Estimates of Inhaled and Deposited Doses following Exposure to Humidifier Disinfectant Containing Polyhexamethylene Guanidine (PHMG)

Abstract

We estimated the inhaled and deposited dose in humans using the International Commission on Radiological Protection (ICRP) and multiple-path particle dosimetry (MPPD) models following exposure to humidifier disinfectant containing polyhexamethylene guanidine (PHMG). The disinfectant has caused at least 1,810 deaths, with an odds ratio of lung injury of 47.3 (95% confidence interval: 6.1–369.7), because of its application in Korea. In this study, the Oxy product, which is regarded as the causative agent of most lung diseases, was sprayed into a cleanroom at normal (6.5 ppm in solution) and worst case (65 ppm in solution) dilutions; the airborne aerosol was monitored with direct reading instruments. Areas of deposition were divided into the head airway, tracheobronchial, and alveolar regions. Four dose scenarios were considered in this study: adults and children in both daily average and sleep conditions. Most PHMG aerosols were smaller than PM1 (96%). Number-based concentration analysis showed that <100 nm nanoparticles comprised 81% and 69% of the aerosol when the 6.5 and 65 ppm solutions were used, respectively. In all scenarios, the number-based deposited dose increased in the order of alveolar, tracheobronchial, and head airway regions; the mass-based deposited dose increased in the order of the head airway, alveolar, and tracheobronchial regions. The deposited dose per unit body weight was higher in children than in adults in terms of both number- and mass-based concentrations. When the humidifier was sprayed, the highest number-based concentration was found at a particle size of 15.4 nm; the highest deposition fraction or dose by PM1 was observed in the pulmonary and head airways in both models.