Polyvinyl Chloride PVC

The Hidden Home Hazard A Guide for Health Care Professionals

Wendy L. Thompson BSN, RN

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, its 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 its 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.

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 its 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.

Polyvinyl Chloride
Naturally hard substance Used in many consumer products Contains potentially harmful chemicals that alter its natural characteristics including DEHP (diethylhexyl 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.

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.

PVC In Our Homes Dioxin

PVC is one of the worlds 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 persons resistance to bacterial, fungal, and other infectious agents. This immunosuppression may also increase a persons 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.

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 its 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.

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.

Toxicokinetics of Polyvinyl Chloride

Metabolism
Cytochrome P-450 monooxygenases

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

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.

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Who is at Risk for Polyvinyl Chloride exposure?

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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.

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Where Can One Be Exposed to Polyvinyl Chloride?

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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.

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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 ATSDRs 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.

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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.

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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.

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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 didnt 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, childrens toys rarely have a label indicating the type of plastic they contain. If a toy is in its 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.

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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 EPAs 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.

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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 PVCs 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.

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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 Raynauds 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.

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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.

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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.

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If PVC Products Are Harmful and They Are Found Everywhere...

Are there any alternatives?

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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 childrens 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.

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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.

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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 its harmful components can cause a variety of health effects, including cancer. There are alternatives available.

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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.cfcefc.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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