Section 3.4. Counseling and Prevention

After completing this section, you will be able to

• identify suitable self-care for patients exposed to tetrachloroethylene,
• identify clinical follow-up for patients exposed to tetrachloroethylene, and
• describe how to counsel patients appropriately on how to avoid further exposure to tetrachloroethylene.

All patients exposed to tetrachloroethylene need basic guidance on

• self-care, so they can minimize further risks and avoid complications to the extent possible and
• clinical follow-up, so they understand when and why to return for further medical attention.

Advise patients to avoid exposures and conditions that might further increase their risk for disease or worsen their existing condition(s).

High levels of exposure can occur during cleanup of contaminated equipment and spills, and might require use of an approved full-face piece self-contained breathing apparatus or similar device. Industries and businesses should establish procedures for spill cleanup in advance, including capping all containers of liquid tetrachloroethylene and storing rags soaked with tetrachloroethylene in sealed containers.

In occupational exposures, the law requires employers or manufacturers to provide pertinent safety data sheets (SDS). The SDS for a chemical product lists its ingredients, describes their potential toxicity, and suggests precautions for safe use.

Advice on self-care for the patient might include the following:

At home

• Use safer alternatives to products with tetrachloroethylene
• When using products containing tetrachloroethylene, ensure plenty of airflow/ventilation (e.g. opening all windows and using fans)
• Use appropriate PPE that protects against tetrachloroethylene (e.g., wear a proper respirator or protective gloves, or both) when using products that contain tetrachloroethylene [NIOSH 2018, OSHA 2005]

At work

• OSHA’s Hazard Communication Standard [OSHA 2012] requires employers to provide labeling, SDS, and safety training on use of chemicals in the workplace.
• Be sure to use the employer-supplied personal protective equipment: gloves, goggles, mask, and respirator as recommended.
• Read employer-provided SDS on products that you use.
• Be sure all containers of chemicals used at work are properly labeled.
• Attend employer-provided training on how to use chemicals safely at work.

Scientific studies have implicated tetrachloroethylene as a probable cause of several types of cancers, including bladder cancer and non-Hodgkin’s lymphoma. Periodic clinical evaluation may help detect abnormalities at an early stage, if they occur. This would also be true for other tetrachloroethylene-related health effects. Consultation with a specialist in occupational and environmental medicine or others with expertise and experience treating patients exposed to tetrachloroethylene may help you develop a periodic monitoring plan, as appropriate.

Patient counseling on the importance of exposure mitigation and ways to reduce exposure risk would be prudent, along with instructions to consult you or another physician if concerns about exposure arise.

Advise patients to consult you or another physician if they develop signs or symptoms of

• CNS disorders or
• other health changes (especially those possibly related to liver and kidney problems).

Please refer to the following online resources for more information on the adverse effects of tetrachloroethylene, the treatment of tetrachloroethylene poisoning, and management of persons exposed to tetrachloroethylene. You may also contact ATSDR (see URLs provided below), your state and local health departments, and university medical centers.

For emergency situations, call CDC Emergency Response: 770-488-7100. To report an oil or chemical spill, call EPA Emergency Response: 800-424-8802.

For non-emergency situations, call CDC-INFO: 1-800-CDC-INFO (1-800-232-4636); TTY 888-232-6348 24 hours/day email: cdcinfo@cdc.gov.

PLEASE NOTE: ATSDR cannot respond to questions about individual medical cases, provide second opinions, or make specific recommendations regarding therapy. Patients should address those issues directly with a health care provider.

ATSDR Toxicological Profile for Tetrachloroethylene https://www.atsdr.cdc.gov/toxprofiles/TP.asp?id=265&tid=48

ToxFAQs™ for Tetrachloroethylene https://www.atsdr.cdc.gov/toxfaqs/TF.asp?id=264&tid=48

Other Sources of Information

Association of Occupational and Environmental Clinics http://www.aoec.org

American College of Occupational and Environmental Medicine http://www.acoem.org

American College of Medical Toxicologists http://www.acmt.net

American College of Preventive Medicine http://www.acpm.org

ATSDR Information Center https://www.atsdr.cdc.gov/contacts.html The National Institute for Occupational Safety and

Health (NIOSH) https://www.cdc.gov/niosh/hhe/

Other CSEMs

“Case Studies in Environmental Medicine: Tetrachloroethylene Toxicity” is one monograph in a series. To view the “Taking an Exposure History” or “Taking a Pediatric Exposure History” CSEMs and other publications in this series, please go to https://www.atsdr.cdc.gov/csem/csem.html.

• Physicians should advise patients to avoid tetrachloroethylene exposures and factors that might further increase their risk for disease or worsen their existing condition(s).
• Physicians should advise patients to contact them or another physician if they develop neurological problems or other health changes.