Toxic chemical exposures associated with food premises

Toxic chemical exposures associated with food premises
Toxic chemical exposures
associated with food premises
Catherine Keshishian
Public Health England
- Centre for Radiation, Chemical and Environmental Hazards
Overview
• About the PHE Centre for Radiation, Chemical and
Environmental Hazards
• Acute incident response
• Chronic enquiries
• Other work
• Chemical poisoning associated with food premises:
• Carbon monoxide poisoning incidents
• Other toxic gases
• Heavy metals
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About the PHE Centre for Radiation,
Chemical and Environmental Hazards
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Public Health England
• Formed on 1 April 2013 under the Health and Social Care act
2012
• Brings together public health functions, including Health
Protection Agency
• Category 1 responders under Civil Contingencies Act
“To protect and improve the nation’s health and to address
inequalities, working with national and local government, the
NHS, industry, academia, the public and the voluntary and
community sector.”
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The three domains of public health
Health Improvement
Health Protection
Healthcare Public Health
–
Inequalities
–
Infectious diseases
–
Clinical effectiveness
–
Education
–
Chemicals and poisons
–
Efficiency
–
Housing
–
Radiation
–
Service planning
–
Employment
–
–
Audit and evaluation
–
Family/community
Environmental health
hazards
–
Clinical governance
–
Lifestyles
–
Equity
–
Surveillance and
monitoring of specific
diseases and risk
factors
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–
Emergency response
* Definitions from the Faculty of Public Health, 2013
CRCE responsibilities
- Acute chemical incident response
- Chronic chemical incident response
- Emergency planning eg COMAH
- Environmental permitting & planning
- Surveillance and research
- Training
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Incident response
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Role during an acute incident
Advice to first line responders / public health:
• Health effects of chemical and environmental
hazards
• Toxicology and decontamination
• Environmental sampling, modelling and
analysis
Actions:
• Undertake public health risk assessment
• Liaise with other agencies, including multiagency groups
• Scientific and Technical Advice Cell
• Air Quality Cell
• Communications
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Public health risk assessment
Exposure assessment
Risk characterisation
Risk = Hazard x Exposure
What is the risk associated with that
exposure?
Risk
communication
Risk management
Review
Hazard identification &
hazard characterisation
Early alerting systems
Fire Services
Ambulance
services
Environment
Agency
CRCE
Local
authority
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Health
Protection
Team
Other (police,
NHS, public etc)
Recovery role
• Interpretation of sampling and
modelling results
• Environmental clean up advice
• Assess long term health effects
• exposure assessment
• epidemiology
• public meetings and
reassurance
• Support return to normality
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Chronic enquiries
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Consultations & planning
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Carbon monoxide poisoning in
restaurants and cafes
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Carbon monoxide
• Tasteless, odourless, colourless gas
• Formed during incomplete combustion of fossil fuels:
COMPLETE
carbon-based + sufficient  carbon dioxide
fuel
O2
(CO2 )
INCOMPLETE carbon-based + insufficient  carbon monoxide
fuel
O2
(CO)
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Acute CO poisoning symptoms
Immediate
• Headache
• Nausea and vomiting
• Dizziness, confusion, SOB, blurred vision, loss of consciousness,
fits, death
Long-term
• Brain damage
• Damage to heart muscle, skeletal muscle, renal failure
• Long-term neurological effects - cognitive and behavioural change
• Post-traumatic stress disorder
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Case study: Acute poisoning
•Two adults in a flat above an Indian restaurant felt ill and phoned
999
•Residents reported having flu-like symptoms and visiting GP over
a few weeks
•Fire service evacuate 7 more people from flats above
•All 9 taken to hospital with CO poisoning
•No source found in flat…
•Source was charcoal burning grill left on overnight while
ventilation switched off.
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Chronic CO poisoning symptoms
Immediate
• Flu-like illness, sore throat, cough
• Low birth weight
• Impaired memory, confusion, hearing deficiency, tiredness
 increased risk of accidents
Long-term
• Emotional, physical, mental disability
• Poor memory, concentration, poor exercise tolerance, apathy,
lethargy
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Case study: Chronic poisoning
•Woman in flat has CO detector installed, which goes off
repeatedly
•Gas engineer finds no problem in house, but detects CO in the
kitchen and seating area of restaurant below
•Gas supply to restaurant shut down
•Over next 6 months, resident’s alarm continues to sound
•Source identified as charcoal burning tandoor oven – extractor
switched off at night while charcoal smoulders
•Resolved when resident becomes so ill and calls emergency
services; local authority and CRCE involved
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Indian restaurant CO levels
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And other cuisines too!
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Home-made CO
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Shisha bars
• 12 patients admitted to hospital with CO poisoning
• Patients had been at a shisha bar, in the basement
• Ambient CO levels 440ppm (fire service)
• WHO guideline 25ppm for one hour
• Actions:
• PHE, council and fire service worked to:
• educate shisha lounge owners
• enforce health and safety
• enforce fire precautions
• Used as evidence for the PHE Shisha Toolkit
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Entertainment venues
(that serve food too)
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Other poisonous gases in catering
premises…
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Refrigerants
•What: chemical cooling agents such as ammonia, carbon dioxide,
hydrocarbons, isobutane, HCFCs and CFCs
•Where: found in fridges, freezers, vending machines, air conditioning
units
•Risks: cold burns, fires, inhalational risks…ozone layer
•Toxicity: mostly low, may cause irritation, dizziness, headaches
•Incident examples:
• 15 people evacuated after refrigerant leaked in basement of pub, two treated on
scene by ambulance for inhalation of fumes
• 33 people in Sainsburys taken ill, 50m cordon, one taken to hospital, due to
refrigerant leak
• Half tonne of ammonia leaked from fractured pipe at food processing plant. Plume
blew off-shore
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Cleaning products
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Cleaning product fumes
•What: usually chlorine; acid fumes / fizzing
•Where: anywhere!
•Risks: toxic gases, burns, strong odours
•Toxicity: depending on chemical and concentration – lung irritation, eye
irritation, unconsciousness and death (rare)
•Incident examples:
• 6 workers at a bar affected by cleaning product, with respiratory problems and
burning sensation
• Restaurant evacuated due to fumes from mixing chemicals in toilet. Sulphuric acid
mixed with something else
• Worker and 2 colleagues at food processing site, plus nurses at hospital, showing
symptoms after first worker mixed bleach and acid. Patient decontaminated; building
evacuated.
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Heavy metals and food
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Heavy metals
•What: toxic metals, such as lead,
cadmium, mercury, arsenic
•Where: naturally occurring in rocks, or
contamination from anthropogenic action
•Toxicity: depends on chemical, dose
and route of exposure. Often cumulative
•Effects: abdominal pain, anaemia, lower
IQ, neurotoxicity, adverse reproductive
outcomes, cancers…and many more
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Heavy metals
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Regulation of heavy metal
contaminants in food
•Regulation of heavy metal contaminants in food by FSA
 surveillance and monitoring
•Committee on Toxicity of Chemicals in Food, Consumer Products and the
Environment (COT); also COM (Mutagenicity) and COC (Carcinogenicity)
•Data: epidemiology, toxicology, No Observed (adverse) Effect Level (if
there is one)  establish Tolerable Daily Intake
•What other sources of exposure are there? Eg water, background levels
in air etc
•Unavoidable contaminants – what can realistically done to reduce
exposure? Eg advise limit weekly intake
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Unregulated sources in ‘food’
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Conclusions
• CRCE provides advice in chemical emergencies and to
chronic environmental enquiries
• Food premises both use and create chemicals, which
have the potential to affect public health
• Many of the chemical exposures in food premises can
be avoided with proper precautions, awareness and
training
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Contact us via your local Health
Protection Team
Surrey and Sussex: 0345 894 2944
sshpu@phe.gov.uk
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