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Leslie Cizmas, Ph.D.

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Environmental Health Management in Schools

Purpose of Training• Learn about school-related

environmental exposures and control measures– Asthma and allergy triggers

– Airborne contaminants

– Pests and pesticides

– Lead

– Mercury

– Asbestos

– PCBs

– Ultraviolet radiation2

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What is Environmental Health?

–First define the environment:

… All things external to the host.

Water

Food

PersonalCare Products

HouseholdChemicals

Indoor AirContaminants

Industrial

Lifestyle

ASTHMA AND ALLERGY TRIGGERS

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Asthma Trends• Asthma prevalence is increasing in the

US: 7.3% in 2001; 8.4% in 2010

5Source: CDC/NCHS, National Health Interview Survey, NCHS Data Brief, http://www.cdc.gov/nchs/data/databriefs/db94.htm

Asthma Trends

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Source: CDC/NCHS, NCHS Data Brief, No. 94, 2012, Trends in Asthma Prevalence

Asthma prevalence by selected demographic characteristics, USA, average annual 2008-2010

(Higher income)

(Lower income)

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Asthma facts

• According to the CDC:– 1 in 11 children had asthma in 2010

– asthma caused 10.5 million missed school days per year (2008 data)

– 1 in 5 children with asthma went at least once per year to an emergency dept. for care related to asthma (2009 data)

– Less than 1 in 2 children get an asthma action plan

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Asthma facts

• In Texas, an estimated 538,000 children had current asthma in 2009

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Source: Texas Asthma Plan, 2011-2014, Texas Asthma Control Program, 2012

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9Source: CDC, Asthma in TX, CDC’s National Asthma Control Program

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Source: CDC, Asthma in TX, CDC’s National Asthma Control Program

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11Source: CDC, Asthma in TX, CDC’s National Asthma Control Program

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Source: CDC, Asthma in TX, CDC’s National Asthma Control Program

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Smoke

• Cigarette smoke

• Secondhand smoke

• Smoke from fires

• Avoid exposure

• Consider all settings

where a child spends

time

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Dust mites

• Reduce clutter• Frequently clean

cloth covered items

• Dust with moist cloth or polish

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Dust mites• Frequently clean

stuffed toys: dust mites, dust, other allergens

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Mold• Inspect for moisture

regularly

• Fix leaks quickly

• Dry wet areas within 48 hr

• Keep indoor air between 30-60% humidity

• If you see mold clean it with:– detergent and water for hard

surfaces

– Cloth may need replacement

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From EPA.gov

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Animal dander

• With pets, it’s the dander, not the fur –(fur length does not matter)

• If a pet in the classroom:– Wash frequently

– Vacuum often

– Damp mop once a week

Pests

• Cockroaches and their droppings are asthma triggers

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Other Triggers for Asthma

• Exercise

• Up to approx. age 10-12, allergy becomes a more important part of asthma each year

• At age 10-12, about 80-90 % of asthmatic children will have allergic triggers 19

Indoor Air Quality (IAQ)

• IAQ Tools for Schools

• Developed by EPA to:– Save $$

– Improve health

– Reduce absenteeism

• http://www.epa.gov/iaq/schools/

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IAQ Tools for Schools

– http://www.epa.gov/iaq/schools/actionkit.html

– See Health Officer/School Nurse Checklist

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INTEGRATED PEST MANAGEMENT (IPM)

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IPM

• IPM: pest control strategy using the least hazardous techniques and chemicals

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IPM in Texas School Districts

• Rule §7.150– IPM Program Must Contain

• School Board Approved IPM Policy – School district’s commitment to follow guidelines

• Definition of IPM

• Reference to Texas Laws on Pesticide use in schools

• Information about who can apply pesticides on school district property

• Information on required training for the school district’s IPM coordinator

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IPM in Texas Schools

• Rule §7.150– IPM Program Must Contain

• Pest monitoring system to determine when corrective action needs to occur

• Preferential use of lower risk pesticides and non-chemical management to control pests

• Record keeping system for inspection reports, work orders, pest control service reports, pesticide applications, and pesticide complaints.

• Plan for educating and informing school district employees about their roles in IPM

IPM in Texas School Districts

• Rule §7.150– Pesticide Use in School Districts

• Schools that engage in pest control must employ or contract a licensed applicator

• All pesticides used on school district property must be in compliance with school IPM program

• Pest control signs must be posted 48 hours before pesticide application indoors or if outside a sign must be displayed at the time of application

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IPM in Texas School Districts

• Rule §7.150– Pesticide Use in School Districts

• Pesticide mixing must occur away from student occupied areas

• Pesticide should not be applied if potential drift could occur

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Pest needs:(and temperature)

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IPM

– Water: • fix water leaks

• In kitchens, inspect drains

– Harborage:• Remove clutter (piles of paper, boxes, old art

projects, etc.)

• Empty and completely clean desks, lockers twice per year

• Clutter helps hide pests

• Spiders, cockroaches and mice love clutter

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IPM

• Everyone plays a role in IPM!– Food:

• Clean up food, crumbs, candy – crumbs attract ants and cockroaches

• Keep food in tightly sealed containers or refrigerator

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IPM– Pest-proofing:

• Size of hole needed to enter:– Mice: size of index finger

– Rats: 2 fingers

• Report cracks and crevices in walls, floors, windows, under doors, holes in screens

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IPM

• Pest-proofing:– Exterior doors all need sweeps

– If you can pull a piece of paper under a door when it is shut, pests can enter

– Properly adjusted sweeps can dramatically reduce pest complaints

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IPM

• Everyone plays a role!– administrators

– staff

– students

– parents

• IPM rules apply to school gardens too

• Communication, education important

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Illegal Pesticides

• Illegal pesticides are common and can be very toxic– Illegal pesticides may look similar to legal

products, may be sold in stores or on street

– Consumers may be unaware they are illegal and unsafe

– Labels have not been reviewed for safety warnings and clear directions

– Product not reviewed for effectiveness, safety

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Illegal Pesticides

Airplane Powder

(methyl parathion) Note: This is often sold without any writing on the baggie

Chinese Chalk

Illegal mothballs

Photo: http://www.epa.gov/opp00001/health/illegalproducts/

from http://www.epa.gov/opp00001/health/illegalproducts/chalk.htm

Avoiding Illegal Pesticides• Pesticides should

always be in original, labeled container

• Look for EPA Registration number and list of active ingredients on container (required)

• Check that label says the pesticide is approved for the intended use (e.g., indoors for a particular pest)

Example: pesticide label

from http://www.epa.gov/opp00001/regulating/labels/pest-label-training/module4/page15.html

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PROTECT CHILDREN FROM LEAD POISONING

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Update on lead guidelines from CDC

• As of 2012, CDC recommends public health actions be initiated if a child’s blood lead levels are over 5 µg/dl (was 10 µg/dl)

• There may not be a “safe” level of lead exposure for children

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Lead Toxicity in Children

• Potential effects in children (0-6 years most affected) include:– Damage to the brain, nervous system

– Behavior and learning problems, e.g., hyperactivity, reduced IQ

– Slowed growth

– Hearing problems

– Headaches

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• Children can be affected even if they look healthy

Lead Toxicity in Adults

• Potential effects in adults:– Anemia

– Hypertension

– Kidney damage

– Neurological effects including difficulty concentrating, fatigue

– Reproductive effects including miscarriages, reduced sperm count and motility

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Lead: Sources/Control• Greta, Azarcon (also called

Rueda, Coral, Maria Luisa, Alarcon, Liga)

• Families should not use these folk remedies

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− Contain up to 90% or more of lead; very toxic

− Symptoms of lead poisoning can be similar to empacho – tiredness, sleeplessness, stomachache, vomiting

− Can lead to severe lead toxicity

Lead Sources/Control

• Most common lead hazards in schools:– Lead-based paint

– Lead dust

– Contaminated soil

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Lead: Sources/Control

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• Lead in paint & lead dust− Paint dust/chips can contaminate dust and soil

− Wash floors and window sills

− Children should wash hands with soap & water before they eat

− Get children tested for lead by their doctor

− If the school plans to paint, repair or renovate, a structure built before 1979, use caution: improper methods can increase lead exposure. See http://epa.gov/lead/pubs/leadinfo.htm.

Lead Sources/Control

• Contaminated soil– Plant grass or cover with other material

– Ingestion of contaminated soil is the greatest concern; have children wash hands with soap and water before eating

– For information on soil testing: contact the Texas Department of State Health Services

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Lead: Sources/Control

• Other sources of lead in the environment:

– Vinyl mini blinds

• Sunlight and heat can break these down and release contaminated dust

• Use lead-free mini blinds or curtains

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Lead: Sources/Control– Lead in water pipes and drinking

water

• Even plumbing that is legally “lead-free” may contain up to 8% lead

• Use only cold water for drinking and cooking

• Don’t drink water that has sat in plumbing for more than 6 hours - let it run for at least one minute before use

• For more information on testing your water, call EPA‛s Safe Drinking Water Hotline at 800-426-4791.

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Lead: Sources/Control• Some Mexican candies and candy

wrappers contain excessive lead, e.g.:– Some candies containing chili

– Some salt-based powdered snack mix products

– Tamarind pulp packaged in lead-glazed bowls

• You can’t see or taste lead in candy

• U.S. FDA recommends that children, pregnant women should not eat candy from Mexico

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Lead: Sources/Control

• Toys and jewelry • Pottery, leaded crystal used

for food

• Certain occupations, e.g.: – Automotive/radiator repair

– Lead smelting, soldering

– Welding

– Valve, pipe fittings

– Brass/copper foundry

– Battery production 50

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Lead: Sources/Control

• Sources of lead in the environment:

– Certain hobbies such as making pottery or jewelry, work with stained glass, refinishing furniture, work with fishing weights, firing range/reloading bullets

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Lead Sources/Control• Actions to take if a parent’s

work or hobby is a source of lead exposure:

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• shower or change clothes, preferably before returning home

• change shoes before entering home• wash contaminated clothes separately from

other clothes• protect the inside of cars with blankets or

sheets• keep children away from hobby areas

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KEEP CHILDREN AND MERCURY APART

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Methylmercury in Fish and Shellfish

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Health effects of methylmercury:• Methylmercury is most harmful to the developing

brain of fetuses and young children• can affect how they think, learn and solve problems

later in life• Adults can also be affected (tingling or numbness of

fingers, toes, tongue, lips; blurry vision, fatigue)

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Methylmercury

• CH3Hg+

• Form of mercury that biomagnifies

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Hg

mea

n c

on

cen

trat

ion

(p

pb

)

Mercury in fish

• See:

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http://www.nrdc.org/health/effects/mercury/walletcard.PDF

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Mercury in personal care products

• Some creams for lightening skin have high levels of mercury (e.g.: Crema de Belleza-Manning, Crema Aguamary; and others)

• High exposures to these can damage the GI tract, brain, nervous system and kidneys

• Symptoms: include irritability, tremors, muscle aches and weakness, extreme fatigue, sores in mouth, skin rashes, mood changes, memory loss, weight loss, high blood pressure

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Crema Aguamary

• Crema Aguamary• Mercury has also been found in at least one

soap in New York (“Jabon Germicida”)

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Mercury in personal care products

• Actions you can take:– Before using personal care products:

• Make sure the ingredients are printed on the label

• Make sure mercury is not an ingredient

– Females should be especially careful if they are pregnant or may become pregnant – mercury can cause brain damage and malformations in the fetus even if the mother doesn’t have symptoms

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Compact fluorescent light bulbs

• Compact fluorescent light bulbs (CFLs) contain elemental (metallic) mercury that can be released if the bulb breaks

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Comparison of LightingLED CFL Incandescent

Average life span (hours) 50,000 8,000 1,200

Electricity used (Watts) for 60W bulb equivalent

6-8 13-15 60

Electricity used (kW/year) for 30 bulbs

329 767 3,285

Annual Cost (30 bulbs) $32.85 $76.65 $329.59

Contains Hg No Yes No

RoHS compliant Yes No Yes

CO2 emissions(lbs/year for 30 bulbs)

451 1,051 4,500

Sensitive to humidity No Yes Some

Turns on instantly Yes No Yes

Price 2012 (1, 60W eq) $9.99 -34.97 $2.99-15.99 $0.49-9.25

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• Don’t use CFLs in lamps that might get knocked over

• Store CFLs in the original packaging

• Always hold the bulb by its base, not the glass tubing

• Never force the bulb to turn in the socket

• When changing a CFL, place a cloth under the light fixture in case the bulb falls and breaks –this will make it easier to clean up

• Consider using LED bulbs or standard light bulbs where bulbs may be broken

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Tips for not breaking CFLs

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Cleaning up a broken CFL or fluorescent bulb

• Before cleanup:– Keep people and pets away from the area until

cleanup complete; don’t let anyone walk through it

– Open the windows; shut doors to other parts of house, and leave the room for 15 minutes before beginning cleanup

– Shut off the heater/air conditioner

During cleanup:

– Clean up all broken pieces and dust: use stiff paper or cardboard to clean up larger pieces & the sticky side of duct tape to clean up smaller pieces, then wipe with damp cloth to clean any dust

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Cleaning up a broken CFL or fluorescent bulb

• To clean up a broken CFL:– Put all waste materials and anything used to clean

up the broken bulb in a closed container, preferably a glass jar with a metal screw top lid

– Store the sealed container with the broken bulb and cleanup materials in a safe place outside the home, away from children

– Wash your hands

– Leave the window open and heater/air conditioner off for several hours

– After this cleanup, open the windows the next several times you vacuum

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• When cleaning up mercury, never:– Never use an ordinary vacuum cleaner

– Never use a broom

– Never wash clothes or other items that have been in direct contact with mercury in a washing machine

– Never walk around in shoes that might be contaminated with mercury

– Never pour mercury down a drain 65

Mercury thermometers

• Mercury thermometers (that have silver liquid) contain about 100 times more mercury than a CFL bulb

• Replace mercury thermometers with digital thermometers

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Disposal of mercury-containing items

• No one should hold or play with mercury

• Keep pets away from areas near spills

• Never throw mercury thermometers, CFL bulbs or fluorescent bulbs in the trash and never burn them

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School Chemical Management and Inventory

• Many schools have chemicals that are unnecessary, outdated, unknown, or improperly stored

• Some of these are extremely hazardous, e.g., mercury

• Toolkit and resources for safe chemical management:www.epa.gov/schools/chemicals.html

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ASBESTOS

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Asbestos Exposure

• Until 1970s, widely used in construction, e.g.:– Insulation products– Boilers– Resilient floor tiles– Adhesives used for flooring– Cement pipe– Laboratory furniture– Heat-protective pads– Roofing products

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Asbestos• Has been used widely in construction

materials:– Shingles for roofing and siding

– Insulation for boilers, pipes

– Ceiling and floor tiles

– Also a contaminant in vermiculite insulation from Libby, MT

Pictures from EPA (http://www2.epa.gov/asbestos/protect-your-family-asbestos-contaminated-vermiculite-insulation)

Asbestos

• Still in many products (read the label or contact the manufacturer):– Automobile clutches

– Brake pads

– Vinyl tile

– Roofing materials

– Vinyl tile

– Imported cement pipe

– Corrugated sheeting 72

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Asbestos & Health

• Problems caused by fibers that are inhaled

• Increased risk of:

– Lung cancer

– Mesothelioma

– Asbestosis

• Adverse health effects do not appear for 20 to 30 years after exposure

• Little health risk from undamaged, non-friable asbestos that is monitored in place, undisturbed

Asbestos Hazard Emergency Response Act (AHERA)

• Requires public school districts and non-profit schools to:– inspect buildings for asbestos

– prepare asbestos management plans

• This plan must be updated with information from:– periodic surveillance every 6 months

– re-inspection every 3 years

– every time a response action is taken in the school

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Asbestos Hazard Emergency Response Act (AHERA)

• Plan files must include records of annual notifications to parents, teachers and staff about the availability of the asbestos management plan

• Act states that:– Employees dealing with asbestos must be

trained and accredited

Asbestos National Emission Standards for Hazardous Air

Pollutants (NESHAP) • Designed to protect the public from

exposure to airborne asbestos

• Regulates: – Renovation and Demolition of Buildings

– Removal Requirements

– Transportation

– Disposal

– Requirements for manufacturing operations that still use asbestos

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POLYCHLORINATED BIPHENYLS (PCBs)

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What are Polychlorinated Biphenyls (PCBs)?

• Set of 209 related hazardous chemicals

• Do not readily break down

• Previously used in:– caulk to give flexibility

– light ballasts as insulators

– transformers

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What are Polychlorinated Biphenyls (PCBs)?

• Processing or use of PCBs banned in 1979

• Found in buildings built/remodeled before 1980

• Has not been found in single-family homes, only apartment complexes and other buildings including schools

PCBs in Schools

• Found in:– caulk

– masonry next to windows

– paint

– contaminated soil or air

– light ballasts in old lighting systems

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PCBs in Schools

• How children are exposed: – Breathing contaminated air or dust

– Touching caulk or contaminated soil • Increased risk for children who put their hands

in their mouths

– Airborne exposure to PCBs if the light ballast containing PCBs breaks or fails

PCBs in Schools

• PCB Health Effects – Bioaccumulation in children:

• Damage to the: – Immune system

– Reproductive system

– Nervous system

– Endocrine systems

– Probably human carcinogen

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What can be done about PCBs in schools?

• Improve ventilation if possible

• Avoid touching PCB-containing caulk

• Remove dust frequently using wet cloths

• Use vacuums with HEPA filters

• Wash hands with soap, water before eating

What can be done about PCBs in schools?

• Wash surfaces, window sills, walls, toys etc. in rooms known to have PCBs

• Replace old lighting systems: – Failure rate for light ballasts increases

significantly when they are near the end of their life span (fires or PCB leaks)

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What can be done about PCBs in schools?

– Typical life span for of magnetic fluorescent light ballast 10-15 yrs

– PCB release due to sudden rupture of these ballasts is expensive and difficult to clean up

What NOT to do

• Do not use dry brooms or dusters –they spread the dust and increase airborne levels

• Do not remove PCB-containing caulk by yourself

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What can be done about PCBs in schools?

• For more information about PCBs: – Call EPA PCB contact Jim Sales, phone:

214-665-6796

– Call EPA’s Toxic Substances Control Act (TSCA) Hotline at 1-888-835-5372

RADON

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Radon

• The leading cause of lung cancer in non-smokers

• EPA recommends testing all schools for radon

• Pressure differences cause buildings to act like a vacuum, drawing in radon from soil

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Source:www.dshs.state.tx.us/radiation/pdffiles/TXCOUNTI.pdf

Mason, Llano counties

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Radon

• Radon levels can vary greatly from building to building: the only way to know your radon level is to test

• Radon Hotline (purchase test kits):

• 1-800-SOS-RADON

• Radon Helpline (questions):

• 1-800-55RADON

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UV PROTECTION

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UV Protection

• Minimize sun exposure 10 am to 4 pm • Promote culture of sun safety• Ask parents for hats, sunscreen• Encourage use of protective clothing• Insect repellent should be applied

separately• 75% higher risk of melanoma with indoor

tanning before age 35 (CDC)

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