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Westerlund, Jessica
Publications (5 of 5) Show all publications
Westerlund, J., Bryngelsson, I.-L., Löfstedt, H., Eriksson, K., Westberg, H. & Graff, P. (2019). Occupational exposure to trichloramine and trihalomethanes: adverse health effects among personnel in habilitation and rehabilitation swimming pools. Journal of Occupational and Environmental Hygiene, 16(1), 78-88
Open this publication in new window or tab >>Occupational exposure to trichloramine and trihalomethanes: adverse health effects among personnel in habilitation and rehabilitation swimming pools
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2019 (English)In: Journal of Occupational and Environmental Hygiene, ISSN 1545-9624, E-ISSN 1545-9632, Vol. 16, no 1, p. 78-88Article in journal (Refereed) Published
Abstract [en]

Personnel in swimming pool facilities typically experience ocular, nasal, and respiratory symptoms due to water chlorination and consequent exposure to disinfection by-products in the air. The aim of the study was to investigate exposure to trichloramine and trihalomethanes (chloroform, bromodichloromethane, dibromochloromethane, and bromoform) from the perspective of adverse health effects on the personnel at Swedish habilitation and rehabilitation swimming pools. The study included ten habilitation and rehabilitation swimming pool facilities in nine Swedish cities. The study population comprised 24 exposed swimming pool workers and 50 unexposed office workers. Personal and stationary measurements of trichloramine and trihalomethanes in air were performed at all the facilities. Questionnaires were distributed to exposed workers and referents. Spirometry, fraction of exhaled nitric oxide (FENO) and peak expiratory flow (PEF) were measured. Personal and stationary measurements yielded trichloramine levels of 1-76 µg/m3 (average: 19 µg/m3) and 1-140 µg/m3 (average: 23 µg/m3), respectively. A slightly higher, but not significant, prevalence of reported eye- and throat-related symptoms occurred among the exposed workers than among the referents. A significantly increased risk of at least one ocular symptom was attributed to trichloramine exposure above the median (20 µg/m3). Lung function (FVC and FEV1) was in the normal range according to the Swedish reference materials, and no significant change in lung function before and after shift could be established between the groups. Average FENO values were in the normal range in both groups, but the difference in the values between the exposed workers and referents showed a significant increase after shift. Hourly registered PEF values during the day of the investigation did not show any unusual individual variability. In conclusion, the increased risk of developing at least one ocular symptom at personal trichloramine concentrations over 20 µg/m3 combined with an increase in the difference in FENO during the work shift of the exposed workers should not be neglected as an increased risk of respiratory inflammation in the habilitation and rehabilitation swimming pool environment.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Occupational exposure, respiratory symptoms, swimming pool, trichloramine, trihalomethanes
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:oru:diva-69906 (URN)10.1080/15459624.2018.1536825 (DOI)000471113200011 ()30335595 (PubMedID)2-s2.0-85060177023 (Scopus ID)
Available from: 2018-11-06 Created: 2018-11-06 Last updated: 2019-07-22Bibliographically approved
Westerlund, J. (2016). Occupational exposure to trichloramine and trihalomethanes: adverse respiratory and ocular effects among Swedish indoor swimming pool workers. (Licentiate dissertation). Örebro: Örebro university
Open this publication in new window or tab >>Occupational exposure to trichloramine and trihalomethanes: adverse respiratory and ocular effects among Swedish indoor swimming pool workers
2016 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Occupational exposure in swimming pool facilities related to disinfection by-products (DBPs) has been an issue for the last 15 years. Trichloramine (NCl3) and trihalomethanes (THMs) are DBPs formed in swimming pool water following a reaction between organic matter containing nitrogen or organic or inorganic matter, and chlorine. Due to its volatility, trichloramine can easily evaporate into the air and cause nausea and irritation of the eyes and upper airways. Symptoms are likely to be particularly pronounced in those suffering from asthma. Chloroform is the dominant THM in swimming pool atmospheres and is classified by the International Agency for Research on Cancer (IARC) as being possibly carcinogenic to humans. There are no adverse health effects reported among swimming pool employees due to occupational exposure levels of THMs found in the air at swimming pools.

There is no OEL for trichloramine adapted in Sweden, but some reference values and recommendations based on stationary measurements at the pool side are available. In 2006, the World Health Organisation (WHO) recommended a reference value for trichloramine of 500 μg/m3. The Swedish OEL for chloroform is 10 000 μg/m3.

This thesis describes research into the occupational exposure to airborne trichloramine and THMs in eight Swedish indoor swimming pool facilities and the investigation into the prevalence of adverse health effects, manifesting primarily as ocular and respiratory symptoms.

Concentrations of trichloramine and chloroform in Swedish indoor swimming pool facilities were found to be in the same range or lower compared to previous studies in other countries. The trichloramine concentrations varied between <1 and 240 μg/m3 for the personal sampling and between <1 and 640 μg/m3 for the stationary sampling. Personal trichloramine levels in the high-exposure group were more than 60% higher compared to the corresponding stationary measurements. The exposed group had a higher frequency of self-reported ocular and nasal symptoms compared to the controls. A significant difference in the concentration of exhaled FENO over a work shift with an increase in the exposed group, indicated acute airway inflammation due to respiratory irritant agent exposure. Although a dose-response effect could not be established, the results indicate an elevated risk of occupational health problems in indoor swimming pools and calls for an OEL to be established, based on personal sampling.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2016. p. 45
National Category
Other Basic Medicine
Research subject
Biomedicine
Identifiers
urn:nbn:se:oru:diva-51601 (URN)
Presentation
2016-06-17, Universitetssjukhuset, Bohmanssonsalen, Södra Grev Rosengatan, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2016-08-08 Created: 2016-08-08 Last updated: 2018-04-20Bibliographically approved
Löfstedt, H., Westerlund, J., Graff, P., Bryngelsson, I.-L., Mölleby, G., Olin, A.-C., . . . Westberg, H. (2016). Respiratory and Ocular Symptoms Among Employees at Swedish Indoor Swimming Pools. Journal of Occupational and Environmental Medicine, 58(12), 1190-1195
Open this publication in new window or tab >>Respiratory and Ocular Symptoms Among Employees at Swedish Indoor Swimming Pools
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2016 (English)In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 58, no 12, p. 1190-1195Article in journal (Refereed) Published
Abstract [en]

Background: This study investigated trichloramine exposure and prevalence of respiratory and ocular symptoms among Swedish indoor swimming pool workers.

Methods: Questionnaires were distributed to pool workers and referents. Lung function and fraction of exhaled nitric oxide (FeNO) were measured before and after work. Exposure to trichloramine and trihalomethanes was measured over work shifts.

Results: The mean personal trichloramine exposure was 36g/m(3). Significantly more exposed workers reported ocular and nasal symptoms. There were significant differences between groups in FeNO change following work, with exposed showing increased FeNO, which grew when analyses included only nonsmokers.

Conclusions: The findings indicate that indoor swimming pool environments may have irritating effects on mucous membranes. FeNO data also indicate an inflammatory effect on central airways, but the clinical relevance is unclear. Low trichloramine levels found in this study were not associated with health effects.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2016
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-54678 (URN)10.1097/JOM.0000000000000883 (DOI)000390238500008 ()2-s2.0-85007337110 (Scopus ID)
Note

Funding Agency:

Department of Occupational and Environmental Medicine, Örebro

Available from: 2017-01-13 Created: 2017-01-13 Last updated: 2018-07-23Bibliographically approved
Westerlund, J., Graff, P., Bryngelsson, I.-L., Westberg, H., Eriksson, K. & Löfstedt, H. (2015). Occupational Exposure to Trichloramine and Trihalomethanes in Swedish Indoor Swimming Pools: Evaluation of Personal and Stationary Monitoring. Annals of Occupational Hygiene, 59(8), 1074-1084
Open this publication in new window or tab >>Occupational Exposure to Trichloramine and Trihalomethanes in Swedish Indoor Swimming Pools: Evaluation of Personal and Stationary Monitoring
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2015 (English)In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 59, no 8, p. 1074-1084Article in journal (Refereed) Published
Abstract [en]

Introduction: Chlorination is a method commonly used to keep indoor swimming pool water free from pathogens. However, chlorination of swimming pools produces several potentially hazardous by-products as the chlorine reacts with nitrogen containing organic matter. Up till now, exposure assessments in indoor swimming pools have relied on stationary measurements at the poolside, used as a proxy for personal exposure. However, measurements at fixed locations are known to differ from personal exposure.

Methods: Eight public swimming pool facilities in four Swedish cities were included in this survey. Personal and stationary sampling was performed during day or evening shift. Samplers were placed at different fixed positions around the pool facilities, at similar to 1.5 m above the floor level and 0-1 m from the poolside. In total, 52 personal and 110 stationary samples of trichloramine and 51 personal and 109 stationary samples of trihalomethanes, were collected.

Results: The average concentration of trichloramine for personal sampling was 71 mu g m(-3), ranging from 1 to 240 mu g m(-3) and for stationary samples 179 mu g m(-3), ranging from 1 to 640 mu g m(-3). The air concentrations of chloroform were well below the occupational exposure limit (OEL). For the linear regression analysis and prediction of personal exposure to trichloramine from stationary sampling, only data from personal that spent > 50% of their workday in the pool area were included. The linear regression analysis showed a correlation coefficient (r (2)) of 0.693 and a significant regression coefficient beta of 0.621; (95% CI = 0.329-0.912, P = 0.001).

Conclusion: The trichloramine exposure levels determined in this study were well below the recommended air concentration level of 500 mu g m(-3); a WHO reference value based on stationary sampling. Our regression data suggest a relation between personal exposure and area sampling of 1:2, implying an OEL of 250 mu g m(-3) based on personal sampling.

Place, publisher, year, edition, pages
Oxford University Press, 2015
Keywords
exposure assessment, exposure assessment methodology, trichloramine, trihalomethanes
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:oru:diva-46443 (URN)10.1093/annhyg/mev045 (DOI)000362788900011 ()26155991 (PubMedID)2-s2.0-84943573115 (Scopus ID)
Note

Funding Agencies:

County council of Örebro

County council of Västmanland

County council of Värmland

County council of Södermanland

Available from: 2015-11-10 Created: 2015-11-10 Last updated: 2018-09-04Bibliographically approved
Löfstedt, H., Westerlund, J., Graff, P., Bryngelsson, I.-L., Mölleby, G., Olin, A.-C., . . . Westberg, H.Respiratory and ocular symptoms among employees at Swedish indoor swimming pools.
Open this publication in new window or tab >>Respiratory and ocular symptoms among employees at Swedish indoor swimming pools
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(English)Manuscript (preprint) (Other academic)
National Category
Other Basic Medicine
Research subject
Biomedicine
Identifiers
urn:nbn:se:oru:diva-51602 (URN)
Available from: 2016-08-08 Created: 2016-08-08 Last updated: 2018-01-10Bibliographically approved
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