How important is inadvertent ingestion of hazardous substances at work?

Much is known about human exposure to workplace hazardous substances by inhalation and from skin contact, but there has been little systematic research into ingestion of hazardous substances used at work. This review attempts to identify whether inadvertent ingestion of hazardous substances is an important route of exposure in the workplace and examines possible methods that could be used to quantify ingestion exposure. A number of papers highlight jobs and substances where inadvertent ingestion may be important, typically through case reports or from a theoretical analysis. These scenarios involve exposure to some metals or metal compounds, pharmaceuticals, pesticides, some infectious agents, unsealed radioactive sources and some high molecular weight allergens. In total we estimate that about 4.5 million workers in the UK could have some regular non-trivial intake of hazardous substances by inadvertent ingestion. A conceptual analysis of inadvertent ingestion exposure highlights the role of hand-to-mouth and object-to-mouth events as the primary exposure processes. Two exposure 'compartments' are defined: the peri-oral area (i.e. the area of skin around the outside of the mouth) and the oral cavity. Several options are highlighted for exposure-related measurements, including peri-oral wipes, saliva samples, mouth-rinse samples, hand-wipes and under-nail scrapings. Further research is necessary to define which measurements may be most informative. Human behaviour has a key role in determining inadvertent ingestion exposure. For example, some people are habitual nail biters or repeatedly touch their mouth, both of which will increase the chance of ingesting contaminants on their hands. The frequency that people touch their face is dependant on the circumstances of their work and probably the degree of psychological stress they are under. A proper understanding of the importance of these factors will help in designing interventions to reduce the risks from ingesting hazardous substances at work. When making inhalation or dermal exposure measurements we recommend that details of personal behaviours should be recorded so that some estimate of ingestion risks can be inferred. It is possible that inadvertent ingestion of hazardous substances at work may become more important as employers put more emphasis on controlling inhalation and dermal exposures. Further research is necessary to ensure that risk reduction strategies for inadvertent ingestion of hazardous substances are appropriate and effective.