Abstract
Hexavalent chromium [Cr(VI)] is a chemical used in many industries and has the potential to cause negative health effects. Occupational health nurses can intervene to protect workers from the health hazards associated with Cr(VI).
Chromium is a naturally occurring element that occurs in three main valent states Cr(0), Cr(III), and Cr(VI). Cr(III) in small amounts is an essential nutrient required for human health; however, Cr(VI) is generally produced by and used in industrial processes, and has been associated with negative health effects. Cr(VI) is valued for its hardness and corrosion resistance, is used in many industries, and has many applications including use in pigments for paints and inks, anticorrosion coatings, stainless steel, textile dyes, wood preservation, and leather tanning. Over 550,000 U.S. workers are exposed to Cr(VI) compounds through inhalation and more than 1 million workers have dermal exposure from working with or handling cement products (National Institute for Occupational Safety and Health [NIOSH], 2013). Smoking and dietary intake are the most important sources of nonoccupational chromium exposure (Agency for Toxic Substances and Disease Registry [ATSDR], 2012).
According to the International Agency for Research on Cancer, Cr(VI) is classified as a human carcinogen. The Environmental Protection Agency (EPA) classified it as a known/likely carcinogen, and NIOSH considers it a well-established carcinogen associated with lung cancer and nasal and sinus cancer (NIOSH, 2013). Other respiratory effects include nose irritation, epistaxis, chronic rhinorrhea, perforated septum, nasal mucosal atrophy, and ulcerations. Cr(VI) exposure is also associated with asthma, cough, wheezing, allergies, pneumoconiosis, and decreased pulmonary function. Dermal effects include dermatitis and chrome ulcers or holes (ATSDR, 2012).
In March 2018, the American Conference of Governmental Industrial Hygienists (ACGIH®) adopted a significantly lower threshold limit value (TLV®) for Cr(VI, water soluble) of .0002 mg/m3 (previously .05 mg/m3) and introduced a new short term exposure limit (STEL) of .0005 mg/m3 (ACGIH®, 2018). In 2006, Occupational Safety and Health Administration (OSHA) lowered the permissible exposure limit (PEL) for Cr(VI, soluble) to the current level of .005 mg/m3 and the action level (AL) to .0025 mg/m3 (OSHA, n.d.-a). OSHA recognizes that PELs are outdated and recommends employers consider using alternate standards such as ACGIH® TLVs® (OSHA, n.d.-b).
Cr(VI) is covered by OSHA under 29 CFR 1910.1026. Welders working with carbon and stainless steel welding, steel mill workers in iron and steel foundries, workers who work with cement and workers in electroplating, wood preservation, or textile dyes industries are all potentially exposed. The standard requires exposure monitoring, employee notification, demarcation of Cr(VI) work areas from the rest of the workplace, engineering and work practice controls, personal protective equipment (PPE), hygiene areas and practices to include change rooms and wash facilities, separate eating and drinking areas, and good housekeeping practices.
The standard mandates medical surveillance for employees who are exposed or may be exposed to Cr(VI) at or above the action level for 30 or more days per year, employees experiencing signs and symptoms of adverse health effects associated with Cr(VI), and employees exposed in an emergency event (OSHA, n.d.-a). The health exam should include an occupational history with an emphasis on Cr(VI) exposure, respiratory system dysfunction, asthma, dermatitis, skin ulceration, nasal septum perforation, and smoking since tobacco smoke contains chromium.
Occupational health nurses can initiate interventions including medical surveillance, recommendations for PPE, and employee education, to protect workers from this hazard. Respirators are used when inhalation exposure to Cr(VI) exceeds the OSHA PEL or ACGIH® TLV®. Workers who have dermal contact should use well-fitting gloves that prevent exposure such as those made of butyl or nitrile and wear long sleeves. Barrier creams are ineffective against Cr(VI) dermal exposure. Workers should be educated on the signs and symptoms of exposure and workers who smoke should be counseled to quit.
Footnotes
The author(s) declared no potential conflicts of interest and received no financial support with respect to the research, authorship, and/or publication of this article.
Author’s Note.
The views expressed in this article are those of the author and do not necessarily reflect the official policy of the Department of Defense, Department of the Army, US Army Medical Department or the US Government.
