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Polyvinyl Chloride “PVC”

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					 Polyvinyl Chloride
       “PVC”
The Hidden Home Hazard
 A Guide for Health Care
     Professionals

    Wendy L. Thompson BSN, RN




                                1
                       Polyvinyl Chloride
         Program Purpose:
           This presentation is a guide for healthcare
           professionals to the hidden hazard of
           polyvinyl chloride in homes. Although the
           use of polyvinyl chloride also exists in
           other areas, it’s widespread use in many
           home materials could cause potentially
           serious health effects in the communities
           that we serve.




Nursing professionals, especially those in the area of Community / Public
Health, should be aware of hazards in our environment, such as Polyvinyl
Chloride exposure, which could potentially affect the communities we serve.
As caregivers, patient advocates, and teachers – nurses have the ability to
educate people on the environmental risks and possible health effects of
Polyvinyl Chloride exposure, as well as the available alternatives.
Although persons who are occupationally exposed to PVC are more
susceptible to it’s acute and chronic effects, exposure does occur in homes
through a large variety of materials. It is important that we empower the
communities that we serve to use less harmful alternatives that are available,
for the protection of health and the environment.




                                                                                 2
              What is Polyvinyl Chloride?

            “Polyvinyl Chloride (PVC) is a chlorinated
             plastic made ready for various uses by the
               addition of fillers, stabilizers, lubricants,
                  plasticizers, pigments, and flame
                               retardants.”


             Health Care Without Harm, American College of Nurse Midwives. Green Birthdays, 2001.




PVC poses two major hazards during it’s lifecycle
1. Its manufacture and incineration produce dioxin (to be discussed later)
2. Its plasticizer DEHP can leach from PVC products to those using them.
PVC was discovered in 1926 by an American chemist, Waldo Semon who
  worked at B.F. Goodrich.
Structurally, PVC is a vinyl polymer. It is similar to polyethylene, but on every
   other carbon in the backbone chain, one of the hydrogen atoms is replaced
   with a chlorine atom. It is produced by the free radical polymerization of
   vinyl chloride.




                                                                                                    3
                       Polyvinyl Chloride
         • Naturally hard
           substance
         • Used in many
           consumer products
         • Contains potentially
           harmful chemicals
           that alter it’s natural
           characteristics –
           including DEHP (di-
           ethylhexyl phthalate)




Polyvinyl Chloride is a naturally hard substance. Phthalates are potentially
harmful chemicals added to PVC to change its natural characteristics.
Phthalates make PVC soft and squishy. Lead and cadmium are added to
make the rigid type of PVC which is more durable. These additives are all
capable of leaching out of PVC plastic.




                                                                               4
                         What is DEHP?
          • DEHP is a plasticizer (manufactured
            chemical) added to products to enhance
            their strength and flexibility.
          • DEHP is not bound to plastic, and can
            therefore migrate out of the products that
            contain it.
          • Long term exposure leads to a variety of
            health effects.
          • DEHP is a hazardous component of PVC!



DEHP is a colorless liquid with almost no odor. It does not evaporate easily.
DEHP is widespread. About 291,000 pounds were released in 1997 from
industries. It is often found near industrial settings, landfills, and waste
disposal sites.
The EPA requires that spills of 100 pounds or more of DEHP to the
environment be reported to the agency.
When DEHP is released to soil, it binds strongly and does not move very far
away from where it is released. When it is released to water, it dissolves very
slowly into underground water or surface waters that contact it. Because
DEHP is not highly volatile, very little goes into the air. DEHP in air can bind
to dust particles and will be carried back down to earth through gravity and
rain or snow. Indoor release of DEHP to the air from plastic materials, coating,
and flooring in home and work environments can lead to higher indoor levels
than are found in the outdoor air.




                                                                                   5
                          PVC In Our Homes –
                                Dioxin
         •   PVC is one of the world’s largest
             dioxin sources

         •   Dioxin is the common name
             referring to a group of 75
             chemicals that are extremely
             potent, persistent toxicants that
             bioaccumulate in the environment.
             (from Green Birthdays)

         •   Dioxins are created when PVC
             plastic is burned in incinerators,
             household stoves, trash burning,
             and accidental fires in buildings
             and vehicles.

         •   Dioxin is a known human
             carcinogen!




Dioxin is a known human carcinogen according to the International Agency for
Research on Cancer.
Dioxin also has widespread effects on reproduction and development, as
shown in animal and human studies.
Dioxin is particularly toxic to the developing immune system causing
immuosuppression and immunodepression, therefore decreasing a person’s
resistance to bacterial, fungal, and other infectious agents. This
immunosuppression may also increase a person’s susceptibility to cancer.
According to the United States EPA, adults eating an average diet are
consuming 300 to 500 times the daily “safe” dose of dioxin.
Once dioxins are released into the environment, they attach to dust particles
and raindrops and fall back to the surface where they coat vegetation. They
have the potential to accumulate in humans and are fat-soluble. Their
concentrations increase as they biomagnify up the food chain. Therefore, the
organism at the top of the food chain (humans) will have the highest
concentration of dioxins.




                                                                                6
          Toxicokinetics of Polyvinyl Chloride

                     Routes of absorption:

                                Inhalation

                                 Ingestion

                                  Dermal




Absorption of polyvinyl chloride takes place mostly via inhalation. Inhalation
absorption of polyvinyl chloride is rapid in humans. It occurs through
breathing air emissions expelled during the manufacture of PVC, or during it’s
disposal through burning in incinerators. The health effects of PVC inhalation
exposure will be discussed later in this presentation. Absorption can also take
place by ingestion. This type of absorption is possible when children chew or
suck on soft, chewy toys made out of PVC plastic. The phthalates used to
make to toys soft are not bound to the plastic, and thus can migrate out of the
infant toys that are chewed and sucked and can be swallowed by children.
Ingestion of PVC can also occur from contaminated food or drinking water.
The dermal absorption of PVC is low but can occur through the contact of PVC
plastics to the skin.
Direct absorption to the bloodstream can occur when PVC materials are used
in hospitals for IV bags and tubing. DEHP is used to make PVC more flexible.
DEHP does not chemically bind to PVC and may therefore leach from
plasticized PVC when a medical devices such as IV tubing and catheters
come into contact with fluids, lipids, and/or heat. The migration of DEHP from
these PVC materials exposes patients to the plasticizer.




                                                                                  7
          Toxicokinetics of Polyvinyl Chloride

                              Distribution

                                    Liver
                                   Kidney
                                    Skin
                                     Fat




Data from rat studies suggest that the distribution of inhaled Polyvinyl Chloride
after inhalation exposure is rapid and widespread, but the storage in the body
is limited by rapid metabolism and excretion.




                                                                                    8
          Toxicokinetics of Polyvinyl Chloride

                             Metabolism

              Cytochrome P-450 monooxygenases




The major metabolic pathway of vinyl chloride involves oxidation by mixed-
function oxidases to form a highly reactive epoxide intermediate, 2-
chloroethylene oxide, which spontaneously rearranges to 2-
chloroacetaldehyde. These intermediates are detoxified mainly through
conjugation with glutathione catalyzed by glutathione S-transferase.




                                                                             9
          Toxicokinetics of Polyvinyl Chloride

                                Excretion

                                Exhaled Air
                                  Urine
                                  Feces




Although no studies were found in relation to excretion of Polyvinyl Chloride in
humans, studies exist with the use of rats. Animal studies indicate that the
importance of exhalation of vinyl chloride as a major route of excretion varies
with the exposure concentration.




                                                                                   10
Who is at Risk for Polyvinyl
  Chloride exposure?




                               11
                                  Young….




                          EVERYONE!!!


                                  …and old




Young children, and the elderly are especially vulnerable to the effects for
PVC exposure. Workers involved in the manufacture and disposal of PVC are
perhaps the most at risk for the health effects of PVC.
According to the American Journal of Public Health, long-term exposure to
polyvinyl chloride flooring in the home may increase the risk of bronchial
obstruction in young children. Researchers report that children exposed to
PVC flooring in nurseries, bedrooms, and other rooms were at an 89% higher
risk for bronchial obstruction, compared with children in homes with wood or
parquet flooring and painted walls / ceilings. This is believed to be because
their breathing zone is closer to the floor and they have a larger volume of
respiration than adults per kilo of bodyweight.
Elderly populations have decreasing function of cardiac, pulmonary, renal, and
immune system processes. These normal aging processes alter their ability to
detoxify chemicals.




                                                                                 12
Where Can One Be Exposed
  to Polyvinyl Chloride?




                           13
             Home                 Playgrounds              Schools



                        EVERYWHERE!
            Hospitals                 Air                    Work




Although this discussion focuses on the exposure to polyvinyl chloride in
homes, it has widespread use in playground equipment, in schools and
workplaces for building materials, and in hospitals for IV bags and tubing, as
well as many other areas. Therefore, exposure to polyvinyl chloride can occur
in many different settings.




                                                                                 14
            What Types of Products Contain
                    PVC / DEHP?
         • DEHP is present in plastic products such
           as wall coverings, tablecloths, floor tiles,
           furniture upholstery, shower curtains,
           garden hoses, swimming pool liners,
           rainwear, baby pants, dolls, some toys,
           shoes, automobile upholstery and tops,
           packaging film and sheets, sheathing for
           wire and cable, medical tubing, and blood
           storage bags.
                    Taken from ATSDR’s Public Health Statement on DI(2-ethylhexyl)phthalate.




You can be exposed to DEHP through air, water, or skin contact with plastics
that have DEHP in them. Food may also contain DEHP, but it is not certain
how much.
The FDA limits the types of food packaging materials that can contain DEHP.
The EPA limits the amount of DEHP in drinking water to 6 parts of DEHP per
billion parts of water.




                                                                                               15
                          PVC In Homes
          • The largest use of
            PVC is in building
            materials such as
            cables, window
            frames, doors, walls,
            paneling, water and
            wastewater pipes,
            vinyl siding, PVC
            flooring, PVC
            wallpaper, furniture,
            window blinds and
            shower curtains.



DEHP levels in the indoor air in a room with recently installed flooring could be
higher than levels in the outdoor air.
Of ten billion pounds of PVC resin produced annually in the U.S., 60% is used
in construction. The most prevalent use of PVC in construction is for piping of
water, gas, and sewer drainage. Vinyl is used in 66% of all American kitchens
as flooring.




                                                                                    16
                         PVC In Homes
           • PVC is used for many consumer articles such
             as credit cards, imitation leather, furniture,
             garden furniture and TOYS!!




           • PVC is used for food packaging such as
             plastic trays in boxed cookies or chocolates,
             candy bar wrappers, and bottles.




Traces of phthalates, which are often used to soften PVC, can leak out into
foods – especially ones with a high fat content and those at higher
temperatures. PVC is also commonly used in teethers, beach balls, bath toys,
dolls, knapsacks, raincoats, and umbrellas.




                                                                               17
                          Hidden Hazards –
                                Toys
          Children are especially
            vulnerable to the
            effects of PVC!
          To a child – a toy is
            something good to
            chew on.
          What you probably
            didn’t know is that
            they are ingesting the
            harmful by-products
            of PVC!



Small children can be exposed to DEHP by skin contact with or by sucking on
plastic objects (toys) and pacifiers that contain DEHP. According to the
Canada Child Care Federation, children’s toys rarely have a label indicating
the type of plastic they contain. If a toy is in it’s original packaging, the words
“vinyl” or “PVC” may appear in the description. Soft PVC products tend to be
soft but not rubbery and tend not to return immediately to their initial shape
after being twisted or bent.. Soft PVC products often have a pungent,
disagreeable odor; however, a masking agent is often applied to cover up the
natural smell of the additive.




                                                                                      18
          Health Effects of PVC Exposure
          “Scientific studies on animals have
               confirmed that exposure to
               phthalates can lead to liver,
                kidney, and reproductive
                     system damage.”



           “Some studies have shown that
            these chemicals are hormonally
              active and may interfere with
             hormone systems that regulate
                   normal growth and
               development in children.”
            Canadian Child Care Federation. Polyvinyl Chloride Toys:
                            Questions & Answers, 1998.




The federal government has developed regulations and recommendations
related to vinyl chloride to protect public health. Vinyl chloride is regulated in
food, water, and air. The EPA requires that the amount of vinyl chloride in
drinking water not exceed 0.002 mg/liter. Under the EPA’s Ambient Water
Quality Criteria for the protection of human health, a concentration of zero has
been recommended for vinyl chloride in ambient air.
In order to limit intake of vinyl chloride through foods, the FDA regulates the
vinyl chloride content of various plastics. These include plastics that carry
liquids and plastics that come into contact with foods. It is recommended that
foods not be microwaved in plastic containers.




                                                                                     19
              Acute Health Effects of Polyvinyl
                    Chloride Exposure

          •   CNS effects
          •   Eye irritation
          •   Respiratory tract irritation
          •   Loss of consciousness
          •   Lung and kidney irritation
          •   Inhibition of blood clotting in humans




Acute exposure of humans to high levels of PVC’s components via inhalation
has resulted in CNS effects such as dizziness, drowsiness, headaches, and
giddiness. These effects can occur within 5 minutes if one is exposed to about
10,000 ppm of vinyl chloride. It is reported to be slightly irritating to the eyes
and respiratory tract in humans. Acute exposure to extremely high levels has
caused loss of consciousness, lung and kidney irritation, and inhibition of
blood clotting in humans. It has shown to cause cardiac arrhythmias in
animals. Although there is a low occurrence of this in exposures to home
products containing PVC, it can occur if there is a home fire. The burning of
PVC products results in the release of dioxins. The hydrochloric acid formed
when PVC is burned, can lead to life-threatening lung damage.




                                                                                     20
           Chronic Health Effects of Polyvinyl
                  Chloride Exposure

         • Liver damage
         • “Vinyl Chloride Disease”
         • CNS effects




Liver damage may result from chronic exposure to vinyl chloride through
inhalation and oral exposure. Vinyl Chloride Disease is a disease that affects
a small percentage of individuals occupationally exposed to high levels of vinyl
chloride. It is characterized by Raynaud’s phenomenon (numbness and
discomfort of fingers when exposed to cold, changes in the bones at the end
of the fingers, joint and muscle pain, and scleroderma-like skin changes).
CNS effects of chronic exposure can include dizziness, drowsiness, fatigue,
headache, visual/hearing disturbances, memory loss, and sleep disturbances.
Peripheral nervous system symptoms have also been reported in workers
exposed to vinyl chloride.




                                                                                   21
              Reproductive / Developmental
                         Effects
         •   Decreased sexual performance in males
         •   Birth defects
         •   Miscarriages
         •   Testicular damage
         •   Decreased male fertility
         •   Decreased fetal weight




Some studies have found the above reproductive and developmental effects
of vinyl chloride exposure, however, the possibility of exposure to other
hazardous chemicals could not be excluded. Epidemiological studies have
suggested an association between men occupationally exposed to vinyl
chloride and miscarriages in their wives’ pregnancies. Testicular damage and
decreased male fertility has been found in rats exposed to low levels of vinyl
chloride for up to 12 months.




                                                                                 22
            Cancer Risk of Polyvinyl Chloride
                       Exposure
         • Inhaled vinyl chloride has been shown to
           increase the risk of a rare form of liver
           cancer (angiosarcoma of the liver) in
           humans.
         • EPA has classified vinyl chloride as a
           Group A, human carcinogen.




The U.S. Environmental Protection Agency estimates a 1 in 1,000 chance of
contracting cancer from dioxin exposure through a typical America diet.
Results from several studies have suggested that breathing air or drinking
water containing low levels of vinyl chloride may increase the risk of getting
cancer. Brain cancer, lung cancer, and some cancers of the blood also may
be connected with breathing vinyl chloride over long periods.




                                                                                 23
If PVC Products Are Harmful…
     and They Are Found
        Everywhere...
    Are there any alternatives?




                                  24
             There Are Alternatives Available!
                           PVC – Free Toys



         •   Fabric teethers
         •   Wooden toys (with non-toxic paint)
         •   Hard plastic toys
         •   Soft teethers (phthalate free)




Fabric teethers, which are phthalate-, lead- and cadmuium free, are sold and
may be a better choice for infants. Other alternatives include wooden toys
(with non-toxic paint) and hard plastic toys. Although hard PVC can contain
lead and cadmium, most hard plastic children’s products are made from other
kinds of plastics containing fewer additives than PVC. There are also soft
teethers made from other types of plastic that do not contain phthlates.




                                                                               25
                            PVC Alternatives
               PVC – Free House
                    Materials
         •   Window profiles - wood
         •   Pipes - concrete, steel,
             galvanized iron, copper, clay
         •   Flooring - linoleum, wood,
             stone, rubber, ceramic
         •   Wall Coverings - paint, tiles,
             paper-based wallpaper
         •   Gutters - galvanized iron
         •   Shutters & Blinds - wood and
             chlorine-free plastics
         •   Furniture - wood, metal, textiles,
             leather
         •   Roof Sheeting – synthetic
             rubber, tar, wood




IKEA is no longer using PVC in the manufacture of their furniture,
wallcoverings, and textiles.
Companies such as Nike, and The Body Shop have committed to eliminating
PVC from their products.




                                                                          26
                  Summary
• PVC is potentially harmful substance contained
  in many consumer products used in homes.
• Everyone is susceptible to the effects of PVC
  exposure, however, certain populations are
  more vulnerable.
• PVC exposure can occur everywhere.
• Exposure to PVC and it’s harmful components
  can cause a variety of health effects, including
  cancer.
• There are alternatives available.




                                                     27
                             References
                                        References
•   Lundquist, P., & Ikramuddin, A. (n.d.). PVC: The most toxic plastic. Retrieved March
    15, 2003, from CHEC Web Site:
    http://www.checnet.org/healthehouse/education/articles-detail.asp?Main_ID=185
•   Polyvinyl chloride toys: Questions and answers. Retrieved March 20, 2003, from
    Canadian Child Care Federation Web Site: http://www.cfc-
    efc.ca/docs/cccf/rs047_en.htm
•   Polyvinyl chloride. Retrieved March 15, 2002, from
    http://www.psrc.usm.edu/macrog/pvc.htm
•   Polyvinyl chloride. Retrieved March 20, 2003, from Greenpeace Web Site:
    http://web.greenpeace.org/campaigns/intro?campaign_id=3988
•   PVC free solutions. Retrieved March 15, 2003, from Greenpeace Web Site:
    http://web.greenpeace.org/extra/?forward%5fdestination%5fanchor=%252fcampaigns
    %252...
•   The poison plastic. Retrieved March 15, 2002, from Greenpeace Web Site:
    http://web.greenpeace.org/extra/?forward%5fdestination%5fanchor=%252fcampaigns
    %252...
•   U.S. Department of Health and Human Services, Agency for Toxic Substances and
    Disease Registry (1997). Toxicological profile for Vinyl chloride (Rev. ed.). Atlanta:
    Sciences International Inc..




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