Presentation on theme: "Pesticide Effects: Integration into Health Care Provider Curricula Faculty and Student Champion Training: Part I Helen Murphy-FNP/MHS Director of Outreach."— Presentation transcript:
1Pesticide Effects: Integration into Health Care Provider Curricula Faculty and Student Champion Training: Part IHelen Murphy-FNP/MHSDirector of OutreachPacific Northwest Agricultural Safety and Health CenterUniversity of WashingtonMay 31, 2006
2Agenda Part I: Nurse Murf Part II – Dr. Matt Rationale Exposure PathwaysThe ChemicalsHealth EffectsRisk CommunicationPart II – Dr. MattEnvironmental/public health contextDiagnosis and treatmentReferrals and Reporting
3Did you know?5 million AG workers at risk for pesticide exposure (U.S. EPA, 1992)physician-diagnosed cases occur per 100,000 agricultural workers (Blondell, 1997).Migrant and seasonal farmworkers are especially at high risk84% of American households used pesticides, most commonly insecticides (Whitmore et al, 1992)Homeowners use 5-10 lbs/ acre/yr on their lawns and gardens, many times greater than farmers apply to corn and soybean fields (Robinson et al, 1994).
4Did you know?Widespread pesticide exposure through non -agricultural sources with use of disinfectants: (e.g., pine oil cleaners, bathroom cleaning products, and cleaning materials for swimming pools).Non-Ag Sector a concern = pest control, nurseries, greenhouses, and landscaping.The medical profession uses disinfectants to sanitize and sterilize surfaces and instruments.Organophosphate and pyrethroid insecticides most implicated for poisonings.Water chlorination is one of the largest (by tonnage) uses of pesticides.
5Where Are Pesticides Used? Forests to control insects and under-story vegetation.Landscapes, parks, and recreational areas to control weeds, insects, and disease pestsRights-of-way along railroads and under electric wires to control vegetationHouses, schools, and commercial and office buildings to control insects, rodents, and fungiBoat hulls to control fouling organisms;
7Washington State Pesticide Events - 2003 67%Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report
8Washington State Source of Case Reports 2002 and 2003 CombinedWorkman’s CompDept of AGPoison ControlSource: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report
9Agricultural vs. Non-Agricultural Cases of Poisonings Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report
10Occupational versus Non-Occupational Cases of Pesticide Poisoning Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report
11Proportion of Poisonings Ranked 8th Cause of Poisonings = 102,754 cases in 2005 (4.2%)AdultsChildrenSource: Watson WA Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System
12US: Intentional vs. Unintentional Accidental84%Suicide8%Out of 196,164 suicide fatalities 7 used pesticides
14ROUTES OF EXPOSURE OP’s are readily absorbed: Across the SKIN with skin contactIn the lungs with INHALATION of pesticide contaminated air/dustIn the gut by INGESTION of pesticide residue on food/dirt/dustSource: EPA Protect Yourself from Pesticides-Guide of Agricultural Workers
16Non Occupational Pesticide Encounters Accidental or intentional ingestionFood and water residuesContaminated clothingTreated wood/structuresResidues on animals/carpetsGarden residuesTermite controlHazardous waste sites/spills
17Professions Exposed to Pesticides Aerial equipment maintenanceAgronomistsBuilding maintenance workEmergency respondersEntomologistsFirefightersForestry workersFormulating end productGreenhouse- nursery workersHazardous waste workersLandscapersLivestock dippers and veterinariansMarina workersMedical personnelPark workersPlant pathologistsResearch chemistrySewer workStorage/warehouse workStructural applicationTransporting pesticidesTreating contaminated workersVector control workersWood treatment workersWork on highway or railroad rights of way
21Children Are More Vulnerable To Pesticides GREATER EXPOSUREHand to mouth behaviorsSKIN contact with floors and lawnsLighter less clothingEat and drink more per weightGREATER ABSORPTION Breathing rates Heart rates Skin surface/weightGREATER SENSITIVITYSensitive developing organsLess ability to detoxify
22Children’s ExposureChildren have twice the amount of pesticide by-products in their urine as adults.What behaviors in young children that would explain this?
23Behaviors Hand to mouth: Taste their environment Near the ground: Spend more time on the groundOutdoors: Spend more time outsideDiet: consume more per weight (water and fruits)
25DietDrinks 2 x more water per their weight than an adultEats 12x more apples per their weight than an adult
26Biology: dermal & dietary dose NewbornYoung ChildOlder ChildAdultSurface area: body mass ratio (m2/kg)0.0670.0470.0330.025< 1 year1-10 years11-19 years20-64 yearsDrinking water (tap) mean intake (ml/kg/day)43.535.518.219.93-5 years12-19 years40-69 yearsFruit consumption (g/kg/day)Citrus188.8.131.52.9Apples5.03.80.4G. Selevan. EHP 2000;108 Suppl 3:
27Pesticides in Urine of 22 Children Before, During, and After Organic Diet Intervention Conventional dietOrganicdietConventionaldietLu et al Environ Health Perspect on-line
28Children’s Biologic Vulnerability Maria’s husband is an applicator but his blood test (cholinesterase monitoring program) is normal. She likes to take her baby with her when she picks him up from work but was advised against this. She cannot understand why being around pesticides would be a problem for her baby when her husband who had direct contact is fine.What is it about a child’s body that would make it more vulnerable than an adult?
29Child’s Biological Factors Higher metabolic rateMore skin per body weightDeveloping organs
30Biology- Higher Dose By: SkinMore permeable: highest at birth2.7 x more skin surface/weight than adultsLungsInhales more per day (1.7x) than adult
31Biology: inhalation dose Age (years)Weight (kg)Inhalation Rate (m3/day)“dose”(m3 per kg per day)<184.108.40.20621-2136.80.5233-5188.30.4616-826100.3859-1136140.38912-1450150.30015-1766170.258
32Vulnerability to Health Effects: Organs Still Developing Nervous SystemSex organsLungsKidneysBonesImmuneMetabolismDigestive system“A little kid goes from a single cell to a laughing, sociable, intelligent, friendly human being over the course of two years. That’s dramatic growth and development!”Kenneth Olden, PhD, former Director, National Institute of Environmental Health Sciences
33Parent ActivitiesRamon and Rosa’s 3 year old has small amounts of OP’s in his urine (he was recruited for a PNASH study). They are asking you how this could occur. The family live 5 miles from the closest orchard.Why is this? What things are the parents doing that would account for this? What questions will you ask and what things will you look for in the household
37Parent Activity Questions Source of food and waterParent occupation?Shower after working before holding children?Work clothes and shoes in the house?Laundry practices ?Use household pesticides ?Garden pesticides ?House and car cleaning ?Pesticide storage?Location of day care?House near fields?
38Key Household Safety Points “ Partly Trained Gorillas Always Run Down Streets Doing Cartwheels”ProximityTake homeGardenAnimalsRecycleDecantStorageDisposalChild play/daycarepesticide
40Pesticide Chemical Families -grouping based on similarities- Similar chemically (similar structure)Attacks pests in a similar way (toxicity)Common treatment + antidotePyrethroidPYOrganophosphateOPCarbamateCOrganochlorineOCChlorophenoxyParaquatDiquat
41Pesticide Sample Label Type of pesticide (used for?)Company nameBrand nameCommon/generic name (active ingredient)Chemical family (? atropine under 1st aid)Signal word (hazard level)
56DisinfectantsAgents used for sanitization and sterilization in the home and hospitalRegistered as pesticides by the U.S. EPAExamples includeAlcoholsChlorhexidineHypochloritesIodinesPhenolsPine oil
57Organophosphates: 30”-240 Carbamates: 15”-30 General central nervous systemFatigueDizzinessHeadacheTremorsAtaxiaConvulsions (uncommon w/carbamate)LOC (uncommon w/carbamate)Coma (uncommon w/carbamate)From muscle over stimulation:Muscle weaknessMuscle crampsMuscle fasciculationsFrom gland over stimulation:Salivary gland- excessive salivationSweat gland- excessive sweatingLachrymal gland-excessive eye tearingFrom organ over-stimulation:EyesGastrointestinalPulmonaryBlurred vision (constricted pupils)Stomach crampsNauseaVomitingDiarrheaChest tightnessWheezingCoughRunny nose
58Pyrethroids Normal use: If ingested: High doses: Pyrethroids: are irritants to the eyes, skin and respiratory tract. The symptoms last from 1-2 hours. Systemic toxicity from inhalation or dermal absorption is low.Normal use:Paresthesias (cyno pyrethroids)Shortness of breath (wheezing)Mucous membrane irritation (throat nose)Skin itchingIf ingested:Loss of consciousness/comaSeizures (cyno-pyrethroids)High doses:VomitingDiarrheaExcessive salivaMuscle fasciculationAtaxiaIrritability: to sound ~ touchCyno-pyrethroids: fenverlate, flucythrinate, fluvalinate cypermethrine, deltapermethrin,
59Organochlorines: 10 - 480 lipophylic CNS EffectsMuscle WeaknessDizzinessHeadacheNumbnessNausea/vomitingLOCSeizuresTremorsAtaxiaAnxiety/restlessnessConfusionThe nerves stimulating glands are not affected so you will NOT see:excessive salivationexcessive sweatingexcessive eye tearing(or over-stimulation of small muscles like)twitching eyelids
60ParaquatParaquat is very toxic to the skin and mucous membranes. Particles are too large to get deep into the lungs*, but once in the blood it collects in the lungs. If ingested high case fatality rate.Skin:dryness, crackserythemablisteringulcerationsNails:discolorationsplitting nailsloss of nailsRespiratory tract:coughnosebleedssore throatEyes:conjunctivitisulceration, scarring, blindnessIngestion:lung fibrosis (stiff lungs)multi-system organ failure, specificallyrespiratory failurekidney failure
61DEET DIETHYLTOLUAMIDE Few toxic cases - given the widespread useToxic if ingestedChildren: toxic encephalopathy w/ heavy use on large surface area on kids (+ ETOH - isopropyl or ethyl)Dermal problems: tingling, irritation, desquamination, contact dermatitis, exacerbate pre-existing skin dzKids: use 5-6.5% formulations
62Boric Acid Ants, Cockroaches in Residences “broiled lobster appearance”
63Boric Acid Respiratory tract irritant Moderate skin irritant Historic antibacterial: poisonings from burn compresses, diaper powder, irrigation solutionsTargets: GI tract, skin, vasculature, brainChronic ingestion more toxic than acute (13 ½ life)Absorption: via gut and abraded skin
64FluoridesTransformed in stomach to corrosive hydrofluoric acid: thirst, nausea-vomiting, diarrhea, abdominal painFluoride ion reduces extra-cellular fluid concentrations of Ca+ and Mg hypocalcemic tetanyCardiac arrythmias- shock 2ndary to fluid/electrolyte imbalances, hypokalemia and the fluoride itselfCNS H.A. muscle weakness, stupor, seizures and coma