# Cholinesterase Monitoring
of Pesticide Handlers in Agriculture : 200 9 Report

Division of Occupational Safety and Health (DOSH)

N OVEMBER 

# 20

, 2009

If you have questions about this re port please contact John Furman PhD, MSN, CIC,

COHN

- S, at 360

- 902

- 5666 or furk235@lni.wa.gov1



### Executive Summary

The Division of Occupational Safety and Health (DOSH) administers t he agriculture cholinesterase monitoring program under WAC 296

- 307

- 148 1 , Cholinesterase Monitoring (the rule)

. During the 200 9 cholinesterase monitorin g season (January 12

– September 17 )

, ~217 growing operations and 2060 pesticide handlers partici pated i n baseline cholinesterase testing.

T wo h undred and forty nine of these pesticide handlers were tested again (periodic testing) at least once during the application sea son

. T he great majority of handlers submitting periodic tests met the testing requireme nt threshold of handling toxicit y class I or II organophosphate or N

methyl

- carbamate pesticides for > 30 hour s in any consecutive 30 day period. However, in some cases employers schedul ed testing regardless of number of handling hours.

Of the se 249 handle rs
, 22 ( 8.8 % ) received at least one test with a serum cholinesterase activity depression of > 20% (action level) requiring the employer to evaluate pesticide handling practices, there were no red blood cell cholinesterase action level depressions. Seven ( 2.8%) of

the 22 handlers were temporarily removed from exposure to c overed pesticides because of a

serum cholinesterase depression of > 4 0%

. All action level cholinesterase depressions occurred

in Labor & Industries (L&I) Region 5 2

. Twelve growing operati ons accounted for the 22 action level cholinesterase depressions.

T he number of pesticide handlers undergoing blood cholinesterase test ing in 2009 rose slightly from 2008 (2013), while the number of participating growing operations remained unchanged

. Howe ver the number of handlers undergoing periodic testing decreased from 314. This is

believed to be affected by actions such as ; a) changes in pest control strategies

, b ) reductions in

Guthion use

, and c) employer actions resulting in limit ing handler expo s ure (e.g., employee

rotation ).

A ll handlers with cholinesterase depression to the action level were employed in the tree fruit industry (DOS H is not aware of any fi e l d crop operations participating in the cholinesterase monitoring program) and all operations applied pesticides through the air blast method. DOSH consultation and compliance fi e l d evaluation s identified common potential over

- exposure scenarios involving respiratory protection, personal protective equipment and decontamination

. Toxicity class I and II cholinesterase inhibiting pesticides handled within the 30 days prior to periodic testing inc luded Lorsban, Guthion

, Imidan, Phosmet, Carbaryl, and Carzol (Sevin 4F and Diazinon 50W Class III pesticides were also used)

. Pathology Associates Medical Laboratories (PAML) continues to conduct all laboratory analysis. Quality control indicators were well within limits and customer satisfaction remains high. PAML will continue to serve as the sole laboratory approved by DOSH in 2010.

In conclusion, the 2009 cholinesterase monitoring program fun ction ed well. The information gleaned from field evaluatio ns is used by DOSH and WSDA in developing pesticide handler

t raining curriculum. The program continues to provide value by maintaining awareness of

hazardous chemicals and worker protections, and bolsters DOSH’s ability to work directly with agriculture em ployers to solidify pesticide worker protection program s

.

1 http://www.lni.wa.gov/WISHA/Rules/agriculture/HTML/part

- j

- 1.htm

2 http://www.lni.wa.gov/Safety/Basics/Assistance/Consultation/consultants.asp2



### B ackground

Acetylcholinesterase (AChE) is an enzyme that removes t he chemical neurotransmitter acetylcholine from the junctions between nerves cells. AChE effectively serves as the nerve

cell “off switch” and is essential to normal nervous system function. Certain pesticides, known as cholinesterase inhibitors, bind wit h AChE resulting in over

- excitement of nervous system pathways.

Exposure to organophosphate or N

- methyl

- carbamate pesticides may lower the level of available

cholinesterase in the nervous system

. Depressed cholinesterase activity may lead to symptoms

ran ging from malaise, blurred vision, and diarrhea to, in extreme cases, coma and death

. Laboratory m onitoring of cholinesterase levels in the blood (both serum and red blood cell [RBC] cholinesterase) detect s reductions in cholinesterase activity prior t o the onset of related

symptoms , as well as provides information regarding pesticide exposure and the effectiveness of

exposure control measures. While cholinesterase levels may be affected by such factors as liver and blood disease, and certain medications in the absence of such factors cholinesterase depression is most likely caused by over

- exposure to the cholinesterase inhibiting pesticides handled by the these workers. Previous reports provide detailed background and describe cholinesterase monitoring experiences during the yea rs 2004

– 08 3

.

WAC 296

- 307

- 148, Cholinesterase Monitoring (the rule)

, was adopted in December 2003 and remains unchanged since amendments were made in 20 05

. The rule requires agriculture employers to : a ) record hours employees handle 4 toxicity class I a nd II organophosphate and N

methyl

- carbamate pesticides (covered pesticides) ; b ) provide cholinesterase blood testing to employees who handle covered pesticides for 30 or more hours in any consecutive 30 day period ; and c ) follow health care provider recom mendations for pesticide handlers regarding pesticide handling practices and medical evaluation. A copy of the licensed health care provider’s (LHCP) written recommendation is provided to the handler by the employer. Health care provider recommendations include cholinesterase percent change from baseline, direction regarding actions to be taken based on cholinesterase activity, and any additional direction regarding further medical evaluation.

DOSH offers consultation services to agriculture employers wi th pesticide handlers who experience a cholinesterase depression >20% from individual baseline (action level cholinesterase depression). In addition to assisting with an evaluation of the employer’s pesticide worker protection program and the pesticide ha ndler’s work practices, information on pesticide handling practices and equipment is gathered. DOSH compliance inspections are opened in certain circumstances such as clusters of action level cholinesterase depressions, and employer refusal to accept cons ultation services 5

.

Reimbursement to employers for testing services and related administrative program costs

3 Previous reports can be found at http://www.lni.wa.gov/Safety/Topics/AtoZ/Chol inesterase/default.asp

4 Pesticide handling is defined in WAC 296

- 307

- 11005

5 DOSH Directive 33.27 Cholinesterase Depression http://www.lni.wa.gov/Safety/Rules/Policies/PDFs/WRD 3327.pdf3

continued in 2009

. S ixty

- one employers requested and were granted reimbursements total ing $12 9 ,000.00

.

Th e following table outlines participation and monitoring outcom es from the inception of the cholinesterase monitoring program.

Washington State Agriculture Cholinesterase (ChE) Monitoring 2004

- 09

2004 2005 2006 2007 2008 2009

# Employers 380 316 244 226 218 217

# Handlers submitting

baseline tests 2630 2263 1889 1857 2013 2060

# Handlers declining testing* Data not

collected 232 184 167 192 229

# Working baselines Data not

collected 165 48 120 71 29

# Handlers with > 1 periodic test 580 611 471 386 314 249

# Periodic tests 911 970 692 532 495 286

# Handlers wi th ChE depression to work

evaluation level 97(16.7%) 49(8.0%) 50(10.6%) 49(12.6%) 21(6.7%) 15(6.1%)

# Handlers with ChE depression to exposure removal

level 22(3.8%) 10(1.6%) 7(1.5% 18(4.6% 1(0.1%) 7(2.8%)

Total # handlers with AL ChE depression 119(20. 5%) 59(9.6%) 57(12.1%) 67(17.3%) 22(7.0%) 22(8.8%)

# H an d l ers reporting pesticide illness
symptoms 0 0 0 0 0 0

Avg. days from

referral to DOSH field

visit ** 34 13 20 12 7 5

* Declinations are reported through polling of medical clinics are mid

- season ** Includ es 9 consultation and 4 compliance visits



### Medical Services

Fifteen medical clinics provided blood collection and medical evaluation services. Twelve clinics

are located in Region 5, two in Region1, and one in Region 4 6

. In preparation for the 2009 monitoring season the DOSH Occupational Nurse Consultant (ONC) contacted all participating

6 http://www.lni.wa.gov/Main/FindAJob/regions.asp?WT.svl=34

clinics. The ONC reviewed the rule and cholinesterase medical monitoring guide lines 7 with each

clinic , o nsite t rain in g to 6 high volume clinics. All clinics reported satisfacti on with the laboratory services a nd support provided by DOSH

.

Pa thology Associates Medical Laboratories (P AML) is the sole laboratory approved to provide testing services. There were no changes in S tandard Operating Procedures 8 from 2008 to 2009. Blood samples are packed in ice and pick ed up at the clinic using same

- day courier services. Samples are analyzed within 24 hour s of collection and reported that same day.

The DOSH Industrial Hygiene L aboratory worked directly with PAML to track quality control

indicators. These activities enta iled weekly reviews of the internal quality control samples, charting of all internal quality control samples and monthly site visits to discuss QC review and status update. DOSH staff also participated in a limited QC program where DOSH staff was

drawn on a monthly basis and the results were compared to other Quality Control date. All quality control indicators demonstrated good precision throughout the season. Dr. Barry Wilson’s Laboratory at the University of California at Davis continued to provide cons ultation

services.



### Monitoring Summary

As in previous years, the vast majority of employers participating in the medical monitoring program had operations located in Central Washington (West Adams, Benton, Chelan, Columbia, Douglas, Franklin, Grant, Kitti tas, Okanogan, Walla Walla, and Yakima counties). North and Southwest counties accounted for the remainder of the samples submitted.

During the 2009 cholinesterase testing season (January 21

– October 11), ~217 growing operations p articipated in testing and 2,060 handlers submitted cholinesterase baseline tests. Baseline submissions increased slightly from 2008. This appears to be related to clinics encouraging baseline testing as a risk management strategy and employers incorporating baseline testing int o hiring practices.

Of the 249 handlers who received at least one periodic test, 22 ( 8.8 %) received at least one periodic test result with a >20 percent cholinesterase depression from baseline (action level cholinesterase depression) requiring the employe r to evaluate pesticide handling practices for possible deficiencies. Of those same 22 handlers, 7 (2.8%) were temporarily removed 9 from handling covered pesticides

. The 22 pesticide handlers (all serum action level cholinesterase depressions) worked fo r 12 different employers, two employers accounted for 12 of the action level cholinesterase depressions. One of the handlers also experienced an action level cholinesterase depression in 2008. No handlers were identified with pesticide illness related

sym ptoms. (see P esticide Incident R eview T racking P anel reports for data on pesticide illness in Washing t o n State http://www.doh.wa.gov/ehp/PIRT/default.htm )

7 http:// www.lni.wa.gov/Safety/Topics/AtoZ/Cholinesterase/files/ProvidersGuidelines1.pdf

8 Available upon request

9 Employees may return to handling covered pesticides when cholinesterase levels return to within 20% of baseline. While medically removed from exp osure to covered pesticides employee pay, seniority and other benefits are maintained at the pesticide handler level for a maximum of 3 months.5

T he rule allows employees to either choose to participate or decline participation in the employer’s cholinesterase testing program. The option is consistent with other WISHA rules that contain medical surveillance provisions. As an additional pr otection against potential coercion regarding the handler’s decision to participate in the program the rule includes the requirement that this decision is made in conversation with the health care provider . All clinics were asked to report handler declina tions; 229 handler declinations were reported from 42 growing operations. DOSH opened compliance inspections with 12 growing operations which

had > 3 handlers decline testing. Thirty seven handlers were interviewed with no instances of employer coercio n found. Reaso ns given for declining included; a) pain and fear of needles, b) limited to no handling of covered pesticides (e.g. organic operations), c) not receiving test results in previous years, d) never experiencing illness, and e) in one case handl ers were sent in for periodic testing on a Friday. Since samples are not collected on Friday they were asked to come back on Monday, however the des k clerk also mistakenly had the handlers sign declination forms. Unfortunately this set of periodic tests wa s never done.

DOSH contacted the 3 employers who had > 3 pesticide handlers with working baselines. All 3 were organic operations with either no use or limited use of cholinesterase inhibiting pesticides. The employers were educated as to the correct ap plication of the rule.

Handler receipt of LHCP written recommendations has been an ongoing stakeholder concern. Of the 22 handlers with action level cholinesterase depressions DOSH did find that in one instance the employer did not provide a copy of the LHCP written recommendation to the

handler. There where two additional instance s where handlers had not been provided a copy of the LHCP written recommendation however the employers had not yet received the written

recommendations fro m the health care pro vider s

. In addition, DOSH conducted 40 inspections in which compliance with the cholinesterase monitoring rule was evaluated. Four growing operations were cited for not providing copies of LHCP written recommendations (these operations did not have handlers with ac tion level cholinesterase depression )

.



### L&I Consul tation and Compliance Findings

All 12 growing operations with handlers who had experienced action level cholinesterase depression received site visits by DOSH consultation or compliance services

. The average number of days between a referral for consultation or compliance acti on was 5, with a low of 3 and high of 15.

In some cases the employer removed the handler from handling cholinesterase in habiting pesticides, e ven though medical removal was not required, while waiting for DOS H t o ai d in the

han d l ing practice evaluation

Note: Upon interview 10 of the 22 handlers with action level cholinesterase depression reported that they had attended the WSDA hands

- on pesticide training. Only 1 of these handlers could be matched by name and employer in the training attendance data base (2006

- 2009) . Two additional handlers were identified by name but not matched by employer. As part of next year’s interviews handlers will be asked if they can provide their training certification card.6

Consul tation V isit S ummaries

Growing O peration 1 : This consultation is in relation to a mixer, applicator that experienced a 25.74 % serum cholinesterase depression. The handling hours reported in the 30 days prior to

testin g was 30.5. Covered pesticides handled in the 30 days pr ior to testing were Lorsban 4E and Carbaryl (Seven 4F a class I I I cholinesterase inhibitor was also applied).

Rule V iolations:

WAC 296

- 307

- 61205: The handler when interviewed had a beard and indicated that he had been spraying while w earing his beard and a North half face respirator.

WAC 296

- 307

- 13045(6)(g)(iii): T here was no written change schedule for the filters used on the North half face respirator

.

WAC 296

- 307

- 14835: T here was no completed written record of the findings of the work practice evaluation done after the company was notified of the action level c holinesterase depression.

WAC 296

- 307

- 60405: The handler’s duties include wearing a fitted respirator to apply organophosp hate containing pesticides. The handler has no t undergone a respirator use medical

evaluation.

WAC 296

- 307

- 13050(4): E mergency flushing water to carry or to be on the tractor while applying pesticides is not provided

.

WAC 296

- 307

- 13025(3)(a): W ritten material or audiovisual training aids were not us ed to provide required WPS training

.

Potential Over

- E xpo sure S cenarios:

The han d l er reported that he had mixed covered pesticides while wearing ripped gloves.

Growing O peration 2 : This consultation is in relation to an applicator that experienced a 28. 82% serum cholinesterase depression. The handling hours reported in the 30 days prior to testing was

30. 0 . Covered pesticides handled in the 30 days prior to testing were Lorsban 4E.

Rule V iolations:

WAC 296

- 307

- 13025(3)(d)(viii): Pesticide handler f ound to be removing chemical resistant hood in order to look back at spray boom while conducting application and making turns. The

h andler also mentioned taking gloves off while unclogging plugged nozzles on the spray equipment.

Potential Over

- Exposure S c enarios:

Removing hood while applying and r emoving gloves to unplug spray nozzles7

Growing O peration 3 : This c onsultation is in relation to a mixer, loader, applicator that experienced a 30.11 % serum cholinesterase depression. The handling hours reported in the 30 days prior to testing was 38.0 . Covered pesticides handled in the 30 days prior to testing were

Lorsban 4E ( Sevin 4F a class III product was also handled )

.

Rule V iolations:

WAC 296

- 307

- 13045(6)(i)(ii ): The area in front of the employees' loc kers is used by pesticide handler/applicators to change into personal protective equipment. This is a concrete floor covered with dirt and gravel. The area is not clean and has no place for workers to sit if needed to put on or take off boots.

WAC 296

- 307

- 14835: T here was no completed written record of the findings of the work practice evaluation done after notification of the handler’s action level cholinesterase depression

.

Potential Over

- Exposure S cenarios:

The han d l er reports removing gloves when cleaning spray nozzles and smoking while on lunch

and bathroom breaks . Also reports an incident where he felt feeling spray on his face when cleaning nozzles even though he was wearing full PPE.

Growing O peration 4 : This consultation is in relation to a loader, mixer, applicator that experienced a 20.92% serum cholinesterase depression. The handling hours reported in the 30 days prior to testing was 30.0. Covered pesticides handled in the 30 days prior to testing were

Lo rsban 4E (Seven 4F a class III product was also handled ).

Rule V iolations :

WAC 296

- 307

- 61205: The handler was found to have a beard and was a designated respirator

user. The beard may interfere with the proper fit and seal of the half face respirator rendering

it less effective.

WAC 296

- 307

- 13025(3)(a): The training provided the handler did not include written material or audiovisual training aids.

WAC 296

- 307

- 12025(3)(f)(iii) : The designated sign prohibiting entry into an orchard was posted on an orchard that had not been sprayed for quite some time. The f oreman indicated that the sign was kept up to keep kids going home from school out of the orchard

.

WAC 296

- 307

- 14835 : T here was no written record of the findings of the work practice

evaluation done after the company was noti fied of the c holinesterase depression

.

P otential O ver

- Exposure Scenarios :

Poor fitting respirator and facial hair inhibiting respirator seal

.

Growing O peration 5 : This consultation is in relation to a loader, mixer, applicator that experienced a 37 .30 % serum cholinesterase depression. The handling hours reported in the 308

days prior to testing was 70 .0. Covered pesticides handled in the 30 days prior to testing were

Lorsban 4E and Carzol SP

.

Rule V iolations :

WAC 296

- 307

- 14835: There was no writ ten record of the findings of the work practice evaluation done after the company was notified of the action level cholinesterase depression.

WAC 296

- 307

- 13025(3)(a): No written material or audiovisual training aids were use d to provide WPS required trai ning

.

WAC 296

- 307

- 13045(6)(g)(iii): T here was no written change schedule for the filters used on the Kasco K80S helmet Respirator

.

Potential O ver

- Exposure Scenarios :

Handler reports that he was sprayed in the face when while performing spray nozzle

m aintenance.

Growing O peration 6 : This consultation is in relation to 4 loader, mixer, applic ators that experienced 43.72%, 23.91%, 25.39%, and 64.12% serum cholinesterase depressions. The handling hours reported in the 30 days prior to testing were 41.5, 38.0, 47.5, and 40.5 respectively. Covered pesticides handled in the 30 days prior to testing were Lorsban 4E for 3 of the handlers, and Lorsban 4E and Carzol SP for the remaining handler. (43.72% cholinesterase depression).

Rule Violations :

WAC 296

- 3 07

- 14835: T here was no written record of the findings of the work practice evaluation done after the company was notified of the c holinesterase depressions

.

WAC 296

- 307

- 61205: One handler was found to have a beard and was a designated respirator

user.

WA C 296

- 307

- 13025(3)(b): The WPS training was not conducted by a qualified individual but by co workers who did not use written materials

.

Potential Over

- Exposure Scenarios :

Han d l ers reported tha t they do not always have time to perform complete decontami nation of PPE and equipment, “tractors are washed about every 3 days”.

One handler had facial hair interfering with respirator seal.

Growing O peration 7 : This consultation is in relation to 7 applicators that experienced 46.14%,
67.86%, 20.69%, 26.01% , 43.8%, 47.39%, and 53.29% serum cholinesterase depressions. The handling hours reported in the 30 days prior to testing were 36. 0 for all of the handlers. Covered pesticides handled in the 30 days prior to testing were Lorsban 4E.9

Rule Violations :

W AC 296

- 307

- 13045(6)(a): A ll handler s indicated that they only used soap occasionally when washing their chemical resistant rain gear. They further indicated that on many occasions they do not wash the PPE at the end of the day due to being hurried

.

WAC 296

- 307

- 61205: One handler (47.39% cholinesterase depression) was found to have a beard and was a designated respirator user

. The beard may interfere with the proper fit and seal

of the full face respirator rendering it less effective.

WAC 296

- 307

- 60605: Both North half and full face respirators are used. The handlers had only been fit tested to the full face respirator.

WAC 296

- 307

- 13045(6)(i)(ii): The area used by pesticide handler/applicators to change into personal protective equipment was mainta ined but the floor was wet. The water extended to most

of the floor in front of the employees lockers.

WAC 296

- 307

- 14835: T here was no completed written record of the findings of the work practice evaluation done after the company was notified of the Chol inesterase depressions

.

WAC 296

- 307

- 14830: The medically removed handlers were paid a dollar less per hour than when they were applying

.

Potential Over

- Exposure Scenarios :

Wearing respirators that were not fit tested and one respirator user with faci al hair.

Han d l ers reported tha t they do not always have time to perform complete decontamination of PPE and equipment.

Wearing contaminated PPE

Growing O peration 8 : This consultation is in relatio n to a loader, mixer that experienced a

38.72% serum ch olinesterase depression. The handling hours reported in the 30 days prior to testing was 32.5. Covered pesticides handled in the 30 days prior to testing were Lorsban 4E.

Rule Violations:

WAC 296

- 307

- 13045(6)(g)(iii): H andler exceeded eight hour s use wi thout replacing cartridges

.

WAC 296

- 307

- 13050(6): Insufficient water at decontamination site. E mployees hauling water in

buckets from approximately 10 0 feet away

.

WAC 296

- 307

- 13045(6)(a): R espirat ors found to be dirty and stored with cart ridges and filte rs attached. C hemical resistant suits were found in similar conditions.

WAC 296

- 307

- 12030(3): The required notice of applications was not displayed at the Central

Notification Board

.10

Potential Over

- Exposure Scenarios :

Use of expired respirator cartridg es

.

Insufficient decontamination and use of contaminated PPE.

Growing O peration 9 : This consultation i s in relation to a mixer, loader , applicator that experienced a 27.31% serum cholinesterase depression. The handling hours reported in the 30 days prio r to testing was 28.0. Covered pesticides handled in the 30 days prior to testing were

Lorsban 4E.

Rule Violations :

WAC 296

- 307

- 13025(1 ) : T he handler was not trained in accordance with the pesticide safety training requirements for handlers.

WAC 29 6

- 307

- 60405: Employer failed to provide medical evaluations for employee s required to use respirators as part of their duties.

WAC 296

- 307

- 62015: The handler failed to properly clean and disinfect respirator, storing it with organic vapor removing cartrid ges and pre filters attached. Two other respirators were

found in the same condition.

WAC 296

- 307

- 13045(6)(f)(iv ) : Respirator cartridges were not changed out during a 28 hour application period.

WAC 296

- 307

- 13045(6)(g)(iii): The handler used a TC23C No rth half

- face respirators with

vapor removing cartridges and exceeded eight hour's of use without replacing cartridges.

WAC 296

- 307

- 30006(2): The employer's Massey Tractor model 135, had power takeoff driven equipment attached which had a damaged shaft co ver.

WAC 296

- 307

- 018(5 ) : Employer d id not have a current OSHA 300 log, still using the 200

version.

Potential Over

- Exposure Scenarios :

Inadequate respirator cartridge change

- out schedule.

Failure to adequately decontaminate PPE

Lack of WPS compliant t raining.11

Compliance Visit Summaries

Growing operation 10 : This inspec tion is in relation to an applicator that experienced a 20.46%

serum cholinesterase depression. The h andling hours reported in the 30 days prior to testing was 2.5. Only Diazinon 50W a class II cholinesterase inhibitor was applied

. The inspection was assigned to compliance after consultation first contacted the employer by telephone and the employer failed to schedule a consultation visit.

Proposed C itations :

None found

.

Potential Over

- Exposure S cenarios:

T he handler does not shower after applying (spray blast method)

.

Growing O peration 11 : This inspec tion is in relation to a mixer, loader, applicator that experienced a 31.41% serum cholinesterase depression. The handling hours reported in the 30 days prior to testing was 35.0. Covered pesticides handled in the 30 days prior to testing were

Lorsban 4E and Phosmet (Sevin 4F a class III cholinesterase inhibitor was also handled)

. The inspection was conducted by compliance due to the fact that compliance was already on site following up on declinations w hen this handler experienced an action level cholinesterase depression. The employer agreed to the compliance inspection.

Proposed C itations :

None found

.

Potential Over

- Exposu re S cenarios:

Not showering after application.

Growing operation 6 : This inspection is in relation to an applicator that experienced a 26.82% serum cholinesterase depression. The handling hours reported in the 30 days prior to testing was

41.0. Covered pesticides handled in the 30 days prior to testing were Guthion and Imidan. The inspection was assigned to compliance after consultation had provided services to this operation earlier in the year due to 4 handlers experiencing action level cholinestera se depression.

Rule Violations :

None found

.

Potential Over

- Exposure Scenarios :

None found12

Growing O peration 12 : This inspection is in relat ion to a mixer, loader, applicator that experienced a 23.75% serum cholinesterase depression. The handling hou rs reported in the 30 days prior to testing was 39.5 . Covered pesticides handled in the 30 days prior to testing were

Lorsban 4E (Sevin 4F a class III product was also handled) . The inspection was assigned to compliance after the employer declined a consul tation visit.

Rule Violations

WAC 296

- 307

- 28016(2)(a): Two instances of unguarded PTO shafts were found.

WAC 296

- 307

- 14815: The handler had no t been provided a copy of the LH CP written

recommendation. However

, had been notified by the employer of th e action level cholinesterase depression.

Potential Over

- Exposure Scenarios :

The handler reports that the respirator sometimes slips

.



### Conclusion

In conclusion, the 2009 cholinesterase monitoring program functioned well. DOSH continues to

work with all stakeholders to make improvements where indicated, e.g., ensuring pesticide handlers receive copies of the health care provider’s written recommendations. Information gleaned from field evalua tions continues to prove useful. For example, the informat ion gleaned from field evaluations is used by DOSH and WSDA in developing pesticide handler training

curriculum

Laboratory services have been solidified and are monitored to identify and limit potential areas

of bias and analytical variability

. Dr. Barry Wilson’s laboratory and the DOSH Industrial Hygiene Laboratory have worked closely with PAML to maintain strong services

.

DOSH would like to thank all of those individuals, stakeholders and entities involved in supporting the L&I Cholinesterase Monitorin g Program

, with particular appreciation to: Pathology Associates Medical Laboratories (PAML); the University of California Davis

- Dr. Barry Wilson, Mr. Jack Henderson ; the DOSH field consultation and compliance staff; and all participating health care pr oviders.