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Dermal Exposure and Risk to Aerosolized Pharmaceuticals in Home Healthcare Workers.

Ishau, Simileoluwa O
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1581333497402733

Abstract Details

2020, PhD, University of Cincinnati, Medicine: Industrial Hygiene (Environmental Health).
Home healthcare workers (HHCWs) provide hands-on long-term care and personal assistance to patients with disabilities or other chronic conditions. Depending on their training, HHCWs duties may include administration of aerosolized medications to patients using a nebulizer. The objective of the first study was to determine a safe dose for commonly encountered aerosolized pharmaceuticals in the home. The rationale of this study was to establish an occupational exposure limit for these medications for the purpose of risk assessment. In healthcare occupations, inhalation and skin contact with systemic absorption are the most likely route of chemical exposure. Therefore, the objective of the second and third studies were to estimate the extent of dermal exposure and the risk associated with such exposures, respectively. In these studies, the effects several factors such as room ventilation, HHCWs’ distance and position relative to the patient and patient’s breathing rate on dermal exposure and risk were explored to provide a set of optimal working conditions to mitigate dermal overexposure to pharmaceutical agents encountered in the home by HHCWs. This dissertation consists of three studies (Study A – C). In study A, the occupational exposure limits (OELs) of albuterol, ipratropium and budesonide was calculated. Information on the mechanism of action and adverse effects for each medication was collected to determine a critical effect (and point-of-departure) suited for the home healthcare work environment. The Risk-based manufacture of pharmaceutical products (RiskMaPP) guidelines was used to apply uncertainty and adjustment factors to the point-of departure to calculate an occupational exposure limit. In study B, sodium chloride (NaCl) was administered to a breathing mannequin representing a patient, with another mannequin (representing the HHCW) placed at varying locations and position relative to the patient in a 24.3 m3 room, with a closed loop ventilation system. The test was conducted at two patient’s respiratory rate: 15 and 30 breaths/min (with a tidal volume 1 L/breath, a mean inspiratory flow (MIF) rate of 15 and 30 L/min was calculated). Also, three room air exchange rates (AERs) was used to simulate turned off room air (0 h-1), high-efficiency room ventilation (5 h-1) and hospital-type ventilation (17 h-1). NaCl deposition on the exposed skin surface of the HHCW was collected. In study C, the equivalent dermal dose for albuterol, ipratropium and budesonide was calculated from the NaCl estimates in study B. Using the IH SkinPerm, the amount of each medication absorbed through the skin over an 8-hour exposure duration was estimated. The systemic OEL for these medications was calculated per RiskMaPP guidelines and a hazard quotient (HQ) was calculated. The absolute risk reduction/increase of systemic overexposure (HQ > 1) from dermal absorption for each medication from changes in the variables in study B were determined. Information on the effect each variable on the absolute risk was used to suggest ways to mitigate overexposure and the likelihood of adverse outcomes in HHCWs who provide aerosolized medication administration. Overall, the results show that the inhalation OEL for nebulized drugs are protective for deleterious effects associated with inhalation exposure by HHCWs. The skin is a significant route of exposure to pharmaceutical agents administered via nebulization within the home environment, and several factors play a role in either lessening or aggravating the dermal exposure. The efforts show that increased turbulence created by increased room ventilation favors dermal exposure, a finding that contrasts with inhalation exposure.
Sergey Grinshpun, Ph.D. (Committee Chair)
Thomas Connor, Ph.D. (Committee Member)
Roman Jandarov, Ph.D. (Committee Member)
M. Maier, Ph.D. (Committee Member)
John Reichard, PharmD Ph.D. (Committee Member)
151 p.
Environmental Health
Home Healthcare; Dermal Exposure; Risk Assessment; Occupational Exposure Limit; Aerosol; Pharmaceuticals

Recommended Citations

Citations

  • Ishau, S. O. (2020). Dermal Exposure and Risk to Aerosolized Pharmaceuticals in Home Healthcare Workers. [Doctoral dissertation, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1581333497402733

    APA Style (7th edition)

  • Ishau, Simileoluwa. Dermal Exposure and Risk to Aerosolized Pharmaceuticals in Home Healthcare Workers. 2020. University of Cincinnati, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1581333497402733.

    MLA Style (8th edition)

  • Ishau, Simileoluwa. "Dermal Exposure and Risk to Aerosolized Pharmaceuticals in Home Healthcare Workers." Doctoral dissertation, University of Cincinnati, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1581333497402733

    Chicago Manual of Style (17th edition)

ucin1581333497402733
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This open access ETD is published by University of Cincinnati and OhioLINK.