Pamphlet 63

First Aid, Medical

Management/Surveillance and
Occupational Hygiene
Monitoring Practices for
Chlorine
Edition 8

June 2011

How to Contact CI

For more information about the

Chlorine Institutes technical
resources and training programs,
visit the Institutes website at
www.chlorineinstitute.org.

CI Bookstore
PO Box 1020
Sewickley, PA 15143-1020
Toll Free telephone: 800-662-3916
Intl calls: 412-741-1289
Fax: 412-741-0609
Email: ChlorineBooks@abdintl.com

CI Headquarters
1300 Wilson Boulevard
Suite 525
Arlington, VA 22209
Telephone: 703-894-4140
Fax: 703-894-4130
Email: pubs@CL2.com
Website: www.chlorineinstitute.org

Table of Contents
1.

INTRODUCTION................................................................................................................... 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7

2.

PURPOSE AND SCOPE ......................................................................................................... 1

CHLORINE INSTITUTE STEWARDSHIP PROGRAM ................................................................... 1
DEFINITIONS AND ACRONYMS .............................................................................................. 2
DISCLAIMER ........................................................................................................................ 4
APPROVAL .......................................................................................................................... 4
REVISIONS .......................................................................................................................... 4
REPRODUCTION .................................................................................................................. 4

HAZARDS TO HEALTH ....................................................................................................... 4

2.1 GENERAL ............................................................................................................................ 4
2.2 ACUTE TOXICITY ................................................................................................................. 5
2.3 CHRONIC TOXICITY ............................................................................................................. 6

3.

FIRST AID............................................................................................................................. 6
3.1 INHALATION ........................................................................................................................ 6
3.2 CONTACT WITH SKIN .......................................................................................................... 9
3.3 CONTACT WITH THE EYES .................................................................................................. 9

4. MEDICAL MANAGEMENT OF CHLORINE EXPOSURES (SUBSEQUENT TO FIRST

AID) .............................................................................................................................................. 9
4.1 GENERAL PRINCIPLES ......................................................................................................... 9
4.2 THERAPY FOR SPECIFIC PHYSIOLOGICAL DISTURBANCES ................................................... 10
5.

MEDICAL SURVEILLANCE ............................................................................................... 11

5.1 BASELINE EXAMINATION .................................................................................................... 11
5.2 PERIODIC EXAMINATION .................................................................................................... 11

6.

OCCUPATIONAL HYGIENE AND EXPOSURE ASSESSMENT MONITORING .............. 12

6.1 OCCUPATIONAL HYGIENE .................................................................................................. 12
6.2 EXPOSURE ASSESSMENT .................................................................................................. 12
6.3 OCCUPATIONAL EXPOSURE LIMITS FOR CHLORINE IN AIR ................................................... 13

7.

EMPLOYEE PROTECTION AND TRAINING .................................................................... 13

7.1 GENERAL .......................................................................................................................... 13
7.2 RESPIRATORY PROTECTION .............................................................................................. 14
7.3 ALARMS AND EMERGENCY RESPONSE PLANS .................................................................... 14

8.

FACILITY DESIGN ............................................................................................................. 15

9.

REFERENCES.................................................................................................................... 15
9.1 CHLORINE INSTITUTE REFERENCES ................................................................................... 15
9.2 OTHER REFERENCES ........................................................................................................ 15
9.3 ADDITIONAL OUTSIDE REFERENCES: ................................................................................. 16

APPENDIX A PAMPHLET 63 CHECKLIST ............................................................................ 18

FIRST AID, MEDICAL MANAGEMENT/SURVEILLANCE AND OCCUPATIONAL

HYGIENE MONITORING PRACTICES FOR CHLORINE

1.

INTRODUCTION

1.1

PURPOSE AND SCOPE

This eighth edition presents information updated from the previous edition and also
includes information pertaining to medical surveillance, chlorine exposure assessment
and occupational hygiene monitoring practices. The information contained in this
pamphlet is intended to provide guidance to anyone who produces, uses, or otherwise
handles chlorine.
This pamphlet provides information for the administration of first aid and medical
treatment for anyone who has been exposed to gaseous or liquid chlorine. In addition,
this pamphlet provides information pertaining to the administration of medical
surveillance programs, exposure assessment programs, and industrial hygiene practices
for persons who may be potentially exposed to chlorine.
In addition to chlorine, other chemical and physical agents may be encountered in
chlorine production, use, or handling facilities. These may include sodium hydroxide,
potassium hydroxide, sulfuric acid, hydrochloric acid, asbestos, mercury, electromagnetic fields, and possibly other materials. Control of exposure to these chemicals
and physical agents should be considered in any overall program of medical surveillance
and hygiene monitoring.
Information on first aid and medical management of chlorine exposure cases is also
provided in the Institutes H-DVD First Response to Chlorine Exposure (9.1).
1.2

CHLORINE INSTITUTE STEWARDSHIP PROGRAM

The Chlorine Institute (CI) exists to support the chlor-alkali industry and serve the public
by fostering continuous improvements to safety and the protection of human health and
the environment connected with the production, distribution and use of chlorine, sodium
and potassium hydroxides, and sodium hypochlorite; and the distribution and use of
hydrogen chloride. This support extends to giving continued attention to the security of
chlorine handling operations.
Chlorine Institute members are committed to adopting CIs safety and stewardship
initiatives, including pamphlets, checklists, and incident sharing, that will assist members
in achieving measurable improvement.
For more information on the Institutes
stewardship program, visit CIs website at www.chlorineinstitute.org.

2
1.3

PAMPHLET 63

DEFINITIONS AND ACRONYMS

The definitions and acronyms listed below are to provide general guidance to the reader.
For additional information, check the specific source.
ACGIH

American Conference of Governmental Industrial

Hygienists (The ACGIH is a private organization
based in Cincinnati, Ohio, that issues guidelines and
recommendations in the control of workplace health
hazards.)

ASR

Air Supply Respirator

Breathing Air

Air that has been tested and certified to be of a

quality for use for breathing purposes or assistance
in breathing.

Ceiling

The concentration that should not be exceeded

during any part of the working exposure (as defined
by the ACGIH).

CI

The Chlorine Institute

CPR

Cardiopulmonary Resuscitation

EPA

Environmental Protection Agency (U. S. government

regulatory body).

FEV1

Forced Expiratory Volume in one second

FVC

Forced Vital Capacity

Humidified Air

Air from either a clean ambient source or from a

container (cylinder/bottle/etc.) that is humidified by
bubbling through a bath with normal saline or sterile
water. Air used from a container should be Grade D
or better (as defined by the most current version of
the Compressed Gas Association document
ANSI/CGA Commodity Specification for Air).

Medical Oxygen

Oxygen that has been tested and certified to be of a

quality for use in oxygen therapy.

Humidified Oxygen

As used in this pamphlet, medical oxygen that has

been humidified by bubbling through a bath with
normal saline or sterile water.

mg/m3

Milligrams per cubic meter

MSDS

Material Safety Data Sheet

FIRST AID, MEDICAL MANAGEMENT/SURVEILLANCE AND OCCUPATIONAL

HYGIENE MONITORING PRACTICES FOR CHLORINE

NIOSH

National Institute for Occupational Safety and Health

(U. S. Department of Health and Human Services)

Normal Saline

Crystalloid solution of 0.9% sodium chloride and

water, which is isotonic with blood.

OSHA

Occupational Safety and Health Administration (U. S.

government regulatory body. Part of the U. S.
Department of Labor)

Oxygen Therapy

The use of medical oxygen in the administration of

medical treatment.

PEL

Permissible Exposure Limit (Regulations established

by OSHA). The maximum concentration that a
worker can be exposed to for a prescribed period of
time (TWA; STEL; Ceiling) without suffering adverse
effects.

PPE

Personal Protective Equipment

ppm

parts per million

RADS

Reactive Airways Dysfunction Syndrome; A chemical

irritant-induced type of asthma.

REL

Recommended Exposure Limit (NIOSH). Unless

otherwise specified, RELs are time-weighted
average (TWA) concentrations for up to a 10 hour
workday during a 40 hour work week.

SCBA

Self-Contained Breathing Apparatus

STEL

Short Term Exposure Limit; The concentration to

which a worker can be exposed continuously for a
short period of time (typically 15 minutes) without
suffering adverse effects.

1.4

PAMPHLET 63

TLV

Threshold Limit Value (guidelines developed by

ACGIH); The concentration that a worker can be
exposed to for a prescribed period of time without
suffering adverse effects (TLV-TWA; TLV-STEL;
TLV-Ceiling).

TWA

Time Weighted Average: TWA is an employees

average air-borne exposure in any eight hour work
shift of a 40 hour work week which shall not be
exceeded.

DISCLAIMER
The information in this pamphlet is drawn from sources believed to be reliable. The
Institute and its members, jointly and severally, make no guarantee, and assume no
liability, in connection with any of this information. Moreover, it should not be assumed
that every acceptable procedure is included, or that special circumstances may not
warrant modified or additional procedures. The user should be aware that changing
technology or regulations may require a change in the recommendations herein.
Appropriate steps should be taken to insure that the information is current when used.
These suggestions should not be confused with federal, state, provincial, municipal or
insurance requirements, or with national safety codes.

1.5

APPROVAL
The Institutes Health, Environment, Safety and Security issue team approved Edition 8
of this pamphlet on June 17, 2011.

1.6

REVISIONS
Suggestions for revisions should be directed to the Secretary of The Chlorine Institute.

1.6.1

Significant Revisions in Current Edition

There are no significant revisions to Edition 8 of this pamphlet.

1.7

REPRODUCTION
The contents of this pamphlet are not to be copied, in whole or in part, without prior
Institute permission. Additional copies of this pamphlet can be obtained from the
Institute.

2.

HAZARDS TO HEALTH

2.1

GENERAL
Chlorine gas is primarily a respiratory irritant. At low concentrations chlorine gas has an
odor similar to household beach. As the concentrations increase from the level of
detection by smell, so does symptomatology in the exposed individual. At chlorine
concentrations above 5 ppm the gas is very irritating, and it is unlikely that any person

FIRST AID, MEDICAL MANAGEMENT/SURVEILLANCE AND OCCUPATIONAL

HYGIENE MONITORING PRACTICES FOR CHLORINE

would remain in such an exposure for more than a very brief time unless the person is
trapped or unconscious. If the symptoms persist for more than a few hours, the effects
of exposure to chlorine may become more severe for several days after the incident. In
such cases, observation of exposed individuals should be a part of the medical response
program.
The following list is a compilation of chlorine exposure thresholds and reported
responses in humans (with considerable variation among subjects):
0.2 - 0.4 ppm - Odor threshold (decrease in odor perception occurs over time)
1 - 3 ppm - Mild, mucous membrane irritation, tolerated up to 1 hour
5 - 15 ppm - Moderate irritation of the respiratory tract
30 ppm - Immediate chest pain, vomiting, dyspnea, cough
40 - 60 ppm - Toxic pneumonitis and pulmonary edema
430 ppm - Lethal over 30 minutes
1000 ppm - Fatal within a few minutes
References in 9.1 and 9.2 provide additional information.
2.2

ACUTE TOXICITY

2.2.1

Respiratory/Cardiovascular
The toxic effects of chlorine are due to its corrosive properties. Chlorine is water soluble
and primarily removed by the upper airways. As indicated above, exposure to low
concentrations of chlorine gas may cause nasal irritation as well as irritation of the
mucous membranes of the respiratory tract. As concentrations increase, there is an
increase in the irritating effect on the upper and lower respiratory tract manifested as
coughing with eventual difficulty in breathing. Inhalation of chlorine gas (>15 ppm) may
lead to respiratory distress associated with airway constriction and accumulation of fluid
in the lungs (pulmonary edema). As the duration of exposure and/or the concentration
increase, the affected individual may develop the immediate onset of rapid breathing,
wheezing, rales, or hemoptysis. In extreme cases difficulty in breathing can progress to
the point of death through cardiovascular collapse from respiratory failure. An exposed
person with a pre-existing respiratory condition can have an exaggerated response.
Cases of Reactive Airways Dysfunction Syndrome (RADS), a chemical irritant-induced
type of asthma, have been reported.

2.2.2

Dermal
Liquid chlorine in contact with the skin will cause local chemical or thermal (frostbite)
burns. Gaseous chlorine in contact with the skin can dissolve in body moisture (i.e.,
perspiration) to form hypochlorous and hydrochloric acids. At 3,500 ppm chlorine in air,
the pH of moisture on the skin would be approximately 4. A pH of 4 is comparable to
carbonated water. While a burning sensation and skin irritation can occur due to such

PAMPHLET 63

exposure, a review of the literature has provided no specific human data to determine
the concentration of chlorine required to produce such effects.
2.2.3

Eyes
Low concentrations of chlorine in the air can result in eye irritation, associated burning
discomfort, spasmodic blinking, redness, conjunctivitis and tearing. Exposure to higher
concentrations of gaseous chlorine may result in more serious injuries. Liquid chlorine in
contact with the eyes will result in serious thermal and/or chemical burns.

2.3

CHRONIC TOXICITY
Most studies indicate no significant connection between adverse health effects and
chronic exposure to low concentrations of chlorine. However, a 1983 Finnish study
(9.2.1) did show an increase in chronic coughs and a tendency for hypersecretion of
mucous among workers. These workers showed no abnormal pulmonary function in
tests or chest x-rays. There have been indirect references in the literature (e.g., in some
MSDSs) indicating that chronic exposure to chlorine may cause corrosion of the teeth.
However, the Institute has not been able to verify the accuracy of such a statement
through its own review.
In December 1993, the Chemical Industry Institute of Toxicology issued its report on a
study on the chronic inhalation of chlorine in rats and mice (9.2.2). Rats and mice were
exposed to chlorine gas at 0.4, 1.0 or 2.5 ppm for up to six hours a day and three to five
days/week for up to two years. There was no evidence of cancer. Exposure to chlorine
at all levels produced nasal lesions. Because rodents are obligatory nasal breathers,
how these results should be interpreted for humans is not clear.

3.

FIRST AID
First aid is the immediate temporary treatment given to an exposed individual. Prompt
action is essential. Reassurance to the individual will help to alleviate anxiety. When
indicated, medical assistance must be obtained as soon as possible. Never give
anything by mouth to an unconscious or convulsing person. If chlorine has saturated an
exposed individuals clothes and/or skin, decontamination should be done by removing
affected clothing and showering as appropriate.
Responders should take the necessary precautions to protect themselves from any
exposure to chlorine while administering first aid and should move the victim from any
contaminated area as quickly as possible.

3.1

INHALATION
An individual with chlorine inhalation exposure should be evaluated for adequate airway,
breathing and circulation after the inhalation. If breathing has apparently ceased, the
victim should be given cardiopulmonary resuscitation (CPR) immediately. If breathing
has not ceased, the exposed individual should be placed in a comfortable position. The
person should sit in an upright position with the head and trunk elevated to a 45-60
position (unless there is a medical contraindication). Slow, deep breathing should be
encouraged. Vital signs (respiratory rate, pulse, and blood pressure) and oxygen
saturation should be obtained if trained personnel and equipment are available. Suitable

FIRST AID, MEDICAL MANAGEMENT/SURVEILLANCE AND OCCUPATIONAL

HYGIENE MONITORING PRACTICES FOR CHLORINE

equipment for the administration of oxygen should be available either on site or at a

nearby facility. Such equipment should be periodically tested.
Historically, oxygen therapy, specifically humidified oxygen, has been considered the
primary treatment for chlorine inhalations. Humidified oxygen is preferred since the
humidity soothes the irritation to the mucous membranes caused by the chlorine.
Oxygen without the humidity can have a drying effect, thus potentially aggravating the
irritant symptoms. However, if humidified oxygen is not available, oxygen without the
humidity should not be withheld if oxygen therapy is indicated. With the advance in
technology, equipment (pulse oximeter) is now available which can quickly measure the
oxygen saturation in an individual. This measurement may be helpful in deciding
whether supplemental oxygen is needed after a chlorine inhalation.
Oxygen therapy may not be necessary for all cases of chlorine inhalation. However, in
any case in which an individual with a chlorine inhalation continues to be symptomatic
after leaving the area of exposure, oxygen therapy is recommended unless it can be
determined that it is not needed. The circumstances in which oxygen therapy is not
needed should be defined in advance by a physician, based on the clinical
findings and a case-by-case determination made by first aid providers specifically
trained in this area.
3.1.1

Administration of Oxygen
Oxygen should be administered by first aid providers trained in the use of the specific
oxygen equipment under the guidance of a licensed health care professional.
If a pulse oximeter is not available, oxygen therapy is recommended for any individual
who has inhaled chlorine and continues to be symptomatic after leaving the area of
exposure.
If a pulse oximeter is available, the following findings comprise a base list of situations
in which oxygen therapy is generally indicated to be given by first aid providers after a
chlorine inhalation. Other criteria may be added to this list if specifically recommended
by a physician:
I.

Sustained pulse-oximetry readings <92%; or

II.

The individual is in obvious respiratory distress (including, but not limited to

rapid respirations, difficulty breathing, using accessory muscles for
respiration, continuous uncontrollable coughing, wheezing); or

III.

The exposed individual is having symptoms of concern, such as significant

chest pain/tightness, extreme weakness, altered/declining mental status, or
the individual is diaphoretic (clammy/pale/sweating not due to environmental
conditions) etc., especially if these or other significant symptoms occur with
an individual with a past history of cardiac problems or asthma; (NOTE:
symptoms of concern generally do not include the typical upper respiratory
tract irritation symptoms which occur with mild chlorine gas inhalations such
as mild/moderate coughing, initial difficulty catching ones breath,
mild/moderate shortness of breath, irritated throat, runny nose, congestion,
headache, and/or mild nausea).

PAMPHLET 63

NOTE: It is recommended that a physician be consulted regarding any individual

meeting one or more of the above criteria in order to determine whether further
evaluation and/or treatment is indicated.
If oxygen therapy is indicated, it should be administered until the symptoms resolve.
Whenever oxygen is discontinued after symptoms resolve, the individual should then be
observed for 30-60 minutes while breathing room air. If significant symptoms do not
resolve within 60 minutes of oxygen therapy, or symptoms return/worsen and/or the
oxygen saturation (when pulse oximetry is available) falls below 92%, it is recommended
that oxygen therapy be restarted (if it had been discontinued) and further evaluation by a
physician be provided.
3.1.2

Administration of Humidified Breathing Air

Not all individuals who have inhaled chlorine require oxygen therapy. It is recommended
that the circumstances in which oxygen therapy is not needed should be defined in
advance by a physician and a case-by-case determination made by first aid providers
specifically trained in this area.
In situations where it has been determined that oxygen therapy is not needed, but the
individual with an inhalation exposure has irritant symptoms, humidified air may be
provided for symptomatic care. While breathing humidified air, the individual should be
closely monitored for 30 - 60 minutes. If the individual continues to show no signs or
symptoms for which oxygen would be indicated, the humidified air can be stopped.
Observation should continue for an additional 30 minutes while the individual is
breathing room air so as to insure that there is no deterioration of the individual's
condition. Oxygen therapy should be started at any time during the above process if
symptoms worsen to the point that oxygen is indicated (3.1.1). Further evaluation by a
physician should be provided in any case in which oxygen therapy is provided.

3.1.3

Symptomatic care
Other symptomatic care measures, such as cool compresses to the face and over-thecounter medications, may help to minimize symptoms. Over-the-counter medications
which may be helpful include:

Irritated/sore throat throat lozenges

Dry cough dextromethorphan, guaifenesin

Headaches acetaminophen, aspirin, ibuprofen

Upset stomach antacids

FIRST AID, MEDICAL MANAGEMENT/SURVEILLANCE AND OCCUPATIONAL

HYGIENE MONITORING PRACTICES FOR CHLORINE

3.2

CONTACT WITH SKIN

If liquid chlorine has contaminated the skin or clothing, an emergency shower should be
used immediately and contaminated clothing should be removed under the shower.
Flush contaminated skin with copious amounts of tepid water for 15 minutes or longer.
Thermal burns, due to the cold temperature of liquid chlorine, may be more damaging
than any chemical reaction of chlorine and the skin. Exposure to gaseous chlorine can
irritate the skin. Do not attempt chemical neutralization or apply any salves or ointments
to damaged skin. Refer to a qualified health care provider if irritation persists after
irrigation or if skin is broken or blistered.

3.3

CONTACT WITH THE EYES

If the eyes have been irritated due to exposure to chlorine, they should be flushed
immediately with copious quantities of tepid water for at least 15 minutes.
Never attempt to neutralize with chemicals.
The eyelids should be held apart during this period to ensure contact of water with all
accessible tissue of the eyes and lids. Medical assistance must be obtained as soon as
possible. If such assistance is not immediately available, eye irrigation should be
continued for a second 15-minute period. Nothing but water should be applied unless
ordered by a qualified health care provider.

4.

MEDICAL MANAGEMENT OF CHLORINE EXPOSURES (SUBSEQUENT TO FIRST

AID)
The following information is intended for general guidance only.
Final
determination of specific medical intervention(s) should only be made by qualified
medical personnel upon full consideration of each patients overall medical
condition. The Institute recommends that any treatment be done in conjunction
with a full medical assessment by qualified personnel.

4.1

GENERAL PRINCIPLES

All individuals who have developed symptoms as a result of an acute

overexposure to chlorine gas by inhalation should be placed under the
supervision of qualified health care personnel.

There is no known specific antidote for acute chlorine exposure. Prompt

medical assessment and supportive measures are necessary to obtain good
therapeutic results.

If the individual is unconscious, take steps necessary to protect the airway

from obstruction.

Alleviate anxiety by communicating with the patient the various procedures

undertaken and elicit his/her cooperation, especially in breathing exercises.

10

PAMPHLET 63

Position the patient with the head and trunk elevated to a 45-60o position
(assuming there are no medical contraindications.)

Encourage slow, regular respiration.

Oxygen therapy should be considered in all individuals who continue to be

symptomatic after a chlorine inhalation. If after medical evaluation it is
determined that an individual does not need oxygen therapy, humidified air
may be helpful an alleviating some of the residual irritant respiratory
symptoms.

4.2

THERAPY FOR SPECIFIC PHYSIOLOGICAL DISTURBANCES

4.2.1

Pulmonary Edema
Once pulmonary edema has developed from acute chlorine inhalation, the treatment is
basically that of acute respiratory failure. This individual should be under the care of a
health care professional familiar with this disease process in an intensive care setting. It
should be noted that there is inconclusive evidence regarding the use of corticosteroids
to prevent or alleviate pulmonary edema after an acute chlorine inhalation.

4.2.2

Bronchospasm (Wheezing)
Bronchodilators administered either by nebulization, or subcutaneously, may be
beneficial if patient is having bronchospasm (wheezing).

4.2.3

Acute Anxiety
Acute anxiety (fear and/or apprehension) by an employee exposed to chlorine may
occur. Reassurance is best accomplished without the use of sedatives. Use of
sedatives should only be considered by qualified medical personnel following medical
assessment and only employed under close supervision of respiratory function to
monitor progress.

4.2.4

Delayed Effects
After an acute exposure to chlorine, pulmonary function usually returns to pre-exposure
levels in 7 to 14 days, and complete recovery usually occurs. Post-incident spirograms
may be used for clinical follow-up. Cases of Reactive Airways Dysfunction Syndrome
(RADS), a chemical irritant-induced asthma, have been reported after significant chlorine
inhalation.
The inhalation of any irritating gas may lead to delayed reactions such as pulmonary
edema. Since physical exercise appears to have some relation with the incidence of
delayed reaction, it is recommended that any patient who has had severe inhalation
exposure should be kept at rest for a period of observation. During the period of
observation, the avoidance of irritants (e.g., cigarette smoke, dust, etc.) is
recommended. The length of observation will depend on the clinical assessment of the
exposed individual. Observation may be required up to several days after exposure.
Excitement, apprehension and/or emotional distress may persist for some period of time
following a severe exposure.

FIRST AID, MEDICAL MANAGEMENT/SURVEILLANCE AND OCCUPATIONAL

HYGIENE MONITORING PRACTICES FOR CHLORINE

5.

11

MEDICAL SURVEILLANCE
The Chlorine Institute recommends a medical surveillance program which would include
baseline and periodic examinations be implemented for personnel working in chlorine
production, use, or handling facilities who are potentially exposed to chlorine, at or
above the ACGIH guideline (9.2.) of 0.5 ppm TWA or 1 ppm STEL during normal
operations (6.3).

5.1

BASELINE EXAMINATION
A baseline medical examination consisting of the following components should be
considered for the above personnel:

5.1.1

Medical History including information on previous acute or chronic respiratory

disease, ophthalmologic conditions (e.g. chronic conjunctivitis), and smoking.

Complete physical examination with special attention paid to examination of

the respiratory system.

Chest X-ray (14" x 17" P.A.).

Pulmonary function studies -- including forced vital capacity (FVC), forced

expiratory volume in one second (FEV1), and FEV1/FVC ratio.

Determination of physical capability to wear respiratory protective equipment.

Contraindications
Any physical or health condition which precludes an individual's use of prescribed
respiratory equipment should be addressed prior to the individual performing tasks with
the potential for exposure to chlorine.

5.2

PERIODIC EXAMINATION
Medical examinations should be performed on a periodic basis as indicated by an
exposure assessment. The frequency of these examinations should be based on actual
exposure data and/or the potential exposure for specific operations, as determined by
knowledgeable occupational health personnel and in accordance with applicable
regulatory requirements.
Periodic medical examinations may include the following components:

Interval medical and work history including details of first-aid treatment and
details of any chlorine overexposure.

Pulmonary function studies, including forced vital capacity (FVC), forced

expiratory volume in one second (FEV1) and FEV1/FVC ratio.

Determination of the physical capability to wear respiratory protective

equipment.

12

PAMPHLET 63

6.

OCCUPATIONAL HYGIENE AND EXPOSURE ASSESSMENT MONITORING

6.1

OCCUPATIONAL HYGIENE
High standards of individual worker cleanliness and hygiene should be followed by all
individuals working with or around chlorine. Company policies and regulatory standards
should be reviewed regarding the storage/consumption of food or drink, the
presence/use of tobacco products, the application of cosmetics/personal hygiene
products, or the taking of medications in work areas where chlorine is handled.

6.2

EXPOSURE ASSESSMENT
Airborne contaminant monitoring (specifically, personal monitoring) is recommended to
evaluate employee exposure to chlorine. Results can indicate where improved controls
are needed and assist in selection of appropriate respiratory equipment. Area
monitoring may be useful in evaluating work areas where chlorine is produced or
handled. Equipment and media used for personal sampling can also be used for area
monitoring/surveys.

6.2.1

Sampling
Airborne contaminant samples should be obtained for those employees that have a
potential for exposure during routine operations. This determination should be made by
someone familiar with the process and associated tasks. If there are work situations in
which the exposures in a job assignment vary because of either the mobility of the
employee or the nature of the production pattern, the most severe situations (maximum
exposure assessment) should be selected for initial sampling. Sample collection should
be as random as practical and of sufficient numbers to be considered representative
(9.2.3). When there is a group of workers having similar risk and type of exposure,
these employees can be grouped and results of sampling applied to the group as a
whole. Sampling typically falls into two basic types: short term and full shift. For
activities that have been identified as having exposure potential that are 15 minutes or
less in duration, short-term exposure sampling should be conducted. Full shift sampling
gives a picture of average exposure for the entire work shift. To be classified as full shift
sampling, the sample must cover 80% of the shift (9.2.3). Good industrial hygiene
judgment should be used to decide how to account for exposure during any shift period
not sampled.
Sampling should be conducted periodically and when there has been a change in
equipment, process, or work practices the exposure risk could change.

6.2.2

Sampling Methods
The following sampling methods may be used to evaluate worker exposure to chlorine.
This list is not exhaustive. Other methods may be available. Chlor-alkali manufacturers
should select the sampling method(s) that best suit their operation and resource
capabilities. When using a sample method that requires a laboratory to perform an
analysis, only AIHA accredited laboratories should be used. When performing shortterm sampling, ensure that the media/method being considered can detect 0.25 ppm or
less for the period of time sampled.

FIRST AID, MEDICAL MANAGEMENT/SURVEILLANCE AND OCCUPATIONAL

13

HYGIENE MONITORING PRACTICES FOR CHLORINE

6.3

OSHA 101 - Chlorine is collected in a fritted glass midget impinger containing

0.1% sulfamic acid. Analysis with ion selective electrode is required (9.2.7).

NIOSH 6011 - Chlorine is collected on a silver membrane filter and analyzed

using ion chromatography (9.2.8).

Colorimetric Tubes - Chlorine is pulled through these devices with a special

air sampling pump producing a color change in the tube. The stain length in
the tube is proportional to the chlorine concentration in the air.

Colorimetric Badges - Chlorine enters these devices through passive

diffusion producing a color change where intensity is proportional to the
chlorine concentration in the air.

Electrochemical Instruments - Chlorine reacts with a special chemical sensor

that produces an electrical potential that is proportional to the concentration
of chlorine in air. Such units can be connected to a data logger to obtain
TWA measurements or can produce an audible alarm at a preset
concentration.

OCCUPATIONAL EXPOSURE LIMITS FOR CHLORINE IN AIR

Source
OSHA (PEL)
ACGIH (TLV)
ACGIH (TLV)
NIOSH (REL)

Value

Type
3

1 ppm (2.9 mg/m )

3
0.5 ppm (1.45 mg/m )
3
1 ppm (2.9 mg/m )
3
0.5 ppm (1.45 mg/m )

7.

EMPLOYEE PROTECTION AND TRAINING

7.1

GENERAL

Ceiling
TWA
STEL (15 minutes)
Ceiling

Worker health and safety depend upon proper training and adequate supervision. The
health hazards associated with the chemical and physical agents encountered should be
thoroughly discussed with workers. It is necessary to insure that they are familiar with
and understand these hazards and the precautionary measures that must be followed to
protect themselves and their co-workers.
Periodic refresher sessions are
recommended.
Information provided to employees should include the following:

The readily accessible locations of the material safety data sheets (or
equivalent)

Explanation of the site labeling system

Hazard warnings

14

PAMPHLET 63

Work procedures and standards

Exposure monitoring results

Measures used to protect employees during both routine and emergency

activities

Potential health effects from overexposure;

Relevant results from medical examinations; and

Appropriate new test or study results.

OSHA regulations require that a written hazard communication program incorporating

the above information be readily accessible (29 CFR 1920.1200).
7.2

RESPIRATORY PROTECTION
A complete Respirator Protection Program meeting all legal requirements should be
established. In the United States these requirements are listed in 29 CFR 1910.134
(9.2.9). Such a program should provide for respirator fit testing, and the training of
employees in the proper use and limitations of each type of respirator, along with
medical clearance to wear assigned respirator.
Employees required to work in chlorine-contaminated atmospheres must use
appropriate respiratory protection certified by NIOSH (9.2.11) for the air concentrations
likely to be encountered.
A NIOSH certified self-contained breathing apparatus (SCBA) or full face air supply
respirator (ASR) with a self-contained air supply (escape air provision) must be used for
protection during upset conditions, emergency response, or maintenance operations
where appropriate. There should be a sufficient number of appropriately located SCBAs
or ASRs to assure their availability when needed.
The proper selection of respirators and their placement should be determined by a
qualified respiratory protection program administrator in accordance with applicable
standards.

7.3

ALARMS AND EMERGENCY RESPONSE PLANS

An emergency response plan should be developed whenever chlorine is produced,
used, stored, or otherwise handled as recommended in CI Pamphlet 64 (9.1). In the
event of an accidental release, in-plant chlorine gas alarms can be a part of an
emergency response plan as discussed in CI Pamphlet 73 (9.1). All emergency
equipment and alarms should be tested regularly, and in accord with manufacturer
recommendations. Personnel should be drilled in their use as discussed in CI Pamphlet
64 (9.1).

FIRST AID, MEDICAL MANAGEMENT/SURVEILLANCE AND OCCUPATIONAL

HYGIENE MONITORING PRACTICES FOR CHLORINE

8.

15

FACILITY DESIGN
The design of a facility is a preferred method to minimize worker exposures to chlorine
and other air contaminants (9.2.9).

9.

REFERENCES
The following sections provide detailed bibliographic information on the Chlorine Institute
publications and other documents.

9.1

CHLORINE INSTITUTE REFERENCES

The following publications are specifically referenced in CI Pamphlet 63. The latest
editions of CI publications may be obtained at http://www.chlorineinstitute.org.
Pamphlet #
& DVD
H-DVD

9.2

Title
Chlorine Institute: First Response to Chlorine Exposure, Video, The
Chlorine Institute: Arlington, VA, 2006.

Chlorine Basics, Pamphlet 1, Edition 7, The Chlorine Institute:

Arlington, VA 22209, 2008.

64

Emergency Response Plans for Chlor-Alkali, Sodium Hypochlorite and

Hydrogen Chloride Facilities, Pamphlet 64, Edition 6-R1; The Chlorine
Institute: Arlington, VA 22209, 2008.

65

Personal Protective Equipment for Chlor-Alkali Chemicals, Pamphlet

65, Edition 5, The Chlorine Institute: Arlington, VA 22209, 2008.

73

Atmospheric Monitoring Equipment for Chlorine, Pamphlet 73, Edition

7; The Chlorine Institute: Arlington, VA 22209, 2003.

OTHER REFERENCES
The following documents are specifically referenced in Pamphlet 63:

9.2.1

Grenquist-Norden, B.: Institute of Occupational Health, pp. 1-83, 1983.

9.2.2

Chemical Industry Institute of Toxicology, A Chronic Inhalation Study of Chlorine in

Female and Male B6C3F1 Mice and Fischer 344 RATS, December 31, 1993.

9.2.3

2009 TLVs and BEIs, American Conference of Governmental Industrial Hygienists,

Cincinnati, Ohio, 2009.

9.2.4

A Strategy for Assessing and Managing Occupational Exposures, Second Edition,

American Industrial Hygiene Association, Fairfax, VA, 1998.

16

PAMPHLET 63

9.2.5

DHHS (NIOSH) Publication No. 77-173, Occupational Exposure Sampling Manual, p.

40). http://www.cdc.gov/niosh/docs/77-173/

9.2.6

American Industrial Hygiene Association http://www.aiha.org/

9.2.7

OSHA Sampling and Analysis, http://osha.gov/sltc/samplinganalysis/index.html

9.2.8

NIOSH Method 6011, http://www.cdc.gov/niosh/nmam/pdfs/6011.pdf

9.2.9

Code of Federal Regulations, U.S. Occupational Safety and Health Administration:

Respiratory Protection - 29 CFR 1910.134
Toxic and Hazardous Substances - 29 CFR 1910.1000
Hazard Communication Standard - 29 CFR 1910.1200

9.2.10 Pocket Guide to Chemical Hazards, DHHS (NIOSH) Publication No., 2005-149, National
Institute for Safety and Health, Cincinnati, OH, 2007.
9.2.11 NIOSH Certified Equipment List as of periodically published, National Institute for
Occupational Safety and Health, Cincinnati, Ohio.
9.3

ADDITIONAL OUTSIDE REFERENCES:

9.3.1

Noe, J.D., Therapy for Chlorine Gas Inhalation, Industrial Medicine and Surgery,
32:411 (October, 1963), Excerpta Med. (Section 27): 1664, (1964).

9.3.2

Gay, H.H., Exposure to Chlorine Gas, Journal of the American Medical Association,
183: 806 (March, 1963).

9.3.3

Kramer, C.G., Chlorine, Journal of Occupational Medicine, 9:193 (April, 1967).

9.3.4

Chester, Edward H. et. al., Pulmonary Injury Following Exposure to Chlorine Gas,
Chest., 72:2, (August, 1977).

9.3.5

Kowitz, T. et. al., Effects of Chlorine Gas upon Respiratory Function, Archives of
Environmental Health, 14, 545-558, (1967).

9.3.6

Weil, H. et. al., Late Evaluation of Pulmonary Function after Acute Exposure to Chlorine
Gas, American Review of Respiratory Diseases, 99, 374-379, (1969).

9.3.7

Jones, R.N. et. al., Longitudinal Changes in Pulmonary Function Following Single
Exposure to Chlorine Gas, American Review of Respiratory Diseases, 123 (suppl.),
125, (1981).

9.3.8

Jones, R.N. et. al., Lung Function After Acute Chlorine Exposure, American Review of
Respiratory Diseases, 134, 1190-1195 (1986).

9.3.9

Morgan & Seaton, Occupational Lung Diseases, Saunders & Company, (1984).

9.3.10 Parks, W.R., Occupational Lung Disorders, Butterworths, (1994).

FIRST AID, MEDICAL MANAGEMENT/SURVEILLANCE AND OCCUPATIONAL

HYGIENE MONITORING PRACTICES FOR CHLORINE

17

9.3.11 Plunkett, E.R., Handbook of Industrial Toxicology, Chemical Publishing Company, New
York (1987).
9.3.12 Burton et. al, Respiratory Care, A Guide to Clinical Practice 4th Edition, Lippincott,
(1997).
9.3.13 Medical Management Guideline for Chlorine. Agency for Toxic Substances and Disease
Registry (ATSDR). (2001) Atlanta, GA; U.S. Department of Health and Human Services,
Public Health Service.
9.3.14 LaDou, J. Occupational and Environmental Medicine. Appleton & Lange, (1997).
9.3.15 Brooks, SM, Weiss MA, Bernstein IL. Reactive airways dysfunction syndrome:
Persistent asthma syndrome after high level irritant exposure. Chest, 88, 376-384
(1985).
9.3.16 Hendrick et al. Occupational Lung Disorders, WB Saunders, (2002).
9.3.17 Rom, W. Environmental and Occupational Medicine 2nd Edition, Little, Brown and
Company, (1992).
9.3.18 Horton, D. et. al. The Public Health Consequences From Acute Chlorine Releases,
1993-2000. Journal of Occupational and Environmental Medicine, 44, 906-914 (2002).
9.3.19 Das R, Blanc PD. Chlorine gas exposure and the lung: a review. Toxicol Indust Health 9,
439-455 (1993).
9.3.20 Schwartz DA. Acute Inhalational Injury. Occup Med 2, 297-318 (1987).
9.3.21 Effects of Exposure to Toxic Gases - First Aid & Medical Treatment, Edition 3; Stopford,
W. and Bumm, W.D., Matheson Gas Products, Inc. Secaucus, N.J., (1988).
9.3.22 Pattys Industrial Hygiene, 6th edition, John Wiley & Sons, (2010).

18

PAMPHLET 63

APPENDIX A PAMPHLET 63 CHECKLIST

This checklist is designed to emphasize major topics for someone who has already read and
understood the pamphlet. Taking recommendations from this list without understanding related
topics can lead to inappropriate conclusions.
Place a check mark () in the appropriate box below:
Yes

No

N/A

1. Have individuals been trained to administer first aid

and CPR to persons exposed to chlorine, and are they
at the facility during all shifts?
2. For facilities that have policies allowing the
administration of humidified air in lieu of oxygen under
specific circumstances:
Do only appropriately trained personnel determine
when humidified air in lieu of oxygen is appropriate
after a chlorine inhalation?

{3.1}

{3.1.2}

3. Are individuals who have developed symptoms as a

result of an acute overexposure to chlorine gas by
inhalation placed under the supervision of qualified
health care personnel?

{4.1}

4. Do individuals qualified to administer first aid for

chlorine exposure observe for delayed effects of an
acute exposure to chlorine?

{4.2.4}

5. Does the facility have a medical surveillance program

in place for workers, including contractors, who are
potentially exposed to chlorine?

{5}

6. Does the facility have an exposure assessment

program in place to evaluate employee exposure to
chlorine?

{6.2}

7. Does the facility have a written hazard

communications program in place and has the
appropriate information been provided to employees?

{7.1}

FIRST AID, MEDICAL MANAGEMENT/SURVEILLANCE AND OCCUPATIONAL

HYGIENE MONITORING PRACTICES FOR CHLORINE

Yes

No

N/A

19

8. Does the facility have a respiratory program in place

that meets all the legal requirements?

{7.2}

9. Does the facility have an emergency response plan in

place?

{7.3}

REMINDER:
Users of this checklist should document exceptions
to the recommendations contained in this pamphlet.