Establishing the burden of carbon monoxide exposure in local authority housing in Hackney, London:

Transcription

1 Establishing the burden of carbon monoxide exposure in local authority housing in Hackney, London: A joint study between the Health Protection Agency (now Public Health England) and Hackney Homes Lucy McCann Field Epidemiology Fellow Centre for Radiation, Chemical and Environmental Hazards Improving Gas Safety in Social Housing All-Party Parliamentary Carbon Monoxide Group, 12 th June 2013 On behalf of the study team: Giovanni Leonardi (PHE), Rebecca Close (PHE), Martin Weaver (Hackney Homes), Les Staines (Hackney Homes), Graeme Cutter (Hackney Homes)

2 Overview Carbon monoxide Health effects Burden of disease Study Background Aims and objectives Methods Results Discussion and conclusions Further steps Recommendations 2 CO exposure in local authority housing in Hackney

3 Carbon monoxide: health effects Acute CO poisoning Immediate: nausea & vomiting, headache; dizziness, confusion, shortness of breath, blurred vision, loss of consciousness, fits, death Long-term: post-traumatic stress disorder; brain damage; damage to heart muscle, skeletal muscle, kidney damage & renal failure Chronic CO poisoning Immediate: flu-like illness, sore throat, cough; impaired memory, confusion, tiredness Long-term: emotional, physical, mental disability; poor memory, concentration, poor effort tolerance, apathy, lethargy 3 CO exposure in local authority housing in Hackney

4 4 CO exposure in local authority housing in Hackney

5 HES inpatient data working with SAHSU Burden of disease of CO Deaths Serious injuries ONS mortality data, coroners text data London Fire service data on CO related call outs Emergency Department consultations General Practice Emergency service data DH A&E experimental dataset RTSS - GP data? Community Hackney Homes and other LA data 5 CO exposure in local authority housing in Hackney

6 Background to the study From 1 st Jan 2010: HH established programme to monitor CO in homes as part of duty of care At least one alarm placed in each of home (n=22,831) estimated completion date: October 2011 Partnership between Hackney Homes and HPA/PHE to investigate causes of alarm activation 6 CO exposure in local authority housing in Hackney

7 Aims and Objectives Aim To undertake a pilot study to establish the burden of CO exposure in local authority homes in Hackney Objectives To estimate the incidence of potential CO exposure as captured by CO alarms To investigate the causes of the CO incidents occurring To describe the interventions put in place after a CO incident has occurred 7 CO exposure in local authority housing in Hackney

8 Methods Study design Cross sectional study Study population All homes managed by HH which had CO alarm fitted (n=22, 831) Measurement of CO in study population CO alarms designed to detect concentration of CO: >50ppm for mins >100ppm for 10-40mins >330ppm within 3 mins Alarms installed in each room containing fuel burning appliance 1-3 metres from source 8 CO exposure in local authority housing in Hackney

9 Methods Following activation, occupant informs HH/National Grid National Grid turn off gas supply meter Within 2 days, HH send qualified gas engineer to investigate Gas Safe Fumes Investigation Report completed Designed to support standard collection of information Results of CO tests Occupants reasons for concern Faults identified Interventions undertaken General observations Results of tests on gas appliances 9 CO exposure in local authority housing in Hackney

10 10 CO exposure in local authority housing in Hackney

11 Methods Study period All CO alarm activations between November 2011 and April 2012 Data collection All Fumes Investigation Reports were: anonymised sent to HPA entered onto database Single data entry, checked, verified, cleaned and coded Descriptive analysis undertaken 11 CO exposure in local authority housing in Hackney

12 Total number Results Nov April 2012: 106 alarm activations 4.64 activations per 1000 households Two excluded from further analysis Illness within household: 6.7% Number of incidents reported by month: November December January February March April 2011 Month and year CO exposure in local authority housing in Hackney

13 Results: causes of CO alarm activation Issues/faults identified during investigation of CO alarm activations Issue identified N %* 1. Cooker defective Boiler defective Fire defective Misuse of cooker/cooking methods CO alarm faulty/low battery/wrongly sited * Denominator for issues 1, 2 and 3 changed depending on whether each gas appliance was reported as present and tested. Number of incidents where a gas cooker was reported as present and tested: 97; Number of incidents where a gas boiler was reported as present and tested: 102; Number of incidents where a gas fire was reported as present and tested: 4 13 CO exposure in local authority housing in Hackney

14 Results: causes of CO alarm activation 14 CO exposure in local authority housing in Hackney

15 Results: main interventions Disconnection of the gas appliance Cooker Boiler Gas fire Replacing CO alarm with new alarm Resiting of current CO alarm Providing advice to tenant on: Size of pans when cooking Other misuses of cooker (e.g. foil around hob) Other CO producing activities (e.g. BBQ indoors) Ventilating kitchen when cooking Some alarm activations required more than one intervention 15 CO exposure in local authority housing in Hackney

16 Discussion Little is known about the burden of CO poisoning in local authority housing Work with Hackney Homes has proven invaluable This study has shown that: 1. Issue with gas appliance identified in >1/3 of activations Presence of unsafe gas appliance linked to increased neurological symptoms (Croxford et al., 2008) 2. Cookers are a major source of CO exposure in the home Faulty cookers Methods of cooking 16 CO exposure in local authority housing in Hackney

17 Conclusions This study provides important information on the path to quantifying CO exposure in this population contributes to more accurate picture of the burden of disease Possible approach to accessing key information on: population exposure to CO realistic interventions to reduce potential exposure Study suggests CO exposure in local authority homes exists and is likely to be under recognised Potential wider implications (Croxford et al., 2008) 17 CO exposure in local authority housing in Hackney

18 Future steps Address the difference between alarm activation and personal exposure Consider investigating: socioeconomic status of occupants housing tenure characteristics of homes regional variations urban vs rural Continuation of development of CO surveillance in UK 18 CO exposure in local authority housing in Hackney

19 Recommendations CO exposure in local authority homes could be more widespread than anticipated Exposure is preventable Hackney Homes approach likely to prevent ill health across England (Croxford et al., 2008) We support replication of Hackney Homes work CO alarm fitted in each local authority home Investigation of alarm activations by gas engineers Implement appropriate interventions Monitoring of alarm activations (research) 19 CO exposure in local authority housing in Hackney

20 Journal of Environmental and Public Health Available at: 20 CO exposure in local authority housing in Hackney

21 Acknowledgements Hackney Homes Les Staines Martin Weaver Graeme Cutter Public Health England Rebecca Close Giovanni Leonardi Mike Studden Harriet Kilcommon Anne Marchant We would also like to acknowledge CO awareness ( for their support with this work 21 CO exposure in local authority housing in Hackney

22 References [1] HPA (2012) Reducing the risk of carbon monoxide poisoning over winter: 19 November 2012 [online] idepoisoning/ [Accessed 19 December 2012] [2] CMO letter (2011) Carbon monoxide poisoning sends 4,000 people to A&E each year. Letter from Professor Dame Sally Davies, Chief Medical Officer for England, 21 Nov 2011 [online] [Accessed 17 December 2012] [3] Clarke, S., Keshishian, C., Murray, V., Kafatos, G., Ruggles, R., Coultrip, E., Oetterli, S., Earle, D., Ward, P., Bush, S., Porter, C. (2012) Screening for carbon monoxide exposure in selected patient groups attending rural and urban emergency departments in England: a prospective observational study BMJ Open, 2: 6 [4] Wright, J. Chronic and occult carbon monoxide poisoning: we don t know what we re missing. Emerg Med J, 2002; 19: p [5] Townsend, C.L., Maynard, R.L. (2002) Effects on health of prolonged exposure to low concentrations of carbon monoxide. Occupational and Environmental Medicine, 59, [6] All Party Parliamentary Gas Safety Group (2011) Preventing Carbon Monoxide Poisoning[online] [7] Hampson, N.B., Zmaeff, J.L. (2005) Carbon monoxide poisoning from portable electric generators. American Journal of Preventive Medicine, 28:1, [8] Karalliedde, L., Keshishian, C. (2008) in Essentials of Toxicology for Health Protection: a handbook for field professionals. Baker, D., Fielder, R., Karalliedde, L., Murray, V., Parkinson, N. (eds.) Cambridge University Press [9] Graber, J.M., Smith, A.E. Results from a State-Based Surveillance System for Carbon Monoxide Poisoning. Public Health Reports, 2007; 122: p [10] Croxford, B., Leonardi, G., Kreis, I. (2008) Self-reported neurological symptoms in relation to CO emissions due to problem gas appliance installations in London: a cross-sectional survey Environmental Health, 7: CO exposure in local authority housing in Hackney

23 References [11] Volans G, Armstrong B, Croxford B, Fletcher T,, Gupta K, Hutchinson E, Johnson M, Karalliedde L, Leonardi G, McKenna L, McParland M, Nicholson L, Oreszczyn T, Riddington M, Wilkinson P, Wiseman H, (2006) Neuropsychological effects of chronic exposure to carbon monoxide in the indoor air. Final Report to the Department of Health, 22 July [12] ONS Mid-2011 Population Estimates (25 September 2012) [online] [Accessed 18 December 2012] [13] ONS (2011) Statistical bulletin: 2011 Census: Key Statistics for England and Wales, March 2011 [online] census-key-statistics-for-england-and-wales.html [Accessed 19 December 2012] [14] Hackney Council (2012) City and Hackney health and wellbeing profile 2011/12 [online] [Accessed 18 December 2012] [15] Hackney Council (2011) Indices of Multiple Deprivation 2010: Briefing, April 2011 [online] [Accessed 11 December 2012] [16] Baker, D. (2008) in Environmental Epidemiology: study methods and application Baker, D., Nieuwenhuijsen., M.J. (eds.) Oxford University Press [17] Walsh P. Domestic carbon monoxide alarms. Long-term reliability and use scoping study. Health & Safety Executive Research Report RR847. Prepared by the Health and Safety Laboratory for the Health and Safety Executive, Available at [Accessed on 10 December 2012]. [18] BSI Standard BS EN 50291: 2001 Electrical apparatus for the detection of carbon monoxide in domestic premises. BSI 2001 [19] EHC 213 (1999) Environmental Health Criteria, No. 213: Carbon Monoxide, 2nd edition. Geneva, World Health Organisation. ISBN [Accessed 10 December 2012] 23 CO exposure in local authority housing in Hackney