Health Hazard 

Evaluation 

Report 

HETA 83-227-1466 

PUGET SOUND NAVAL SHIPYARD

BREMERTON., WASHIN6W* 
PREFACE 


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The Hazard Evaluations and Technical Assistance Branch of NIOSH conducts field 

investigations of possible health ~azards in the workplace. T~ese 

investigations are conducted under the authority of Section 20(a)(f) cf the 

Occupational Safety and Health Act of 197C, 2£ u.s.c. 66S(a)(6) which 

authorizes the Secretary of Health and Human Services, following a written 

request from any employer or authorized representative of employees, to 

determine whether any substance normally found in the place of employment has 

potentially toxic effects in such concentrations as used or found. 

The Hazard Evaluations and Technical Assistance Branch also provides, upon 

request, medical, nursing, and industrial hygiene technical and consultative 

assistance (TA) to Federal, state, and local agencies; labor; industry and 

other groups or individuals to control occupational health hazards and to 

prevent related trauw.a and disease. 

Mention of cotnpany narr.es or products does not constitute endorsement by the 

National Institute for Occupational Safety and Health. 
HETA e3-227-1466 NIOSH Investigators: May 1984 Arvin G. Apol PUGET SOU~D NAVAL SHIPYARD Roy G. Parrish, M.D. 

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BREMERTON, WASHINGTON 

I SUMMARY 

In May Hl?3, the National Institute for Occupational Safety and Health 

(tHOSH) was asked to determine if exposure to 2-ett.oxyethanol, a solvent 

used in some paints at the Puget Sound Naval Shipyard (PSNS), Bremerton, 

Washington, was the cause of nasal and rectal bleeding experienced by 

seven painters. In August 1983, a tlIOSH physician met with the PSNS 

physician, reviewed the medical records of these seven painters and of 

one additional painter, and interviewed five of the painters. 

Review of the medical records and medical interviews revealed that three 

painters had episodes of rectal bleeding; two had episodes of nasal 

bleeding; and three had episodes of both rectal and nasal bleeding. Most 

of the episodes of rectal bleeding lasted 1-3 days, and the number of 

rectal bleeding episodes ranged from one to several intermittent episodes

extending over a few wonths. At present none of the painters reports any 

bleeding. Physical examination revealed hemorrhoids in three of the four 

who were examined, and this was felt to be the most probable source of 

bleeding in these three. Physical examination in the fourth painter, done two months after the bleeding episode, showed minor irritation of 

the crypts, but no active bleeding . In the two others, the exa~inins 

physicians felt that the rectal bleeding was secondary to nosebleeds in 

one painter and that no determination of the source of bleeding could be 

made in the other due to the interval between the bleeding episode and 

the exarr.. The medical records and interviews of the affected painters did not implicate exposure to 2-ethoxyethanol as the cause of the rectal 

bleeding. · 

Of the five painters reporting nosebleeds, two had a single episode. The 

other three had recurrent, intermittent bleeding over a period of a few 

weeks. The irritant effects of 2-ethoxyethanol vapors could have 

contributed to the nosebleeds; however, due to the use of supplied air 

respirators, significant inhalation of the vapcrs was unlikely. It seems 

more probable that drying of the nasal mucosa secondary to weather or 

respirator use or a minor trauma to the nasal irucosa caused the nasal 

bleeding episodes. The PSNS management stated that 2-ethoxyethanol could 

be removed from use. In December 1983, it was confirmed that 

2-ethoxyethanol was no longer being used. 

On the basis of this investigation, NIOSH determined that nasal and 

rectal bleeding experienced by seven painters was probably not caused by 

exposure to 2-ethoxyethanol. Tt.is is based on examination of the medical 

records and interviews with the affected painters and a literature search 

that showed no studies associating nasal and rectal bleeding with 

exposure to 2-ethoxyethanol. However, NIOSH recommends that 

2-ethoxyethanol (2EE) be regarded in the workplace as having the 

potential to cause adverse reproductive effects, including teratogenesis. Recommendations to reduce exposure to 2-ethoxyethanol are included in 

this reoort. 

KEYHOROS: SIC 3731 (Ship Building and Repairing) 2-ethoxyethanol 

(2EE }[other synonyirs: ethylene glycol monoethyl ether (EGM); ethyl 

cellosolve; cellosolve]. 
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II INTRODUCTION 

In May 1983, the National Trades Council, Bre111erton, Washington, requested NIOSH to detennine if exposures to 2-ethoxyethanol , a solvent 

used in some oaints at the Puget Sound Naval Shipyar~ (PSNS), was the 

cause of nasal and rectal bleeding experienced by seven of the two 

hundred twenty painters in Shop 71. An initial visit was made on 

July 18, 1983. On August 23, a NIOSH phvsician met with the PSNS 

physician, reviewed the PSNS medical records of these seven painters, and interviewed five of them. An interim report was providerl on 

January 2, 1 q94. 

III BACKGROUND 

The Puget Sound Naval Shipyard refurbishes navy ships. There are 

approximately 10,000 employees at this facil itv. During refurhishment, 

the interior and exterior are painted. OnP. of the paints used is the 

Mare Island Paint and its counterpart is Rule 66 paint. Both are 

epoxy-polyamide paints and differ only in their solvent. The Rule 60 

paint contains 2-ethoxyethano1 in 1 ieu of hutyl alcohol and naphtha in 

the Mare Island Paints. From Februarv 1983 to July 1Q83, the average 

2-ethoxyethanol usage was about ?.50 gallons per month. 

T~e protective eauipment usect by the painters when painting with the 

Mare Island paints or the Rule 66 paints WP.re~ fl) supplied air 

respirator when sprav painting; (2) cartridge (air purifying) respirators when'cleaning equipment or when ro11er or hrush painting; (3) cotton gloves or ~isoosable g1oves; and (4) covPra11s and 

headcovers. The PSNS has a respirator tP.st fit program for workers who 

wear respirators. 

IV EVALUATION DESIGN AND METHODS 

The MIOSH medical officer met with the PSNS physician who had seen ttie 

seven painters; reviewed the PSNS medical records of these seven 

painters and one additional painter; and interviewed five of the eight 

oainters {one was retirerl, one was on leave, and one was unavailable for 

interview). 

V EVALU~TION CRITERIA 

A. Environmental Criteria 

As a guirle to the evaluation of the hazards posed by workplace 

exposures, NIOSH field staff employ environmental evaluation criteria 

for assessment of a number of chemical and p~ysical agents. Often the 

NIOSH recommendations are lower than the corresponding OSHA standards, 
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• ;.e., 2-Ethoxyethanol. The NIOSH recon111endations are based on more 

recent infonnation than are the OSHA standards. The OSHA standards also 

may be required to take into account the feasibility of controlling 

exposures in various industr;es where the aqents are used; the 

NIOSH-recon111ended standards, by contrast, are based primarily on 

concerns relating to the prevention of occupat;onal d;sease. 

The 8-hour time weighted average pennissable exposure level for 

2-ethoxyethonol is 200 ppm. The American Conference of Goverrwnent 

Industr;al Hygienist's Threshold Limit Value is 50 ppm with a 

recommended reduction to 5 ppm. NIOSH urges employers to voluntarily 

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assess how thP.ir workers may be exposed to 2-ethoxyethono1 and to reduce 

exposure to the lowest extent possible. 

B. Toxicity and Medical Criteria 

Glycol Ethers 

The glycol ethers ( 2-methoxyethanol f 2ME] and 2-ethoxyethanol r2EEl), 

are widely-used industrial solvents which are miscible both with water 

and with a large number of other solvents. Thev have a wide variety of 

uses in industry because of their versatile solvent properties. Some of 

these uses include cleaning an~ thinning agents and coatings such as 

epoxies, wood stains, varnishes, paints and inks (2). 

Glycol ethers, in general, have low acute toxicity when administered in 

single doses. The liquid glycol ethers can be mildly irritating to the 

skin and eyes. The vapors can irritate the eyes, nose, and throat, 

causing burning or itching. But glycol ethers can penetrate the skin or 

be inhaled without causing irritation, so that irritation is not a good warning of exposure (1,2). 

Overexposure to any glycol ether can cause anemia, a low number of red 

blood cells. Symptoms of anemia may include tiredness, weakness, and 

shortness of breath, particularly during or .iust after exertion. Mild 

anemia often does not cause symotoms but can be diagnosed hy having a 

blood test (1,2). 
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Overexposure to one of the glycol ethers. 2ME, has caused central 

nervous system (brain) effects in workers. The symptoms included 

confusion, tiredness, loss of appetite, loss of weiqht, headache, 

nausea, vomiting and trembling hands . These symptoms were greatly 

improverl when exposure was rerluced or eliminated (1,2). 

Both 2EE and 2ME caused serious hirth defects in the offsprinq of test 


animals exposed during pregnancy . In addition, these two ethers injured 
 - the testes amt spem of exposed test animals, damage that can result in 

infertility. These birth defects and testicular rtamage occurred at 

levels near the permissible exposure level for workers. The anima1s 

showerl no other evidence of ham that miqht give a warning of 

overexposure. There is no infomation on whether or not these chemicals 

affect the human reproductive system (l,?,3). 

There is insufficient infomation avai1ahle at the present time to 


enable an assessment of the cancer producinq potential of the glycol 


ethers ( 2) . 


Nasal Bleeding 

Probably the most common cause of nosebleed is nose picking, learling to 


tearing of the rich network of veins in the frnnt part of the nose. 


Minor nosebleeds may also appear in the course nf viral infections of 


the upper respiratory tract. Several ~acterial infections mav be 


accompanied by nosebleeds. In addition, there are several other causes 


of nosebleerl, including low humidity in the air, hypertension, blee~ing 

disorders, acute sinusitis , especially involving the ethmoirl sinus, and 


tumors of the nose and paranasal sinuses. Episodes of bleerling or the 


severity of attacks are frequently increased in people taking aspirin 


( 3) • 

Some compounds encountered in the occupational setting have been 


associated with acute nosebleed. They are usually chemicals that 


irritate and damage the lining of the nose, particularly caustic 


materials, such as strong acirls and bases. Additional compounds 


associated with acute nosebleed include: bervllium, oxalic acid, 


selenium, vanadium; and those associated with chronic nos~bleert includP.: 


benzene, carbon tetrechloride, proteolytic enzymes, hexamethyl-para­
 rosal ine, phosphine, phthalic anyhydride , tetranitromethyl aniline, 


tetryl, trimethyl henzenes, and xylenes (4). 


Rectal Bleeding 

Small amounts of bright red blood on the surface of the stool and toilet 


tissue are often caused bv hemorrhoids, which are ve~v common in the 


adult population; such bleeding is qenera11y precipitated by the 


strained oassage of hard stool. This bleeding is usually milrl and 


intermittent. However, a rare patient may have such prolonged and 

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massive bleerling as to develop an iron-deficiency anemia. Bleeding is a 

more coT11T1on symptom of hemorroids than is pain (5). Anal fissures and 

fistulas may also be accompanied by bleeding. In addition to these 

colllTlon sources of rectal bleeding, several other causes exist which are 

associated with problems in other parts of the small or large bowel. 

These problems include colonic polyps, inflammatory howel disease, 

colonic diverticula, and cancer of the colon. 

It is unlikely that a chemical encountered in the workplace would 

produce rectal bleeding. 

VI RESULTS AND DISCUSSION 

~eview of the medical records and medical interviews revealed that three 

painters had episodes of rectal bleeding; two had episodes of nasal 

bleeding; and three had episodes of both rectal and nasal bleeding. 

Onset of bleeding is depicted in Figure l. 

Most of the epi sades of rectal bleeding lasted 1-3 da.vs, and the number 

of rectal bleeding episodes ranged from one to several intennittent 

episodes extending over a few months. At present none of the painters 

reports any bleeding. Most de.scribe<! the presence of bl ooti on the stool 

or on toilet paper, although there was one description of the hlood in 

the toilet bowl water. Physical examination revealed hemorrhoids in 

three of the four who were examined, and this was felt to be the most 

probable source of bleeding in these three. Ph.vsical examination in the 

fourth painter, done two months after the blee~ing episode, showed minor 

irritation of the crypts, but no active bleeding. In the two others, 

the examining physicians felt that the rectal bleeding was secondary to 

nosebleeds in one painter and that no detennination of the source of 

bleeding could be made in the other due to the interval between the 

bl eedinq eoisode and the exam. It is unusual to find briqht ret1 bloorJ 

in the stool as a result of a nosebleed unless a siqnificant amount of bloo~ is swallowed and it passes through the digestive tract rapidly. 

Thus, it is unclear to NIOSH whether the explanation given above can 

account for t~e blood in this oainter 1 s stool. 

Of the five painters reporting nosebleeds, two had a single episode. The other three hart recurrent, intermittent bleeding over a period of ~ 

f~w weeks . One of these was treated with cautery. 

Several of the painters noted that in the course of paint~ng, 

particularly when painting the interior of a s~ip, their gloves and 

coveralls frequentiy became saturated with paint. Their hands and/or 

skin elsewhere on their body were thus exposed to the paint and solvents 

with the potential for skin absorption . 
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VII SUMMARY AND CONCLUSIONS 

Neither the temporal occurrence of bleedinq, probable etiology of 

bleeding, nor the known tox ic effects of 2EE suggests that the episodes 

of rectal bleeding in the ~ix painters at PSNS were caused by exoosure 

to 2EE. 

The irritant properties of 2EE may have contributed to t~e nosebleeds in 

some of the workers if they were exoosed to the vapors during work. 

However, since supplied air respirators were reportedly used hy all the 

painters, significant inhalation exposure to the vapors is unlikely. It 

seems more probable that drying of the nasal mucosa, secondary to either 

the weather or respirator use, or minor trauma to the nasal mucosa 

caused the nasal bleeding episodes. Thus, NIOSH does not feel that the 

oh served bleeding resulted from exposure to 2EF. at PSNS. 

NIOSH recommends that 2-ethoxyethanol (2EE) be reqarderl in the workplace 

as having the potential to cause adverse reprot:!uctive effects, including 

teratogenesis. Exoosure shoul~ be limited to onlv those workers 

essential to the process or operation, and wor~olace exposure levels 

should he minimized. Less hazardous solvents should be substituterl 

where practicable. BecausP therP. have ..,een sever al stu,,ies that 

reported reproductive effects as a result of skin a~sorption, every 

effort should be mad~ to eliminate skin exposure. 

In a 1 etter to NIOSH from the Director of Occupat·ional Safetv and 

Health, PSNS, dated July ?.?, 1983, it was st~te<t that "because Shop 71 

is not satisfied with the 2-et~oxvethanol tliinner that there woulrl be no 

problem in switching from 2-ethoxyethanol to hiqli f1 .,s~ naphtha. 11 On 

OecembPr 2, 1983, both the union and the PSNS industrial hygienist 

confirmed that 2-ethoxyethanol is no 1 onger used anrl in the future wou1 rl 

only be usert in an emerqency. 

VIII RECOMMENDATIONS 

1. If bleeding recurs or new bleedin~ appears, painters should 

imnediately see either a plant physician or their personal physir.ian. If they see their personal physician, the plant physician should be 

notifierl so that a record can be kept in a central location. 

2. In light of the potential adverse health effects, and the potential for skin absorption, worker exposure to ?.EE shoulrl be controlled. There 

are four hasic methods of limiting worker exposure to 2ME and 2EE, none 

of which is a simple industrial hygiene or management decision. Caref~l 

planning and thought should he used prior to implementation. These are 

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a. Product Substitution. The subsitution of an alternative 

material with a lower potential health risk is an imoortant method 

for reducinq exposure. Extreme care must be used when selecting 

substitutes. Although the test results for some structurally related glycol ethers reported in t~is bulletin seem to suggest less 

hazardous compounds, the testing is not yet sufficient to i~entify a 

glycol ether substitute for 2ME and 2EE. Possible health effects 

and potential exposures of alternatives to 2ME and ?.EE should be 

fully evaluated prior to selection. 

b. Contaminant r.ontrols . Airborne concentrations of ~ME anrl 2EE 

can be most effectivP.1 v controll er1 at the source of cQntamination by 

enclosure of the operation and use of local exhaust ventilation. 

Guidelines for selected processes anrl operations can be found in 

NIOSH's Recommended Industrial Ventilation Guirlelines (36). When 

enclosinq a process or operation, a slight vacuum-snDulrl be used to 

create negative pressure so that lea~age will cause external air to 

flow into the enclosure and minimize contamination of the 

workplace . This can he accomplished with a well-designed local 

exhaust ventilation system that physically encloses the process as 

much as possible, with sufficient captu~e velocity to keep the 

contaminant from entering the workplace atmosohere. The desiqn of 

ventilation systems should take into account the reactive cha~acteristics of 2ME and 2EE • 

Ventilation equipment should be chec~Pd at least every three months 

to ensure adequate perfonnance. System effectiveness shoul~ also be checke~ soon after ·anv change in production, process, or contro1 

that miqht result in significant increases in airborne exposure to 

'ME and 2EE. 

c. Worker Isolation. If feasible, workers may be isolated from 

direct contact with t~e work environment hy the use of automaterl 

equipment ooerated frOITI a closed control booth or room. The control 

room should he maintainert at a qreater air pressure than that 

surrounding the orocess equipment so that air flows out of, rather 

than into, the room. This type of contro1 will not protect workers 

who must perfonn process checks, adiustrnents, maintenance, and 

related operations. Therefore, soecial precautions are often 

necessary to prevent or limit worker exposure in these situations 

and frequentl.v involve the use of personal protective equi pme'lt. 

d. Personal Protective Equipment. Personal protective equipment, whic~ may include goggles, gloves, coveralls, footwear, an~ 

respirators, should not he the only means of preventing or 

minimizing exposure during routine operations. Since 2ME and 2EE 

can penetrate the skin, personal protective clothing and equipment 

shoulrl be selected that is impenneable to 2ME and 2EE . 
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IX REFERENCES 

1. Hazard Evaluation System and lnfonnation Service, Hazard Alert: 


Glycol Et~ers. Berkelev, California. 1~82. Hazard Evaluation System
 and Infonnation Service, State of California, Department of Health 


Services/Department of Industrial Relations. 


2. Hazard Evaluation System and Infonnation Service, The Toxicity of 


Glycol Ethers. Berkeley, California, 1982. Hazard Evaluation System 


and Infonnation Service, State of California, Department of Health 


Services/Department o~ Industrial Relations. 


3. Isselbacher, KJ and Popp, JW. Chapter 38: Hematemesis and Melena. 


From Principles of Internal Medicine. Ninth Edition, Erlited by 


Isselhacher et al. 


4. Daugaard, J. Symptoms and Signs in Occupational Disease: A 


Practical Guide. Copenhagen, Munksgaard (Year Book Medical Publishers)


1978, page 21. 


5. Spiro, HM. Clinical Gastroenterology. New York, MacMillan 1970. 

~. NIOSH Current Intelligence Bulletin 39. May?, 1983, Glycol Ethers 


(2-Methoxyethanol, 2-Ethoxyethano1). 


X AUTHORSHIP AND ACKNOWLEDGEMENTS 

Report preoared by: 

Arvin r,. Apol 

Industrial Hygienist 

Roy G. Parrish, M.D. 

Medical Officer 

Medical Section 

Originating Office: Hazard Evaluation and Technical 


Assistance Branch 


Division of Surveillance, Hazard 


Evaluations and Field Studies 

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XI DISTRIBUTION AND AVAILABILITY OF REPORT 

Copies of this re1Jort are currently available upon request from NIOSH, 

Division of Standards Development and Technology Transfer, 4676 Columbia 

Parkway, Cincinnati, Ohio 45226. After 90 days, the report will be 

available through the National Technical Information Service fNTIS), 

5285 Port Royal. Springfield, Virginia 22161. Inforination regarding 

its availability through NTIS can he obtained from t~e NIOSH 

Publications Office at the Cincinnati address. Copies of this report ~ave been sent to: 

l. 	Puget Sounri Naval St'lipyard, Bremerton, Washington. 

2. 	 National Trade Council, Bremerton, Washington. 

3. 	 U. S. Department of Labor, Occupational Safety and Health Agency 

(OSHA), Region X, Se~ttle, Washington. 

For the purpose of informing affected employees, copies of this report 

shall be posted by the employer in a prominent place accessihle to the 

employees for a period of 30 ca1P.ndar rlays • 
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Figure 1. Onset of Bleeding Episodes. Shop 71, 

Puget Sound Naval Shipyard, Bremerton, Washington, 

1982-1983. (N = Nosebleed; R = Rectal Bleeding) 

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QI 

ca 3
 Ill 

u 2 
 ~ l 0 

*' 

R 

N 

R 

1 2 3 4 s 6 1 a 9 io 11 12 1 2 3 4 s 6 1 a 9 10 11 12 


1982 1983 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

PUBLIC HEALTH SERVICE 

CENTERS FOR DISEASE CONTROL 


NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY ANO HEALTH 


ROBERT A . TAFT LABORATORIES 


4676 COLUMBIA PARKWAY, CINCINNATI. OHIO 45226 


Third Class Mail OFFICIAL BUSINESS 


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