Young child crawling across the floor in a house.

Asbestos Take-Home Contamination and Household Contact Exposure

Indirect exposure may extend beyond the workplace. Dust and fibers may be carried home, resulting in exposures of household members. The exposure of household contacts has often been called “secondary”, “domestic”, “para-occupational”, and/or “take-home” exposure (Grandjean & Bach, 1986; Sahmel J. , et al., Evaluation of Take-Home Exposure and Risk Associated with the Handling of Clothing Contaminated with Chrysotile Asbestos, 2014). Furthermore, asbestos dust carried home may be retained for a considerable time and even accumulate with time. Asbestos has been identified in a home more than 20 years after the cessation of occupational exposure (Selikoff & Lee, 1978).

Dust very likely may be carried home in the hair, especially if a cap is not worn at a dusty workplace and if showering and careful hair washing are not done before changing (Grandjean & Bach, 1986). Plus, there have been cases in which workers have taken contaminated items home from work.

Grandjean and Bach (1986) suggested that large amounts of dust may be released by shaking or brushing used work clothing. Asbestos fibers released from clothing will settle onto the surfaces in the home, which provides other potential sources of exposure through re-entrainment from such activities as sweeping, vacuuming or other cleaning projects (Grandjean & Bach, 1986).

Fibers can transfer to uncontaminated clothing washed with the contaminated clothing. Fibers can also be transferred to a family members clothing or hair during various other interactions with asbestos-contaminated items (e.g., carpeting, furniture, clothing, etc.) and/or activities (such as hugging family members, laundering or handling contaminated clothing, etc.).

Although airborne concentrations are expected to be lower in homes of asbestos workers, studies have shown household contacts of asbestos workers to have tissue asbestos burdens similar to the median value for some occupational groups (Huncharek, Capotorto, & Musca, 1989; Roggli, Sharma, Butnor, Sporn, & Vollmer, 2002). Family members may be exposed to asbestos dust and fibers most of the day, all night or most of the year (Grandjean & Bach, 1986), which results in a higher overall dose than an individual exposed during a traditional 8-hour work period, all else remaining equal. According to the Finnish Institute of Occupational Health (1997), exposures such as those occurring among household members may approach occupational levels in some circumstances (Finnish Institute of Occupational Health, 1997).

Young children, because of their normal habits, are especially at risk to exposure to toxic dusts that are brought home. They commonly get into dirt and messes, put their hands in their mouth, and suck on their fingers and objects. Plus, their breathing zones are closer to dust reservoirs such as carpets and furniture and clothing when hugging family members. Furthermore, children’s respiratory and immune systems are not fully developed, which inherently increases their risk for developing an illness.

NIOSH’s Report to Congress on Workers’ Home Contamination Study (1995), which was conducted under the Workers’ Family Protection Act (29 U.S. C. 671a) concluded, “…families of asbestos-exposed workers have been at increased risk of pleural, pericardial, or peritoneal mesothelioma, lung cancer, cancer of the gastrointestinal tract, and non-malignant pleural and parenchymal abnormalities as well as asbestosis” (NIOSH, 1995; Workers’ Family Protection Act).

NIOSH (1995) indicated that several studies of asbestos workers’ families inferred that asbestos-related diseases were due to home contamination emanating from clothes contaminated at work, especially due to laundering the clothes. However, no studies evaluated the relationships between home contamination by asbestos, contamination of clothing brought home from work, and exposures during home laundering. NIOSH (1995) further reported that children were also exposed by playing in areas where asbestos-contaminated shoes and work clothes were located, or where products containing asbestos were used or stored (NIOSH, 1995).

NIOSH (1995) reported that home contamination has occurred in some cases when workers took home contaminated items from work for their own use. In one case, asbestos-contaminated cotton cloth bags that had been used to transport molded asbestos insulation were taken home by a worker and used as diapers. Three family members died of mesothelioma at an early age. Dirty clothes were also brought home (NIOSH, 1995; Li, Lockich, & Lapey, 1978).

Donovan et al. (2012) performed a review of the published literature on take-home exposure potential for asbestos. They summarized the published studies of asbestos-related disease among household contacts. They also classified these cases by industry and disease classification. The authors indicated that household contacts were linked with occupations historically characterized by the potential for high exposures to asbestos; however, they further noted that quantitative estimates of exposure levels experienced by the household contacts were unavailable (Donovan E. P., Donovan, McKinley, Cowan, & Paustenbach, 2012).

Goswami et al. (2013) evaluated epidemiologic studies of asbestos-related diseases or conditions among domestically exposed individuals and exposure studies that provide either direct exposure measurements or surrogate measures of asbestos exposure (Goswami, Craven, Dahlstrom, Alexander, & Mowat, 2013). The authors identified several case reports and case series of pleural mesothelioma, beginning with a case series of pleural mesothelioma in 1960 (Wagner, Sleggs, & Marchand, 1960). Goswami et al. (2013) also identified several epidemiological studies that evaluated asbestos-related diseases and/or conditions in domestically exposed individuals. Mesothelioma was the most common disease reported. They reported that the occupations of the workers included in the studies were primarily those associated with traditional high-risk trades (e.g., asbestos miners, asbestos factory workers, shipyard/dock workers, textile workers, furnace/engine/boiler room workers, railway carriage builders, pipefitters, and insulators). However, the authors noted that none of the epidemiologic studies reported the level of asbestos exposures experienced by the domestic cases themselves. Goswami et al. (2013) identified a total of 19 domestic exposure studies. Three of these studies reported measurements of airborne or settled dust in homes of asbestos workers; one study reported air sampling results of handling and laundering contaminated clothing; five exposure simulation studies were identified; and 10 lung burden studies related to domestic exposures were identified.

The importance of providing protective clothing (as well as change room and wash facilities) when working with or around hazardous dusts have been known for over a hundred years. In his book entitled, Safety: Methods for Preventing Occupational and Other Accidents and Disease, Tolman (1913) stated the following: “The importance of wearing suitable clothing on the premises should be strongly impressed upon workers in dangerous trades…The working-suit should be taken off before the midday meal and before leaving the factory and exchanged for the street-clothes…When dealing with dusty, poisonous materials the workman should be provided with a suitable head-dress, as poisonous dust readily adheres to hair and scalp…Employers should see the advantages of providing and maintaining suitable working-clothes for employees, where there is danger of poisoning. But, as before mentioned, the mere provision is not enough; employees must be compelled to wear them if the benefits are to be at all apparent…Of very great importance is the provision of rooms for changing clothing, with adequate washing facilities and lockers for holding both the street and working clothes. Each worker should have an appointed washing-place and a locker for his individual use. The best type of locker is one divided by a partition into two separate compartments closed by separate doors, one compartment for the working-clothes and the other for street-garments. This separation of the clothing worn inside and outside the premises is of importance in factories dealing with poisonous materials” (Tolman, 1913).

The U.S. Department of Labor (1951) issued safety and health standards in 1951 that included the requirement that, “Workers who handle or are exposed to harmful materials in such a manner that contact of work clothes with street clothes will communicate to the latter the harmful substances accumulated during working hours should be provided with facilities which will prevent this contact and also permit the free ventilation or drying of the work clothes while they are not in use” (U.S. Department of Labor, 1951)

The National Safety Council (1963) published a Data Sheet on safety procedures for handling hazardous materials in industry. This 1963 document recommended, “Good washing facilities, clean lunchrooms, and clean clothes can help prevent additional, even though minor, exposure to toxic materials. Also, contaminated work clothes should not be taken home where a toxic dust could contaminate the home or expose other members of the family” (National Safety Council, 1963).

Newhouse and Thompson (1965) published their study showing a clear association of mesothelioma among household members (children and housewives) who’s only known exposure to asbestos was contamination brought home by another household member with occupational exposure to asbestos (Newhouse & Thompson, 1965).

Harries (1968) published an article concerning the necessity of providing workers exposed to asbestos with protective clothing and respiratory protection as well as using typical engineering controls such as isolation and ventilation. He also reported mesothelioma in boilermakers, fitters, laborers, shipwrights, and welders at the shipyard he studied (Harries, 1968).

NIOSH (1972) reported cases of mesothelioma in children and housewives who washed the work clothes of family members who brought home asbestos contaminated clothing. They proposed to OSHA regulatory language to require employers to provide workers exposed to asbestos with separate “coveralls or similar full body protective clothing and hat” (NIOSH, 1972).

OSHA promulgated its individual asbestos regulation in 1972. It required issuance of protective clothing and the special handling of asbestos contaminated clothing during transport and laundering (OSHA, 1972).

Two studies conducted by NIOSH analyzed bulk samples of dust on workers’ clothing at friction product manufacturing plants (Seixas & Ordin, 1986; Driscoll & Elliott, 1990). Seixas and Ordin (1986) found chrysotile asbestos in all clothing vacuumed as employees left work at a brake shoe manufacturing facility. Driscoll and Elliott (1990) reported that asbestos contamination was found on personal clothing and automobiles in 11 of 13 (85%) of the samples. The two negative samples were from automobile seats; in one case, the car was less than a year old and not generally driven to work by the worker.

Millette (2000) examined a shirt for asbestos. The shirt was from a worker who inadvertently picked up a piece of asbestos-containing insulation and held it against his shirt. Although visual contamination of the shirt did not show gross contamination, several bundles of chrysotile asbestos were identified on the shirt. A microvac sample collected by vacuuming areas on the right and left front forearms of the shirt showed a level of asbestos fibers over 100,000 asbestos structures per square centimeter. For reference purposes, the lab report levels of asbestos structures on garments recently cleaned with wet methods as having less than 1,000 structures per square centimeter (Millette, 2000).

Selikoff and Lee (1978) described a study performed by Mount Sinai regarding asbestos workers’ homes, wherein workers were employed at asbestos factories during 1941 to 1954. Small amounts of amosite were identified in settled dust in the workers’ homes and in neighboring homes of non-asbestos workers up to 400 yards downwind of factories. The authors attributed these amosite fibers found in workers’ homes to the clothing workers brought home from the workplace (Selikoff & Lee, 1978).

There are three studies that report sampling results in homes of asbestos workers. Only two of the sources reported asbestos concentrations. The other study reported asbestos fibers in settled dust (Selikoff & Lee, 1978; Goswami, Craven, Dahlstrom, Alexander, & Mowat, 2013; WHO, 1986; National Research Council, 1984). In the study carried out by the Mount Sinai group, asbestos was found 20-25 years later in the settled dust of asbestos workers’ houses from factory operations. Selikoff and Lee (1978) stated the asbestos dust found in the settled dust of the workers’ homes was probably from workers bringing asbestos dust and fibers home on their clothes (Selikoff and Lee, 1978, pp. 117-118). This finding by Selikoff and Lee (1978) indicates that asbestos fibers and dust stay in the home for many years, even after the worker stops working with asbestos materials.

WHO (1986) reported the air concentrations in the homes of South African miners ranging from 0.002 to 0.011 f/cc with a mean of 0.006 f/cc [n=6, GSD=1.865] (WHO, 1986). Nicholson et al. (1980) found air concentrations [n=13] from over 50 to 5000 ng/m³ in the homes of chrysotile miners and millers in California and Newfoundland where homes were described as having visible fibers and dust in living areas and laundry facilities. Concentration measurements taken in the homes of non-miners were 32-65 ng/m³ (Nicholson, Rohl, Weisman, & Selikoff, 1980). Others (Goswami, Craven, Dahlstrom, Alexander, & Mowat, 2013) have converted ng/m³ to f/cc based on a conversion factor presented by the National Research Council (National Research Council, 1984); however, conversion factors are imprecise because the conversion involves assuming particular fiber dimensions, which vary greatly depending on the material, activity, environment, and other factors. None-the-less, the National Research Council (1984) cites the following conversion factor: 30 micrograms per cubic meter (µg/m³) = 1 f/cc (fibers longer than 5 µm using a light microscope). Based on this conversion factor, the 32-65 ng/m³ concentration range cited for homes of non-miners is equivalent to 0.001-0.002 f/cc. These converted results show a very small range of concentrations which suggests that the background concentration is likely at a somewhat steady-state concentration. This would be expected because there should be less variation in air concentrations as the contaminants get better-mixed in the air in the home and further away from the source(s). Furthermore, these converted results are generally the same order of magnitude as the data cited by WHO (1986).

Mangold (1984) conducted a series of experiments to determine the exposure concentrations generated solely by contaminated clothing. The results were as follows:

While wearing heavily contaminated coveralls used during rip-out of pipe insulation, the results ranged from 1.0 to 1.8 f/cc with an average of 1.4 f/cc [n=3].

While wearing medium contaminated coveralls three days before changing, the results ranged from 0.2 to 0.8 f/cc with an average of 0.5 f/cc [n=3].

While wearing lightly contaminated coveralls for three days before changing, the results ranged from 0.05 to 0.2 f/cc with an average of 0.1 f/cc [n=3].

While wearing coveralls contaminated from handling gaskets and other small asbestos parts, the results ranged from 0.03 to 0.08 f/cc with an average of 0.05 f/cc [n=3].

(Mangold, 1984)

Carter (1970) measured airborne concentrations of asbestos from asbestos-contaminated laboratory coats worn by workers who were simulating operating small machines in an unventilated room and handling, carrying, and stacking asbestos-containing cement board. He measured airborne concentrations [PCM >1.5 µm] from handling and cleaning operations between 0.3-2.4 f/cc [n=3] (Carter, 1970).

Sawyer (1977) evaluated concentrations associated with laundering clothes contaminated during the removal of an asbestos-containing ceiling. The laundry operation was examined due to its relevance to household exposures. The personal air samples resulted [by PCM analysis] in a mean fiber concentration of 0.4 f/cc with a maximum concentration of 1.2 f/cc [n=12]. The area air samples while picking of clothing and loading the washer resulted in mean concentrations of 0.4 f/cc [n=4] and 0.4 f/cc [n=5], respectively. The area air samples [n=6] collected while loading the dryer were below the limit of detection (Sawyer, 1977).

Another important aspect of laundering asbestos-contaminated clothing is that the fibers can transfer to uncontaminated clothing washed with the contaminated clothing. NIOSH (1971) conducted a series of tests on a woman’s coat consisting of 72% reprocessed wool, 20% nylon, and 8% asbestos. Wear tests with and without a simulated infant (a box with a membrane filter at the site of a child’s nose), whisk broom tests, and dry cleaning of the garment with companion clothing. The findings before and after dry cleaning the coat indicate that fibers are transferred from coat to ambient air in the wear and whisk broom tests and that fibers are transferred to companion garments during the dry-cleaning tests (NIOSH, 1971).

NIOSH (1972) conducted a test to measure the airborne concentration of asbestos generated from shaking an empty burlap bag that had contained pure asbestos. The test was conducted in a small room (4’ x 6’ x 8’) which had no ventilation. The only source of asbestos was that remaining of the bag. The personal samples during the two, four-minute tests resulted in fiber concentrations (>5 µm) of 410 and 570 f/cc. Three area air samples (collected at floor, chair, and standing levels) during the test resulted in fiber concentrations of 500, 350, and 470 f/cc, respectively (Fleming, 1972).

Two simulated exposure studies were conducted to measure airborne concentration levels during packing and re-packing boxes of brakes and clutches (Jiang, et al., 2008; Madl, Scott, Murbach, Fehling, & Finley, 2008). The studies also included air sampling during clothes handling following the simulated activities. These studies reported PCME values ranging from 0.002-0.015 f/cc during the clothes-handling activity.

For mechanics performing brake repair on heavy equipment, PCME mean values following clothes handling were 0.036 f/cc and 0.010 f/cc for primary workers and bystanders, respectively (Madl, Gaffney, Balzer, & Paustenbach, 2009).

During agitation of a brake mechanic’s coveralls following brake work, Weir et al. (2001) reported a 30-minute airborne concentration of 0.72 f/cc by PCM analysis (Weir, Tolar, & Meraz, 2001). During the experiment, clothing within the chamber was agitated for each alternating 5-minute interval, then allowed to sit at rest for the next five minutes. This schedule of agitation and rest continued for the 30-minute duration.

Longo (1999) conducted a series of experiments to estimate asbestos fiber release from contaminated clothing. Under controlled conditions, the researchers contaminated typical work clothing by handling asbestos-containing insulation. They then shook and brushed the clothes to represent the cleaning the dust off prior to placing the clothes into the washing machine. The clothes were shaken for approximately one minute. The entire operation took seven to eight minutes, which included shaking, brushing, and placing the clothes into the washing machine. Exposure concentrations [by PCM] experienced by the person handling the contaminated clothing ranged from 5.74 to 10.16 f/cc [n=8] with a mean concentration of 8.35 f/cc [n=8]. The fiber concentrations for the area air samples ranged from <0.01 to 3.27 f/cc with a median concentration of 2.06 f/cc [n=3]. Four personal samples and two area samples collected during the shaking and brushing of clothing were overloaded and were excluded from the above summary statistics; thus, the estimated mean and/or median are likely an underestimation of the actual results(Longo, 1999; Longo, 1999; Longo, 1999).

Millette (March 24, 2006) conducted a test to estimate the release of asbestos fibers from contaminated clothing. In the first test, a shirt sleeve was contaminated with approximately 0.25 grams of asbestos dust generated by sanding an asbestos gasket. The sleeve was then shaken inside a glove box. Asbestos fiber concentrations of 2.4 and 7.0 f/cc [by PCM] were measured. The TEM analysis indicated that 100% of the fibers were asbestos(Millette, 2006).

Millette (March 31, 2006) conducted a second test to measure the asbestos fibers released from contaminated clothing when worn by a worker exposed to airborne asbestos fibers generated by his using compressed air and dry sweeping to suspend approximately 1 gram of asbestos gaskets and packing dust and debris. After exposure, the clothes were handled in a clean test chamber and air samples were collected. The samples resulted in airborne concentrations of 1.7 and 2.1 f/cc [by PCM]. The TEM analysis indicated that 100% of the fibers were asbestos(Millette, 2006).

Abelmann et al. (2018) simulated laundry preparation activities following asbestos cement pipe cutting “loading” events. A total of four shake-out simulation events were performed over the course of one day. Each event involved the unfolding and shaking out of clothing from two cutting events (two shirts and two pairs of jeans for a total of four pieces of clothing). Each shake-out simulation lasted for a total of 30 minutes, during which all of the clothes handling was conducted over the course of one minute (i.e., approximately 15 seconds per article of clothing), after which there was a period of no activity. The mean PCME 30-minute asbestos concentration over all 16 shake-out simulation personal samples was 0.52 f/cc. The PCME 30-minute asbestos concentrations for the shake-out simulation personal samples ranged from 0.27 to 1.1 f/cc [n=16] (Abelmann, et al., 2018).

Sahmel et al. (2014) conducted a study to examine the take-home asbestos exposure pathway by simulating handling of work clothing contaminated with chrysotile asbestos. Two clothes-loading events involving different sets of clothing were conducted at each target concentration for 31-43 minutes. The articles of clothing were contaminated at three different airborne concentration ranges – low (0-0.1 f/cc), medium (1-2 f/cc), and high (2-4 f/cc). Prior to each loading event, mannequins were dressed in new, unwashed clothing. The authors did not report the type of clothing material

that were used in the study. The clothes-loading events were also limited to clothing contamination from airborne fibers and ignores potential contamination from direct contact from handling asbestos-containing materials. Six, 30-minute clothes-handling and shake-out events were performed during the study using the clothing that was contaminated during each loading event to simulate laundering in the home environment. Each shake-out event consisted of 15 minutes of active clothes handling, followed by an additional 15 minutes of no activity. The arithmetic mean PCM concentrations for the clothes handler during the 15-minute active clothes-handling period ranged from 0.312 to 0.687 f/cc. The arithmetic mean TEM concentrations during the 15-minute active clothes handling period ranged from 0.014 to 0.097 f/cc (Sahmel J. , et al., 2014).

Sahmel et al. (2016) conducted a subsequent study to measure airborne chrysotile concentrations associated with laundering of contaminated clothing worn during a simulated full-shift workday. Three types of clothing were utilized – new 100% cotton, new 35% cotton/65% polyester, and used 100% cotton. Work clothing fitted onto mannequins was exposed to 6.5 hours to a mean airborne concentration of 11.4 f/cc [11.1-11.7 f/cc by PCME] of chrysotile asbestos and was subsequently handled and shaken. Each handling and shakeout event consisted of 15 minutes of active clothes handling followed by a period of no activity for an additional 30 minutes (for a total of 45 minutes per event). A total of six personal samples were collected on the clothes handler during each handling and shakeout event. Specifically, one 5-minute lapel personal sample and a pair of 15-minute right and left lapel personal samples were collected during the active clothes-handling period. During the subsequent 30-minute period of no activity, one 5-minute sample was collected for the 15-20 minute time period, one 15-minute sample was collected for the 15-30 minute period, and a final sample was collected during the 30-45 minute period during each of the six clothes-handling events. The mean (PCME) five-minute and 15-minute airborne concentrations during active clothes handling and shake-out were 3.15 f/cc [1.24-6.24 f/cc] and 2.94 f/cc [1.17-5.05 f/cc], respectively. The mean (PCME) airborne concentrations during the 15 minutes of inactivity following the clothes handling and shakeout event was 1.31 f/cc [0.21-2.17 f/cc] (Sahmel J. , et al., 2016).

Sahmel et al. (2014) performed the clothes handling and shakeout testing in a negative-pressure, containment consisting of 16 feet x 16 feet x 8 feet in size with high-particulate filtration that exhausted directly to the outdoors. The ventilation rate during the study events was between 13-19 air changes per hour (ACH) (Sahmel J. , et al., 2014). During their follow-up study, Sahmel et al. (2016) performed the study events within a high-efficiency particulate air (HEPA) ventilation air filtration device (AFD) operated at a ventilation rate of 3.5 ACH based on an average the U.S. EPA reported for naturally-driven room-to-room airflow within residential buildings, as presented in the U.S. EPA’s indoor air quality monitoring program RISK, Version 1.5 (Sahmel J. , et al., 2016). However, according to various other sources (Jayjock & Havics, 2018; Sherman, 2007; Yamamoto, Shendell, Winer, & Zhang, 2010; Persily, Musser, & Emmerich, 2010), residential homes in the U.S. typically have a median ACH of 0.3/hour for whole house ventilation and 0.6/hour for inter-zonal ventilation. The User Manual for the EPA Program RISK Version 1.5 cited by Sahmel et al. (2016) provides some general conclusions regarding whole house ACH. In general, reasonable values of air exchange between the indoors and outdoors are 0.3/hour for tight construction, 0.5/hour for typical energy efficient construction, and 1.0 for construction over 30 years old (Sparks, 1996). The EPA Program RISK Version 1.5 also reports an inter-zonal (room-to-room) ACH of at least 3/hour reportedly from EPA test house experiments. Given the EPA data and analysis, some investigators estimated and used an inter-zonal ACH of 3.5/hour or 3-6/hour when modeling exposure based on the following statement: “An inter-zonal ACH of 3.5/hour is a good order of magnitude estimate for the airflow associated with a forced air system” (Sparks, 1996). However, the central fans do not run 100% of the time but only when the thermostat declares the need for heating or cooling. Furthermore, residential heating and cooling systems are often oversized for a variety of reasons, which means they can run only fraction of the time unless it is very hot or very cold outside (Jayjock & Havics, 2018).

Grandjean and Bach (1986) indicated that the extent and significance of family exposures may be considerably underestimated if evaluated only from the scattered evidence that is available (Grandjean & Bach, 1986).

Conclusions

The scientific literature and other applicable information pertaining to secondary exposures such as household contact exposures (i.e., familial and take-home exposure) indicates:

Familial exposures to hazardous dusts brought home by other family members, whose occupation brought them into contact with the dust, has been recognized for at least a least a century.

Studies have shown that working with and/or around asbestos-containing material can transfer asbestos onto the clothing and body of the individual.

Contaminated clothing can release fibers into the breathing zone of other family members.

Contaminated workers can transfer fibers to other household members’ clothing as well as furniture, towels, bedding, etc. within the household.

Asbestos dust and fibers brought in the home are regularly disturbed and re-suspended in the air from normal household and domestic activities.

Family members are exposed to airborne concentrations of asbestos as a result of coming in contact with or manipulating contaminated clothing.

Studies suggest that large amounts of dust are released by shaking or brushing used work clothing and that asbestos fibers released from clothing provide other sources of exposure through re-entrainment.

Household background contamination most likely results in on-going asbestos exposures long after the work clothes were washed.

Studies suggest that asbestos dust carried home may be retained for a considerable time and even accumulate with time.

Exposure concentrations can be substantially similar as those experienced by tradesmen working with asbestos-containing material.

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