Health survey of employees regularly using 3D printers

Health survey of employees regularly using 3D printers Abstract Background 3D printers emit potentially hazardous ultrafine particles and volatile organic compounds. Workers using 3D printing technologies may be at risk of respiratory illness from occupational exposure. Aims To assess whether 3D printing is associated with health effects in occupational users. Methods This was a preliminary survey. Workers in 17 companies using 3D printing, including commercial prototyping businesses, educational institutions and public libraries, in the Greater Toronto Area, Canada, were asked to complete survey questionnaires concerning demographic, occupational and health information. Associations between self-reported health history variables and occupational characteristics were examined by chi-square and Fisher’s exact tests. Results Among 46 surveyed workers, 27 (59% of participants) reported having respiratory symptoms at least once per week in the past year. Working more than 40 h per week with 3D printers was significantly associated with having been given a respiratory-related diagnosis (asthma or allergic rhinitis) (P < 0.05). We observed a wide variation in occupational hygiene practices in the 17 printing workplaces that we surveyed. Conclusions Our finding of frequently reported respiratory symptoms suggests a need for additional studies on exposed workers in this field. 3D printing, asthma, respiratory, ultrafine particles, volatile organic compounds Introduction The term 3D printing encompasses various technologies that share a layer-by-layer basis of product fabrication using 3D computer-aided design. Its popularity has been led by the advent of inexpensive, consumer-grade printers, most of which use fused deposition modelling, a technology that involves melting and extrusion of filaments to form the product [1]. The heating of materials at temperatures >200°C [2] could expose users to hazardous aerosols and thermal decomposition products. Recently, there have been studies examining the emission of ultrafine particles (UFPs) (<100-nm diameter) and volatile organic compounds (VOCs) from 3D printer operation [2–4]. UFPs are thought to exert unique respiratory, allergic and cardiovascular toxicities [5]. There has been a case report of hypersensitivity pneumonitis associated with nylon powder used in 3D printing [6] and a case report of asthma associated with 3D printing [7], as well as two cases of contact dermatitis [8]. This study was a pilot investigation that aimed to evaluate any links between occupational 3D printing use and detrimental health outcomes. Methods Workers who were directly involved in the maintenance and use of 3D printers or regularly exposed to their operation were surveyed. A questionnaire capturing demographic, occupational and health history (Supplementary data available at Occupational Medicine Online) was offered in person to consenting individuals at sites using 3D printing that had been identified by online searching in the Greater Toronto Area. Data collection occurred from May to June 2016. Informed consent was obtained verbally and in writing. The study protocol was granted ethical approval by an academic hospital in Toronto and administrative approval by a public university in Canada. Analyses were performed using IBM SPSS 22. Proportions were compared by chi-square or Fisher’s exact tests to determine if occupational characteristics were associated with participants’ health histories. Results We approached 24 locations, of which 17 (71%) consented to participate, three (13%) expressed an interest but did not follow up and four (17%) declined to participate. From the surveyed locations, 46 completed questionnaires by employees were obtained (100% of workers present on visit days). There were approximately seven employees not present on the survey dates who did not participate. All participants had reported exposures to 3D printers in their work. Of the 46 workers, 80% were male with a median age of 26 years (interquartile range 24–30 years). Demographic and occupational characteristics of study participants are shown in Table 1. Current cigarette smokers comprised 13% of the surveyed participants, and 24% of participants were previous smokers. Most surveyed workers (78%) were employed at commercial prototyping businesses. In total, seven commercial prototyping businesses, seven educational institutions (universities and colleges) and three public libraries were surveyed. Polylactic acid (PLA) (45%), acrylonitrile butadiene styrene (ABS) (19%) and nylon (16%) were the most commonly used printing materials reported by employees with knowledge of these materials. Fifty-two per cent of participants reported not using any form of personal protective equipment (PPE). Table 1. Demographic and occupational characteristics of study participants n (%) or median (IQR) Demographic characteristics (n = 46)  Gender   Male 37 (80)   Female 9 (20)  Age 26 (24–30)  Educational background   Elementary school 1 (2)   High school 6 (13)   College/trades degree 4 (9)   Bachelor’s degree 27 (59)   Graduate/professional degree 8 (17)  Smoking   Current smoker 6 (13)   Quit more than 1 year 5 (11)   Never smoked 35 (76) Occupational characteristics (n = 46)  Worksite category   Commercial prototyping service 36 (78)   Educational institution 7 (15)   Public library 3 (7)  Years in current position in 3D printing company (n = 45)a   <1 19 (41)   1 to < 3 17 (37)   3–5 2 (4)   >5 7 (15)  Hours worked per week with 3D printers   <20 19 (41)   20–40 18 (39)   >40 9 (20)  Tasks responsible for in workplace   Loading/pouring raw powder materials in printers 17 (37)   Direct handling of precursor materials with bare hands 25 (54)   Cleaning/maintaining ventilation equipment 12 (26)   Cleaning/maintaining floors and surfaces in studio 30 (65)   Applying glazes/coats/paints to finished prints 16 (35)   Cleaning/maintenance of printers 34 (74)   Creating 3D prints 37 (80)   Drafting and design of prints 28 (61)   Sanding/smoothing finished parts 27 (59)   Disposal of raw materials/paints/glaze 27 (59)   Other (including paperwork, handling of printing materials, client consultation, gluing, soldering) 12 (26)  Personal protective equipment used   Respirator or mask 16 (35)   Eye protection 15 (33)   Gloves or skin protection 17 (37)   Other 11 (24)   None 24 (52) n (%) or median (IQR) Demographic characteristics (n = 46)  Gender   Male 37 (80)   Female 9 (20)  Age 26 (24–30)  Educational background   Elementary school 1 (2)   High school 6 (13)   College/trades degree 4 (9)   Bachelor’s degree 27 (59)   Graduate/professional degree 8 (17)  Smoking   Current smoker 6 (13)   Quit more than 1 year 5 (11)   Never smoked 35 (76) Occupational characteristics (n = 46)  Worksite category   Commercial prototyping service 36 (78)   Educational institution 7 (15)   Public library 3 (7)  Years in current position in 3D printing company (n = 45)a   <1 19 (41)   1 to < 3 17 (37)   3–5 2 (4)   >5 7 (15)  Hours worked per week with 3D printers   <20 19 (41)   20–40 18 (39)   >40 9 (20)  Tasks responsible for in workplace   Loading/pouring raw powder materials in printers 17 (37)   Direct handling of precursor materials with bare hands 25 (54)   Cleaning/maintaining ventilation equipment 12 (26)   Cleaning/maintaining floors and surfaces in studio 30 (65)   Applying glazes/coats/paints to finished prints 16 (35)   Cleaning/maintenance of printers 34 (74)   Creating 3D prints 37 (80)   Drafting and design of prints 28 (61)   Sanding/smoothing finished parts 27 (59)   Disposal of raw materials/paints/glaze 27 (59)   Other (including paperwork, handling of printing materials, client consultation, gluing, soldering) 12 (26)  Personal protective equipment used   Respirator or mask 16 (35)   Eye protection 15 (33)   Gloves or skin protection 17 (37)   Other 11 (24)   None 24 (52) IQR, interquartile range. aOne missing value. View Large Table 1. Demographic and occupational characteristics of study participants n (%) or median (IQR) Demographic characteristics (n = 46)  Gender   Male 37 (80)   Female 9 (20)  Age 26 (24–30)  Educational background   Elementary school 1 (2)   High school 6 (13)   College/trades degree 4 (9)   Bachelor’s degree 27 (59)   Graduate/professional degree 8 (17)  Smoking   Current smoker 6 (13)   Quit more than 1 year 5 (11)   Never smoked 35 (76) Occupational characteristics (n = 46)  Worksite category   Commercial prototyping service 36 (78)   Educational institution 7 (15)   Public library 3 (7)  Years in current position in 3D printing company (n = 45)a   <1 19 (41)   1 to < 3 17 (37)   3–5 2 (4)   >5 7 (15)  Hours worked per week with 3D printers   <20 19 (41)   20–40 18 (39)   >40 9 (20)  Tasks responsible for in workplace   Loading/pouring raw powder materials in printers 17 (37)   Direct handling of precursor materials with bare hands 25 (54)   Cleaning/maintaining ventilation equipment 12 (26)   Cleaning/maintaining floors and surfaces in studio 30 (65)   Applying glazes/coats/paints to finished prints 16 (35)   Cleaning/maintenance of printers 34 (74)   Creating 3D prints 37 (80)   Drafting and design of prints 28 (61)   Sanding/smoothing finished parts 27 (59)   Disposal of raw materials/paints/glaze 27 (59)   Other (including paperwork, handling of printing materials, client consultation, gluing, soldering) 12 (26)  Personal protective equipment used   Respirator or mask 16 (35)   Eye protection 15 (33)   Gloves or skin protection 17 (37)   Other 11 (24)   None 24 (52) n (%) or median (IQR) Demographic characteristics (n = 46)  Gender   Male 37 (80)   Female 9 (20)  Age 26 (24–30)  Educational background   Elementary school 1 (2)   High school 6 (13)   College/trades degree 4 (9)   Bachelor’s degree 27 (59)   Graduate/professional degree 8 (17)  Smoking   Current smoker 6 (13)   Quit more than 1 year 5 (11)   Never smoked 35 (76) Occupational characteristics (n = 46)  Worksite category   Commercial prototyping service 36 (78)   Educational institution 7 (15)   Public library 3 (7)  Years in current position in 3D printing company (n = 45)a   <1 19 (41)   1 to < 3 17 (37)   3–5 2 (4)   >5 7 (15)  Hours worked per week with 3D printers   <20 19 (41)   20–40 18 (39)   >40 9 (20)  Tasks responsible for in workplace   Loading/pouring raw powder materials in printers 17 (37)   Direct handling of precursor materials with bare hands 25 (54)   Cleaning/maintaining ventilation equipment 12 (26)   Cleaning/maintaining floors and surfaces in studio 30 (65)   Applying glazes/coats/paints to finished prints 16 (35)   Cleaning/maintenance of printers 34 (74)   Creating 3D prints 37 (80)   Drafting and design of prints 28 (61)   Sanding/smoothing finished parts 27 (59)   Disposal of raw materials/paints/glaze 27 (59)   Other (including paperwork, handling of printing materials, client consultation, gluing, soldering) 12 (26)  Personal protective equipment used   Respirator or mask 16 (35)   Eye protection 15 (33)   Gloves or skin protection 17 (37)   Other 11 (24)   None 24 (52) IQR, interquartile range. aOne missing value. View Large Table 2 shows recent symptoms and previous diagnoses. Respiratory symptoms were the most common among participants (59%): symptoms of nasal congestion (26%); rhinorrhoea (20%); cough (20%); and itchiness of the nose, throat or eyes (20%) were the most often reported. Twenty per cent reported cutaneous symptoms, particularly dry skin or pruritus of the hands. Some participants reported alleviation of their symptoms while away from work, but no significant trends were observed. Asthma was the most frequent previous diagnosis, reported by 10 (22%) participants. When symptoms or diagnoses were assessed in relation to hours worked per week, having a previous respiratory diagnosis, including asthma or allergic rhinitis, was significantly associated with working >40 h per week with 3D printers compared with working 40 h or less per week (56 versus 16% P < 0.05). There was no evidence of an association between use of any specific materials, polymers or printing technologies with respondents’ health histories. Table 2. Symptoms and past diagnoses of study participants n (%) Symptoms experienced more than once per week in the past year  Any symptoms 30 (65)   Respiratory symptoms 27 (59)a    Upper respiratory symptoms 17 (37)     Rhinorrhoea 9 (20)     Itchy nose/throat/eyes 9 (20)     Nasal congestion 12 (26)     Sneezing 1 (2)    Lower respiratory symptoms 14 (30)     Shortness of breath 7 (15)     Cough 9 (20)     Wheeze 3 (7)     Chest tightness 4 (9)   Headaches 8 (17)   Cutaneous 9 (20)    Dry/cracked skin on hands 9 (20)    Blistered, itchy, red, bleeding and/or swollen skin on hands 3 (7) Previous physician diagnoses  Any respiratory or cutaneous diagnosis 14 (30)  Respiratory 11 (24)b   Asthma 10 (22)   Allergic rhinitis 1 (2)  Cutaneous 3 (7)   Hives/urticaria 1 (2)   Allergic contact dermatitis 1 (2)   Irritant contact dermatitis 1 (2)   Atopic dermatitis/eczema 1 (2) n (%) Symptoms experienced more than once per week in the past year  Any symptoms 30 (65)   Respiratory symptoms 27 (59)a    Upper respiratory symptoms 17 (37)     Rhinorrhoea 9 (20)     Itchy nose/throat/eyes 9 (20)     Nasal congestion 12 (26)     Sneezing 1 (2)    Lower respiratory symptoms 14 (30)     Shortness of breath 7 (15)     Cough 9 (20)     Wheeze 3 (7)     Chest tightness 4 (9)   Headaches 8 (17)   Cutaneous 9 (20)    Dry/cracked skin on hands 9 (20)    Blistered, itchy, red, bleeding and/or swollen skin on hands 3 (7) Previous physician diagnoses  Any respiratory or cutaneous diagnosis 14 (30)  Respiratory 11 (24)b   Asthma 10 (22)   Allergic rhinitis 1 (2)  Cutaneous 3 (7)   Hives/urticaria 1 (2)   Allergic contact dermatitis 1 (2)   Irritant contact dermatitis 1 (2)   Atopic dermatitis/eczema 1 (2) aWe specifically excluded symptoms for one case of apparent respiratory infection and one case of seasonal allergies. bThe proportion of workers reporting a respiratory diagnosis was increased in those working >40 h per week compared with those working <40 h per week (P < 0.05). View Large Table 2. Symptoms and past diagnoses of study participants n (%) Symptoms experienced more than once per week in the past year  Any symptoms 30 (65)   Respiratory symptoms 27 (59)a    Upper respiratory symptoms 17 (37)     Rhinorrhoea 9 (20)     Itchy nose/throat/eyes 9 (20)     Nasal congestion 12 (26)     Sneezing 1 (2)    Lower respiratory symptoms 14 (30)     Shortness of breath 7 (15)     Cough 9 (20)     Wheeze 3 (7)     Chest tightness 4 (9)   Headaches 8 (17)   Cutaneous 9 (20)    Dry/cracked skin on hands 9 (20)    Blistered, itchy, red, bleeding and/or swollen skin on hands 3 (7) Previous physician diagnoses  Any respiratory or cutaneous diagnosis 14 (30)  Respiratory 11 (24)b   Asthma 10 (22)   Allergic rhinitis 1 (2)  Cutaneous 3 (7)   Hives/urticaria 1 (2)   Allergic contact dermatitis 1 (2)   Irritant contact dermatitis 1 (2)   Atopic dermatitis/eczema 1 (2) n (%) Symptoms experienced more than once per week in the past year  Any symptoms 30 (65)   Respiratory symptoms 27 (59)a    Upper respiratory symptoms 17 (37)     Rhinorrhoea 9 (20)     Itchy nose/throat/eyes 9 (20)     Nasal congestion 12 (26)     Sneezing 1 (2)    Lower respiratory symptoms 14 (30)     Shortness of breath 7 (15)     Cough 9 (20)     Wheeze 3 (7)     Chest tightness 4 (9)   Headaches 8 (17)   Cutaneous 9 (20)    Dry/cracked skin on hands 9 (20)    Blistered, itchy, red, bleeding and/or swollen skin on hands 3 (7) Previous physician diagnoses  Any respiratory or cutaneous diagnosis 14 (30)  Respiratory 11 (24)b   Asthma 10 (22)   Allergic rhinitis 1 (2)  Cutaneous 3 (7)   Hives/urticaria 1 (2)   Allergic contact dermatitis 1 (2)   Irritant contact dermatitis 1 (2)   Atopic dermatitis/eczema 1 (2) aWe specifically excluded symptoms for one case of apparent respiratory infection and one case of seasonal allergies. bThe proportion of workers reporting a respiratory diagnosis was increased in those working >40 h per week compared with those working <40 h per week (P < 0.05). View Large We observed marked differences in the 17 occupational printing sites we visited, especially for commercial prototyping businesses. Some operated as professional, large-scale manufacturers with workplace safety protocols, such as using enclosed, ventilated printing environments and PPE. In contrast, there were prototyping services using basic printing equipment fulfilling orders for small businesses and hobbyists. Often, prototyping services incorporated other methods of manufacturing; we encountered workers whose duties included welding, soldering, laser cutting and sanding. Discussion Our pilot study found that respiratory symptoms were often reported by workers using 3D printing. Fifty-nine per cent reported respiratory symptoms, 20% cutaneous symptoms and 17% headaches occurring more than once per week in the past year. We noted that individuals working for >40 h per week with 3D printing were more likely to report a previous respiratory-related diagnosis including asthma or allergic rhinitis. Little has been published about respiratory disease associated with 3D printing. However, there have recently been case reports of a worker who developed asthma while using ABS filaments with 3D printing [7] and of a worker who developed hypersensitivity pneumonitis while exposed to 3D printing using nylon filaments [6]. 3D printing is associated with emission of VOCs, including styrene [2], a possible respiratory sensitizer and carcinogen, from ABS; methyl methacrylate [3], a respiratory and dermal sensitizer and respiratory irritant, from PLA; and caprolactam [2,4], a potential inducer of contact dermatitis, from nylon [9]. We noted marked differences in the exposure environments and control measures in various 3D printing environments. Short et al. have published a guide reviewing chemical hazards and environmental concerns in rapid prototyping environments and current occupational safety guidelines [10]. From our assessment of 3D printing workplaces, there are no standardized safety guidelines that are widely implemented in this setting. Weaknesses of our study include a small sample size and cross-sectional design. Additionally, our study lacked a non-exposed control group, and we developed our own (non-validated) questionnaire to assess health effects in this work sector. Larger prospective studies would be helpful in the future. We observed that some 3D printing workers reported respiratory symptoms, but there has been little published evidence supporting a causal association. While our survey is the first examining potential health effects associated with 3D printing exposure, further studies in this nascent field are needed. Key points 3D printing generates ultrafine particles and volatile organic compounds that may have adverse effects on workers. In this study, 3D printing users reported respiratory symptoms including upper and lower respiratory tract symptoms. Working >40 h per week with 3D printers was significantly associated with a previous respiratory-related diagnosis, including asthma or allergic rhinitis. Funding The study was supported in part by the Centre for Research Expertise in Occupational Diseases, funded by the Ontario Ministry of Labour, and Felix Chan was supported in part by a summer student award from Institute of Medical Science, University of Toronto and the Centre for Research Expertise in Occupational Disease. Competing interests None declared. References 1. Gibson I. Additive Manufacturing Technologies: 3D Printing, Rapid Prototyping, and Direct Digital Manufacturing . In: Rosen DSB , ed. New York, NY : Springer , 2015 . 2. Azimi P , Zhao D , Pouzet C , Crain NE , Stephens B . Emissions of ultrafine particles and volatile organic compounds from commercially available desktop three-dimensional printers with multiple filaments . Environ Sci Technol 2016 ; 50 : 1260 – 1268 . Google Scholar CrossRef Search ADS PubMed 3. Steinle P . Characterization of emissions from a desktop 3D printer and indoor air measurements in office settings . J Occup Environ Hyg 2016 ; 13 : 121 – 132 . Google Scholar CrossRef Search ADS PubMed 4. Floyd EL , Wang J , Regens JL . Fume emissions from a low-cost 3-D printer with various filaments . J Occup Environ Hyg 2017 ; 14 : 523 – 533 . Google Scholar CrossRef Search ADS PubMed 5. Health Effects Institute (HEI) Review Panel on Ultrafine Particles . HEI Perspectives 3: Understanding the Health Effects of Ambient Ultrafine Particles . Boston, MA: HEI , 2013https://www.healtheffects.org/system/files/Perspectives3.pdf (23 February 2018, date last accessed). 6. Johannes J , Rezayat T , Wallace WD , Lynch JP . Chronic hypersensitivity pneumonitis associated with inhaled exposure to nylon powder for 3-D printing: a variant of nylon flock worker’s lung disease ? Am J Respir Crit Care Med 2016 ; 193 : A7071 . 7. House R , Rajaram N , Tarlo SM . Case report of asthma associated with 3D printing . Occup Med (Lond) 2017 ; 67 : 652 – 654 . Google Scholar CrossRef Search ADS PubMed 8. Creytens K , Gilissen L , Huygens S , Goossens A . A new application for epoxy resins resulting in occupational allergic contact dermatitis: the three-dimensional printing industry . Contact Dermat 2017 ; 77 : 349 – 351 . Google Scholar CrossRef Search ADS 9. TOXNET: Hazardous Substances Data Bank (HSDB) . U.S. National Library of Medicine . Caprolactam. https://toxnet.nlm.nih.gov/newtoxnet/hsdb.htm ( 23 February 2018 , date last accessed). 10. Short DB , Sirinterlikci A , Badger P , Artieri B . Environmental, health, and safety issues in rapid prototyping . Rapid Prototyp J 2015 ; 21 : 105 – 110 . Google Scholar CrossRef Search ADS © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Occupational Medicine Oxford University Press

Health survey of employees regularly using 3D printers

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© The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com
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Abstract

Abstract Background 3D printers emit potentially hazardous ultrafine particles and volatile organic compounds. Workers using 3D printing technologies may be at risk of respiratory illness from occupational exposure. Aims To assess whether 3D printing is associated with health effects in occupational users. Methods This was a preliminary survey. Workers in 17 companies using 3D printing, including commercial prototyping businesses, educational institutions and public libraries, in the Greater Toronto Area, Canada, were asked to complete survey questionnaires concerning demographic, occupational and health information. Associations between self-reported health history variables and occupational characteristics were examined by chi-square and Fisher’s exact tests. Results Among 46 surveyed workers, 27 (59% of participants) reported having respiratory symptoms at least once per week in the past year. Working more than 40 h per week with 3D printers was significantly associated with having been given a respiratory-related diagnosis (asthma or allergic rhinitis) (P < 0.05). We observed a wide variation in occupational hygiene practices in the 17 printing workplaces that we surveyed. Conclusions Our finding of frequently reported respiratory symptoms suggests a need for additional studies on exposed workers in this field. 3D printing, asthma, respiratory, ultrafine particles, volatile organic compounds Introduction The term 3D printing encompasses various technologies that share a layer-by-layer basis of product fabrication using 3D computer-aided design. Its popularity has been led by the advent of inexpensive, consumer-grade printers, most of which use fused deposition modelling, a technology that involves melting and extrusion of filaments to form the product [1]. The heating of materials at temperatures >200°C [2] could expose users to hazardous aerosols and thermal decomposition products. Recently, there have been studies examining the emission of ultrafine particles (UFPs) (<100-nm diameter) and volatile organic compounds (VOCs) from 3D printer operation [2–4]. UFPs are thought to exert unique respiratory, allergic and cardiovascular toxicities [5]. There has been a case report of hypersensitivity pneumonitis associated with nylon powder used in 3D printing [6] and a case report of asthma associated with 3D printing [7], as well as two cases of contact dermatitis [8]. This study was a pilot investigation that aimed to evaluate any links between occupational 3D printing use and detrimental health outcomes. Methods Workers who were directly involved in the maintenance and use of 3D printers or regularly exposed to their operation were surveyed. A questionnaire capturing demographic, occupational and health history (Supplementary data available at Occupational Medicine Online) was offered in person to consenting individuals at sites using 3D printing that had been identified by online searching in the Greater Toronto Area. Data collection occurred from May to June 2016. Informed consent was obtained verbally and in writing. The study protocol was granted ethical approval by an academic hospital in Toronto and administrative approval by a public university in Canada. Analyses were performed using IBM SPSS 22. Proportions were compared by chi-square or Fisher’s exact tests to determine if occupational characteristics were associated with participants’ health histories. Results We approached 24 locations, of which 17 (71%) consented to participate, three (13%) expressed an interest but did not follow up and four (17%) declined to participate. From the surveyed locations, 46 completed questionnaires by employees were obtained (100% of workers present on visit days). There were approximately seven employees not present on the survey dates who did not participate. All participants had reported exposures to 3D printers in their work. Of the 46 workers, 80% were male with a median age of 26 years (interquartile range 24–30 years). Demographic and occupational characteristics of study participants are shown in Table 1. Current cigarette smokers comprised 13% of the surveyed participants, and 24% of participants were previous smokers. Most surveyed workers (78%) were employed at commercial prototyping businesses. In total, seven commercial prototyping businesses, seven educational institutions (universities and colleges) and three public libraries were surveyed. Polylactic acid (PLA) (45%), acrylonitrile butadiene styrene (ABS) (19%) and nylon (16%) were the most commonly used printing materials reported by employees with knowledge of these materials. Fifty-two per cent of participants reported not using any form of personal protective equipment (PPE). Table 1. Demographic and occupational characteristics of study participants n (%) or median (IQR) Demographic characteristics (n = 46)  Gender   Male 37 (80)   Female 9 (20)  Age 26 (24–30)  Educational background   Elementary school 1 (2)   High school 6 (13)   College/trades degree 4 (9)   Bachelor’s degree 27 (59)   Graduate/professional degree 8 (17)  Smoking   Current smoker 6 (13)   Quit more than 1 year 5 (11)   Never smoked 35 (76) Occupational characteristics (n = 46)  Worksite category   Commercial prototyping service 36 (78)   Educational institution 7 (15)   Public library 3 (7)  Years in current position in 3D printing company (n = 45)a   <1 19 (41)   1 to < 3 17 (37)   3–5 2 (4)   >5 7 (15)  Hours worked per week with 3D printers   <20 19 (41)   20–40 18 (39)   >40 9 (20)  Tasks responsible for in workplace   Loading/pouring raw powder materials in printers 17 (37)   Direct handling of precursor materials with bare hands 25 (54)   Cleaning/maintaining ventilation equipment 12 (26)   Cleaning/maintaining floors and surfaces in studio 30 (65)   Applying glazes/coats/paints to finished prints 16 (35)   Cleaning/maintenance of printers 34 (74)   Creating 3D prints 37 (80)   Drafting and design of prints 28 (61)   Sanding/smoothing finished parts 27 (59)   Disposal of raw materials/paints/glaze 27 (59)   Other (including paperwork, handling of printing materials, client consultation, gluing, soldering) 12 (26)  Personal protective equipment used   Respirator or mask 16 (35)   Eye protection 15 (33)   Gloves or skin protection 17 (37)   Other 11 (24)   None 24 (52) n (%) or median (IQR) Demographic characteristics (n = 46)  Gender   Male 37 (80)   Female 9 (20)  Age 26 (24–30)  Educational background   Elementary school 1 (2)   High school 6 (13)   College/trades degree 4 (9)   Bachelor’s degree 27 (59)   Graduate/professional degree 8 (17)  Smoking   Current smoker 6 (13)   Quit more than 1 year 5 (11)   Never smoked 35 (76) Occupational characteristics (n = 46)  Worksite category   Commercial prototyping service 36 (78)   Educational institution 7 (15)   Public library 3 (7)  Years in current position in 3D printing company (n = 45)a   <1 19 (41)   1 to < 3 17 (37)   3–5 2 (4)   >5 7 (15)  Hours worked per week with 3D printers   <20 19 (41)   20–40 18 (39)   >40 9 (20)  Tasks responsible for in workplace   Loading/pouring raw powder materials in printers 17 (37)   Direct handling of precursor materials with bare hands 25 (54)   Cleaning/maintaining ventilation equipment 12 (26)   Cleaning/maintaining floors and surfaces in studio 30 (65)   Applying glazes/coats/paints to finished prints 16 (35)   Cleaning/maintenance of printers 34 (74)   Creating 3D prints 37 (80)   Drafting and design of prints 28 (61)   Sanding/smoothing finished parts 27 (59)   Disposal of raw materials/paints/glaze 27 (59)   Other (including paperwork, handling of printing materials, client consultation, gluing, soldering) 12 (26)  Personal protective equipment used   Respirator or mask 16 (35)   Eye protection 15 (33)   Gloves or skin protection 17 (37)   Other 11 (24)   None 24 (52) IQR, interquartile range. aOne missing value. View Large Table 1. Demographic and occupational characteristics of study participants n (%) or median (IQR) Demographic characteristics (n = 46)  Gender   Male 37 (80)   Female 9 (20)  Age 26 (24–30)  Educational background   Elementary school 1 (2)   High school 6 (13)   College/trades degree 4 (9)   Bachelor’s degree 27 (59)   Graduate/professional degree 8 (17)  Smoking   Current smoker 6 (13)   Quit more than 1 year 5 (11)   Never smoked 35 (76) Occupational characteristics (n = 46)  Worksite category   Commercial prototyping service 36 (78)   Educational institution 7 (15)   Public library 3 (7)  Years in current position in 3D printing company (n = 45)a   <1 19 (41)   1 to < 3 17 (37)   3–5 2 (4)   >5 7 (15)  Hours worked per week with 3D printers   <20 19 (41)   20–40 18 (39)   >40 9 (20)  Tasks responsible for in workplace   Loading/pouring raw powder materials in printers 17 (37)   Direct handling of precursor materials with bare hands 25 (54)   Cleaning/maintaining ventilation equipment 12 (26)   Cleaning/maintaining floors and surfaces in studio 30 (65)   Applying glazes/coats/paints to finished prints 16 (35)   Cleaning/maintenance of printers 34 (74)   Creating 3D prints 37 (80)   Drafting and design of prints 28 (61)   Sanding/smoothing finished parts 27 (59)   Disposal of raw materials/paints/glaze 27 (59)   Other (including paperwork, handling of printing materials, client consultation, gluing, soldering) 12 (26)  Personal protective equipment used   Respirator or mask 16 (35)   Eye protection 15 (33)   Gloves or skin protection 17 (37)   Other 11 (24)   None 24 (52) n (%) or median (IQR) Demographic characteristics (n = 46)  Gender   Male 37 (80)   Female 9 (20)  Age 26 (24–30)  Educational background   Elementary school 1 (2)   High school 6 (13)   College/trades degree 4 (9)   Bachelor’s degree 27 (59)   Graduate/professional degree 8 (17)  Smoking   Current smoker 6 (13)   Quit more than 1 year 5 (11)   Never smoked 35 (76) Occupational characteristics (n = 46)  Worksite category   Commercial prototyping service 36 (78)   Educational institution 7 (15)   Public library 3 (7)  Years in current position in 3D printing company (n = 45)a   <1 19 (41)   1 to < 3 17 (37)   3–5 2 (4)   >5 7 (15)  Hours worked per week with 3D printers   <20 19 (41)   20–40 18 (39)   >40 9 (20)  Tasks responsible for in workplace   Loading/pouring raw powder materials in printers 17 (37)   Direct handling of precursor materials with bare hands 25 (54)   Cleaning/maintaining ventilation equipment 12 (26)   Cleaning/maintaining floors and surfaces in studio 30 (65)   Applying glazes/coats/paints to finished prints 16 (35)   Cleaning/maintenance of printers 34 (74)   Creating 3D prints 37 (80)   Drafting and design of prints 28 (61)   Sanding/smoothing finished parts 27 (59)   Disposal of raw materials/paints/glaze 27 (59)   Other (including paperwork, handling of printing materials, client consultation, gluing, soldering) 12 (26)  Personal protective equipment used   Respirator or mask 16 (35)   Eye protection 15 (33)   Gloves or skin protection 17 (37)   Other 11 (24)   None 24 (52) IQR, interquartile range. aOne missing value. View Large Table 2 shows recent symptoms and previous diagnoses. Respiratory symptoms were the most common among participants (59%): symptoms of nasal congestion (26%); rhinorrhoea (20%); cough (20%); and itchiness of the nose, throat or eyes (20%) were the most often reported. Twenty per cent reported cutaneous symptoms, particularly dry skin or pruritus of the hands. Some participants reported alleviation of their symptoms while away from work, but no significant trends were observed. Asthma was the most frequent previous diagnosis, reported by 10 (22%) participants. When symptoms or diagnoses were assessed in relation to hours worked per week, having a previous respiratory diagnosis, including asthma or allergic rhinitis, was significantly associated with working >40 h per week with 3D printers compared with working 40 h or less per week (56 versus 16% P < 0.05). There was no evidence of an association between use of any specific materials, polymers or printing technologies with respondents’ health histories. Table 2. Symptoms and past diagnoses of study participants n (%) Symptoms experienced more than once per week in the past year  Any symptoms 30 (65)   Respiratory symptoms 27 (59)a    Upper respiratory symptoms 17 (37)     Rhinorrhoea 9 (20)     Itchy nose/throat/eyes 9 (20)     Nasal congestion 12 (26)     Sneezing 1 (2)    Lower respiratory symptoms 14 (30)     Shortness of breath 7 (15)     Cough 9 (20)     Wheeze 3 (7)     Chest tightness 4 (9)   Headaches 8 (17)   Cutaneous 9 (20)    Dry/cracked skin on hands 9 (20)    Blistered, itchy, red, bleeding and/or swollen skin on hands 3 (7) Previous physician diagnoses  Any respiratory or cutaneous diagnosis 14 (30)  Respiratory 11 (24)b   Asthma 10 (22)   Allergic rhinitis 1 (2)  Cutaneous 3 (7)   Hives/urticaria 1 (2)   Allergic contact dermatitis 1 (2)   Irritant contact dermatitis 1 (2)   Atopic dermatitis/eczema 1 (2) n (%) Symptoms experienced more than once per week in the past year  Any symptoms 30 (65)   Respiratory symptoms 27 (59)a    Upper respiratory symptoms 17 (37)     Rhinorrhoea 9 (20)     Itchy nose/throat/eyes 9 (20)     Nasal congestion 12 (26)     Sneezing 1 (2)    Lower respiratory symptoms 14 (30)     Shortness of breath 7 (15)     Cough 9 (20)     Wheeze 3 (7)     Chest tightness 4 (9)   Headaches 8 (17)   Cutaneous 9 (20)    Dry/cracked skin on hands 9 (20)    Blistered, itchy, red, bleeding and/or swollen skin on hands 3 (7) Previous physician diagnoses  Any respiratory or cutaneous diagnosis 14 (30)  Respiratory 11 (24)b   Asthma 10 (22)   Allergic rhinitis 1 (2)  Cutaneous 3 (7)   Hives/urticaria 1 (2)   Allergic contact dermatitis 1 (2)   Irritant contact dermatitis 1 (2)   Atopic dermatitis/eczema 1 (2) aWe specifically excluded symptoms for one case of apparent respiratory infection and one case of seasonal allergies. bThe proportion of workers reporting a respiratory diagnosis was increased in those working >40 h per week compared with those working <40 h per week (P < 0.05). View Large Table 2. Symptoms and past diagnoses of study participants n (%) Symptoms experienced more than once per week in the past year  Any symptoms 30 (65)   Respiratory symptoms 27 (59)a    Upper respiratory symptoms 17 (37)     Rhinorrhoea 9 (20)     Itchy nose/throat/eyes 9 (20)     Nasal congestion 12 (26)     Sneezing 1 (2)    Lower respiratory symptoms 14 (30)     Shortness of breath 7 (15)     Cough 9 (20)     Wheeze 3 (7)     Chest tightness 4 (9)   Headaches 8 (17)   Cutaneous 9 (20)    Dry/cracked skin on hands 9 (20)    Blistered, itchy, red, bleeding and/or swollen skin on hands 3 (7) Previous physician diagnoses  Any respiratory or cutaneous diagnosis 14 (30)  Respiratory 11 (24)b   Asthma 10 (22)   Allergic rhinitis 1 (2)  Cutaneous 3 (7)   Hives/urticaria 1 (2)   Allergic contact dermatitis 1 (2)   Irritant contact dermatitis 1 (2)   Atopic dermatitis/eczema 1 (2) n (%) Symptoms experienced more than once per week in the past year  Any symptoms 30 (65)   Respiratory symptoms 27 (59)a    Upper respiratory symptoms 17 (37)     Rhinorrhoea 9 (20)     Itchy nose/throat/eyes 9 (20)     Nasal congestion 12 (26)     Sneezing 1 (2)    Lower respiratory symptoms 14 (30)     Shortness of breath 7 (15)     Cough 9 (20)     Wheeze 3 (7)     Chest tightness 4 (9)   Headaches 8 (17)   Cutaneous 9 (20)    Dry/cracked skin on hands 9 (20)    Blistered, itchy, red, bleeding and/or swollen skin on hands 3 (7) Previous physician diagnoses  Any respiratory or cutaneous diagnosis 14 (30)  Respiratory 11 (24)b   Asthma 10 (22)   Allergic rhinitis 1 (2)  Cutaneous 3 (7)   Hives/urticaria 1 (2)   Allergic contact dermatitis 1 (2)   Irritant contact dermatitis 1 (2)   Atopic dermatitis/eczema 1 (2) aWe specifically excluded symptoms for one case of apparent respiratory infection and one case of seasonal allergies. bThe proportion of workers reporting a respiratory diagnosis was increased in those working >40 h per week compared with those working <40 h per week (P < 0.05). View Large We observed marked differences in the 17 occupational printing sites we visited, especially for commercial prototyping businesses. Some operated as professional, large-scale manufacturers with workplace safety protocols, such as using enclosed, ventilated printing environments and PPE. In contrast, there were prototyping services using basic printing equipment fulfilling orders for small businesses and hobbyists. Often, prototyping services incorporated other methods of manufacturing; we encountered workers whose duties included welding, soldering, laser cutting and sanding. Discussion Our pilot study found that respiratory symptoms were often reported by workers using 3D printing. Fifty-nine per cent reported respiratory symptoms, 20% cutaneous symptoms and 17% headaches occurring more than once per week in the past year. We noted that individuals working for >40 h per week with 3D printing were more likely to report a previous respiratory-related diagnosis including asthma or allergic rhinitis. Little has been published about respiratory disease associated with 3D printing. However, there have recently been case reports of a worker who developed asthma while using ABS filaments with 3D printing [7] and of a worker who developed hypersensitivity pneumonitis while exposed to 3D printing using nylon filaments [6]. 3D printing is associated with emission of VOCs, including styrene [2], a possible respiratory sensitizer and carcinogen, from ABS; methyl methacrylate [3], a respiratory and dermal sensitizer and respiratory irritant, from PLA; and caprolactam [2,4], a potential inducer of contact dermatitis, from nylon [9]. We noted marked differences in the exposure environments and control measures in various 3D printing environments. Short et al. have published a guide reviewing chemical hazards and environmental concerns in rapid prototyping environments and current occupational safety guidelines [10]. From our assessment of 3D printing workplaces, there are no standardized safety guidelines that are widely implemented in this setting. Weaknesses of our study include a small sample size and cross-sectional design. Additionally, our study lacked a non-exposed control group, and we developed our own (non-validated) questionnaire to assess health effects in this work sector. Larger prospective studies would be helpful in the future. We observed that some 3D printing workers reported respiratory symptoms, but there has been little published evidence supporting a causal association. While our survey is the first examining potential health effects associated with 3D printing exposure, further studies in this nascent field are needed. Key points 3D printing generates ultrafine particles and volatile organic compounds that may have adverse effects on workers. In this study, 3D printing users reported respiratory symptoms including upper and lower respiratory tract symptoms. Working >40 h per week with 3D printers was significantly associated with a previous respiratory-related diagnosis, including asthma or allergic rhinitis. Funding The study was supported in part by the Centre for Research Expertise in Occupational Diseases, funded by the Ontario Ministry of Labour, and Felix Chan was supported in part by a summer student award from Institute of Medical Science, University of Toronto and the Centre for Research Expertise in Occupational Disease. Competing interests None declared. References 1. Gibson I. Additive Manufacturing Technologies: 3D Printing, Rapid Prototyping, and Direct Digital Manufacturing . In: Rosen DSB , ed. New York, NY : Springer , 2015 . 2. Azimi P , Zhao D , Pouzet C , Crain NE , Stephens B . Emissions of ultrafine particles and volatile organic compounds from commercially available desktop three-dimensional printers with multiple filaments . Environ Sci Technol 2016 ; 50 : 1260 – 1268 . Google Scholar CrossRef Search ADS PubMed 3. Steinle P . Characterization of emissions from a desktop 3D printer and indoor air measurements in office settings . J Occup Environ Hyg 2016 ; 13 : 121 – 132 . Google Scholar CrossRef Search ADS PubMed 4. Floyd EL , Wang J , Regens JL . Fume emissions from a low-cost 3-D printer with various filaments . J Occup Environ Hyg 2017 ; 14 : 523 – 533 . Google Scholar CrossRef Search ADS PubMed 5. Health Effects Institute (HEI) Review Panel on Ultrafine Particles . HEI Perspectives 3: Understanding the Health Effects of Ambient Ultrafine Particles . Boston, MA: HEI , 2013https://www.healtheffects.org/system/files/Perspectives3.pdf (23 February 2018, date last accessed). 6. Johannes J , Rezayat T , Wallace WD , Lynch JP . Chronic hypersensitivity pneumonitis associated with inhaled exposure to nylon powder for 3-D printing: a variant of nylon flock worker’s lung disease ? Am J Respir Crit Care Med 2016 ; 193 : A7071 . 7. House R , Rajaram N , Tarlo SM . Case report of asthma associated with 3D printing . Occup Med (Lond) 2017 ; 67 : 652 – 654 . Google Scholar CrossRef Search ADS PubMed 8. Creytens K , Gilissen L , Huygens S , Goossens A . A new application for epoxy resins resulting in occupational allergic contact dermatitis: the three-dimensional printing industry . Contact Dermat 2017 ; 77 : 349 – 351 . Google Scholar CrossRef Search ADS 9. TOXNET: Hazardous Substances Data Bank (HSDB) . U.S. National Library of Medicine . Caprolactam. https://toxnet.nlm.nih.gov/newtoxnet/hsdb.htm ( 23 February 2018 , date last accessed). 10. Short DB , Sirinterlikci A , Badger P , Artieri B . Environmental, health, and safety issues in rapid prototyping . Rapid Prototyp J 2015 ; 21 : 105 – 110 . Google Scholar CrossRef Search ADS © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

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Occupational MedicineOxford University Press

Published: Mar 10, 2018

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