• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.29 no.1
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• pp.13-20
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• 2019

Objective: This study was performed to propose a domestic occupational exposure limit(OEL) following a health hazard assessment, calculation of a non-carcinogenicity reference concentration worker($RfC_{worker}$) value, and examination of international agencies' exposure limits. It also recommends legal management within the Occupational Safety and Health Act for PHMG-Phosphate(CAS No. 89697-78-9), It is a humidifier disinfectant that generated many lung injuries. Methods: We have investigated the recommendation or guidelines of foreign OEL for PHMG-Phosphate and the actual state of legal management in Korea. To examine the procedures and methods for recommendation OEL. Toxicological hazard and health hazard classifications were examined and a non-carcinogenicity $RfC_{worker}$ value was calculated for PHMG-Phosphate. An OEL and the necessity of legal management were recommended as well. Results and Conclusions: The OEL for PHMG-Phosphate is recommended to be $0.01mg/m^3$. The recommended OEL is close to 10 times the RfCworker value of $0.000833mg/m^3$ calculated from the chemical dose-response hazard assessment, which is a 2017 study. The CMIT/MIT(3:1) mixture, which was a social issue as a humidifier disinfectant substance, was also exposed to the same ratio in March 2018, establish the OEL. It is recommended to establish OEL for PHMG-Phosphate to prevent worker health hazards and for chemical safety management.

• Journal of Environmental Health Sciences
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• v.48 no.3
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• pp.183-194
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• 2022

Background: No study has examined the regulatory factors associated with fatal health problems due to the use of humidified disinfectants (HD) in South Korea. Objectives: This study aimed to identify and discuss the deficiencies and limitations found in the Toxic Chemical Control Acts (TCCA) that failed to prevent the health risk of chemicals in HD products. Methods: The South Korean TCCA was reviewed focusing on acts in operation from 1994 through the end of 2011, the period when HD was allowed in manufacturing and marketing. Results: The TCCA was the act intended to regulate the toxicity of chemicals in HD products. We found the TCCA to lack three key legal clauses which would have been essential to controlling the health risk of HD. First, there was the exemption of toxic and hazard testing for existing chemicals, including chloromethylisothiazolinone (CMIT), methylisothiazolinone (MIT), and benzalkonium chloride (BKC). Secondly, there were no articles requiring industry to provide animal inhalation test result for polymers such as polyhexamethylene guanidine (PHMG) and Oligo(2-)ethoxyethoxyethyl guanidine chloride (PGH). Finally, there was a lack of articles on examining the risk of products as well as on addressing changes in the usage of products. These articles were found to be generally provided in the US Toxic Substance Chemical Act (TSCA) and the EU Registration, Evaluation and Authorization of Chemicals (REACH). Conclusions: In conclusion, the Ministry of Environment of South Korea had not updated key articles for regulating hazardous chemicals, causing large-scale health problems due to HD which had been fundamentally addressed in chemical-related acts in other countries.

• Journal of Environmental Health Sciences
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• v.42 no.3
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• pp.141-146
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• 2016

In South Korea, many cases of humidifier disinfectant-associated lung injury (HDLI) have been reported among people who used humidifier products containing humidifier disinfectant (HD). The objectives of this study are to estimate both airborne HD concentration in the room where HD was used and the amount of humidifier disinfectant absorbed into the respiratory system. Information and data on the HDs were collected using a structured questionnaire and home environmental investigations include the volume of HD (ml) and hours used per day, concentration of disinfectants contained in the HD brand (${\mu}g/ml$), volume of the room ($m^3$), assumed ventilation rate ($m^3/hr$) and breathing rate assumed ($m^3/hr$). We used children aged under five years old as a sample and estimated both airborne HD concentrations and amount of HD absorbed into the respiratory system. The estimated airborne concentration of HD in the room ranged from 68 to $369{\mu}g/m^3$ for PHMG (polyhexamethylene guanidine phosphate) and from 16 to $239{\mu}g/m^3$ for PGH (oligo (2-(2-ethoxy) ethoxyethyl guanidine). The amount of HD absorbed in the respiratory system per day was estimated to range from 227 to $1,225{\mu}g$ for PHMG and from 53 to $794{\mu}g$ for PGH. In conclusion, a great amount of HD was likely absorbed into respiratory system, likely beyond the level of the capacity of the immune system to remove the HD absorbed.

• Journal of Environmental Health Sciences
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• v.44 no.4
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• pp.301-314
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• 2018

Objectives: The aim of this study was to introduce the overall progress of exposure assessment to humidifier disinfectant (HD); to present participants' demographic characteristics, exposure characteristics to humidifier disinfectant, and exposure classification; and furthermore to compare those characteristics between survivors and non-survivors. Methods: An assessment of environmental exposure to HD was conducted using modified HD-specific questionnaires that had been previously validated. We analyzed the data from 4,482 participants who had been potentially exposed to HD and had registered with the KEITI (Korea Environmental Industry & Technology Institute) from September 2016 to May 2018 (the fourth survey). Environmental exposure assessments were performed as follows: 1) contact with participants, 2) environmental exposure assessment though face-to-face interviews, 3) assessment review and coding, and 4) exposure rating. Results: Overall, survivors made up 77.1% (3,457 subjects) and non-survivors made up 22.9% (1,025 subjects). When compared with the survivors, non-survivors had a higher proportion of subjects aged >60 years and subjects who answered as suffering lung damage and having purchased HD because it is "Beneficial to health" (p<0.05). For the exposure characteristics compared to survivors, non-survivors had a higher proportion of cases of distance from humidifier to face being less that one meter and the spray direction being toward the face (p<0.05). Overall, respondents who used the "Oxy Ssak Ssak New Gaseupgi Dangbun", "Aekyung Gaseupgi Mate", "Homeplus Gaseupgi Chungjungje", and "E-Mart Gaseupgi Salgyunje" products made up 66.1, 12.3, 4.0, and 3.6%, respectively, and 72.5% of respondents used products with PHMG as the active chemical. When compared with survivors, non-survivors had a higher proportion of use of "Oxy Ssak Ssak New Gaseupgi Dangbun" but a lower proportion of use of products with CMIT/MIT, PGH, or PHMG as the active chemical. Conclusions: This study provided demographic characteristics and exposure assessment for applicants who have been injured by HD. In spite of the limitations of performing past exposure assessment through a questionnaire survey, such as recall bias, useful results may be obtained by comparing survivors with non-survivors. Further studies such as the exposure rating method and so on are necessary to assess past exposure to HD.

• Journal of Environmental Health Sciences
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• v.49 no.3
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• pp.159-168
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• 2023

Background: An ongoing environmental exposure assessment of humidifier disinfectants (HDs) has been conducted since November 2011 among individuals who experienced HD exposure-related adverse health effects. It is being performed in order to determine and quantify exposure to humidifier disinfectants in victims and their families. To date, the assessment has encompassed Cycles I-to-V. There is no report summarizing the characteristics of the subjects from the overall cycles. Objectives: We intended to examine the individual characteristics related to demographics, HD usage, and HD exposure using integrated data from Cycles I-to-V of the environmental exposure assessment of HDs and the changes with the cycles. Methods: We included 7,543 individuals who participated in Cycles I-to-V of the environmental exposure assessment of HDs. We summarized the participants' characteristics regarding their demographics (e.g., sex, education level, and age), HD usage history (e.g., product name, ingredient, and frequency of HD use), and HD exposure (e.g., daily time of HD use, cumulative time of HD use, and exposure intensity). In addition, their characteristics were compared across the cycles of the exposure assessment. Results: Among the 7,543 participants from Cycles I-to-V, there were more male participants than females (51.05% overall), except for Cycles I and III. Across all cycles, a higher proportion of survivors was observed than deceased individuals. While PHMG was the most prevalent ingredient in HDs throughout all the cycles, its proportion gradually decreased over the course of the examination cycles. Participants in Cycle I reported longer daily times of HD use compared to those in the subsequent cycles. On the other hand, cumulative time of HD use was shorter in the earlier cycles than in the later cycles. Conclusions: Using the integrated data from the full cycles of the environmental exposure assessment, this study identified changes in demographic characteristics as well as the HD exposure characteristics between the participants across different cycles.

• Journal of Environmental Health Sciences
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• v.46 no.3
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• pp.285-296
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• 2020

Objective: The objective of this study was to describe the characteristics of exposure to humidifier disinfectants (HDs) and their association with the presence of a person who experienced the adverse health effects in general households in Korea. Methods: During the month of December 2016, a nationwide online survey was conducted on adults over 20 years of age who had experience of using HDs. It provided information on exposure characteristics and the experience of health effects. The final survey respondents consisted of 1,555 people who provided information on themselves and their household members during the use of HD. Exposure characteristics at the household level included average days of HD use per week, average hours of HD use per day, the duration within which one bottle of HD was emptied, average input frequency of HD, amount of HD (cc) per one time used, and active ingredients of HD products (PHMG, CMIT/MIT, PGH, or others). The risk of the presence of a person who experienced adverse health effects in the household was evaluated by estimating odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for monthly income and region using a multiple logistic regression model. Subgroup analyses were conducted for households with a child (≤7 years) and households with a newborn infant during HD use. Results: The level of exposure to HD tended to be higher for households with a child or newborn infant for several variables including average days of HD use per week (P<0.0001) and average hours of HD use per day (P<0.0001). The proportion of households in which there was at least one person who experienced adverse health effects such as rhinitis, asthma, pneumonia, atopy/skin disease, etc. was 20.6% for all households, 25.3% for households with children, and 29.9% for households with newborn infants. The presence of a person who experienced adverse health effects in the household was significantly associated with average hours of HD use per day (P_trend<0.001), duration within which one bottle of HD was emptied (P_trend<0.001), average input frequency of HD (P_trend<0.001), amount of HD per one use (P_trend=0.01), and use of HDs containing PHMG (OR=2.23, 95% CI=1.45-3.43). Similar results were observed in subgroup analyses. Conclusion: Our results suggest that level of exposure to HD tended to be higher for households with a child or newborn infant and that exposure to HD is significantly associated with the presence of a person who experienced adverse health effects in the household.