UCSF

Background: Occupational exposure to solvents, such as perchloroethylene has been associated with neurotoxicity. Within the dry-cleaner population, several technological advances have reduced exposure to solvents, however little research has been conducted to ensure that workers are adequately protected. Therefore it is important to determine the prevalence of central nervous system (CNS) toxicity symptoms in a recent dry-cleaner worker population. It is also necessary for workers to engage in safe work behaviors to further reduce exposure to solvents. Hence, an understanding of predictors that promote engagement in safe work behavior is important.

Objective: The aims of this research were: 1) summarize existing research on CNS toxicity symptoms that are associated with perchloroethylene exposure below 100 parts per million. 2) assess the prevalence of CNS toxicity symptoms in dry-cleaners exposed to organic solvents. 3) identify predictors of safe work behavior among dry-cleaners.

Methods: Articles for the literature review were primarily selected from three search engines of peer-reviewed literature. Secondary analysis of an existing cross-sectional dataset of a convenience sample of198 dry-cleaner workers, working primarily in the Midwestern United States. Data collection included self- reported information regarding personal and work-place characteristics, personal beliefs regarding health effects and sources of solvent exposure, symptoms experienced within the prior twelve month period use of personal protective equipment (PPE) and engagement in personal protective behavior (PPB).

Results: In total 14 of the 15 articles reviewed found perchloroethylene exposure below 100 ppm was associated with at least one symptom of CNS toxicity. Symptoms associated with perchloroethylene exposure included: visual impairment, dizziness, motor-coordination deficits, impaired memory and attention deficits. The secondary data analysis revealed that, controlling for use of PPE, workers in the high exposure group were four times more likely (prevalence risk [PR]=4.2; 95%CI 0.9-19.6) to report memory loss and three times more likely (PR= 3.4; 95%CI 1.1-10.7) to report loss of visual perception compared to their counterparts in the low/ moderate-exposure group, however, being an owner was the strongest predictor for CNS toxicity symptoms. In regards to engaging in safe work behavior, receiving safety training and working in high exposure group predicted PPB with the final model explaining 30% (p<.001) of variance. Being an owner, male, having a lower perceived exposure score, and using an alternative solvent to perchloroethylene predicted PPE use, explaining 32% (p<.001) of variance.

Conclusion: Both the literature review and the descriptive study highlight the need for more rigorous research to better understand the risk of CNS toxicity and predictors of safe work behavior in the current dry-cleaner workforce exposed to solvents. Future interventions to increase engagement in safe work behavior should focus on increasing personal protective equipment use among dry-cleaners, especially those who use Perchloroethylene.