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Pesticide Effects: Integration into Health Care Provider Curricula Faculty and Student Champion Training: Part I Helen Murphy-FNP/MHS Director of Outreach.

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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:

1 Pesticide Effects: Integration into Health Care Provider Curricula Faculty and Student Champion Training: Part I Helen Murphy-FNP/MHS Director of Outreach Pacific Northwest Agricultural Safety and Health Center University of Washington May 31, 2006

2 Agenda Part I: Nurse Murf Rationale Exposure Pathways The Chemicals Health Effects Risk Communication Part II – Dr. Matt Environmental/public health context Diagnosis and treatment Referrals and Reporting

3 Did 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 risk  84% 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).

4 Did 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.

5 Where Are Pesticides Used? Forests to control insects and under-story vegetation. Landscapes, parks, and recreational areas to control weeds, insects, and disease pests Rights-of-way along railroads and under electric wires to control vegetation Houses, schools, and commercial and office buildings to control insects, rodents, and fungi Boat hulls to control fouling organisms;

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7 Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report 67% Washington State Pesticide Events

8 Washington State Source of Case Reports 2002 and 2003 Combined Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report Poison Control Workman’s Comp Dept of AG

9 Agricultural vs. Non-Agricultural Cases of Poisonings Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report

10 Occupational versus Non-Occupational Cases of Pesticide Poisoning Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report

11 Proportion of Poisonings Ranked 8 th Cause of Poisonings = 102,754 cases in 2005 (4.2%) Source: Watson WA Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System Children Adults

12 US: Intentional vs. Unintentional Out of 196,164 suicide fatalities 7 used pesticides 8% 84% Accidental Suicide

13 WHO Sentinel Surveillance

14 ROUTES OF EXPOSURE Source: EPA Protect Yourself from Pesticides-Guide of Agricultural Workers OP’s are readily absorbed: Across the SKIN with skin contact In the lungs with INHALATION of pesticide contaminated air/dust In the gut by INGESTION of pesticide residue on food/dirt/dust

15 Where Are Pesticides Used? Aquatic sites Wood products Food preparation areas Human skin Household pets Livestock

16 Non Occupational Pesticide Encounters Accidental or intentional ingestion Food and water residues Contaminated clothing Treated wood/structures Residues on animals/carpets Garden residues Termite control Hazardous waste sites/spills

17 Professions Exposed to Pesticides Aerial equipment maintenance Agronomists Building maintenance work Emergency responders Entomologists Firefighters Forestry workers Formulating end product Greenhouse- nursery workers Hazardous waste workers Landscapers Livestock dippers and veterinarians Marina workers Medical personnel Park workers Plant pathologists Research chemistry Sewer work Storage/warehouse work Structural application Transporting pesticides Treating contaminated workers Vector control workers Wood treatment workers Work on highway or railroad rights of way

18 Agriculture Pesticide Applications aerial air blast sprayer enclosed cab back pack-wand Boom sprayer

19 Agriculture Jobs orchard thinner mixer loader flagger picker

20 Agriculture Worker Risk Factors Indonesia: –Cocktail mixture of multiple products –Spray frequency –Skin contact > wet clothing – Use of toxic products (1a/Ib, II) Washington state: –Baseball caps? –Facial exposure – poor fitting masks? –Contaminated hands: urinating/eating? –Improper decontamination?

21 Children Are More Vulnerable To Pesticides GREATER EXPOSURE –Hand to mouth behaviors –SKIN contact with floors and lawns –Lighter less clothing –Eat and drink more per weight GREATER ABSORPTION –  Breathing rates –  Heart rates –  Skin surface/weight GREATER SENSITIVITY –Sensitive developing organs –Less ability to detoxify

22 Children’s Exposure Children have twice the amount of pesticide by-products in their urine as adults. What behaviors in young children that would explain this?

23 Behaviors Hand to mouth: Taste their environment Near the ground: Spend more time on the ground Outdoors: Spend more time outside Diet: consume more per weight (water and fruits)

24 Behavior: soil ingestion 2.5 year oldAdult Soil ingestion Indoor50mg20mg Outdoor60mg0.4mg G. Selevan. EHP 2000;108 Suppl 3:

25 Diet Drinks 2 x more water per their weight than an adult Eats 12x more apples per their weight than an adult

26 Biology: dermal & dietary dose NewbornYoung ChildOlder ChildAdult Surface area: body mass ratio (m 2 /kg) < 1 year1-10 years11-19 years20-64 years Drinking water (tap) mean intake (ml/kg/day) < 1 year3-5 years12-19 years40-69 years Fruit consumption (g/kg/day) Citrus Apples G. Selevan. EHP 2000;108 Suppl 3:

27 Pesticides in Urine of 22 Children Before, During, and After Organic Diet Intervention Conventional diet Organic diet Conventional diet Lu et al Environ Health Perspect on-line

28 Children’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?

29 Child’s Biological Factors Higher metabolic rate More skin per body weight Developing organs

30 Biology- Higher Dose By: 1.Skin More permeable: highest at birth 2.7 x more skin surface/weight than adults 2.Lungs Inhales more per day (1.7x) than adult

31 Biology: inhalation dose Age (years)Weight (kg) Inhalation Rate (m 3 /day) “dose” (m 3 per kg per day) <

32 Vulnerability to Health Effects: Organs Still Developing  Nervous System  Sex organs  Lungs  Kidneys  Bones  Immune  Metabolism  Digestive 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

33 Parent Activities Ramon 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

34 Sources – Child-Pesticide Encounters

35 Proximity Data from Agricultural Washington State PNASH Center Research

36 Parental Take-Home

37 Parent Activity Questions Source of food and water Parent 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?

38 Key Household Safety Points 1.Proximity 2.Take home 3.Garden 4.Animals 5.Recycle 6.Decant 7.Storage 8.Disposal 9.Child play/daycare “ Partly Trained Gorillas Always Run Down Streets Doing Cartwheels” pesticide

39 Pesticide ‘cide = to kill Disinfectants Fumigants

40 Pesticide Chemical Families - grouping based on similarities- 1.Similar chemically (similar structure) 2.Attacks pests in a similar way (toxicity) 3.Common treatment + antidote Organophosphate OP Carbamate C Pyrethroid PY Organochlorine OC Chlorophenoxy Paraquat Diquat

41 Pesticide Sample Label Type of pesticide (used for?) Company name Brand name Common/generic name (active ingredient) Chemical family (? atropine under 1 st aid) Signal word (hazard level)

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43 Pesticide Classification Table #TypeCompany Name Brand Name Common Name Chemical Family Signal Class 1.insecticide Gowen Supracide methidathion OP organophosphate Danger- Poison Ib

44 COMPANYBRANDCOMMONTYPEFAMILYSIGNALWho Pesticide Labels BayerTemikAldicarbInsecticideCarbamateDanger-poisonla VerdiconSevinCarbarylInsecticideCarbamateCautionll UCP AllianceThiodanEndosulfanInsecticideOrganochlorineWarningll BayerGuthionAzinophos methylInsecticideOrganophospateDanger-poisonlb DowDursbanChlorpyrifosInsecticideWarningll SyngentaGramoxoneParaquatHerbicideParaquatDanger-poisonll HelenaWeed Rhap2, 4-DHerbicideChlorophenoxyDangerll DuPontAsanaEsfenverlateInsecticidePyrethroidWarninglV BayerCaptan FungicideDanger-poison MaxRoundupGlyphosateHerbicideCautionU-IV II Dow Dithane Mancozeb Fungicide Caution U-IV Cerexagri-Nisso Ziram Fungicide Danger III Exercise: Classifying Pesticides Organophospate

45 How toxic is it? Source: Richards, Kerry Penn State University Extension Service

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47 LD 50 Lethal dose = Amount of chemical it takes to kill 50% of an experimental population

48 Source: Richards, Kerry Penn State University Extension Service

49 Adapted from Richards, Kerry Penn State University Extension Service DANGER/POISON = extremely toxic by ingestion DANGER = extremely toxic high potential for skin and eye irritation * *

50 Source: Richards, Kerry Penn State University Extension Service

51 Insecticides ChE Inhibitors: –Organophosphates –n-methyl carbamates Pyrethroids –Pyrethrins (ocloresin extract of chrysanthemum) –Pyrethroids (the synthetic derivative) Organochlorines (e.g. DDT) DEET Boric Acid Fluorides Nicotine Arsenicals

52 Herbicides Chlorophenoxy herbicides (e.g. 2-4D) Paraquat and diquat Pentachlorophenol and dinitrocresol (wood preservatives) Copper chromium arsenate ( decks, fences, and children’s wood playground sets – d/c 2003 )

53 Fungicides Hexachlorobenzene Thiram Maneb Methylmercury compounds

54 Fumigants Cyanide, 1, 3-dichloropropane Metam sodium Methyl bromide Naphthalene Phosphine gas (from aluminum phosphide)

55 Rodenticides Warfarin-related compounds: –Warfarin –Coumarins –Brodifacoum –Difenacoum (so-called “super warfarins”) Others: –Thallium –Zinc phosphide –Sodium fluoroacetate

56 Disinfectants Agents used for sanitization and sterilization in the home and hospital Registered as pesticides by the U.S. EPA Examples include –Alcohols –Chlorhexidine –Hypochlorites –Iodines –Phenols –Pine oil

57 General central nervous system Fatigue Dizziness Headache Tremors Ataxia Convulsions (uncommon w/carbamate) LOC (uncommon w/carbamate) Coma (uncommon w/carbamate) From muscle over stimulation: Muscle weakness Muscle cramps Muscle fasciculations From gland over stimulation: Salivary gland- excessive salivation Sweat gland- excessive sweating Lachrymal gland-excessive eye tearing From organ over-stimulation: Eyes Gastrointestinal Pulmonary Blurred vision (constricted pupils) Stomach cramps Nausea Vomiting Diarrhea Chest tightness Wheezing Cough Runny nose Organophosphates: 30”-24 0 Carbamates: 15”-3 0

58 Pyrethroids 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 itching If ingested: Loss of consciousness/coma Seizures (cyno-pyrethroids) High doses: Vomiting Diarrhea Excessive saliva Muscle fasciculation Ataxia Irritability : to sound ~ touch Cyno-pyrethroids: fenverlate, flucythrinate, fluvalinate cypermethrine, deltapermethrin,

59 Organochlorines: lipophylic The nerves stimulating glands are not affected so you will NOT see: excessive salivation excessive sweating excessive eye tearing (or over-stimulation of small muscles like) twitching eyelids CNS Effects Muscle Weakness Dizziness Headache Numbness Nausea/vomiting LOC Seizures Tremors Ataxia Anxiety/restlessness Confusion

60 Paraquat Paraquat 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, cracks erythema blistering ulcerations Nails: discoloration splitting nails loss of nails Respiratory tract: cough nosebleeds sore throat Eyes: conjunctivitis ulceration, scarring, blindness Ingestion: lung fibrosis (stiff lungs) multi-system organ failure, specifically respiratory failure kidney failure

61 DEET DIETHYLTOLUAMIDE Few toxic cases - given the widespread use Toxic if ingested Children: 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 dz Kids: use 5-6.5% formulations

62 Boric Acid Ants, Cockroaches in Residences “broiled lobster appearance”

63 Boric Acid Respiratory tract irritant Moderate skin irritant Historic antibacterial: poisonings from burn compresses, diaper powder, irrigation solutions Targets: GI tract, skin, vasculature, brain Chronic ingestion more toxic than acute (13  ½ life) Absorption: via gut and abraded skin

64 Fluorides Transformed in stomach to corrosive hydrofluoric acid:  thirst, nausea-vomiting, diarrhea, abdominal pain Fluoride ion reduces extra-cellular fluid concentrations of Ca + and Mg  hypocalcemic tetany Cardiac arrythmias- shock  2ndary to fluid/electrolyte imbalances, hypokalemia and the fluoride itself CNS  H.A. muscle weakness, stupor, seizures and coma


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