Hazardous-chemical releases in the home.
The typical American home contains many toxic, flammable, corrosive, or chemically reactive household products such as bleach, paint, drain cleaner, fertilizer, insect repellent, oven cleaner, nail polish, and car wax (Federal Emergency Management Agency [FEMA], 1993; Menon & Kodama, 1998). Unintentional releases and misuse of hazardous household products in the home have the potential to harm a substantial number of people. Unintentional releases can occur when household products are stored, cleaned up, or disposed of improperly. Misuse of hazardous household products can occur when
* incompatible products (i.e., ammonia and bleach) are mixed together and produce toxic fumes;
* certain products are used in a confined space, causing inhalation of dangerous fumes; or
* personal protective equipment is not used or is used improperly (American National Red Cross, 1994).
The literature notes some examples of the impact and extent of chemical releases in the home. In December 1992, hundreds of people in more than 17 states reported to their local poison control centers respiratory and other symptoms associated with the use of an aerosol leather conditioner (Centers for Disease Control and Prevention [CDC], 1993). An investigation into the illnesses found that most people had used the product indoors or in other areas with limited ventilation. As a result, a voluntary nationwide recall of this product was issued. Another example is an analysis of data from a regional poison control center that found 500 cases of ocular chemical exposures during a six-month period; 84 percent occurred in the home and involved common household products (Kersjes, Reifler, Maurer, Trestrail, & McCoy, 1987). Another review of records of 94 patients admitted to a hospital burn unit for chemical burns during a 19-year period found that 14 percent were injured at home with routine household cleaning products (Wibbenmeyer et al., 1999).
Most of the literature on hazardous house-hold products has centered on intentional and accidental poisonings, especially of children (Al-Sekait, 1989; Gad Johannsen, Mikkelsen, & Larsen, 1994; Klepac, Busljeta, Macan, Plavec, & Turk, 2000; Menon & Kodama, 1998; Nhachi & Kasilo, 1994; Ozane-Smith, Day, & Parsons, 2001). This article focuses on unintentional releases or misuses of hazardous products in the home using data from a comprehensive multistate surveillance system.
Data from the Agency for Toxic Substances and Disease Registry's (ATSDR's) Hazardous Substances Emergency Events Surveillance (HSEES) system were analyzed to describe the chemicals, causal factors, temporal patterns, types of adverse health effects, and public health actions (e.g., an evacuation) associated with unintentional releases or misuses of hazardous products in the home. The goal of HSEES is to reduce the morbidity and mortality that result from hazardous-substances events that are experienced by first responders, employees, and the general public. ATSDR established HSEES in 1990 to collect and analyze information about releases of hazardous substances that need to be cleaned up or neutralized according to federal, state, or local law. Threatened releases resulting in a public health action that can potentially affect the health of employees, responders, or the general public, such as an evacuation, also are recorded in the system if the amount of substance threatened to be released entailed the need for removal, cleanup, or neutralization according to federal, state, or local law. Releases involving only petroleum are excluded from HSEES because the authorizing legislation for ATSDR, the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA), excludes any forms of petroleum that have not been refined to the point of becoming single-chemical products such as pure xylene.
Standardized data-collection forms were used to obtain information on each event, including location of the release, chemicals released, number of victims, and evacuations. State health department personnel used a variety of sources (e.g., records and oral reports of state environmental agencies, police and fire departments, and hospitals) to collect information about the hazardous events. Before 2000, data were entered by participating state health departments into a computerized data entry system designed by ATSDR, and data were transmitted quarterly to ATSDR for quality control checks and analysis. Beginning in January 2000, data were entered into a Web-based application that enabled ATSDR to instantly access the data.
A victim is defined as a person experiencing at least one documented adverse health effect (such as respiratory irritation or chemical burns) that likely resulted from the event and occurred within 24 hours of the release. The HSEES system does not identify the immediate cause of the adverse health effect other than the event itself. For the analyses, the chemicals released were grouped into 11 categories: acids, ammonia, bases, chlorine, mixture across categories, paints and dyes, pesticides, polychlorinated biphenyls, volatile organic compounds, other inorganic substances, and other substances. Mixture across categories consisted of chemicals that were mixed before release, including chemicals from more than one of the other 10 chemical categories used. "Other inorganic substances" comprised all inorganic substances except acids, bases, ammonia, and chlorine, and included chemicals such as mercury, carbon monoxide, and sodium hypochlorite. The "other" category consisted of chemicals such as asbestos, ethylene glycol, and styrene that could not be classified into any one of the other 10 chemical categories. Carbon monoxide releases due to suicide, permitted releases, and faulty heaters are excluded from HSEES.
Events captured by the HSEES system from 1996-2001 that occurred in private residences (including apartment buildings) and were not caused by a business (such as a lawn care, repair, or construction company) were included in the analysis. Events involving illegal methamphetamine production were excluded from the analysis. This analysis includes only data from 1996 through 2001 because detailed information about whether the events involved methamphetamine production is available only for events occurring after 1995: at the time of analysis, data collection was completed through 2001. Also excluded from this analysis are five events that further investigation indicated were caused by businesses.
Thirteen states participated in HSEES during the entire time period analyzed: Alabama, Colorado, Iowa, Minnesota, Missouri, Mississippi, New York, North Carolina, Oregon, Rhode Island, Texas, Washington, and Wisconsin. An additional four states participated during portions of the time period: Louisiana (2001), New Hampshire (1996), New Jersey (2000-2001), and Utah (2000-2001).
Descriptive statistics are presented for number of events occurring in private residences each year, chemicals involved in the releases, causal factors contributing to the releases, time and day of week of the releases, categories of victims, types of adverse health effects, severity and disposition of the victims, types of personal protective equipment worn, decontaminations, and evacuations.
During 1996-2001, 39,766 events were reported to the HSEES system by participating state health departments. Of these, 682 events (2 percent) involved releases of hazardous chemicals in private residences; 23 of those (3 percent) were threatened releases, 636 (93 percent) were actual releases, and 23 (3 percent) involved a situation in which release of some chemicals was threatened and some chemicals actually were released. The 23 threatened events had the potential to release 241 chemicals, and evacuations were ordered in nine (39 percent) of these events. The remainder of this article describes the 659 events in which chemicals were actually released into the environment.
More than one-third of the events (n = 204, 31 percent) occurred during the summer months of June, July, and August. Most of the events (n = 372, 68 percent) occurred between 9 a.m. and 7 p.m. (information on time of day was missing for 111 events). Almost half of the events (n = 284, 43 percent) and most of the increase observed from 1997-2001 occurred in one state (Table 1).
Causal factors contributing to releases in private residences were known for 604 (92 percent) of the 659 events. Only one or two causal factors could be reported per event. Human error (n = 392, 56 percent) was the most frequently reported causal factor, followed by equipment failure (n = 85, 12 percent), illegal or unauthorized dumping (n = 52, 7 percent), improper mixing (n = 49, 7 percent), deliberate damage/illegal activity (n = 46, 7 percent), fire (n = 20, 3 percent). bad weather (n = 6, 1 percent), and other (n = 51, 7 percent).
Evacuation and Decontamination
Evacuations were ordered in 128 (20 percent) events. Most of the evacuations (90 percent) were from a building or affected part of a building. More than 900 people were evacuated from their homes (median = 3 people, range = 1-100), and the length of evacuation ranged from one hour to 60 days (median = 2 days). Evacuation order status was unknown for four events (1 percent), type of area evacuated for one event (1 percent), the number of people evacuated for 22 events (17 percent), and length of evacuation for 26 events (20 percent).
Decontamination at a medical facility was done for 29 members of the general public in 22 events and for 11 responders in four events. Decontamination at the scene was done for 55 members of the general public in 32 events, 134 responders in 24 events, and one employee who was a cleanup contractor. Information on decontamination at the scene was missing for 22 events (3 percent), and information on decontamination at a medical facility was missing for 16 events (2 percent).
There were a total of 361 victims in 172 events in private residences (26 percent of all events in private residences). Most events (n = 146, 85 percent) had one or two victims; however, the number of victims per event ranged from 1 to 54. Most of the victims (n = 307, 85 percent) were members of the general public, while the other victims comprised volunteer firefighters (n = 24, 7 percent), career firefighters (n = 18, 5 percent), police officers (n = 9, 3 percent), emergency medical technicians (n = 2, 1 percent), and responders, type unknown (n = 1, <1 percent). The sex of 68 percent of the victims was known; 55 percent were male. The age was known for 187 victims (52 percent). Sixteen victims (9 percent) were under five years of age, 18 (10 percent) were between 5 and 14 years of age, 13 (7 percent) were between 15 and 19 years of age, 94 (50 percent) were between 20 and 44 years of age, 38 (20 percent) were between 45 and 64 years of age, and 8 (4 percent) were 65 years of age or older. The mean age was 31 years (range = 1-95 years). Use of personal protective equipment was known for 52 (96 percent) of the responder victims; 37 (71 percent) wore firefighter turn-out gear, 1 (2 percent) wore Level A protection, and 14 (27 percent) wore minimal or no protection.
The 361 victims experienced 690 adverse health effects. Most victims (81 percent) reported one or two adverse health effects with five being the maximum number of adverse health effects reported per victim. Dizziness/central-nervous-system symptoms (20 percent) and respiratory irritation (19 percent) were the most frequently reported adverse health effects (Table 2). Most victims (n = 203, 56 percent) were treated at a hospital and released, 76 (21 percent) were treated on the scene with first aid, 36 (10 percent) were treated at a hospital and admitted, 21 (6 percent) had their adverse health effects reported by an official within 24 hours of the event, 12 (3 percent) were seen by a personal physician within 24 hours of the event, four (1 percent) were observed at a hospital but did not receive treatment, and 9 (2 percent) died.
All nine fatalities occurred in members of the general public; five were male. The ages of eight of the people who died were known and ranged from 5 to 53 years. Six people died in three events from carbon monoxide exposure. Carbon monoxide replaces oxygen in the bloodstream, which eventually leads to suffocation (National Fire Protection Association, 2000). One person died from respiratory problems in an event that involved improper mixing of drain cleaner, oxidizer, vinegar, and a mixture of sodium hydroxide/sodium hypochlorite/sodium silicate. One person died after improperly ingesting the pesticide dinitrophenol for weight loss, and one person died from respiratory problems following exposure to hydrochloric acid.
Six members of the general public had detectable levels of mercury in the blood; however, these individuals were not counted as victims because they did not exhibit any signs or symptoms of an adverse health effect. One person was admitted to a hospital, three were treated at a hospital and released, and two were observed at a hospital but did not receive treatment. Four were male, and two were female. The ages of four people were known: One person was between 15 and 19 years of age, and three were between 20 and 44 years of age.
A total of 726 chemicals were released in the 659 events. The number of chemicals released per event ranged from 1 to 21, but in most events only one chemical (n = 623, 95 percent) was released. "Other inorganic substances" (e.g., mercury and calcium hypochlorite) was the category of chemicals most frequently released in events in private residences (n = 301, 42 percent), followed by pesticides (n = 104, 14 percent) (Table 3). Mercury (n = 200, 28 percent) was the most frequently released chemical (Table 4), yet only a small number of mercury events (3 percent) resulted in adverse health effects. While sodium hypochlorite (bleach) was released in only 3 percent of all events, 74 percent of these events resulted in adverse health effects. Twelve additional events involved a reaction between chlorine and another chemical, usually a cleaning agent.
The public health consequences of releases of hazardous chemicals in the home can be serious. More than 25 percent of the events in private residences involved victims, compared with 7 percent of all events captured by HSEES during 1996-2001. The percentage of events with victims in private residences may, however, appear higher than that of other events because the less serious events in private residences are likely to be underreported. Nine fatalities resulted from chemical releases in the home. Slightly more victims died or were admitted to the hospital as a result of chemical releases in the home compared with all releases captured by the system (2.5 percent versus 1.7 percent and 10.0 percent versus 7.7 percent, respectively). Fifteen percent of the victims experiencing adverse health effects were responders, the population group most likely to have worn the proper personal protective equipment and to have received training. The chemicals most likely to be released were not necessarily the most likely to result in victims.
The 10 chemicals most frequently released in private residences are found in typical household products. Four of the chemicals are used for cleaning: hydrochloric acid for general cleaning; sodium hypochlorite, which is household liquid bleach; chlorine as a disinfectant; and sulfuric acid, which is the main component of drain and toilet bowl cleaners (Lewis, 1993). Malathion is the active ingredient in mosquito-control products and in other pesticide products used indoors and on pets to control ticks and insects (U.S. Environmental Protection Agency, 2002).
Exposure to carbon monoxide resulted in two-thirds of the deaths in this analysis. Carbon monoxide, a by-product of incomplete combustion, can enter the home from any fuel-burning appliance, furnace, water heater, fireplace, wood stove, or space heater, and from poorly maintained or blocked vent connections in chimneys. Exposure to carbon monoxide also can occur from sitting in a running vehicle in a garage. In addition, carbon monoxide can infiltrate homes and apartments from cars left running in attached garages.
Adverse health effects likely resulted from a lack of awareness among the general public of the hazardous nature of common household products. Consumers need to be educated about the hazards and potential dangers of common household products that contain chemicals (Menon & Kodama, 1998; Wibbenmeyer et al., 1999). There is a need for ongoing education advising the general public to read instructions carefully before using or disposing of a chemical product, to store chemicals in secured containers in well-ventilated areas according to instructions on the label, to store incompatible materials away from each other, to keep flammable materials away from heat sources, and to avoid mixing incompatible cleaning products such as bleach with ammonia or chlorine with sulfuric acid (About, Inc., n.d., American National Red Cross, 1994; FEMA, 1993; FEMA, 2003; Wibbenmeyer et al., 1999). The U.S. Consumer Product Safety Commission recommends yearly inspections of fuel-burning appliances for leaks and cracks by a qualified technician and the installation of carbon monoxide detectors in homes (U.S. Consumer Product Safety Commission, n.d.). In addition, the commission advises against the use of charcoal grills as an indoor heat source.
States participating in HSEES conduct prevention outreach activities aimed at reducing morbidity and mortality associated with hazardous-substance releases. Activities need to be supported by the data and involve a mix of target audiences. Examples of planned and conducted activities targeted to the general public include public-access Web sites with links to fact sheets on frequently spilled chemicals and maps showing number of releases and number of releases with injuries by county; a collaborative effort with poison control centers (PCCs) to improve the interactions between PCCs/first responders and victims of hazardous-substance releases; newspaper articles in counties with the highest numbers of releases; distribution of fact sheets to retailers who sell chlorine-based household products on the hazards of improperly mixing bleach with other products; presentations to farm wives about agricultural chemical releases; educational programs for retailers selling methamphetamine precursor chemicals; and distribution of fact sheets on preventing carbon monoxide injury/death related to the improper use of heating sources.
The number of hazardous-chemical releases occurring in homes is likely underestimated because many of these events do not get reported to state environmental agencies or other notifying sources. In 2000, the New York HSEES conducted a one-year pilot project, called the Hospital Hazmat Emergency Response Surveillance (HHERS), to assess hospital emergency department responses in handling contaminated patients and the impact of the incidents on hospital emergency department operations. Hospital emergency department data were collected on the frequency and injuries of patients who presented to 12 departments after exposure to hazardous substances. Hospital emergency departments do not currently serve as a direct notification source for HSEES. This project picked up many events that were not captured by the current reporting sources, and many of these events occurred in the home. Because of this additional reporting and the addition of several other unique reporting sources, the number of events reported for private residences has increased in New York in recent years. Therefore, the HSEES system needs to develop a mechanism to receive notification from hospital emergency departments.
According to a recent report, poison control centers handled more than 3.2 million telephone calls in 2001 (Litovitz et al., 2002). Almost 90 percent of the inquiries involved incidents in the home, and almost 30 percent involved exposure to toxic substances. During 1996-2001, only 2 percent of events in the home were reported to HSEES by PCCs or medical facilities. A PCC might be the only agency consulted when hazardous household chemicals are released in the home, especially when the quantities released are small. ATSDR is working to develop partnerships with PCCs in participating states so that the HSEES system can receive notification of these events.
Chemical releases in private residences are more likely to involve victims than other types of chemical releases. States participating in HSEES should expand their efforts to educate the general public about the potential hazards of chemicals found in common household products. Because of the number of events that were captured during the New York HHERS pilot project that were not reported to HSEES by other sources, ATSDR should pursue partnering with hospital emergency department staff to collect this information. ATSDR should also continue discussions with PCCs about using them as a notification source.
TABLE 1 Distribution, by Year, of Hazardous Substances Emergency Events Surveillance (HSEES) System Events Occurring in Private Residences, 1996-2001 Year Number of Number of Percentage* Number of Percentage of Participating Events Events with Events with States Victims Victims* 1996 14 70 10.6 13 18.6 1997 13 53 8.0 9 17.0 1998 13 70 10.6 16 22.9 1999 13 73 11.1 15 20.5 2000 15 161 24.4 56 34.8 2001 16 232 35.2 63 27.2 Total -- 659 99.9 172 26.1 *Percentages do not total 100 percent because of rounding. TABLE 2 Distribution of Adverse Health Effects Experienced by Victims of Events Occurring in Private Residences, HSEES System, 1996-2001 Adverse Health Effect Number Percentage Dizziness/central-nervous-system symptoms 137 19.9 Respiratory irritation 132 19.1 Gastrointestinal problems 113 16.4 Headache 104 15.1 Eye irritation 58 8.4 Carbon monoxide--related symptoms* 40 5.8 Skin irritation 29 4.2 Chemical burns 27 3.9 Other 17 2.5 Shortness of breath 12 1.7 Thermal burns 10 1.4 Heart problems 7 1.0 Trauma 4 0.6 Total 690 100.0 *Includes lethargy, suffocation, sleepiness, unconsciousness, and elevated levels of carboxy hemoglobin in the blood. TABLE 3 Number of Chemicals Released in Private-Residence Events and Events with Victims, by Chemical Category, HSEES System, 1996-2001 Total Releases Releases with Victims Chemical Category Number Percentage Number Percentage of Releases with Victims Other inorganic substances 301 41.5 58 30.4 Pesticides 104 14.3 35 18.3 Other substances 81 11.2 18 9.4 Acids 62 8.6 16 8.4 Volatile organic compounds 58 8.0 23 12.0 Mixture across categories 47 6.5 24 12.6 Paints and dyes 28 3.9 3 1.6 Chlorine 16 2.2 7 3.7 Bases 11 1.5 6 3.1 Polychlorinated biphenyls 9 1.2 0 0 Ammonia 8 1.1 1 0.5 Total* 725 100.0 191 100.0 Releases with Victims Chemical Category Percentage of Releases in Substance Category Other inorganic substances 19.3 Pesticides 33.7 Other substances 22.2 Acids 25.8 Volatile organic compounds 39.7 Mixture across categories 51.1 Paints and dyes 10.7 Chlorine 43.8 Bases 5.5 Polychlorinated biphenyls 0 Ammonia 12.5 Total* 26.3 *One chemical could not be categorized. TABLE 4 Top 10 Chemicals Released in Private-Residence Events and Events with Victims, HSEES System, 1996-2001 Standardized Number of Releases Number of Releases Percentage of Chemical Name with Victims Releases with Victims Mercury 200 5 2.5 Pesticide not otherwise specified 27 10 37.0 Hydrochloric acid 24 8 33.3 Paint or coating* 24 2 8.3 Carbon monoxide 23 15 65.2 Malathion 22 5 22.7 Sodium hypochlorite 19 14 73.7 Chlorine 15 7 46.7 Sulfuric acid 15 4 26.7 Acid not otherwise specified 12 0 0 *Includes paint fumes and paint waste.
Acknowledgements: The authors extend grateful appreciation to their partners in the participating state health departments who, with diligence and dedication, researched and gathered much of the data for this publication. Without their assistance, ideas, and comments, this work would not have been possible.
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Perri Zeitz Ruckart, M.P.H.
Maureen F. Orr, M.S.
Wendy E. Kaye, Ph.D.
Corresponding Author: Perri Zeitz Ruckart, Division of Health Studies, ATSDR, 1600 Clifton Rd., MS E-31, Atlanta, GA 30333. E-mail: firstname.lastname@example.org.
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|Author:||Kaye, Wendy E.|
|Publication:||Journal of Environmental Health|
|Date:||Dec 1, 2004|
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