSSf 5* sail-t Es^Si4Z 210 ue9 ov5e^^? l 11 lui 1J f Sgi S 5 11|1 c 5 f s is 1!Ta! 5m 2| 21 S " -e I^S Sf*SESl a |a. *s c1 S.ffi S 8 I- L E tj 2 ES" *1! = 6t S* *aS ^v v3 = Si X1 g5 w M*t iUj i e -a s . is *S S IE f| U Q. . 2N s 9 5-S s .2 II ! Hi Ifi o no l0 -8E a 1w -"e 8 a3 aw < c. e. SP< xr.: Iii m no xr Tfcble & (Continued) Health Bffecta o f Tkkc-lloroe Aabeitoa B q x m ra (C ue Setlet) i M S6 11 123 St 3*5; - ' I tit 1Eg 23 Sw 0>*. f Jl JII*oS ?jIUS 3-5 f* J-s i !S2 8S |11s3g <*p> "o a - 83 2 * illo < o 502ti=| mi 3. '12Jes 21** 3 s up^2 e ill's | SHfil flllll - I 6g-3" i2 salifss 5 i3s V S ^9 r =| SS5 IN? E?'- S'2 8= fr ^ - & 2|= sCoof<lJssi-5t!i #53B -ir5;l-s==*E SoSsie. till |l|l "8 5&-85 35 ml Jill = -S 2LJ Ut* 3 1** - 3i 1= s^ t as I8 fe 2z hi If Zui$Siue i| e. ihi30 2a rijj 5 <5 E S8 1 f * e?!" 5i-K=8 S52e--=M*^" SI* S j- l Jt - 3 J{*S o =3 s^ vi 3 See 1 -S S S frjt slsiSe ill 2 o -5.5 J2 Jf ^s o5 E sE 0u -i3 so if 2V 5 3 2 6E Ct> I * s 58 s8 i*s 1f g leg O nD js| 111 OQfl 3 Jgl S4 t l.s *0 in Tkble & (Cootintied) Health Effect! o f Take-Home Arteatoe Espocura (CMe Seriea) IV -- PE Z5. Shj'l?a illf!jI | =S --sP 5-sP &8^.**m1* C"s *2sPea 25 1838 SaiS2|EgE5 Eli Is fila1 O J5 C S 11 SS 3 1 ll. Ill if 5.3 5 g | el | SK '6* *1fE*S7-t 5** ftiJ3 !e v3 "!ao s S it's ilillf H BA ^gsRg I I g S 2 I e | f Mf ifll 8 l sf s |3 "o 1 S i ~ f 8s|-5 If f J |Ss11^1^1g "'Ss|5SsgSfS| II ll| J-2 *11 ll s'RSc. 'ots>ea.-lElPlClii's=eKj*5Fa*x^v-|ChSo3i X5io fm = ii^ Jill 1-2 "4 U^s e|M lisa sasl illg .3 1 lSS TS | t if 8." is !l si *J! n "3 11 COMMENTS/ ISSUES l h HE SB 1 c B jl i Ig II ll * i u 2V in E g2 F B E QV. 1 1p 8"E 1 P !E s 1 =5 ,*Ei ^"a-s 52J J g !U E53 ^v ^" w i e ia ae sI saa 5s e 1v 'o aVi lgC BHM E9 J3Si --t> m s 18 X.7B. XS.o7. 1E3 U I| "1 7^ If E a 1 ^?11 S 5 E 7-S Ii. Is if I </3 *a2 Xo> Pleural plaques el necropsy were found In S5% o f 121 women with h lilo iy o f domettIc exposure. Slflaia JcJ .e X* S& d jc .e2 I "I u 1! I sflSs-l 58. felSS~ 8& 3=.^g S^o ^-5-1 s S e D-1 ^i s 3i a g -9S. S&i. M% E H iii S? XSL07. tl 1 8 1E 0 2e ff wa AUTHO YEAR COUNT 1 *; 1(S Ssm' *Ss. !*>. n Ilfo e,i5 I03s* T itle 6. (Continued) Health [3/fect* o f Tilte-I loroe Aifeetto* Bipoeurc (C ue Setka) trn- e I 2m I its S *8 f* b v _o s ss 3i e. s 3 e S.JS I g"5 g| ii si! ifiii S| S.2-2 y^-s 8 | ?i S - #"= -5 T1i S-?-- sfttavt "cSj |5S .SI2 toi; "^"5 isIi .'C Z OM 3 ^ " e -- TC ^ - -E -O 11 Eg |Sfi 5* * o3*e3q1 S# e s. s5 8I g fll o g -Si hi fti nf. iMi fill ii 11 ii u i *3 n* il- *! I gg2 <E8 ill 2= S5-n- e * a8 1= '? .x^ II *-Sfis * * * fi I! #83| HHtii eJ ! r -S_>s&6Sv' aoSfce*a5sEC=Se)?6o?lE2e i ill ill Tkble & (Continued) Health R/Tertt of Thke-Homc A lbedo* D iponiic (Caae S trict) c3V s-i SX *. 8 ** E Ii 5^ 5 ^8 -=, <3 Ii| o s ^o Ow ^c GW *8?S f sii n " jf r I~lS= !S y gI Sl 12 I g g T0 SUeC ,<S6 " O .1 ii *2 ii -g. = e3 -S8-" --1 -KS jt<t-= -E5B s; i| l I ||IeS i If H Sill E B"S i^ ;E! a Si ngl I* f!_v 5ST.se "sa. Si S o "*1ioj Bu- 8O' 5| 9 83 = <22-|8 38 S3 u 8 E sis o Irl 58 ill 2 S.B. 2 =. o/o> Table 6. (Continued) Health Q Tt* o f 'IU c-ffoow Acbeatoe Q qxm re (Cbee Settee) rrr -S 18 *M! I -- *B I ill 2 fc*J -g2-5! b81 r=* gi Ct- 5 " SH r c R 5 o1 "`eiaSiJsi JS |g e<Ss 1 -V E e*".*s s g5.5s.s <sH "i?Ed O ^a V W = w iEltl* B 1 1 t'C- T) 1 ^MV ^ 1zo -J J* |fpi?!E fE !Ni % <> iSSsBE "5 |s y~v E E 8 DM It 1i V ill tiT,. iDASi T ibia 15, Woriceit' Home Conlaminatfoo-IoduatTUI Hygiene Aipecta T*hle L5, (Continued) Wortcre* Home ConUmlfiJtlon-I&durtrUI llyjle n e Aipecd e6 Z1 i3-g ss SB -g|l*z 8* : l |sSe g Z t 2 -p E"*Is &g f5 -3 s* 1k 50 *, w v v^ e *65 |3 -?JI -g2o2t 132J .0 ill Jii A oV -Me Zt *1 ee II. a^ B S' | * I * K Ills ii&J HE* * s SI S ><"eOc =e2fc Scep* 4Soe8? b m >1 Se ! Po _ 8. : u8 3E8i ^ 4 g -2 4i - o. g E C E Fi CeCi V) 5 - s I iff >s*s g g ill! lll :|Si Sif| j 1*1* IIl i &g SI --5 jow CBw iIn* o zExo O -c*s. >s "mS a' S- sti *8n -23*s**wo> 8=: S *0* Tc3 M H ss is I 1: 8 ^ V^ o 1 if f^Ii --O O33 *sii slil- eGu S 8? *Sgi 111 "S| fig >38 b E . |j -* :Ve55-e 5H 5 H MJ ^ JS Q s S .2 til li* S s| 5 z2 KS1 g 3 fc-2 ! ! l s 11 JltlEL. *i s s . I* 5 P- se. ov *e "5> M.e <2 * 8se3 2I1I (= Ef oS O 'g E| li ^ Xg0 3'g 5 -I . E * Ill ^***f0i 43, 8e II I * S5 J"ngIc JIeVSi ! < S.S f-2 l| E m l^3 l9 O (A x> i ZEE E = g, 3 -E K" if 8 Ji 5** A .1 Il f|i 2 .3 s uu M II 88 Hu 8 z. 1 t A1* gSM\H-f5c |r* oSc a=o 2g^ 5* Jii iorr.Di Jx nmD co T ib le 13. (Contloued) W oitera' Home ConUmliutioo-IiidtBtrU] Hygfeoa A ipccti 1 3i ii -1 1- s P c 8 s -1 1i -= ii yI_ c S*. g S I If ^ E I HC *> C8 tli ""11 f-S S|S? 5 0 -e si e = s h M = E8 - E frg Sla gs! i5* -SB 8S *--5 J$Ri 1?= "i e? tE l*> av I SA vO I* ee n Pc fc J 1 | -i. ! | 6i|St- Ji s-g i:5ii5 If, I$fsf*i*fslsift ii lg e S| if e2 *1 sa 1 l-'s 2 sn<ialil*5 aI *1 tf a | ?AS|s8--l* ?S1S E iJh* Eilf* 5 | frS |s c ! 1 Ms l!fi r-si-s s z o. > s. a "iiiJi lgl|jo.j E |Hl S g " E8 g 1 S^-o 8f -g -* IJlfL sa J|-jIses - S.3.S V- ps V -0 is n *co li 3** "o 'Sis C oC o t* Qiggf .iev=P X*Vl - p*--i &3 2SS3 5e m 'a*'C w ll? I* -==L?-s" S8 -aljJs l3 8 "! s: I 111 ^5 so. -iEsill - 931S jE Ca 1 s s: oMg -^E Si| | g5 ilbi *a si i- 111 % I-t sInl 8 si Nil #Sf _8s**S 8S - ?s" "I -1 -- s.* 111 *! <e 3 5c s_ I- S O.S sill 11!fft-i o S fg *3 -is ef af |? 1 51 i 11 3S | S | j E 3? 3 > ji i i Hi* ?|IS | -|ll g E^ 0 Sg -S V i*1| O C3 tB .&g o fQ8*X Ev .zs 1* &l! -2= sa v s -5 1 g| l !|n|l | S 2S1 Si 1 | it -l lie *l*o*e=sg8-=E1|_ESas.^8 Sli li ess S c> 2SsC> ^s3w 1 e? 1 ? <XX*om1 f--oBO 83 -i Sfr 1" il i3 S if li 5M 1, III iI 8* jal 8 3 8 S J ^1 z!^i.l0|z 1 I2o| I8 I8 11 5 1 2mO c 1 s* %To in |1|.3 T ib le 15. (Cootintted) Worker*' llo o x Coot*mkntioo-Induttriii/ Hygiene Afpecta Inin jid t*>. l l* 8g 2ag5l-"g* --So =e* Vv,, mf*i- IcJ- *2 s; "1111 ^^ Ec u. e I III! e jCf'ac jg! 11s*3 !t *15 *e fie fi 3 S2 2 3 "1 I< ilH lU 5* - *X=i 2t 5e *S - SIS I -2 C ^ 3* c Ji 1" I*, ggi w * -2 05" ,O St I i- I51I8 V A4W 9 g = - -3 *1 2 %* i!V# *<2 =g t?j!! jaa amm !i8- o s => r| s|*c S' -55, 5 :fJSS gv EO g ^A S 5 ! 3 3 ~**= * " C c |is S$ I iss f ~E L iHs-o I E "5e I^fi I1s2 18 |! li | S I** e Eg IE -v -- s^Z e$ H Ji a. EV * g 4i. E !-'" -Je- - TM= s ? 3 5 l 5 e3 Q e 5-^ h el | itsh ll^l -m si . - T5 _* 3 tmst 8*3 ej r 5L I|| " 32|S(S 1 e - 2 K| li 1 a - -e e; 5 I SLa v -o a ell 81 a <3 5| - P JSKl^S J cu c a. E a < 1 * 8T7 4- a ff TsJ 3 1s !K e Ufc1 kE i. s E ^9 "E -5 * e I|SE= * J1i 5. || 8 '0*0.3 ? Em lilt ? EC a l !l^ M,2 * g. (Si ,, fc s !|! i fi slit I = * O C m Z&4 3 o Jg Ism* -bV HC i ui,7 ill r 5 au -e i &e- ds V 5E S- fc> e 8 3J 3 T*J sV ,C9g V E E _w S= Xa 1afea au IS -i3 2Jm5gti 00 'i * 5 | I* p V =. E | So lo UII(It) s I6 Ia 3 lit jab9c : ay T ib le 17. (Continued) Federal Lnwt Relevant to W o rte ri' Home GntamlncUon T * a Si eS'>E2 w.S" Iu '5*, - mv Z 2 IIA> a I t r e* eo ii .s t/I 0 as c E ?g. Zfi JS --o. cr ^jj 1 ^ T -- 5 5l3- <<-> sc1 '=c- & Sg>.-E Is T|= oUSu2It 12 If I ii S ,S --c sg VS-3* &3 e sKS3 1, 5,^1 S.Am ill li MI it 11*1 2 o 111 ? ow ^u g *-S -- .g 2 OSrf-3M3i "--5 St C M5 %2 S -r aJF s j r !i j iis k Si 3 S. II 0 D -r a* K gx| !| Ii ill C(NS C Tb!e tH. R ip tilio r u of Pcdcnl Agcnciet Relevant to Wortera' Tamily Protection f S ^ sl 0. n jrf w _ Is S all e y S s =f ia O e- B-TS 4** B* *y C ,,<S ,g2 JvS oE yV; 'yP P nr 8 s-S. Elf s Q. If s B-cH. E a _* J&uS Jvb w ecy *_ 5=1 s IIs15 E Ob S v.'v! vt"- 1! &5 B -a s. 5 - ~ e b P E `C o na - 5L all S I'S 2a 5 s.S *sE 2 L JS ^ V * V W u V -o OV ll c =i j*" l1s " t; <n O 2 4li 4 2 u |w c 8 j " -3 w 5: " e ^ * 1 V V fc 5 1 n MS lea 8e Cy vy fc -VS VS WC I gl 5 Ss uly a* = B -f in E?H las v v g C v1 Ss?UTb1.e5:*>&?{t5.;?l`25 y I pssiE | s o o= s* 5 = 2 6 - 2 i- t: a8 * ncsi 5u-S 8 5y 2= oB*S^of rS l|31 i ga! vX ^ |- g W | 1VwJX=r.yg >j4t ; S:a 1e8 sat s`*" Kgyg_s; 8 f .-I y ^ t; *o -o c; Hi e & a- < -sag o uo Oe -. X " lr3"ElN8^a^rb-s 0 0 5^ a iI!" 1 sc ui e3 jb g"c I fa 55: g o.- -3 a bai s e t_VV- llSc* fi5 ISf s'is-wi v6 _ su -Q a Ztla |1 S-5.2 B11 51' see*; E JD -- C. ^ o JJ f - E " . O r 'C L* w 'E c o *" (X g "- * S js eI ,, ?I &gI V 6* U ^ sc3 bficf ia st> ^j 3 'y ^ as s| &1 S si I e !l* v If ; * s i_iv. a g pe sy ^4> * Hi eEc -- -* j: |EI 9y 'a ^ Ov f^ |* 1 Ic E J M- BSE ^ e t> o -yo sT a 8 |tr a-- Vl ~ s " & l> i. 5 i I a*ur M -e " "e CT B ,, i a ;E :E2s"oso' flill o^ y ^c *eo* Sc B5 <to] J,,2 --; c n. 4-b C 4TS? T! y ^y 'oC - 8I2 -- s -a _ 3 ! o S t> ;ts*";; T "O ;. sa ?" il, *. f et 1 S = 3 I = ea Ss o 8 JI Xh o uJ* sJt ;i ^c c8 P* 3C * s9 a| u y ec* ef 4 1 =f s sl i. o " e - ^W "e ya. -^ glJ If W - B C c. * 5E5 ; = i io iVE_ iVs--E lsJs-tcroi. I aa s*' 1 ** a *J Ss i 3SS-soi=.c "S MP l-HM o q -- E TD Stn;fD as , b V O_ ; |xS a|:& ^ E'jS ^- &C-c^ ,H ^u y_ c S E S B i . - bV Es5^f Si: ;5 v a -1 3 SS l. Z Vq Ss ^y L aK || 5 3H T a. & g ES yw g e b ESI vo yg Jy ri E*a -i^ acV e|bJ p s -=f s-ag *s tc|-iyp a I eu C y Ue W Pe 2 * -o 's3 ^ if U= 6U Xesi s K.S yv O ey 'esis 3U *r y E ~x o y II ii. o. ea^i ti "1 ! s = 5- rec HSf 4is SEtS Hll -- i-a 1!" =B S. E H 8g i So - E "c f S.P? "sjCCo**c ycO.t-.*yccc..!^== c c^ S i 11.1 a 6 .5 -. 5 S |S E ??Ss5 2 S y x . 3" Jgt-* attf e^s! E . 3 ^'E o S 2 o *5 2 E J B | 55 I 3| S 5SS, E E| g s-i-i oS5 S^I wyE fy2 * -C c s3^5 lCa- y ! a ^ j-s'ii o s ~o is 5 ^e -2 g ;r wI6 ?MC- SyS " c cC -V v o * y .= v bV| 5e 1 e 1 ee = 1.* Iw0S w wW O . ^'3 e ^ o* y si3 I"s ! S.E- 11 .Bt SJ' EJ | H-a ! ^ j- 2. I li'S ^ VH i .5 1i =| aE Is= E e ** b Eb-4 if Zd JZ * S-l-8^ f -gsyi*C' y*3c E" g s? K 2 gj y 5SK 'oew .yS 2ts": -ccvE _yujo y .ysi e * yy S Oo *> y 3 B. c - _ e rsli-s V? o t/i O ol/> fOJ ill U f* a* c vS- e O^9 mCch* N o ft e >&&& i ^ .9 .El S fi fl && c> ^ 'B'-i lis a &s PO pN Mp^ i5 i ^ es a p; Juuu 0S r* 9rS* f4.