Cholinesterase (ChE) Monitoring Training for Pesticide Handlers Department of Labor & Industries WISHA Services.

Cholinesterase (ChE) Monitoring

Training for Pesticide Handlers

Department of Labor & Industries WISHA Services

How are some pesticides a human health risk?

Certain pesticides calledcholinesterase-inhibitorsaffect the nervous system in ways that can cause illness.

Nervous system

• Nerve cells send electrical signals to each other

• A chemical called a “transmitter” communicates the electrical signal across the gap between the nerves

Nervous system

• CHOLINESTERASE removes the transmitter so the nerve is ready for the next signal

• Insects and humans share the same transmitter and cholinesterase system

What can effect cholinesterase levels?

• Medical conditions– Liver diseases

– Blood diseases

• Certain medications

• Certain pesticides

What pesticides effect the cholinesterase system?

• Organophosphates and N-methyl-carbamates

– Over-exposure may decrease available cholinesterase

– Nerves continuously fire (no “off switch”)

– Effecting muscles, glands, and organs

Which pesticides are most dangerous?

• Toxicity category I– on the label

• Toxicity category II – on the label

Examples of covered pesticides*

• Organophosphates– Guthion– Lorsban– Imidan– Monitor– Mocap

• N-methyl-carbamates– Sevin– Temik– Lannate– Vydate

*These are just examples, you can get a full list from L&I or the Department of Agriculture

What are some symptoms of overexposure?

• Headache

• Blurred vision

• Loss of balance

• Nausea

• Diarrhea

• Sweating

• Change in heart rate• Difficulty breathing• Muscle twitching• Convulsions• Unconsciousness• Death

Will you always be sick?

• No, ChE levels return on their own

• Most common treatment is removal from

exposure

• Hospitalization only with severe poisoning

• There is some evidence of long-term effects

(memory loss, depression, poor muscle control)

Can cholinesterase (ChE) levels be monitored?

YES,

• Simple blood test

blood ChE = nervous system ChE

• Yearly off season baseline test followed by tests during the season

Types of cholinesterase

• Nervous system cholinesterase

• Blood cholinesterases

– Red blood cell (RBC) cholinesterase

- Same as nervous system cholinesterase

– Plasma (serum) cholinesterase

Why is a baseline test necessary?

• Each person has their own normal ChE levels

• Periodic tests are compared to baseline

• Allows doctors to determine when

cholinesterase levels have:

– Dropped

– Returned to your normal level

What are the benefits of cholinesterase monitoring?

• Helps to prevent illness

• Increases hazard awareness

• Supports a safer workplace

• Allows for better medical care

• Helps to protect your family

Cholinesterase Monitoring Rule

• Chapter 296-307-148

• Part of the Pesticide Worker Protection Standard

• Adopted December 2003

• Became effective February 2004

Background

• 1993 - Cholinesterase monitoring recommendation

• 1995 - TAG report on cholinesterase monitoring

• 1997 - L&I sued for not adopting a mandatory

monitoring rule

• 2002 - Rios decision, L&I directed to initiate

rulemaking on a mandatory monitoring rule.

Who does the rule apply to?

• Agricultural pesticide handlers

Who

• Handle category I and II organophosphate or N-methyl-carbamate pesticides

What is pesticide handling?

It includes:

• Mixing / loading / applying

• Disposing of pesticides or containers

• Handling open pesticide containers

• Maintaining application equipment

• Acting as a flagger

When must your employer provide cholinesterase monitoring?

• Provided at no cost when you:– Handle covered pesticides 30 or more

hours in any consecutive 30 days*

• Employer must keep records of all hours handling covered pesticides

*First day of handling starts the clock

Are all hours spent handling included?

NO,• Employers do not need to provide testing to

employees who handle only N-methyl-carbamate pesticides

• Hours spent mixing and loading using closed systems do not need to be included in determining periodic testing

How does the 30 day schedule work?

• Your employer has two options:

1. Test every 30 days no matter how long you handle pesticides

OR

2. Test when 30 hour handling time is met

• No more often than every 30 days

Must you be tested?

NO,

• Employer must give you the opportunity

• You make the decision about testing after talking to

a doctor or nurse

• You can accept or decline testing by signing a form

at the medical clinic

• You may your change mind at any time

Must I go to the doctor or clinic my employer chooses?

YES,

• Your employer will be paying the cost

for all medical services

• Only your test results may be shared with

your employer. All other medical

information remains confidential

When do Cholinesterase (ChE) test results require action?

• Work practice evaluation– ChE drop of >20% from baseline

• Exposure removal– RBC ChE drop of >30%– Plasma ChE drop of >40%– Resume handling when levels return to

within 20% of baseline

If I am removed does this mean I can’t work?

• No, you can perform other duties

• Your job, salary and benefits will be protected for up to 3 months– Pay

– Seniority

– Other rights and benefits

How long does it take for cholinesterase to return to normal?

• Plasma cholinesterase levels may return to normal within hours to several days

• RBC cholinesterase levels take longer, returning at about 1% per day

Can I see my records?

• Yes, you’re employer is required to keep:– Time spent handling– Medical provider (contact info. posted)– Test results (medical provider may keep)– Work recommendations– Work program evaluations– Medical removal dates– Declination statements

Will you be given training?

• Your employer must provide training on the:– Hazards of cholinesterase-inhibiting

pesticides

– The purpose and requirements of cholinesterase testing

How will this rule be enforced?

• L&I will collect information from employers and workers in order to evaluate the rule whenever:

– Cholinesterase depression is reported– As part of targeted inspection activities– Whenever a complaint is received

How will we know if the rule is working?

• Scientists and a group of employer and

worker representatives will evaluate the rule

• All reports and recommendations will be

available to the public

• L&I must submit reports to the legislature

at the end of each year

2004 experience

# of tests 3800

# of baselines 2650

# handlers with at least one periodic test

600

# handlers requiring work evaluation

95

# handlers requiring exposure removal

22

Consultation findings*

• Respiratory protection– No fit testing– No cartridge change schedule– Removing respirator during application– Not cleaning respirator after use– Improper storage

*Possible exposure routes no common link has been established

Consultation findings*

• Decontamination– Inadequate eyewash or emergency showers

– Inconsistent hand washing

– Protective coveralls worn home home

– Baseball type caps worn during application

– Equipment not rinsed after each use

*Possible exposure routes no common link has been established

Consultation findings*

• Personal Protective Equipment (PPE)

– Inconsistent use

– PPE not rinsed after each use

– Gloves not always worn during equipment maintenance e.g. unplugging nozzles

*Possible exposure routes no common link has been established

Consultation findings

• In most cases employers and handlers are found to be in compliance with all WPS requirements

• Handlers are encouraged to pay attention to the details of safe pesticide handling

• Report any problems to your employer

2005

• The exposure threshold changes to 30 hours in any consecutive 30 days

• Baseline testing will begin in the beginning of January

• Be active in your medical care

• Participate in L&I consultation activities

• Contact your local L&I office if you have any questions

Questions???