DCHAS-L Archives, Aug 25 2014 - Re: [DCHAS-L] Cadaver labs and formaldehyde

-----Original Message-----
From: Demer, Frank R - (demer) (demer) <demer**At_Symbol_Here**EMAIL.ARIZONA.EDU>
To: DCHAS-L <DCHAS-L**At_Symbol_Here**MED.CORNELL.EDU>
Sent: Mon, Aug 25, 2014 3:58 pm
Subject: Re: [DCHAS-L] Cadaver labs and formaldehyde

Different embalming agents/formulations have been tried to reduce formaldehyde exposures with some reported promise but with some drawbacks in specimen preservation. Post embalming re-profusion or injection with formaldehyde neutralizers and formaldehyde substitutes have reportedly had effects in reducing formaldehyde exposures. Two such commercially available products are Perfect Solution® (Carolina Biological Supply, Burlington, NC.) and InfuTrace® (American Bio-Safety, Rocklin, CA). Perfect Solution® is a proprietary tissue preservative containing alcohol and an unspecified but low formaldehyde concentration. Infutrace is a product containing a proprietary formulation that, when applied to tissue after standard formaldehyde embalming, binds free formaldehyde by a chemical polymerization process that is undisclosed but involves as the active ingredient. A study by Whitehead et. al. indicated that both Perfect Solution® substituted for standard formaldehyde embalming and InfuTrace® infused through the vasculature after formaldehyde embalming, resulted in lower concentrations of formaldehyde in area, personal and tissue samples than embalming with 2% formaldehyde alone or in combination with body cavity injection of InfuTrace®.. However, Perfect Solution® reportedly yielded suboptimum fixation and a different texture, color and smell than the formaldehyde treatments . Burkel et. al. compared InfuTrace® to monoethanolamine and concluded that post embalming re-profusion with a monoethanolamine solution was just as effective as InfuTrace® in neutralizing formaldehyde (2.5%) and glutaraldehyde (1.08%) and cheaper, and unlike InfuTrace®, did not leave the reported undesirable white precipitates on tissues and dissecting tables. After monoethanolamine treatments, formaldehyde levels were reduced to below occupational exposure limits when combined with engineering controls. Glutaraldehyde levels were not measured. The recommended exposure limit for glutaraldehyde by ACGIH is 0.05 ppm, as a ceiling. This is more than ten times lower than the recommended formaldehyde exposure limit by ACGIH (0.3 ppm as a ceiling). Sleek et. al. showed significant decreases of between 42 to 84% in formaldehyde levels above InfuTrace® treated cadavers when compared with their untreated counterparts using 5% formaldehyde. Arterial re-perfusion of formaldehyde-fixed cadavers (3.7% formaldehyde) with saturated ammonium carbonate solution by Kawamata, S., et. al. reduced formaldehyde levels both in air and in various tissue fluids. The ammonia re-perfusion resulted in softer tissue consistency in the cadavers and greater mobility of the neck, shoulders and limbs. However, the ammonium carbonate solution was distributed inhomogeneously in the cadaver and considerable formaldehyde remained in some tissues. Also, after inactivation of formaldehyde, a method to suppress bacterial and fungal proliferation is necessary and this problem still needs to be resolved. All of these studies used different formaldehyde concentrations in the embalming solutions. Standardized embalming fluids with a lower concentration of formaldehyde has been proposed by Dixit, D. as a means of controlling exposures. Coleman R., et. al. used a low formaldehyde (0.5- 0.75%), high salt (sodium chloride) embalming solution and long-term storage before dissection (3 months to a year), along with local exhaust to control formaldehyde exposures to below even the most stringent exposure limits. The preservative was inexpensive and resulted in minimal structural distortion or shrinkage, supple tissue which was easy to dissect, tissues that retained much of their natural color with no "browning oxidation effects and no fungal growth. The high salt content prevented any further significant desiccation but there was some minor salt deposits on the skin or internal organs. So far, alternative embalming agents/formulations for formaldehyde exposure control is an approach which may have promise but it is still very experimental.

From: DCHAS-L Discussion List [mailto:dchas-l**At_Symbol_Here**MED.CORNELL.EDU] On Behalf Of Wayne Wood
Sent: Monday, August 25, 2014 11:06 AM
To: DCHAS-L**At_Symbol_Here**MED.CORNELL.EDU
Subject: Re: [DCHAS-L] Cadaver labs and formaldehyde

We looked into the possibility of plasticizers, which leaves the cadaver's blood vessels nicely color-coded for teaching purposes, but the prep work is extremely dangerous and the prep room would have cost a fortune in controls. I believe Queen's University was and may be still using this technique.

We've been using Infutrace for over a decade, mostly in animal anatomy. We haven't had any problems to report but the users aren't crazy about it due to the fact it doubles up the preservation prep work. This is because it is a formalin replacement solution, not a substitute, so you still have to do a formalin-based perfusion, but then after the specimen is fixed you have to repeat the process to purge out all the formalin-based embalming solution. Despite our best efforts we haven't been able to find out the exact ingredients because they have all been in exempted quantities under our Hazardous Products Act. In other words there are no hazardous ingredients, at least not above the thresholds specified in the Act i.e. 1% if the ingredient is a carcinogen and 0.1% if it has other toxic effects.

From our discussions with the supplier we believe the Infutrace is a blend of buffer solution(s) mixed with some sort of polymer resin. While this is clearly not enough info to do one's own risk assessment we were comfortable in concluding that it has to be safer than the phenol-methanol-formaldehyde triumvirate used in classic embalming fluid.

Monona cites some really good examples of situations where products like PCB's and Halons of known toxicity were replaced by compounds of unknown (untested) toxicity, with disastrous results. Another classic one is the replacement of degreasers over the years, starting with carbon tetrachloride, then methylene chloride, then TCE, then PERC, but all of those substitutions had one thing in common - they were merely replacing the offending compound with their evil cousins (similar compounds). Great lessons learned. I don't think we're making the same mistake with our choice of Infutrace but Monona is right (as always!) to say that you should always conduct your risk assessment before choosing a substitute.

From: DCHAS-L Discussion List [mailto:dchas-l**At_Symbol_Here**MED.CORNELL.EDU] On Behalf Of Monona Rossol
Sent: Monday, August 25, 2014 11:30 AM
To: DCHAS-L**At_Symbol_Here**MED.CORNELL.EDU
Subject: Re: [DCHAS-L] Cadaver labs and formaldehyde

Wayne, Thanks for the study. Clearly it shows that Infutrace reduces the amount of airborne formaldehyde and does it better than the other product. There's nothing there about the hazards of the replacements.

So dang, what is it? Have tests been done for skin absorption, glove permeation, and or for any significant chronic hazards? All I see on the MSDS is sparse acute data. And if we knew the structure of the ingredients, we might even be able to make some guesses about chronic toxicity.

I keep thinking of the endless progressions of substitutes that had significant hazards of their own. I go back a long way to the 70s when industry replaced banned PCBs with PBBs (polybrominated biphenyls) with a disastrous accidental food chain human exposure in Michigan. Next they stuck an oxygen in between the PBB phenyl groups and we have the polybrominated diphenyl ethers to contend with. And when the EU banned many of these, Chemtura created a replacement unregulated chemical called Fire Master 550 which is untested but whose structure is identical to diethylhexyl phthalate except for four bromines on the benzene ring. This leaves the business end of DEHP free to do its thing while making the molecule even more persistent in the environment.

I won't bore you with a litany of these stories, but I no longer accept any replacement chemical with unknown hazards.

If you want to talk plasticizers, I'm in leaving tomorrow for a university building planning project in Aberdeen, SD. I will be incommunicado until I'm back in my NYC office on Sept 1 (yes, I'll work Labor day unless the union asks this decrepit old lady to march with them).

Monona Rossol, M.S., M.F.A., Industrial Hygienist

President: Arts, Crafts & Theater Safety, Inc.

Safety Officer: Local USA829, IATSE

181 Thompson St., #23

New York, NY 10012 212-777-0062

actsnyc**At_Symbol_Here**cs.com www.artscraftstheatersafety.org

-----Original Message-----
From: Wayne Wood <wayne.wood**At_Symbol_Here**MCGILL.CA>
To: DCHAS-L <DCHAS-L**At_Symbol_Here**MED.CORNELL.EDU>
Sent: Mon, Aug 25, 2014 10:49 am
Subject: Re: [DCHAS-L] Cadaver labs and formaldehyde

Good point Monona, it is always wise to assess the hazards before embarking on a quest to substitute one chemical product for another.

Infutrace (and Perfect Solution) have been around for a while and so far the assessments are promising:

http://www.ncbi.nlm.nih.gov/pubmed/18058900

These are formaldehyde "replacements", and not plasticizers. I know very little about the plasticizers but if any of you do, please share.

From: DCHAS-L Discussion List [mailto:dchas-l**At_Symbol_Here**MED.CORNELL.EDU] On Behalf Of Monona Rossol
Sent: Monday, August 25, 2014 10:02 AM
To: DCHAS-L**At_Symbol_Here**MED.CORNELL.EDU
Subject: Re: [DCHAS-L] Cadaver labs and formaldehyde

Well, I'm between trips so I haven't seen all of this thread, but I'm disappointed. If HOCH is replaced in anatomy labs, where is the information about the replacements?

I got the MSDS (2012) for Infutrace (Sasco Chemical) and it is proprietary, unregulated and untested for chronic toxicity. But that doesn't mean it doesn't have any chronic toxicity. I have a problem with exposing students to a large volume of an untested, unidentified chemical. And worse--it may be a plasticizer as suggested which means it's going right through those thin surgical gloves. And if it plasticizes a stiff, it can plasticize a live body as well.

The MSDS recommends Neoprene gloves, but there's no information on thickness, how long they should be used, etc. And usually students attacking a cadaver use thin surgical gloves.

I don't think we need to go into the many "safe" plasticizers that later have been found to be a big problem in even miniscule amounts. I don't understand how people can justify recommending a chemical product for a purpose like this without knowing what it is, what is known about it and, more importantly, what is NOT known about it.

A risk assessment is needed here.