**4. Discussion**

#### **4.1 Location of dry cleaning facilities in Sfax and residential exposure**

First of all, since there was no list of dry cleaning facilities in Sfax city, we encountered some difficulties during the identification and location steps. That is why, it was decided to conduct a door-to-door canvassing in the study area.

**35**

*Per- and Trichloroethylene Air Monitoring in Dry Cleaners in the City of Sfax (Tunisia)*

The lack of dry cleaners in the medina quarter may be explained by its transformation into a commercial zone with plenty of stores. However, this is not the case in the Sidi Mansour road, which is predominantly an industrial zone. It is a less populated area and seems like its inhabitants did not see the need for dry cleaning, which could be explained by their relatively low standard of living. Finally, we noticed that the facilities are generally located in densely populated areas of Sfax city. Indeed, the downtown area that includes 40% of the total number has a high demographic density. Actually, this could represent a major issue for the health of people living close to the dry cleaning facilities. In fact, they could be exposed to higher concentrations of solvents in comparison with the rest

Several studies have explored many adverse health effects related to the exposure of people residing near dry cleaning facilities and TCE- or PCE-emitting sites. A study showed that the maternal age increased the risk of fetal heart defects when mothers were living around a trichloroethylene-emitting site [11, 18]. Many epidemiological studies have reported that visual functions, such as contrast sensitivity, were reduced when residents were exposed to low perchloroethylene levels from dry cleaning facilities in their neighborhood [12, 29, 30]. This association was also confirmed in children in further studies but with even lower levels [12]. These Visual alterations are rather considered as neurological effects [12, 29]. Actually, other studies showed the increase of neurobehavioral difficulties, such as memory, cognitive, and attention impairments, in people living in residential buildings that include a dry cleaning facility [12, 29]. These neurological effects were also noticed in occupationally exposed populations, but according to a meta-analysis study, they were more significant in the general population [12]. This could be explained by the fact that the general populations include all ages and genders, which increases the

On the other hand, a study conducted in North Carolina demonstrated that the dry cleaning facility was the main source of drinking water contamination with trichloroethylene [11]. Since many Sfaxians are using rainwater harvesting, this could induce a great concern about possible supplementary adverse health effects

OELVs are established to prevent occupational illnesses in general but they are not specific to a health effect or target organ. Thus, even though the TCE and PCE concentrations are below the OELVs, some serious adverse health effects may occur [31]. Furthermore, since the general population is also involved, people, including the occupationally exposed ones, are more effectively protected if the air concentrations are below the toxicological reference values (TRV). These TRVs are exclusively established based on scientific considerations [31]. In this section, we are only discussing TRVs that are protecting populations from

Since there are no Tunisian values, we are checking TRVs that are conceived from French and American agencies. The French values are constructed by the French Agency for Food, Environmental and Occupational Health & Safety

(ANSES) [32]. The TCE chronic TRV via inhalation is constructed based on noncarcinogenic renal effect because of a well-established nephrotoxicity mechanism [33].

times the French TRV, which means that there is a great risk of nephrotoxicity for workers. Among the American TRVs, we can mention, for instance, the ones that are established by the Environmental Protection Agency (US EPA) [34]. The TCE

. The mean value of all TCE concentrations is 13.4

*DOI: http://dx.doi.org/10.5772/intechopen.86725*

of the general populations [12].

worry about them.

threshold effects.

The TRV is fixed on 3.2 mg/m3

related to other routes of exposure through water.

**4.2 Occupational exposure limit values and threshold effects**

### *Per- and Trichloroethylene Air Monitoring in Dry Cleaners in the City of Sfax (Tunisia) DOI: http://dx.doi.org/10.5772/intechopen.86725*

The lack of dry cleaners in the medina quarter may be explained by its transformation into a commercial zone with plenty of stores. However, this is not the case in the Sidi Mansour road, which is predominantly an industrial zone. It is a less populated area and seems like its inhabitants did not see the need for dry cleaning, which could be explained by their relatively low standard of living. Finally, we noticed that the facilities are generally located in densely populated areas of Sfax city. Indeed, the downtown area that includes 40% of the total number has a high demographic density. Actually, this could represent a major issue for the health of people living close to the dry cleaning facilities. In fact, they could be exposed to higher concentrations of solvents in comparison with the rest of the general populations [12].

Several studies have explored many adverse health effects related to the exposure of people residing near dry cleaning facilities and TCE- or PCE-emitting sites. A study showed that the maternal age increased the risk of fetal heart defects when mothers were living around a trichloroethylene-emitting site [11, 18]. Many epidemiological studies have reported that visual functions, such as contrast sensitivity, were reduced when residents were exposed to low perchloroethylene levels from dry cleaning facilities in their neighborhood [12, 29, 30]. This association was also confirmed in children in further studies but with even lower levels [12]. These Visual alterations are rather considered as neurological effects [12, 29]. Actually, other studies showed the increase of neurobehavioral difficulties, such as memory, cognitive, and attention impairments, in people living in residential buildings that include a dry cleaning facility [12, 29]. These neurological effects were also noticed in occupationally exposed populations, but according to a meta-analysis study, they were more significant in the general population [12]. This could be explained by the fact that the general populations include all ages and genders, which increases the worry about them.

On the other hand, a study conducted in North Carolina demonstrated that the dry cleaning facility was the main source of drinking water contamination with trichloroethylene [11]. Since many Sfaxians are using rainwater harvesting, this could induce a great concern about possible supplementary adverse health effects related to other routes of exposure through water.
