Formal(in)dehyde exposure

[Thanatopsis]

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Hi all,

Un-ironically (see name, chosen before med school if you can believe it) I'm very interested in pathology. The irony comes in the knowing this without having done a pathology rotation yet (MS4 who will be doing a transitional year). My questions may be simple; I want to know how you mitigate your exposure to formaldehyde in the lab. Are masks worn? Do you work under a hood? Is there some kind of negative pressure ventilation? Are formaldehyde levels monitored regularly? You're not embalming; are the ppm too low to warrant worry?

I am less worried about cutaneous exposure than lung exposure as I quite enjoy increasing my cardiac output. Do any of you know pathologists who maintain a rigorous fitness regiment?

Thanks for your help!

 

[mlw03]

Yeah, I know a pathologist who "maintains a rigorous fitness regimen" --> dr mlw (i run, half marathons and marathons). formalin exposure is not a concern unless you're a pregnant woman in your first trimester. grossing is (or at least should be) done under a negative pressure hood. some people gross with masks on, most do not. i've never seen formalin levels formally monitored.

 

[Thanatopsis]

Thanks for the reply (and the spelling correction)!

 

[mlw03]

No spelling correction. I believe formaldehyde used to be used as a fixative, but now the standard is 10% buffered formalin, which I think is supposed to be a safer product than formaldehyde. This really is a non-issue, unless you have major respiratory disease that could be aggravated by formalin or embalming fluids. One of my forensic path friends does have asthma and she struggles with autopsies of embalmed decedents, which are sometimes necessary in both forensic path (also did a few in residency).

 

[Thanatopsis]

Regimen, not regiment, was the correct word, so it would be more appropriate to thank you for the word substitution.

Glad to hear it's a non-issue if by all indicators your lungs aren't pissed off already.

 

[Entgegen]

Agree, shouldn't be an issue if you don't already have problems. One of my co-residents has asthma and she had a pretty bad reaction at one point and now just wears an n95 mask.

 

[Pathologee]

The only real side effect is that, if you are a guy, all of your future children will be girls. You can't have boys. Formalin kills that y chromosome.

Also, homeschooling is not all its cracked up to be.

 

[Ombret]

I think that formalin is formaldehyde plus water, so everyone is right in terms of vocabulary. I'm not certain that formalin fumes are filtered out by N95 or any other mask; aren't those for catching particles (and droplets, but we're still talking macromolecules)? But for sure, with a mask on you will smell your own breath instead of the formalin. Could be worse, depending.

OSHA mandates that labs maintain safe airborne formalin levels, so your lab will have taken various measures to mitigate exposure. These mainly involve air handling (negative pressure, air filters) and source control (using less, keeping it covered and not having it right next to people's faces). I think labs are mandated to do badge monitoring at set intervals. I know I got monitored once at random, and my current department monitors the PGY-1s at least once in their first year.

In any case, at realistic (and legal) occupational levels, you are not going to be formalin-fixing your own lungs. No one really knows the adverse effects of formalin exposure, which suggests they are minimal (or someone would have noticed). There is a paper out there that talks about increased risk of sinonasal adenocarcinoma, but how many pathologists have had that? In terms of the experience of being around formalin, some people are very sensitive to it at baseline, like the asthmatic mentioned below. You can apparently get sensitized to it by a big exposure. One of our residents spilled a bunch on himself and afterward, was much less tolerant of it. But overall, if you are interested in pathology, don't have second thoughts because of the formalin issue, because it looms less large than you might expect.

 

[KCShaw]

👍

Monitoring is supposed to be occasionally performed, but to my knowledge it is very rarely above the maximum recommended/required level, even after dumping out a big gross bucket on a table in the middle of an autopsy room, with just a little quick wash. That doesn't mean it's not a little nasty on the lungs at times if you lean over and get a good whiff, but most of your work is done in a ventilated area with some sort of air intake limiting your exposure (particularly gross stations). I'm pretty sure there are articles addressing this, including career/lifetime risks, as someone already mentioned.

I got more than a good whiff a couple of times which messed up my eyes for a few hours, and sinuses and the back of my throat for a day or two, but that was rare and probably stupid related. I also found a cut glove with a fingertip full of formalin a couple of times, which led to some very dry and unappealing skin for probably a week or so. But, no lasting damage that I'm aware of. And I know, or know of, a number of highly active pathologists who reported no problems I'm aware of; the better question these days is probably how PA's/grossing techs do after 20+ years of formalin, as the average pathologist doesn't spend 8 hrs a day working with formalin -- even residents only do that for limited stretches -- but some PA's do.

 

[Blind Guy]

We got monitored once...got an 8 hour exposure in 15 minures. It was obviously the residents' fault. The just told us to stop breathing, and it would be ok.