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Accuracy of a semiquantitative method for Dermal Exposure Assessment (DREAM)
  1. B van Wendel de Joode1,
  2. R Vermeulen4,
  3. J J van Hemmen3,
  4. W Fransman2,
  5. H Kromhout2
  1. 1Risk Assessment in the Work Environment, a collaborative centre between TNO Quality of Life and IRAS; Currently at: Central American Institute for Studies on Toxic Substances (IRET), National University, Heredia, Costa Rica
  2. 2Environmental and Occupational Health Division, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands
  3. 3TNO Quality of Life, Netherlands
  4. 4Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA
  1. Correspondence to:
 Dr H Kromhout
 Environmental and Occupational Health Division, Institute for Risk Assessment Sciences, Utrecht University, PO Box 80176, 3508 TD Utrecht, Netherlands;


Background: The authors recently developed a Dermal Exposure Assessment Method (DREAM), an observational semiquantitative method to assess dermal exposures by systematically evaluating exposure determinants using pre-assigned default values.

Aim: To explore the accuracy of the DREAM method by comparing its estimates with quantitative dermal exposure measurements in several occupational settings.

Methods: Occupational hygienists observed workers performing a certain task, whose exposure to chemical agents on skin or clothing was measured quantitatively simultaneously, and filled in the DREAM questionnaire. DREAM estimates were compared with measurement data by estimating Spearman correlation coefficients for each task and for individual observations. In addition, mixed linear regression models were used to study the effect of DREAM estimates on the variability in measured exposures between tasks, between workers, and from day to day.

Results: For skin exposures, spearman correlation coefficients for individual observations ranged from 0.19 to 0.82. DREAM estimates for exposure levels on hands and forearms showed a fixed effect between and within surveys, explaining mainly between-task variance. In general, exposure levels on clothing layer were only predicted in a meaningful way by detailed DREAM estimates, which comprised detailed information on the concentration of the agent in the formulation to which exposure occurred.

Conclusions: The authors expect that the DREAM method can be successfully applied for semiquantitative dermal exposure assessment in epidemiological and occupational hygiene surveys of groups of workers with considerable contrast in dermal exposure levels (variability between groups >1.0). For surveys with less contrasting exposure levels, quantitative dermal exposure measurements are preferable.

  • BZ, benzene
  • CP, cyclophosphamide
  • DEGBE, di-ethyl-glycol-butyl-ether
  • DREAM, Dermal Exposure Assessment Method
  • DU, DREAM units
  • GM, geometric mean
  • GSD, geometric standard deviation
  • LOD, limit of detection
  • MWF, metal working fluids
  • OS, organic solvents
  • TL, toluene
  • semiquantitative
  • dermal exposure assessment
  • accuracy
  • validation

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