Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1696597157188.pdf (United States)
WORKPLACE CHEMICAL HAZARDS TO REPRODUCTIVE HEAL TH A Resource for Worker Health and Safety Training and Patient Education Hazard Evaluation System and Information Service Occupational Health Branch California Department of Health Services 850 Marina Bay Parkway Building P, 3rd Floor Richmond, CA 94804 This booklet was prepared by Patricia Coyle, MPH, based on a draft by Catherine Sonquist Forest.

It was reviewed and edited by the staff of HES IS.


HESIS is a joint service of the California Department of Health Services and the California Department of Indus­ trial Relations.

Design and illustrations by Jane Norling.

Typeset by Will Forest.

First printing May I 990.

Second printing November I 999.

HESIS publications can be obtained by written request or by calling toll free (866) 627-1586 to leave a message.

This booklet may be reproduced without permission, except for profit-making purposes.
CONTENTS Workplace Chemical Hazards to Reproductive Health Reproduction Reproductive Disorders and .

.

.

.

.

.

.

.

.

Adverse Pregnancy Outcomes How Do We Know If a Chemical Can Harm Reproduction?

.

.

.

.

.

.

.

.

.

.

.

Specific Chemicals Factors That Determine Hazard to Reproduction Evaluating Workplace Hazards .

.

How Can Exposures Be Reduced?

.

.

.

.

.

Workplace Regulations Pregnant Workers' Legal Rights Conclusion For More Information .

.

.

.

.

.

Glossary .

.

.

.

.


.

.

.

.

.

.

.

.

Appendix: Estimating Workplace Exposure .

.

.

.

.

1 3 7 .

12 .

14 .

19 .

21 .

24 .

27 .

28 .

31 .

32 .

35 .

37 WORKPLACE CHEMICAL HAZARDS TO REPRODUCTIVE HEAL TH Many men and women wonder if toxic substances at work, at home, or in their communities affect their ability to have healthy children.
They are concerned that chemical exposures might cause reproduc­ tive health problems such as infertility, miscarriage, birth defects, mental deficiencies, or cancer in their children.

This concern is understandable, since the ability to bear healthy children is often one of the most cherished aspects of life.

Many chemical exposures pose no hazard to reproduc­ tion.

Some chemicals don't harm the fetus or the repro­ ductive system.
In other cases, exposure to chemicals is too brief or too small to create a hazard However, frequent use of certain chemicals without the proper protections may be cause for concern.

It is important, then, that both men and women find out about the chemi­ cals they use at work before starting a family.

This booklet is intended as an aid to patient education and worker health and safety training.

It is written for health care providers and people responsible for workplace health and safety.
HESIS has also published a less tech­ nical fact sheet which deals with evaluating hazards to pregnancy.
To help the reader better understand how hazardous chemicals can affect reproductive health, and how harm can be prevented, this booklet will: • review the reproductive biology of both men (formation of sperm) and women (menstrual cycle and pregnancy) • discuss possible reproductive disorders and adverse pregnancy outcomes and how they may be associated with exposure to certain hazardous substances • summarize the methods used to determine the repro­ ductive toxicity of chemicals 1 •list a few of the agents which are known reproductive hazards in humans or animals •summarize workplace the steps involved hazards to reproductive in evaluating health on how workers information •provide can be protected by reducing their exposures overview •give a brief workers.
of the rights of pregnant •define some of the more technical words.

Some readers may want to refer to the glossary (page 35) as they read this booklet.

The Impact Of Workplace On Chemicals Reproductive Function Reproductive occur frequently the causes are not known, although and other drugs, smoking, heredity can all have profound in the general disorders and adverse pregnancy In most cases population.

outcomes alcohol poor nutrition, lack of prenatal care, age, and effects on reproduction.
ex1>9sures con­ chemical is much less clear.

expo­ The extent to which workplace tribute impairment to reproductive But even if we don't know how much workplace sures contribute, cause of reproductive practices chemicals magnitude which reduce or prevent does not have to wait until of the risk chemical exposure to hazardous we know the exact presents.

we do know that they are a preventable dysfunction.

The adoption exposure of work have not been adequate ly For this to affect reproduction.
with certain­ to conclude exposure can chemical chemicals Most industrial tested for their ability reason, it is not usually possible or not a particular ty whether cause harm.

However, information ly evaluate of worker to protect that workers ductive effects as well.

even when reproductive to reasonab­ it may be possible is incomplete, risk based on what we do know and estimates exposure.
workers from all other health is controlled it's likely If workplace effects, exposure toxicity will often be protected from harmful repro­ 2 A Woman's Reproductive Cycle REPRODUCTION A brief review of the reproductive cycles of women and men will help us discuss how workplace expo­ sure to chemicals can affect reproductive func­ tion.

This section discusses the cycles by which eggs and sperm are formed and the stages of pregnancy.
Every month during a woman's reproductive years her body prepares itself for childbearing.

Monthly changes in the levels of hormones (the body's chemical messengers) in the blood determine when a woman ovulates (releases an egg from the ovary) and menstruates (sheds the lining of the uterus).

A woman's entire reproductive cycle is regulated by these hormones.

If a chemical disturbed the release of hormones it could cause irregular periods or excessive bleeding.
In addition, it could change the timing of ovulation or prevent ovulation from occurring at all.

Without ovulation a pregnancy cannot occur.

This is how contraceptive (birth control) pills prevent pregnan­ cy.

The effect of industrial chemicals on menstrual func­ tion has not been studied well.

Menstrual disorders have been reported in women exposed to synthetic hormones and inorganic mercury in the workplace.
All of the eggs that a woman will ever have (about half a million) are present in her ovaries at the time she is born, but only about 500 of these eggs will mature and be released during her lifetime.

These eggs carry the genes (genetic material) which determine the characteristics she will pass on to her children (eye and hair color, blood type, etc.).

Each month several of these eggs mature and one is released into the fallopian lubes.
Because a woman's eggs are present throughout her life, they can be damaged by exposure to chemicals at any time.

There is some evidence that exposure to high levels of ionizing radiation prior to fertilization can damage the egg and in­ crease the chance of miscarriage.

The extent to which preconception exposure to industrial chemicals may 3 Pregnancy damage the egg is not known.

We haven't yet identified other agents which have this effect.
At the same time that eggs are maturing in the ovaries, the lining of the uterus thickens to prepare for a fertilized egg.

If fertilization does not occur, the lining of the uterus is shed, resulting in menstruation ("period").

If fertilization (the union of egg and sperm to form an embryo) occurs, the fertilized egg travels down the fallopian tube and becomes implanted in the uterus.

Some intrauterine device (ruD) contraceptives probably prevent pregnancy by preventing the embryo from im­ planting.
In theory, a chemical could similarly interfere at this stage.

Sensitive Periods for Effects on Fetus Week of Pregnancy 2 7 8 12 16 , 20-38 Brain and Spinal Cord Eyes Genitals Ear Most Fetal Death ; Not Usually Likely Vulnerable to Effect: Other Effects Major Physical Defects Developmental Delay and Minor Physical Defects Shading represents highly sensitive periods; clear area represents periods that are less sensitive to teratogens.
4 An implanted embryo develops into a fetus, nourished by the mother through the placenta.

The nine-month preg­ nancy is divided into three phases called trimesters.

Each trimester is 13 weeks long.

First Trimester After implantation and up until the end of the third month of pregnancy, the cells of the fetus rapidly divide and fonn the organs and limbs.

This is the period in which the fetus is most susceptible to agents which can cause physical defects.
While some chemicals do not cause physical defects, they can delay nonnal growth of the fetus.

Susceptibility to developmental delay continues throughout pregnancy.

Second and Third Trimesters During the second and third trimesters of pregnancy, the fetus grows in size and the organ systems (e.g., the ner­ vous system) develop.

From the fourth month until birth, chemicals which can hann the fetus are more likely to affect brain development or result in low birth weight than to cause physical defects.
However, certain organ systems (such as the urinary and reproductive systems) develop throughout the pregnancy and remain susceptible to agents which cause physical defects.

5 A Man's Reproductive Cycle spenn at puberty and continue to their adult life.

Spenn are stem cells) in a man's in a series of steps which takes ten weeks to com­ Men begin to develop produce sperm throughout produced from special cells (called testicles plete.

This is, like a woman's mones.


If an agent altered the secretion mones it could disrupt on a man's desire for and ability course.

menstrual cycle, regulated by hor­ of these hor­ the cycle as well as have an effect inter­ to perform sexual cycle of sperm production (spennatogenesis) or physical the stem cells, agents or the mature can damage a man's sperm formed from in a reduction in the num­ a total absence of sperm, changes to move, or changes Some chemical testicles, them.
This damage can result ber of sperm produced, in their shape or ability material in the sperm cell.

A reduction in sperm count can result the other changes mobility Changes miscarriage may have.

Changes might make sperm less likely material in genetic in shape and an egg.

to fertilize the chance of We don't really know what effect in infertility.

in a man's partner.

might increase in the genetic eggs, which are all present at the time during a are produced continually from years.
Once a man is removed Unlike a woman's she is born, sperm man's reproductive exposure to a damaging production cells have been damaged, be permanently affected.

agent, of normal sperm can occur after several months.
If the stem however, recovery sperm production can 6 Reduced Sex Drive Infertility REPRODUCTIVE DISORDERS AND ADVERSE PREGNANCY OUTCOMES Birth defects are the most highly publicized of all adverse reproductive outcomes, yet chemicals can affect reproductive function in men and women at any stage and can cause a variety of adverse outcomes.

The specific effect produced depends on the agent, the dose, and the timing of exposure.
The range of potential adverse reproductive outcomes and the possible mech­ anisms by which reproductive toxins may exert their effects are discussed below.

Chemicals which affect the nervous system or the secretion (release) of sex honnones could lower the sex drive or alter sexual response in both men and women.

Changes in sex drive or sexual response are usually accompanied by other symptoms of toxicity.
Other fac­ tors which can affect sex drive include fatigue, stress, ill­ ness, and some medications.

~ Examples: lead (a metal used in battery manufacture, soldering and many other occupations); mercury (a metal used in medical devices, in making dental amalgams, etc.)

Infertility is the inability of a couple who want a child to become pregnant after trying for one year.

About 10 to 15% of couples fail to conceive after one year of unpro­ tected intercourse.
Factors which have been associated with infertility include a history of sexually transmitted disease, substantial weight loss, and advanced maternal age.

Chemicals could cause infertility by: In men: • damaging the testes, resulting in inability or reduced ability to produce spenn.

• directly damaging the sperm, leading to reduced spenn count or abnonnally shaped sperm.

Abnonnal­ ly shaped sperm might be less likely to fertilize an egg.
7 Spontaneous Abortion ~ Examples: 2-methoxyethanol (an industrial solvent); dibromochloropropane (a pesticide, banned for use in the United States) In women: • directly damaging the egg.

• changing the balance of sex hormones, which could result in a lack of ovulation (release of egg) or abnor­ mal periods.

Menstrual irregularities are a common problem and are often due to stress, changes in diet or exercise, or other factors.
There is only limited evi­ dence in humans that chemical exposure contributes to menstrual irregularities.

However, changes in menstrual function are difficult to measure and have not been studied well.

~Examples: lead; ionizing radiation Spontaneous abortion is a naturally occurring loss of the embryo or fetus before full term.

It is estimated that 15% to 30% of all pregnancies end in spontaneous abortion.
A spontaneous abortion can occur before a woman knows she is pregnant, so that all she is aware of is a late, possib­ ly heavy, period.

The causes of these spontaneous abor­ tions are largely unknown.

Several factors known or suspected to be associated with an increased risk of spon­ taneous abortion are advanced maternal age, smoking, gynecological disorders such as physical abnormalities of the uterus, and infection.
Chemicals could cause a spon­ taneous abortion by: In men: • damaging the genetic material in the sperm so severe­ ly that an egg fertilized with this sperm cannot sur­ vive.

This has been seen in animals but not yet in humans.

~ Example: ethylene oxide (a chemical sterilizing agent) 8 In women: • damaging the genetic material in the egg so severely that the egg cannot survive once fertiliz.ed.

• preventing the fertilized egg from implanting in the uterus.
• directly affecting the developing embryo or fetus, causing a lethal (deadly) physical defect or lethal toxic effect.

~ Examples: lead; anesthetic gases; antineoplastic drugs (drugs used to treat cancer) Birth Defects A birth defect is a physical abnormality present at birth, although it may not be detected until later.

About 2% to 3% of all newborns have a serious defect The proportion of these birth defects which is attributable to hazardous substances is unknown.
In fact, the causes of most defects are not known.

Several factors which are associ­ ated with an increased risk of birth defects are poor nutri­ tion, advanced maternal age, certain maternal diseases such as diabetes and sickle cell anemia, and certain maternal infections such as rubella (German measles) and toxoplasmosis.

Chemicals can cause birth defects by directly damaging tissues in the developing fetus.

Agents which cause birth defects are called teratogens.
The period of most concern is the first trimester, because this is when the organs and limbs are being formed.

During this period many women are not yet aware that they are pregnant and therefore may not take appropriate measures to protect themselves from exposure to agents which can cause birth defects.

Some chemicals can harm the fetus even at exposure levels that do not affect the mother, so that the mother may have no symptoms to warn her that her fetus is being harmed.
~ Examples: glycol ethers; ionizing radiation (X-rays, radiologic medicine); antineoplastic drugs 9 Fetotoxicity Neurobehavioral Defects Some agents can delay the growth or harm the health of the fetus without causing physical defects.

These agents are calledfetotoxins.

The most common fetotoxic effect is low birth weight.

Babies with particularly low birth weight are at increased risk of illness or death in the first year of life.

Fetotoxicity can occur at levels of exposure not toxic to the mother.
Factors which have a significant effect on fetal growth and birthweight are nutrition, smok­ ing, and consistent prenatal care.

=> Examples: ethanol (alcohol); smoking; toluene (an industrial solvent) The mental development and behavior of infants and children can be harmed by substances that their mother was exposed to during pregnancy.

The effects include hyperactivity, irritability, decreased attention span, slow learning ability, and in severe cases, mental retardation.
They can occur in addition to physical defec~ or alone, and may not be apparent at the time of birth.

'-Some of these effects may be temporary (e.g., irritability), while others are permanent (e.g., mental retardation).

Exposure to toxic substances before birth is only one of many fac­ tors which can affect the development and behavior of a child.
Other factors which have a profound effect on a child's development are nutrition, genetic defects (for ex­ ample, Down's Syndrome), interactions between the child and his or her parents, and the quality of the child's educa­ tion.

Only a few drugs and even fewer industrial chemi­ cals have been identified which cause neurobehavioral defects.

However, neurobehavioral defects are difficult to measure and have not been well studied.
=> Examples: lead; ethanol; narcotic drugs (e.g., cocaine, heroin) Childhood Cancer Many cancer-causing substances (carcinogens) can reach the fetus through the mother.

Some can cause cancer in the child or young adult These chemicals are called transplacental carcinogens.

There are very few known transplacental carcinogens.

However, any carcinogen which can cross the placenta should be considered a potential transplacental carcinogen.
10 Exposure After Birth ~ Example: diethylstilbestrol ("DES," a drug given to many pregnant women in the 1950's-60's.

A small per­ centage of their daughters develop a rare type of can­ cer as yourig adults.)

Many toxic chemicals concentrate in fat tissue once they are absorbed into the body.

Since breast milk is high in fats, a breast-feeding child can be exposed to these toxic chemicals (e.g., perchloroethylene).
Other chemicals leave the body within a very short period of time or do not concentrate in breast milk and should not pose a prob­ lem to the breast-feeding infant.

If chemicals, especially metal dusts such as lead and cad­ mium, are brought home on skin or clothes, children may also be exposed.

Good personal hygiene (showering or washing after work, changing out of work clothes and shoes) can prevent this type of exposure.
11 Human Studies HOW DO WE KNOW WHETHER A CHEMICAL CAN HARM REPRODUCTIVE FUNCTION?

There are three types of studies which scientists use to determine whether a chemical can harm repro­ duction: studies of human populations (epidemio­ logical studies), studies of animals, and tests for mutagenicity (the ability to damage genetic material).

Each of these methods has strengths and weaknesses in helping us to understand reproductive hazards and to take action to prevent them.
Epidemiologists study human populations to look for un­ usual or abnormal patterns of health problems.

They try to determine whether these unusual patterns are associ­ ated with a particular exposure.

These studies provide the most reliable evidence for human reproductive hazards.

However, it is difficult to show that harm to pregnancy or reproduction in humans is the result of exposure to a specific substance.
Humans are difficult to study because we are usually exposed to many substances at the same time and it is often difficult to estimate the level of expo­ sure to a particular substance.

Also, harm to pregnancy or reproduction is often difficult to measure.

Finally, epi­ demiologists must study very large numbers of people to be able to detect a difference between exposed and un­ exposed people.

Because of these difficulties, few agents have been studied in humans.
One disadvantage to relying on epidemiological evidence is that we can't recognize problems until they actually occur in humans.

In contrast to studies in humans, animal studies and tests of mutagenicity can serve as warnings of a potential hazard before people are harmed.

12 Animal Studies Tests of Mutagenicity Standard animal reproductive toxicity tests expose groups of laboratory animals to different amounts of a chemical for different periods of time.
These animals are then com­ pared with animals that were not exposed.

to see if there are differences in sperm production.

birth defects in off­ spring.

or other reproductive functions.

We usually assume that most agents which harm repro­ duction in animals also have the potential to harm human reproduction.

Although there may be exceptions, we make this assumption because most known human repro­ ductive toxins have similar effects in laboratory animals.
Most of our information about reproductive hazards comes from testing animals.

One way to predict whether a chemical could affect repro­ duction is to determine in laboratory tests whether it causes mutations (changes in the genetic material of a cell).

The use of mutation studies to predict ~productive toxicity is based on the assumption that if mutations occur in laboratory test cells, they could also occur in human germ cells (egg or sperm).

However.
However.

not all mutagens (chemicals which cause mutations) adversely affect reproduction, and not all reproductive toxins are mutagens.

Scientists sometimes use these tests for screening chemi­ cals to determine which ones should have the highest priority for animal testing.

13 SPECIFIC CHEMICALS Most of the thousands of industrial chemicals in use today have not been tested for their ability to affect reproductive function.
Compared to our knowledge of the immediate health effects of chemicals, little is known about the ability of chemicals to affect reproduction.

For this reason, it is not usually possible to conclude with certainty whether or not a particular expo­ sure can cause harm.

The surest way to prevent toxic chemicals from causing harm to workers or to a develop­ ing fetus is to minimize or prevent exposure.
Since it is not possible to discuss all the agents that workers may be exposed to, we have provided informa­ tion in the following tables (fables 1 to 4) on a few of the chemical compounds most frequently encountered in California workplaces.

Chemical agents are classified as known reproductive toxins.probable reproductive toxins, possible reproductive toxins, and substances unlikely to harm reproduction.

This is not a list of reproductive toxins which may be encountered in the workplace.
It is a list of chemicals men and women frequently inquire about, accompanied by a qualitative assessment of potential for reproductive harm.

Just because a chemical is not on this list does not mean that it is safe.

Because this booklet focuses on reproductive health ef­ fects, the general health effects of the substances on the following lists are not identified or discussed.

Readers are encouraged to obtain general toxicity information from another source (see page 32).
14 Table 1 A Few Known Human Reproductive Toxins Which May Be Encountered in the Workplace Effect Comment • reduced spenn count • spontaneous abortion • low birth weight • behavioral abnonnalities some effects may occur at levels below those which cause other toxic effects • birth defects • spontaneous abortion • reduced spenn count effects may occur at levels below those which cause other toxic effects Substance lead antineoplastic drugs diethylstilbestrol (DES) • cancer in children no longer widely used; possible exposure in the pharmaceutical industry dibromochloropropane (DBCP) • damages testes use is banned in the United States ethanol (alcohol) • birth defects • low birth weight • behavioral abnonnalities ionizing radiation • birth defects • spontaneous abortion • low birth weight • cancer in children • reduced spenn count unlikely to occur through occupational inhalation exposures; significant risk through ingestion recommended dose limit to the fetus in occupationally exposed women is 0.5 rem during the entire pregnancy Note: ''Effect" refers to adverse reproductive effect that has been associated with this substance in human or animal studies.
This does not mean that this effect will necessarily occur in response to exposure.

Response depend~ on a number of factors, including dose, and the point in the reproductive process at which exposure occurs.
15 Table 2 A Few Probable Human Reproductive Toxins Which May Be Encountered in the Workplace Substance Effect* 2-methoxyethanol** • birth defects (A) • reduced sperm count (A) 2-ethoxyethanol** ethylene oxide** nitrous oxide** cycloheximide** mercury (inorganic)** • birth defects (A) • reduced sperm count (NH) • toxic to sperm (A) • spontanoous abortion (NH) • spontanoous abortion (NH) • birth defects (A) • birth defects (A) • damages testes (A) • toxic to sperm (A) • birth defects (A) • fetotoxicity (A) • menstrual irregularities (H) * See "Note" at the bottpm of Table 1.
** Reproductive effects may occur at lower exposure levels than other toxic effects, so that there may be no obvious symptoms to warn that workers' reproductive health is being harmed.
A = evidence in animals; H =limited evidence in humans 16 Table 3 A Few Possible Human Reproductive Toxins Which Are Frequently Encountered in the Workplace Substance Effect* methyl ethyl ketone • fetotoxicity** (A) methanol • birth defects at very high exposure levels** (A) methylene chloride • fetotoxicity** (A) trichloroethane (TCA) • fetotoxicity** (A) perchloroethylene • fetotoxicity** (A) styrene xylene toluene • death of the embryo** (A) • fetotoxicity** (A) • birth defects at levels toxic to mother** (A) • fetotoxicity** (A) • birth defects*** (H) * See "Note" at the bottom of Table l. ** In animals; this does not occur at exposure levels near the Permissible Exposure Limit (PEL).
However, because of the uncertainty inherent in animal testing, workplace exposure should be minimized.

*** Case reports in children of women who abused toluene (by sniffing glue) throughout pregnancy.

A = evidence in animals; H =limited evidence in humans 17 Table 4 A Few Substances Which Are UnJikeJy to Harm Reproduction Some chemicals are not likely to harm reproductive func­ tion, because very little of the chemical is absorbed into the bloodstream.
For example, strong irritants react with the first body tissue they contact, usually the eyes, nose, throat, or skin.

Therefore, they are unlikely to affect other parts of the body, including the fetus.

However, most of these substances can have other serious effects at the site of contact.

A few chemicals which are believed to pose no danger to pregnancy or reproduction are listed below.
ammonia chlorine hydrochloric acid nitric acid sulfuric acid sodium hydroxide potassium hydroxide sodium hypochlorite (bleach) fiberglass asbestos silica 18 Route of Exposure FACTORS THAT DETERMINE HAZARD TO REPRODUCTION In order for a chemical to harm the developing fetus or the reproductive systems of men or women, it must first enter the body and circulate in the bloodstream.
Several factors detennine whether a chemical can harm a worker or a developing fetus: • the route of exposure (how the chemical enters the body) • the dose (the amount of the chemical absorbed into the body and how much reaches the fetus); and • the toxicity of the chemical itself.

In the workplace, the most common routes of exposure to chemicals are by inhalation (breathing a substance into the lungs), skin absorption, and accidental ingestion (swallowing).
,­ Inhalation: Inhalation is the most common way that workplace chemicals can enter the body.

Some chemi­ cals, such as ammonia, are potent irritants.

Since these chemicals react with the first tissue they contact, very little enters the bloodstream; therefore they are unlikely to affect other parts of the body, including the reproductive system or a developing fetus.
Other chemicals, however, are absorbed through the lungs into the bloodstream, can reach the reproductive organs or the developing fetus, and may cause harm.

Skin contact: The skin is a protective barrier that helps keep foreign chemicals out of the body.

However, some chemicals can be absorbed though the skin and enter the bloodstream.

If the skin is cut or cracked or if a skin rash is present, chemicals can penetrate the skin more easily.
Ingestion: Swallowing chemicals is the least common soUICe of exposure in the workplace.

Chemicals can be ingested if they are left on hands, clothing, or beard, or if they accidentally contaminate food, drinks, or cigarettes.

19 Dose 0 w LL LL w Chemicals present in the workplace as dusts (for example, metal dusts such as lead or cadmium) are easily ingested.
In general, the greater the amount of a substance that enters the body, the greater i8 the likelihood or the severity of an effect on the individual and/or a fetus.

This connection between amount and effect is called the dose-response relationship.
When an individual is ex­ posed to a toxic chemical, the dose received depends on several factors: the level (concentration) of chemical in the air, • • how hard (fast and deep) he or she is breathing, which depends on the degree of physical exertion; • • the degree of skin contact (for chemicals which can be absorbed through the skin); the potential for ingestion through hand-to-mouth contamination; • how easily the chemical is absorbed into the DOSE bloodstream; and • how long the exposure lasts (duration).
Toxicity If a worker is pregnant, the dose she receives determines the dose that is received by the developing fetus.

In addition to route of exposure and dose, the toxic properties of the specific chemical determine the effects on the reproductive system or on the fetus.

Just as many chemicals do not cause cancer, many chemicals do not harm reproductive function.
Since some chemicals are much more toxic to the reproductive system than others, it is necessary to keep exposure to some substances lower than others.

Exposure to a specific chemical may be harmful at one level but not at a lower level.

Unfortunate­ ly, there is not enough information on the reproductive toxicity of many chemicals to determine a "safe" level of exposure.

It is wise therefore to keep exposure to any toxic substance as low as is reasonably possible.
20 Hazard Identification Exposure Assessment EVALUATING WORKPLACE HAZARDS TO REPRODUCTION Each worker and worksite is unique; therefore, occu­ pational risks to reproduction must be assessed on a case-by-case basis.

A complete evaluation of hazard to reproduction has three steps: a) Identify the substance(s) used on the job.

Information about a product's chemical composition, physical characteristics, and toxicity can be obtained from the Material Safety Data Sheet (MSDS).
Under Cali­ fornia law, manufacturers must supply an MSDS for any product that contains certain toxic substances.

Employers obtain the MSDS when they purchase the product, and must make theMSDS available to employees on request.

Employers also have a legal obligation to provide a treat­ ing physician with this information if it is requested.

b) Determine whether there is evidence in animals or humans that the substance is a reproductive toxin.
Unfortunately, MSDSs rarely include adequate informa­ tion on reproductive health effects.

In most cases, consul­ tation with an occupational medicine specialist or refer­ ence to reproductive hazard reference texts or databases is necessary (see "For More Information" on page 32).

a) Estimate the level ofworker exposure to any hazards identified in step one (i.e., how much.for how long, and how often are workers exposed?).
Industrial hygiene measurements of air levels of chemi­ cals usually provide the best estimate of worker exposure.

For chemicals which can easily be absorbed through the skin, information on the amount of skin exposure is essen­ tial.

If monitoring has been done, workers have a legal right to see the results relevant to their work area.

Usual­ ly this information will not be available.


The appendix, "Estimating Workplace Exposure," lists the questions that need to be answered in order to roughly estimate levels of exposure when monitoring results are not available.

21 Risk Assessment Employer's Responsibility Personal Physician's Responsibility b) Estimate the likelihood ofa chance high exposure.
Find out if there is a history of unusual situations, such as equipment breakdowns or spills, that may expose workers to other chemicals or to larger amounts of chemicals used routinely.

Estimate the likelihood ofharm based on information gathered in steps one and two (i.e., how close is estimated worker exposure to the lowest dose which causes repro­ ductive harm in animals or humans?).

Sometimes, assessing risk is relatively simple.


For ex­ ample, occasional worker exposure to small amounts of substances such as paint fwnes or roofing tar fumes is un­ likely to affect pregnancy or reproduction.

In many cases of on-going, frequent exposure to chemicals, however, assessing risk to reproduction is a difficult task.

In more complicated situations it may be necessary to consult with an occupational medicine physician, an occupational health clinic, or an industrial hygiene consulting finn.
Employers are responsible for evaluating workplace hazards to reproduction, informing employees about these hazards, and protecting them from these hazards to the ex­ tent feasible.

These responsibilities cannot be passed on to an employee's personal physician.
If an employer does not have the professional staff necessary to evaluate occu­ pational risks to reproduction, the employer should en­ gage the services of an industrial hygiene consulting finn, an occupational health clinic, a consulting occupational medicine physician, or the Cal/OSHA Consultation Ser­ vice (see "For More Information" on page 32).
It is the responsibility of the personal physician to deter­ mine whether a worker has any special medical condi­ tions that make him or her unusually susceptible to any workplace hazards, so that he or she may need to be treated differently from other employees.

For example, women with certain complications of pregnancy, such as high blood pressure or excessive weight gain, may be at higher risk of an adverse pregnancy outcome than women with uncomplicated pregnancies.
These complications may make it inadvisable for a woman to continue work­ 22 ing at a job which is physically demanding or requires the use of a respirator.
While it is not the responsibility of the personal physician to evaluate workplace hazards fer the employer, he or she does have a responsibility to the patienL If an employer has not conducted an adequate evaluation, a personal physician may be able to help a patient by consulting with an occupational medicine physician, or by referring a patient directly for an evaluation.

In some cases, the physician may feel comfortable handling the question on his/her own.

23 HOW CAN EXPOSURES BE REDUCED?


If the evaluation process identifies a hazard to reproduc­ tion, action should be taken to reduce the hazard.

The most desirable action is to control exposures to accept­ able levels for all workers.

The surest way to prevent toxic chemicals from caus­ ing harm to workers or a developing fetus is to mini­ mize or prevent exposure.

Below are some methods of controlling exposure.

Engineering Controls Limiting exposure at the source is the preferred way to protect workers.
The types of engineering controls are listed below in order of effectiveness: Substitution is the use of a less hazardous substance.

But before a substitute is chosen, its health and safety hazards must be carefully considered.

For example, mineral spirits (Stoddard Solvent) and Freon® dry clean­ ing fluids are less toxic than perchloroethylene; however, mineral spirits pose a greater fire hazard and Freons® are a major cause of environmental air pollution.
Process or equipment enclosure is the isolation of the source of exposure, often through automation.

This can completely eliminate routine exposure of workers.

For example, handling of radioactive materials is often done by mechanical arms or robots.

Local exhaust ventilation is a hood or intake, at or over the source of exposure, which draws contaminated air from its source so that it cannot spread into the room and into a worker's breathing zone.
General or dilution ventilation is continual replacement and circulation of fresh air sufficient to keep concentra­ tions of toxic substances diluted below hazardous levels.

However, concentrations will be highest near the source, 24 and overexposure air is not well mixed with the room air, pockets of high concentrations may occur in this area.

If the dilution may exist.

Personal Protective Equipment The following neering controls are not possible reduce exposure.
devices should be used only when engi­ or are not sufficient to substances in consists of devices A respirator is effective only equipment Respiratory protective that cover the mouth and nose to prevent the air from being inhaled.

program estab­ when used as part of a comprehensive lished by the employer, measurement of concentrations the proper respirator, fitting of the respirator of parts when necessary.
placement training the worker which includes of all hazardous substances, selection of in its proper use, and re­ to the worker, maintenance, it has been determined not be assigned to tasks requiring use of should A worker a respirator unless that he or she is physically while using the required respiratory equipment is a change in health status, physician it is recommended that a use.
be consulted about continued able to perform the work by a physicia respirator If there n by a pregnant use a respirator worker must also be women harm.

However, such as high blood for a woman to con­ basis.

Most pregnant without complications The use of a respirator evaluated on a case-by-case can probably of pregnancy, certain pressure, may make it inadvisable tinue working at a job which requires ator.
As with all respirator should physician, demands of the job, the type of respirator, plications taking into account of pregnancy.

woman use, use by a pregnant medicine occupational by a qualified be evaluated and any com­ the use of a respir­ the exposure, the physical 25 should be exercised Caution tasks requiring the use of a respirator sure, such as could result result in significant harm.
from respirator if a single failure, overexpo­ could in assigning any worker to includes gloves, aprons, goggles, Protective clothing boots, face shields, and any other items worn as protec­ tion.

It should be made of material designed to resist penetration by the particular chemical being used.

Such material is "impervious" turer of the protective information blocked.

All protective meated with chemicals clothing regarding the substances materials and should be replaced to that chemical.
eventually become per­ usually can provide some The manufac­ that are effectively frequently.

Safe Work Practices can also reduce exposure to hazard­ instruct workers in Employers must and must provide safe work practices specific in­ Safe work practices ous substances.

general structions ment (General Some general hazardous +Store chemicals are: substances about hazards unique Safety Orders, Industry recommendations in sealed containers when they are Section.3203).
for workers handling to a worker's job assign­ not in use; + A void skin contact + Do not eat, drink, smoke, with chemicals; in work or apply make-up areas; spill +If chemicals away and wash yourself with soap and on you, change right out of contaminated clothing water.

26 Hazard Communication Standard Permissible Exposure Limits Personal Protective Equipment WORKPLACE REGULATIONS California's Division of Occupational Safety and Health (Cal/OSHA) regulates workplace chemical exposure.
Several of the more important regula­ tions are summarized below.

The Hazard Communication Standard (General Industry Safety Order [GISO] 5194) requires employers to provide workers with information about the hazardous substances to which they may be exposed and to train them to use these substances safely.

Infonnation on health hazards includes information about hazards to reproductive func­ tion.
Employers are also required to have an MSDS (see page 21) for any workplace product that contains a hazardous substance, and must make the MSDS available to workers or to a treating physician on request.

Cal/OSHA establishes Pennissible·Exposure Limits (PELs) which are intended to protect the health of workers exposed every day over a lifetime of working with a substance (mostly in GISO 5155).
These limits are intended to represent the maximum amount (concentra­ tion) of a chemical which can be present in the air with­ out presenting a health hazard.

However, exposure limits are not always completely protective.

The PELs for most chemicals do not take adverse reproductive effects into account A few exceptions are ethylene glycol methyl ether, ethylene glycol ethyl ether, ethylene oxide, and DBCP.
Employers are required to provide protective clothing and other equipment when necessary (GISO 3380-3400 and 5144).

The selection of appropriate protective equipment is a complex task.

An industrial hygienist or other know­ ledgeable person should be consulted to ensure that the equipment is appropriate and is used correctly.

For more infonnation about Cal/OSHA and Cal/OSHA Consultation Services, see page 32.
27 Pregnancy Discrimination Act Fair Employment and Housing Act PREGNANT WORKERS' LEGAL RIGHTS There are few well-defined regulatory or legal guidelines to protect workers against reproductive hazards in the workplace.

However, there are state and federal laws to protect pregnant workers from discrimination.

These laws also provide for limited dis­ ability and unemployment benefits and up to four months of unpaid pregnancy disability leave.
They do not solve all the problems pregnant workers may face, but they can help.

The following is a summary of two of the most important laws.

This law is an amendment to the federal Civil Rights Act It applies to all workplaces with 15 or more employees.

The law establishes that discrimination against women on the basis of pregnancy is sex discrimination, and is il­ legal.

It states that an employer cannot refuse to hire or promote a woman because she is or may become preg­ nant.
It also states that disability due to pregnancy must be treated the same as any other medical disability.

An employer may not single out pregnancy-related condi­ tions for special procedures for determining an employee's ability to work.

This California law provides the basis for regulations in the California Code of Regulations (CCR), Title 2, sections 7291. l and 7291.2.
These regulations protect pregnant and fertile women from employment discrimina­ tion and generally require that an employee temporarily disabled due to pregnancy, childbirth, or related medical conditions must be treated in the same way as any other temporarily disabled employee.

The law covers all busi­ nesses with five or more employees.

Discrimination: Under the law, discrimination in employ­ ment because of pregnancy, childbirth, or related medical conditions is sex discrimination and is illegal.
Employers cannot require that an employee be sterilized as a condi­ tion of employment.

28 Disability Leave: In general, the law requires large employers (those with more than 14 employees) to treat disability due to pregnancy the same as any other medical disability.

Any benefits or privileges available to other temporarily disabled employees, including transfer to a less hazardous or strenuous position, must be available to employees disabled due to pregnancy.
An employer may not single out pregnancy-related conditions for special procedures for determining an employee's ability to work.

The law also requires employers to provide unpaid leave for pregnant workers during the period of pregnan­ cy disability (for not more than four months), with the right of reinstatement to the same (or, under certain circumstances, to a substantially similar) job.
Women have this right to a pregnancy disability leave even if the employer does not provide such a leave for other tempor­ ary disabilities.
Transfer Rights: If working conditions pose a greater danger to the health, safety, or reproductive functions of employees of one sex than to individuals of the other sex, employers must in most cases make reasonable accom­ modation either to alter working conditions to eliminate the danger or, upon the request of the employee of the en­ dangered sex, to transfer the employee to a less hazardous position for the duration of the greater danger.
If an employee disabled by pregnancy, childbirth, or a related medical condition transfers to a less hazardous position, an employer must allow her to return to her original job or to a substantially similar job when she is no longer dis­ abled.

Some employers have set up their own policies for preg­ nant workers, and some offer benefits in addition to those required by law.

Workers should ask their employers about the policies in their workplace.
Employer policies regarding hazard to pregnancy or reproduction must not violate existing laws prohibiting sex discrimination, and in most cases any benefits available to other temporarily disabled employees must be available to employees dis­ abled due to pregnancy.
29 Employer Policies Ifa worker feels that her employer has discriminated against her because ofpregnancy, childbirth, or related medical conditions, she may file a complaint with: Department of Fair Employment and Housing (DFEH) - See "State Government Offices" in the government section of the white pages of the phone book.
Ifa woman wishes to file for unemployment and/or disability benefits, she should contact: Employment Development Department (EDD) - See "State Government Offices" in the government section of the white pages of the phone book.

For information on unpaid pregnancy disability leave, contact: Department of Fair Employment and Housing (see above).

30 CONCLUSION It is important to remember that exposure to chemicals is only one of many factors which can harm reproduc­ tive function.
In addition, much is still unknown about the extent to which workplace hazards contribute to repro­ ductive problems.

However, workplace exposure to chemicals is a preventable cause of reproductive harm.

Therefore, the goal for employers and workers should be to reduce exposures as much as is reasonably possible.

This is the surest way to prevent toxic chemicals from harming workers or the fetus.
31 FOR MORE INFORMATION contact or help with workplace or who want to file a com­ want information and safety regulations, should Employees who health plaint, Division See "State Occupational section the nearest Safety of Occupational Offices, nd Health" Government Safety a of the white pages of the phone book.

office of California's and Health Industrial in the government Relations, (Cal/OSHA).
Cal/OSHA Consultation who want free help to evaluate and improve the nearest health should contact and safety Employers workplace office of the Cal/OSHA non-enforcement program public- Government Safety section and private-sector Offices, Industrial Relations, and Health Consultation" of the white pages of the phone book.

in the government Occupational Consultation Service.

This is a available to both with services employers.
See "State Hazard Evaluation System and Information Service (HESIS) / Services of Health of Industrial Department Department 850 Marina Bay Pkwy, Bldg P, 3rd Fl Richmond, CA 94804 www.cdph.ca.gov/hesis Relations HESIS provides health substances professionals in the workplace information about the health to workers, effects and of toxic and how to use them safely.
employers, California Information Teratogen Service and Clinical Program Research Center of Pediatrics/8446 UCSD Medical Department 200 W. Arbor Drive San Diego CA 92103-8446 (619)543-2131 http:/ /orpheus-1.ucsd.edu/otis or (800)532-3749 program Information is a statewide Service that offers information and other interested The Teratogen counseling women, physicians the effects that drugs, chemicals, agents clinical drug exposures to pregnant individuals and physical may have on the fetus.
The TIS emphasizes follow-up and performs clinical viruses, about 32 studies provide counseling of drug-exposed on topics such as labor law.

pregnant women.

They do not Personal Physician see your or think you are pregnant, care is one of the most prenatal a healthy child.

to toxic substances or is hazardous If you think your repro­ to your fetus, talk to your has affected in having Consistent If you are pregnant doctor.

important factors that exposure ductive health doctor.
you work with, and describe these substances may have on you or your fetus.

your concern about the effect Tell him or her what you do and what substances Other Resources for Workers who need information to toxic substances a company health Workers exposure want to contact company industrial rep re sen ta ti ve.

or are concerned that might affect their health may and safety officer, hygienist, company doctor, or union Other HESIS Publications HESIS has produced workplace chemicals.
nant, Can the Chemicals is a more basic version publications other languages.

other booklets and factsheets on The HESIS fact sheet "If I'm Preg­ I Work With Harm My Baby?"

of this booklet.

AIi HESIS are free.

Some are available in Spanish For a publications or list and order form, call toll free (866) 627-1586, visit or write to: or http://www.cdph.ca.gov/ohb, HESIS 850 Marina Bay Pkwy , Bldg P, 3rd Fl CA 94804 Richmond, 33 Written References Reproductive Hazards ofthe Workplace, L.M.

Frazier and M.L.
Frazier and M.L.

Hage, John Wiley & Sons, New York, 1998.

A thorough review of current knowledge about reproductive hazards, containing summary toxicity information about an extensive list of chemicals, as well as sections on physical agents, infectious agents, ergonomics, etc., with introductory chapters addressing nonnal reproductive biology, risk assessment, risk communications, risk reduction, and laws and regulations.
Occupational and Environmental Reproductive Hazards: A Guide for Clinicians, Maureen Paul, ed., Williams & Wilkins, Baltimore, I 993 .

Very similar to the above, with slightly more orientation toward the health professional audience and less comprehensive attention to specific agents; has chapters on how epidemiology and animal testing work.

Reproductive Health Hazards in the Workplace, U.S. Congress, Office of Technology Assessment, Govern­ ment Printing Office, Washington, DC, OTA-BA-266, 1985.
A report prepared for Congress on the current know­ ledge of workplace reproductive hazards.

This is a broad review that includes sections on reproductive risk assessment, regulation, and ethical issues, in addition to a summary of the principles of reproductive biology and reviews of selected chemicals.

34 GLOSSARY birth defect A physical abnormality present at birth.

A birth defect may not be detected at the time of birth.

carcinogen A chemical or physical agent capable of causing cancer.
Such an agent is "carcinogenic."

The ability to cause cancer is "carcinogenicity."

dose The amount of a chemical that enters or is absorbed by the body.

Dose is usually expressed in milligrams of chemical per kilogram of body weight (mg/kg).

embryo The developing organism from conception until about 8-9 weeks.

epidemiology The study of the pattern of disease in a population of people.

fertilization The union of egg and sperm to form an embryo.
fetotoxin A chemical agent which delays the growth or harms the health of the fetus without causing physical defects.

Such an agent is often described as fetotoxic.

fetus The developing organism from about 8-9 weeks until birth.

gene The part of the genetic material of a cell that carries a particular inherited characteristic.

infertility The inability of a couple desiring a child to become pregnant.

ingestion Taking in a substance through the mouth and swallowing it.
inhalation Breathing in a substance.

irritant A substance which can cause an inflammatory response or a reaction of the eye, skin, or respiratory system.

menstruation Shedding the lining of the uterus.

35 MSDS Material Safety Data Sheet.

A fonn which lists the hazardous ingredients, physical and chemical proper­ ties, and health and safety hazards of a product or a sub­ stance.

mutagen A chemical or physical agent which can change the genetic material in cells.
neurobehavioral defect Abnonnal mental development or behavior in a child that results from damage to, or abnormal development of, the central nervous system (brain) which occurred during pregnancy.

ovulation Release of an egg from the ovary.

PEL Permissible Exposure Limit, a maximum allowable exposure level under OSHA regulations.

reproductive health hazards Agents which can adverse­ ly affect sexual function or the ability of men and/or women to produce healthy children.
respirator A device worn to prevent inhalation of hazardous substances.

route of exposure The way in which a chemical enters the body.

The common routes of exposure in the work­ place are inhalation, ingestion, and absorption through the skin.

spermatogenesis The ten-week cycle of sperm produc­ tion.

Spenn are produced in a man's testicles.

spontaneous abortion A naturally occurring death of the embryo or fetus before full tenn. A miscarriage.
teratogen A chemical or physical agent which can lead to malformations (physical defects) in the fetus or in chil­ dren or animal offspring.

Such an agent is " teratogenic."

The ability to cause birth defects is "teratogenicity."

transplacental carcinogen A carcinogen which crosses the placenta and causes cancer in the child or young adult.

36 APPENDIX: Estimating Workplace Exposure This questionnaire is for men and women who use chemi­ cals frequently at work.
Instructions for Workers: Read the questions below and collect the information you need to answer them.

Share the information you collect with your doctor or other health professional, such as a nurse or genetics counselor.

He or she can help you determine if the chemicals you work with can harm you or your fetus.

If your health care provider needs help in determining if there is a problem, suggest that he or she consult with a board-certified occupational medicine physician.
See page 32 for others who can help.

I.

Are you currently employed?

2.

What job do you do?

Describe it.

3.

What does your company manufacture, or what kind of services does it provide?

4.

What are the names of the chemicals in the products you work with?

Brand names aren't very helpful.

Sometimes a product label has ingredient information, but often the informa­ tion on labels is incomplete and unreliable.
The best way to find out what chemicals are in the product(s) being used is to get a copy of the Material Safety Data Sheet (MSDS) for that product from the employer.

An MSDS lists the hazardous ingredients in a product.

A sample MSDS and a letter requesting an MSDS are on pages 42 and 43.

Employers are required by law (General Indus­ try Safery Orders [GISOJ 5194) to provide workers with a copy ofthe MSDS, upon request.

Employers must also provide this information to a treating doctor on request.
37 5.

How do you use these chemicals?

Which ones do you use most frequently?

How often?

For how long each time?

How much of each product do you use each time?

Do other people in your area use these chemicals too?

Do people in your area use any other chemicals?

How many people?

What other chemicals?

6.

Are any of these chemicals heated?

If yes, which ones?

To what temperature?

7.

Can you smell or taste any chemical fumes or vapors where you work?

If yes, which ones?

8.


Do you feel sick when you work with any of the chemicals, and feel better at other times?

Describe how you feel.

Did you have these symptoms before becoming pregnant?

9.

Do any of the chemicals you work with get on your skin?

If yes, which ones?

10.

Do you eat, drink, smoke, or apply make-up in the work area?

11.

What kind of ventilation is in your work area?

A hood with power exhaust near the chemical source?

General ventilation (wall fans, roof fans, ceiling vents)?
Natural ventilation (open windows and doors)?

Do you think the ventilation is effective in reducing your exposure?

Is it always turned on when you are using chemicals?

Does it usually work well?

38 12.

Are there any unusual situations at work, such as equipment breakdowns or spills, that may expose you to any other chemicals or to larger amounts of those you use routinely?

Describe them.

13.

Do you wear any special clothing, such as gloves or an apron?

If so, what?

What is each item made out of?


Do chemicals leak through the clothing?

14.

Do you wear a respirator?

What kind?

Paper mask?

Hard plastic with cartridges?

What kind of cartridges does it have?

When do you wear a respirator?

What are the specific chemicals for which you wear a respirator?

Have you been fit-tested and trained to use your respirator?

15.

Does your employer give you any instructions and warnings about the use of chemicals?

If so, what are they?

16.


Have the air levels of chemicals in your work area been measured?

If monitoring has been done, you have a legal right to see the results relevant to your work area (GISO 3204).

Do you know the results?

What were they?

17.

Do you do any other work outside your regular job, or have any hobbies, which involve exposure to chemi­ cals?

Describe them.
Describe them.

39 Sample Letter Requesting Material Safety Data Sheets Date Manufacturer Address Attention: MSDS Request Dear Sir/Madam: The CaVOSHA Hazard Communication Standard (Sec­ tion 5194 of the General Industry Safety Orders of Title 8 of the California Administrative Code) requires employ­ ers to have in their possession up-to-date Material Safety Data Sheets (MSDSs) for all hazardous substances used in their workplaces.
In general, an MSDS should list the hazardous ingredients of a product, describe its health and safety hazards, and suggest ways to use the product safe­ ly.

It should also contain information about any fire and explosion hazards, first aid, and procedures for cleaning up leaks and spills.

State law requires manufacturers of hazardous substances to prepare and provide MSDSs to their purchasers, either directly or through their suppliers (California Labor Code, Division 5, Chapter 2.5, Section 6390).
Accordingly, we request that you either provide us with current MSDSs for each product which we purchase from your company (see attached list), or provide us with a statement explaining why the product is exempt from these regulations.

Also, please certify that your MSDS meets the requirements ofGlSO Section 5194.

An early reply will be very much appreciated.


Sincerely, Purchaser's Name Title Address (Note: Copies of the Director's List of Hazardous Sub­ stances, the above-mentioned regulations, and general in­ formatiori may be available from CaVOSHA Consultation Service.)

40 HESIS Publications are available HESIS publications quantities, Publications English prefer the other language.

and may be reproduced that are availabl are noted.


e in a language other than Where available, please note if you free of charge for free distribution.

in limited for workers, Fact Sheets are written ers without are 4-6 page summaries use common chemicals.

formal scientific or medical employers, and oth­ They training.
and safe ways to of health effects /88) (Spanish) (l/89) (l/89) (6/89) Bromide (8 Chloride Epoxy Resin Systems Oxide (2/89) Ethylene (Freons) Fluorocarbons Formaldehyde (8/88) (Spanish) (3/89) Glutaraldehyde Ethers Glycol Isocyanates (11/89) Mercury ( 11 /89) Methyl Methylene (l/96) Methyl Methacrylate (4/89) PCBs (2/88) Perchloroethylene (6/89) Styrene Toluene (5/89) Trichloroethane Trichloroethylene (l l/97) Wood Preservatives Xylene "If I'm Pregnant, (10/89) (5/88) (3/89) (Korean) (Arsenic and chromate) (9/87) Can the Chemicals Harm My Baby?"
('90) (Spanish) I Work With Evaluating Workplace Roles of the Employer Hazards to Pregnancy: and the Personal ('90) Physician Bloodbome Standard Pathogens Hepatitis to Hepatitis B Vaccination and the Cal/OSHA (7 /92 ) Exposure Workplace (9/96) Tuberculosis Guidelines for Selecting Against Exposure Respirators for Tuberculosis to Rabies Protection Occupational Pulmonary Function Testing (Spanish) C (1 2/98) ('97) 41 are summaries similar to HESIS Fact They are issued hazard is first identified.
Later, when a new or previously they are replaced unrec­ Hazard Alerts Sheets.

ognized by Fact Sheets.

(graphical and technical versions) (6/92) Chromium-6 Cycloheximide Ribavirin (12/90) (7 /87) BOOKLETS are much more comprehensive Sheets.

with some training than Fact for use by people intended and safety.
They are generally in health Understanding Toxic Substances: An Introduction to Chemical Hazards in the Workplace HESIS Guide to Solvent HESIS Guide to Metalworking Fluids Safety ('97; Spanish '85) by an illustrated informational flier) (accompanied Up Your Jewelry Up Your Jewelry Polish Polish Photography Shop: Guide for Employers Shop: Guide for Employees A Guide to Chemical and Your Health: Hazards in the Darkroom Fingernail Artificial Exposures in the Nail Salon Products: A Guide to Chemical TECHNICAL DOCUMENTS and selected tion for Hazard Alerts technical.
are lengthy and highly are scientific other chemicals.

documenta­ They Reproductive Glycol on Derivative and Hematopoietic Ethers: Compounds ('88) of the Toxicity An Update, With Emphasis MEDICAL GUIDELINES are brief advisory for diagnosing specific for health protocols poisonings when They are written care professionals.

therapy is available.

industrial and managing antidotal Arsenic Carbon Monoxide Cyanide Hydrogen Sulfide Lead Mercury Organophosphates and Carbamates 42