• 한국환경보건학회지
• /
• 제42권6호
• /
• pp.365-374
• /
• 2016

Objectives: Studies are needed to examine the characteristics of health effects reported by people who used humidifier disinfectant (HD), including the distribution of victims. Methods: We analyzed the distribution of health effects including lung injury that were asserted by a total of 699 individuals who registered with the first through third national programs to determine health effects associated with the use of HD. Results: We found that HD-associated lung injury (HDLI) occurred every year from 2002 through 2011, and in 2011 for 37.2% (n=96) of the total of 258 clinically evaluated HDLI victims. More than half of the victims responded that they were victimized between 2010 and 2011. This was consistent among all classifications by sex, age, HD brand and HD chemical ingredient. Conclusion: This study assumed that the major reason for the outbreak of the health effect between 2010 and 2011 could be the variations in concentrations and physical properties related to polyhexamethylene guanidine (PHMG). Further studies are necessary to examine if some factors related to the chemical disinfectants contained in HD brands may have caused the massive outbreak of health effects including HDLI.

• 한국환경보건학회지
• /
• 제42권3호
• /
• pp.141-146
• /
• 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.

• 한국환경보건학회지
• /
• 제46권5호
• /
• pp.481-494
• /
• 2020

Objectives: No study has been conducted to review characteristics of humidifier disinfectants (HD) products, such as real numbers, levels and types of HD substances contained, or the volume marketed. We aimed to review the characteristics of HD through a literature review. Methods: We collected literature reporting the names, numbers, and ingredients of HD and discussed them with a focus on the number of HD products and the chemicals used as a disinfectant. Results: A total of eight publications has reported the names of HD brands or types of disinfectants from 2011 to 2020. To date, a total of 40 HD products have been used, excluding four products. Eight HD products used polyhexamethylene guanidine phosphate (PHMG) and 14 used a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) as disinfectants. Benzalkonium chloride (BKC) and sodium dichloroisocyanurate (NaDCC) were also used as a disinfectant in several HD products. A total of 19 HD products were associated with the development of HD associated lung injury (HDLI). The Oxy Saksak HD product containing PHMG showed the highest number of HD associated health effects. The type of disinfectant from a total of 14 HD products has not been identified. Conclusions: A total of 40 HD products have been marketed in South Korea since 1994. Further studies should be conducted to identify the association of product characteristics, including type of HD ingredients, with health effects.

• 한국환경보건학회지
• /
• 제42권3호
• /
• pp.147-159
• /
• 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 objective of this study is to characterize exposure to HD among a total of 221 HDLI patients who used HD. Information and data on the HDs used were collected through a structured questionnaire and home environmental investigations. The conditions of these 221 HDLI patients were clinically confirmed to be caused by the use of HD. Children aged under 5 years old made up the highest proportion of HDLI cases (n=125, 56.6 %), followed by pregnant women (n=35, 15.8%). Forty-three percent (n=95) of the victims died. There were three cases of fetuses and 35 pregnant women among the victims. The number of HDLI patients who used only the Oxy Saksak brand of HD was found to be 85 (38.5%), followed by the HD brands Cefu (n=24, 10.9%), Lottemart Wiselect (n=9, 4.1%) and Aekyung (n=3). Patients who exclusively used HD brands containing polyhexamethylene guanidine phosphate (PHMG) (n=13, 55.7%) as an active ingredient made up the largest share, followed by those who exclusively used HD containing only oligo(2-(2-ethoxy) ethoxyethyl guanidinium (PGH) (n=24, 10.9%) and by those who only used a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) (n=3, 1.4%). HD products containing PHMG were found to be the most commonly used among the confirmed HDLI patients. Three exposed fetuses who never used HD after birth developed lung injuries, indicating a probability of exposure to HD during gestation. All HDLI patients responded that they used HD while sleeping and for longer than 10 hours per day. In conclusion, the development of HDLI was clinically found to be associated with the use of several HD products containing PHMG, PGH and CMIT/MIT.

• 한국환경보건학회지
• /
• 제44권4호
• /
• pp.301-314
• /
• 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.

• 한국환경보건학회지
• /
• 제49권3호
• /
• pp.159-168
• /
• 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.

• 한국환경보건학회지
• /
• 제38권2호
• /
• pp.166-174
• /
• 2012

Introduction: After 17 years since the first production of humidifier disinfectants in Korea, Korea Centers for Disease Control and Prevention (KCDC) announced that the odds ratio of lung injury related with humidifier disinfectant usage was 47.3 (95% confidence interval 6.0-369.7) according to a case-control study with 18 adult cases, including 8 pregnant women at a university hospital in Seoul. Results: From September 2011 to April 2012, one-hundred and seventy four victim cases have been reported to an environmental non-governmental group (NGO). We summarized timetable of humidifier disinfectants accidents, analyzed health outcomes (death, lung or lung and heart transplantation, pulmonary disease) of reported victims, and classified some information for humidifier disinfectants with health outcomes, and government action for this accident. Among the victims, number of death cases are 52 (30.0%), including 26 babies less than 3 years old. Sixty-nine victims come from twenty-seven family with 2 to 4 members per family. About twenty types of humidifier disinfectant products and about 600,000 product items a year have been sold. Fifty-two death cases used 7 different types of disinfectant products, including imported goods and some private brands of well-known supermarkets. KCDC confirmed inhalation toxicity of 6 products through an animal experimental test, and based on this observation recalled disinfectants containing PHMG (polyhexamethylene guanidine) and PGH (Oligo(2-(2-ethoxy)ethoxyethyl guanidinium chloride). Discussions: The use of these biocides involved highly fatal consequences among biologically vulnerable victims, such as pregnant women, several family member victims after semi-acute exposure. This is the first biocide disaster in Korea with non-specific targets, and unknown scale of victims, warranting concerns on use of biocides in the living environment. Conclusions: Special administrative agency for chemical safety and compensation act for environmental health victims are needed to prevent similar problems.

• 과학기술학연구
• /
• 제18권1호
• /
• pp.63-127
• /
• 2018

본 논문은 1994년에 첫 가습기살균제가 만들어지고 2011년에 가습기살균제가 원인 미상의 간질성 폐질환의 원인임이 밝혀진 시점까지, 어떻게 이렇게 유독한 제품이 촘촘한 규제의 법망을 피해서 만들어졌고 유통되었는지를 분석하고 있다. 이를 위해서 본 논문은 가습기 살균제에 사용된 화학물질들이 어떻게 허가를 받았고, 이것이 어떻게 가습기살균제라는 상품으로 출시되었으며, 이런 제품이 어떻게 회사와 정부의 독성검사를 피해서 오랫동안 가정에서 사용되게 되었는가를 법정 문서와 국회 청문회 자료 등을 이용해서 미시적으로 살펴볼 것이다. 지금까지의 연구들은 살균제 참사의 원인이 부도덕한 기업이나 무능한 정부 조직에서 찾곤 했는데, 본 연구는 이를 제조한 기업과 이를 심사한 정부라는 관료적 조직의 구조적 비밀주의, 위험에 대한 "평가절하 어림짐작"(disqualification heuristic), 칸막이 문화, 피드백과 소통의 단절 같은 문제가 가습기살균제 재앙의 중요한 원인임을 보일 것이다. 즉, 부도덕함이나 무능 같은 개인의 문제보다 관련 기업의 부처들, 그리고 정부의 부처 같은 조직들 내부의 소통의 문제가 더 중요한 변수였다는 얘기다. 개인이 아닌 조직에 대한 분석은 이런 참사가 되풀이 되지 않기 위해서 기업과 국가 조직에서 개선할 점이 무엇인가에 대한 시사점을 줄 수 있다.

• 한국환경보건학회지
• /
• 제47권6호
• /
• pp.513-520
• /
• 2021

Background: Benzalkonium chloride (BKC) has been extensively used as a preservative in industrial products and in hygiene, medical, and cosmetic applications. Humidifier disinfectant (HD) products containing BKC have been used in South Korea. Objectives: This study was aimed to review types of products containing BKC, to summarize the regulations in the US, EU, Japan, and South Korea, and to review the health effects associated with the use of HD. Methods: We reviewed and summarized documents which were searched through PubMed and Google Scholar with the key words: BKC and asthma/contact dermatitis, humidifier disinfectant-associated lung injury (HDLI), and more. Results: Regulations in most countries including South Korea do not allow its use as disinfectants in spray-type of products for medicine, cosmetics, and household products. Two types of HD containing BKC (800~1,270 ppm) were marketed in South Korea from 1996~2003. Health effects reported from people who used products containing BKC were allergic contact dermatitis, erythema, and respiratory disease, including asthma. Two people who responded as HD users containing BKC only were confirmed to have developed asthma. HD-associated lung injury (HDLI) was reported by consumers who used both HD containing polyhexamethylene guanidine (PHMG) and HD containing BKC. Conclusions: In conclusion, the use of BKC as a biocide has to be controlled considering the route and pattern of exposure. Products containing BKC as preservatives were reviewed with exposure routes and sites in the human body such as skin, eyes, and the respiratory tract. HD containing BKC was clinically evaluated to be associated with asthma.

• 한국환경보건학회지
• /
• 제48권3호
• /
• pp.183-194
• /
• 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.