What Instructions Should Be Given to Patients Potentially Overexposed to Arsenic?
- Learning Objective
- Introduction
- Self Care
- Preventive Messages to Avoid or Reduce the Risk of Over Exposure to Arsenic
- Preventive Messages to Help Avoid or Minimize Potential Health Effects from Over Exposure to Arsenic
- General preventive messages to reduce the risk of cancer
- Preventive Messages for Avoidance of Over Exposure to Arsenic in the Workplace
- ATSDR Patient Education Care Instruction Sheet
- Key Points
- Progress Check
Upon completion of this section, you will be able to
- describe instructions for patient self care.
Message:
Patients who may have been over exposed to arsenic through drinking water should be advised to have their well tested. They should use bottled water for drinking until their well is shown not to be a source of arsenic exposure or until appropriate water filtration systems are put in place to remove the arsenic.
Rationale:
By law, water from public supplies must be tested for arsenic. Please see drinking water standards. In areas with known high arsenic in ground or well water, private wells should be checked to determine if they are a source of arsenic exposure. Information on how to obtain testing for arsenic in well water is often available from the local health department.
Message:
Patients should be advised when using (CCA)-treated lumber in nonresidential applications to follow the warnings regarding the wearing of personal protective equipment such as gloves, eye, and respiratory protection.
Rationale:
Avoiding over exposure to known sources of arsenic in the environment is prudent. There should be a warning label with the CCA-treated lumber (if at a store or lumber yard for consumers) or at a designated place at the worksite (for employees).
Message:
Parents should be advised to have children wash their hands after playing on playground equipment made with CCA-treated lumber.
Rationale:
Avoiding over exposure to known sources of arsenic in the environment is prudent. Research is ongoing as to whether there are health risks from contact with CCA-treated lumber now in use. Children who play on playground equipment made of CCA–treated lumber may have higher than normal background levels of arsenic on their hands. Hand washing after playground visits is recommended.
Message:
Patients should be advised to consider applying a sealant on existing exposed CCA-treated lumber surfaces annually.
Rationale:
Prevention of the release of arsenic from CCA-treated lumber already in place may be accomplished by annual application of a sealant. The U.S. Environmental Protection Agency (EPA does not currently recommend the removal of CCA-treated lumber. EPA has more information on this on its Website, provided in the next section.
Message:
The patient should contact the health department for assistance if a source of arsenic over exposure is not identified.
Rationale:
Where the source of arsenic over exposure is not identified, a concerted effort must be made to identify it. Assistance may be obtained form the local health department.
Message:
Patients should be advised to maintain a well-balanced diet rich in selenium, other antioxidants, and folate.
Rationale:
There is evidence that mal- or undernourishment affects arsenic metabolism. There is also evidence that selenium is antagonistic to arsenic. Methyl donors such as folate may help in arsenic metabolism and excretion. Therefore, a diet rich in selenium and other antioxidants may prevent arsenic toxicity.
Message:
Avoid ingestion of Hijiki seaweed as it has been found to have high levels of inorganic arsenic.
Rationale:
Avoiding dietary sources of inorganic arsenic is prudent toward avoiding arsenic toxicity.
Message:
Patients should contact their doctor if they develop signs of health changes.
Rationale:
Early detection and treatment may improve prognosis.
Message:
Patients should be advised to stop smoking. They should also be informed that smoking along with arsenic over exposure increases the risk for developing lung cancer.
Rationale:
Smoking causes lung cancer. Studies have shown that smoking coupled with arsenic inhalation or ingestion can increase the risk of developing lung cancer. Smoking cessation may help reduce lung cancer risk.
Message:
Limit sun exposure.
Use sunscreen.
Rationale:
Limiting sun exposure and use of sunscreen may decrease the risk of skin cancer. Arsenic-induced skin cancers and the probable combined roles of arsenic exposure and UVB radiation in producing skin lesions has been reported [Yu et al. 2006].
Message:
Patients should be encouraged to discuss their concerns regarding prevention of hazardous exposures at the workplace with their employer and/or workplace health and safety representative.
Rationale:
OSHA’s health hazard risk communication standard requires covered employers to educate their employees on health hazards in the workplace and how to prevent them. See OSHA Website for more specifics on the health hazard risk communication standard. URL: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=standards&p_id=10099
ATSDR has developed a patient education, care instruction sheet on arsenic toxicity that you might find useful. It can be found at http://www.atsdr.cdc.gov/csem/arsenic/patient_education.html.