TESIS HUBUNGAN KADAR XYLENE DARAH DENGAN KELUHAN NEUROLOGIS PADA PEKERJA PENGECATAN MOBIL JALAN PENGENAL SURABAYA

Oleh : ARIE ARIZANDI KURNIANTO NIM. 101324253007 UNIVERSITAS AIRLANGGA FAKULTAS KESEHATAN MASYARAKAT PROGRAM MAGISTER PROGRAM STUDI KESELAMATAN DAN KESEHATAN KERJA SURABAYA 2016

HUBUNGAN KADAR XYLENE DARAH DENGAN KELUHAN NEUROLOGIS PADA PEKERJA PENGECATAN MOBIL JALAN PENGENAL SURABAYA TESIS Untuk memperoleh gelar Magister Keselamatan dan Kesehatan Kerja Program Studi Keselamatan dan Kesehatan Kerja Fakultas Kesehatan Masayarakat Universitas Airlangga Oleh: ARIE ARIZANDI KURNIANTO NIM. 101324253007 UNIVERSITAS AIRLANGGA FAKULTAS KESEHATAN MASYARAKAT PROGRAM MAGISTER PROGRAM STUDI KESELAMATAN DAN KESEHATAN KERJA SURABAYA 2016

PENGESAHAN Dipertahankan di depan Tim Penguji Tesis Program Studi Keselamatan dan Kesehatan Kerja Fakultas Kesehatan Masyarakat Universitas Airlangga dan diterima untuk memenuhi persyaratan guna memperoleh gelar Magister Keselamatan dan Kesehatan Kerja (M.KKK) pada tanggal 28 Desember 2015 Mengesahkan Universitas Airlangga Fakultas Kesehatan Masyarakat Dekan, Prof. Dr. Tri Martiana, dr., M.S. NIP 195603031987012001

Tim Penguji: Ketua : Dr. Abdul Rohim Tualeka, Drs., M. Kes Anggota : 1. Prof. Dr. Tri Martiana, dr., M.S.

2. Prof. Soedjajadi Keman, dr., M.S., Ph.D.

3. Dr. Diah Indriani, S.Si., M.Si.

4. Linda Dewanti, dr., M.Kes., M.HSc., Ph.D.

5. Sahabat Sutanto, S.KM., M.Kes.

PERSETUJUAN

TESIS

Diajukan sebagai salah satu syarat untuk memperoleh gelar

Magister KESELAMATAN DAN KESEHATAN KERJA (M.KKK)

Program Studi KESELAMATAN DAN KESEHATAN KERJA

Fakultas Kesehatan Masyarakat

Universitas Airlangga

Oleh :

ARIE ARIZANDI KURNIANTO

NIM. 101324253007

Menyetujui,

Surabaya, Januari 2016

Pembimbing Ketua Pembimbing

Mengetahui,

Ketua Program Studi KESELAMATAN DAN KESEHATAN KERJA

Dr. Abdul Rohim Tualeka, Drs., M.Kes

NIP 196611241998031002

Prof. Dr. Tri Martiana, dr., M.S. NIP. 19560303 19870 121001 Prof. Soedjajadi Keman, dr., M.S., Ph.D. NIP. 195203151979031008

PERNYATAAN TENTANG ORISINALITAS

Yang bertandatangan di bawah ini, saya: Nama : Arie Arizandi Kurnianto NIM : 101324253007 Program studi : Keselamatan dan Kesehatan Kerja Angkatan : 2013 Jenjang : Magister

Menyatakan bahwa saya tidak melakukan kegiatan plagiat dalam penulisan tesis saya yang berjudul: HUBUNGAN KADAR XYLENE DARAH DENGAN KELUHAN NEUROLOGIS PADA PEKERJA PENGECATAN MOBIL JALAN PENGENAL SURABAYA Apabila suatu saat nanti saya terbukti saya melakukan tindakan plagiat, maka saya akan menerima sanksi yang telah ditetapkan. Demikian surat pernyataan ini saya buat dengan sebenar-benarnya.

Surabaya, Januari 2016 Arie Arizandi Kurnianto

KATA PENGANTAR

Puji syukur kehadirat Allah SWT, karena atas limpahan rahmat-Nya penulis dapat menyelesaikan tesis yang berjudul “Hubungan Kadar Xylene Darah dengan Keluhan Neurologis pada Pekerja Pengecatan Mobil Jalan Pengenal Surabaya ”.

Tesis ini berisikan mengenai hubungan kadar xylene darah dengan keluhan neurologis, maka penelitian ini menganalisis hubungan antara kadar xylene darah dengan keluhan neurologis pada pekerja pengecatan mobil di Jalan Pengenal Surabaya.

Ucapan terima kasih yang tak terhingga saya sampaikan kepada Prof. Dr. Tri Martiana, dr., M.S., selaku pembimbing yang telah dengan kesabaran dan perhatiannya dalam memberikan bimbingan. Ucapan terima kasih yang tak terhingga juga saya sampaikan kepada Prof. Soedjajadi Keman, dr., M.S., Ph.D., selaku pembimbing kedua yang telah banyak meluangkan waktu untuk memberikan bimbingan, dengan sabar serta memotivasi dan saran demi kesempurnaan tesis ini.

Dengan terselesaikan tesis ini, perkenankan saya mengucapkan terima kasih yang sebesar-besarnya kepada :

1. Prof. Dr. Moh. Nasih, SE., MT., Ak., CMA. selaku Rektor Universitas Airlangga

2. Prof. Dr. Tri Martiana, dr., M.S., selaku Dekan Fakultas Kesehatan Masyarakat, Universitas Airlangga.

3. Dr. Abdul Rohim Tualeka, drs., M.Kes, selaku ketua program studi Keselamatan dan Kesehatan Kerja Fakultas Kesehatan Masyarakat, Universitas Airlangga beserta dosen dan para staff.

4. Tim penguji Dr. Abdul Rohim Tualeka, drs., M.Kes, Dr. Diah Indriani, S.Si, M.Si, Sahabat Sutanto, S.KM., M.Kes., dan Linda Dewanti, dr., M.Kes., M.HSc., Ph.D., atas kesediaan dan membimbing perbaikan penelitian tesis ini.

5. Tim Beasiswa USAID-PRESTASI dan teman-teman Cohort 4, terkhusus kepada Ibu Mira Sambada, Wiwin Erikawati, Sri Kurniaty, dan Bapak Hanif Saleh yang dengan sabar memfasilitasi semua kebutuhan kami, para scholars.

6. Bapak Maryanto Jamhuri, S.Ag. dan Ibu Mukarramah, S.Si., Apt, Adik Ikmar Masykur, S.E.dan Reski Syamsu, S.Si., Apt. serta seluruh keluarga yang selalu menyemangati dalam penyelesaian pendidikan.

7. Bapak Jauhari selaku ketua PPLDC Surabaya dan seluruh responden penelitian yang telah berpartisipasi dalam penelitian ini.

8. Teman-teman seperjuangan S2K3 angkatan 2013 dan 2014, serta pihak yang telah memberikan dukungan dan bantuan dalam penulisan usulan penelitian tesis ini. Demikian, semoga tesis ini bisa member manfaat bagi diri kami sendiri dan pihak lain yang menggunakan.

Surabaya, Januari 2016 Penulis

SUMMARY RELATIONSHIP OF BLOOD XYLENE LEVELS AND NEUROLOGICAL SYMPTOMS OF CAR PAINTING WORKERS IN PENGENAL STREET, SURABAYA

Xylene is one of substances that is the most dominant in spray painting in the automotive industry. Some studies showed that xylene can cause health problems, one of which is a neurological symptoms. When the paint is sprayed, the worker will be exposed not only by the steam, but also very inconvenient aerosol inhaled by workers, especially if not wearing a mask and appropriate work clothes. Xylene levels in the blood reach the top depends routes of exposure, such as oral, inhalation or through the skin. However, exposure to xylene is a major route through the respiratory system. Toxicodynamic of xylene in the body is depicted in how xylene cause toxic effects on the target organs. Liposulibility properties (lipophilic) of xylene to the nerve cell membrane can interfere with the activity of proteins that play an important role in normal neuronal function. In addition, exposure to xylene vapors can cause a decrease in stimulus due to the disruption of axonal transport and a decrease in hypothalamus catecholamine levels which is assumed to cause disruption neurologic.

This study was designed as an observational study and conducted by cross sectional method. Samples were obtained by using stratified random sampling technique were 51 painters. The dependent variable in this study was neurological symptoms which were meant by German version of the Q18 questionnaire, while the independent variables were characteristics of workers (age, exercise habits, body mass index, respiration rate, the habit of using personal protective equipment, smoking), xylene levels in the blood, which was measured by ELISA, and occupational factors (working period, duration of work and job description).

Levels of xylene in work environment area in Pengenal Street, Surabaya among five locations that manage the car painting business, respectively 31.70 ppm, 60.68 ppm, 65.93 ppm, 271 ppm and 341 ppm, with levels of xylene in the air two workshops are known to exceed the threshold limit value (TLV), which is 100 ppm. The results of Pearson and Spearman correlation analysis between independent variables include characteristics of workers, levels of xylene in blood and job factor with the dependent variable, neurologic symptoms of car painting workers in Jalan Pengenal Surabaya showed a significant correlation on age, working time, the habit of using PPE mask, smoking habits, and xylene levels in the blood. It can be seen from the probability (p) is smaller than 0,05 respectively with

Pearson’s correlation coefficient (r) which is a measure of the strength of the association between the two variables. Pearson correlation test for age (p = 0.000; r = 0.697) showed an association between age and neurological symptoms on workers. However, Spearman correlation test for habitual use of personal protective equipment (PPE) such as masks (p = 0.000; r = 0.695) showed an association between habitual use of personal protective equipment such as masks with neurological symptoms on workers. Smoking habits (p = 0.016; r = 0.335) showed a correlation between smoking and neurological symptoms on workers. Exercise habits (p = 0.170; r = -0.195) showed respectively have no correlation between exercise habits with neurologic symptoms on workers. Blood xylene levels (p = 0.000, r = 0.711) considered have a strong association between blood xylene levels with neurological symptoms on workers.

For job factors where the period of work factor analyzed by Pearson correlation test (p = 0.000; r = 0.713) showed a relationship between period of work with neurologic symptoms on workers. Employment based on job description factors (p = 0.476; r = 0.102), showed no relationship between job description with neurological symptoms on workers. Working time or duration of work (p = 0.471; 0.103) showed no association between Working time with neurologic symptoms on workers. Simple linear regression analysis (multivariate analysis) which is an analysis simultaneously on all independent variables with the dependent variable, which is neurological symptoms. In this study, using simple linear regression, which is known the results showed that the most dominant factor associated with neurological symptoms is working period, the habit of using PPE such as masks and xylene levels in the blood. The correlation coefficient (R-square) for this regression test was 0.761. It means that for a variable period of employment, habit of using PPE such as masks and xylene levels in the blood are able to explain or predict the value of the dependent variable neurologic symptoms amounted to 76.1% and 23.9% influenced by other factors.

As the conclusion, there was a correlation between xylene exposure with levels of xylene in blood and neurological symptoms of car painting workers on Pengenal Street, Surabaya. Recommendation for business owner technically should have to provide the equipment that support the painting as well as personal protective equipment, especially masks. In addition, it should be made a rule not to smoke while working. For workers, especially painters need to raise awareness to stop smoking

and use such personal protective equipment while working

ABSTRACT RELATIONSHIP OF BLOOD XYLENE LEVELS AND NEUROLOGICAL SYMPTOMS OF CAR PAINTING WORKERS IN PENGENAL STREET, SURABAYA Xylene is the most dominant substance in spray painting in the automotive industry. Some studies showed that xylene can cause health problems, one of which is a neurological symptoms.This study was conducted in one area of car painting on Jalan Pengenal, Surabaya. The aim of this study was to analyze the relationship of levels of xylene in blood with neurological symptoms on car painting workers in Pengenal Street, Surabaya.

This study was designed as an observational study and conducted by cross sectional method. Samples were obtained by using stratified random sampling technique were 51 painters. The dependent variable in this study was neurological symptoms which were meant by German version of the Q18 questionnaire, while the independent variables were characteristics of workers (age, exercise habits, body mass index, respiration rate, the habit of using personal protective equipment, smoking), xylene levels in the blood, which was measured by ELISA, and

occupational factors (working period, duration of work and job description).

This research showed that levels of xylene of work environment in two out of five workshops were 271 ppm and 341 ppm respectively higher than threshold limit value (TLV), 100 ppm. The results of Pearson correlation analysis showed a significant correlation on age, period of working, and duration of working, and Spearman correlation analysis showed that habit of using PPE mask, smoking habits, and xylene levels in the blood,where probability is smaller than p-value 0,05, which strongly considered have a strong association with neurological symptoms on workers. Based on simple linear regression analysis showed that correlation coefficient (R-square) was 0.718, which means PPE masks and xylene levels in the blood were able to explain the value of neurologic symptoms amounted to 71.8% and 28.2% were influenced by other factors.

It is concluded that blood levels of xylene is related to neurological symptoms in informal car painters. Relationship of xylene exposure with neurological symptoms reveals by monitoring levels of xylene in blood and habitual use of PPE masks. In advance, as suggestion for owner is to substitute organic compound safer

than xylene and always provide suitable PPE mask for workers during work time.

Keywords: xylene exposure, xylene in blood, neurological symptoms, car painting workers

DAFTAR ISI

28 2.4 Keluhan neurologis .....................................................................

60 4.4 Kerangka Operasional .................................................................

60 4.3 Populasi dan Sampel ...................................................................

60 4.2 Lokasi dan Waktu Penelitian ......................................................

58 BAB 4. METODE PENELITIAN 4.1 Jenis Penelitian .............................................................................

56 3.2 Hipotesis Penelitian .....................................................................

51 BAB 3. KERANGKA KONSEPTUAL 3.1 Kerangka Konseptual ..................................................................

30 2.5 Pengecatan Mobil ........................................................................

26 2.3 Sistem Saraf Manusia ..................................................................

Halaman HALAMAN JUDUL ....................................................................................... ii PERSYARATAN GELAR .............................................................................. iii PENGESAHAN ............................................................................................... iv PERSETUJUAN .............................................................................................. v PERNYATAAN TENTANG ORISINALITAS .............................................. vi KATA PENGANTAR...................................................................................... vii SUMMARY ..................................................................................................... viii ABSTRACT ..................................................................................................... x DAFTAR ISI ................................................................................................... xi DAFTAR TABEL ........................................................................................... xiii DAFTAR GAMBAR ...................................................................................... xiv DAFTAR LAMPIRAN ................................................................................... xv DAFTAR SINGKATAN.................................................................................. xvi

13 2.2 Biomonitoring Xylene .................................................................

12 BAB 2. TINJAUAN PUSTAKA 2.1 Xylene .........................................................................................

11 1.5 Manfaat Penelitian ......................................................................

11 1.4 Tujuan Penelitian ........................................................................

6 1.3 Rumusan Masalah .......................................................................

1 1.2 Kajian Masalah ............................................................................

BAB 1. PENDAHULUAN 1.1 Latar Belakang ............................................................................

4.5 Variabel Penelitian dan Definisi Operasional ..............................

62 4.6 Sumber Data .................................................................................

64 4.7 Teknik dan Instrumen Pengumpulan data ...................................

65 4.8 Pengolahan dan Analisis Data .....................................................

70 BAB 5. HASIL PENELITIAN 5.1 Gambaran Umum Lokasi Penelitian ...........................................

72 5.2 Kadar Xylene Darah .....................................................................

75 5.3 Identifikasi Faktor Karakteristik Responden ...............................

76 5.4 Hasil Analisis Keluhan Neurologis .............................................

5.5 Uji Hubungan antara Faktor yang Berhubungan dengan Keluhan Neurologis ...................................................................................

5.6 Uji Multivariat antara Faktor yang Berhubungan dengan Keluhan Neurologis ...................................................................................

86 BAB 6. PEMBAHASAN 6.1 Tingkat Paparan Xylene pada Pekerja .........................................

92 6.2 Kadar Xylene Dalam Darah .........................................................

94 6.3 Keluhan Neurologis Pekerja Pengecatan Mobil ..........................

6.4 Analisis Hubungan antara Karakteristik Individu dengan Keluhan Neurologis ..................................................................................

6.5 Analisis Hubungan antara Karakteristik Pekerjaan dengan Keluhan Neurologis .................................................................................. 105

6.6 Analisis Hasil Analisis Faktor yang Berhubungan dengan Keluhan Neurologis ................................................................................... 108

6.7 Keterbatasan Penelitian ................................................................ 110

BAB 7. KESIMPULAN DAN SARAN

7.1 Kesimpulan .................................................................................. 111

7.2 Saran ............................................................................................ 111 DAFTAR PUSTAKA ...................................................................................... 113 LAMPIRAN

DAFTAR TABEL

5.4 Distribusi Karakteristik Responden di Kawasan Pengecatan Mobil Jalan Pengenal Surabaya ..................................................................................... 76

5.12 Ringkasan Hasil Uji Regresi Tentang Faktor yang Berhubungan dengan Keluhan Neurologis Responden di Kawasan Pengecatan Mobil Jalan Pengenal Surabaya ..................................................................................... 88

5.11 Hasil Analisis Regresi Linier Tentang Faktor yang Berhubungan dengan Kadar Xylene Darah Responden di Kawasan Pengecatan Mobil Jalan Pengenal Surabaya ..................................................................................... 87

5.10 Ringkasan Hasil Uji Regresi Tentang Faktor yang Berhubungan dengan Kadar Xylene Darah Pekerja di Kawasan Pengecatan Mobil Jalan Pengenal Surabaya ..................................................................................... 86

5.9 Uji Hubungan Faktor yang Berhubungan dengan Keluhan Neurologis Responden di Kawasan Pengecatan Mobil Jalan Pengenal Surabaya ........ 85

5.8 Hasil Uji Chi-square antara Faktor Karakteristik Pekerja terhadap Keluhan Neurologis pada Pekerja Pengecatan Mobil Jalan Pengenal Surabaya ...... 83

5.7 Distribusi Frekuensi Pekerja Bedasarkan Lokasi Kerja dengan Keluhan Neurologis Responden di Kawasan Pengecatan Mobil Jalan Pengenal Surabaya.. ..................................................................................................

5.6 Distribusi Frekuensi Keluhan Neurologis Responden di Kawasan Pengecatan Mobil Jalan Pengenal Surabaya .............................................. 80

5.5 Distribusi Frekuensi Faktor Pekerjaan Responden di Kawasan Pengecatan Mobil Jalan Pengenal Surabaya ................................................................. 79

Keluhan Neurologis di Kawasan Pengecatan Mobil Jalan Pengenal Surabaya ..................................................................................................... 75

NO JUDUL TABEL HALAMAN

Jalan Pengenal Surabaya ............................................................................ 75 5.3b Distribusi Frekuensi Hubungan Kadar Xylene Darah Responden dengan

74 5.3a Deskripsi Kadar Xylene Darah Responden di Kawasan Pengecatan Mobil

5.2 Distribusi Frekuensi Jumlah Pekerja Berdasarkan Lokasi Kerja di Kawasan Pengecatan Mobil Jalan Pengenal Surabaya .............................

5.1 Hasil Pengukuran Kadar Xylene di Kawasan Pengecatan Mobil Jalan Pengenal Surabaya .................................................................................... 74

4.1 Variabel Penelitian dan Definisi Operasional ........................................... 63

2.5 Hasil Analisis Sampel Tiner dan Campuran Cat ....................................... 54

2.4 Kategori Ideks Massa Tubuh (IMT) berdasarkan Depkes RI ................... 47

2.3 Daftar Pertanyaan Kuesioner Q18 Versi Jerman ...................................... 41

2.2 Indeks Monitoring Biologi Xylene ........................................................... 26

2.1 Karakteritik Fisika dan Kimia Xylene ...................................................... 15

5.13 Hasil Analisis Regresi Linier Tentang Faktor yang Berhubungan dengan Keluhan Neurologis Responden di Kawasan Pengecatan Mobil Jalan Pengenal Surabaya ..................................................................................... 89

DAFTAR GAMBAR

NO JUDUL GAMBAR HALAMAN

2.1 Skema Metabolisme Xylene ......................................................... 20

2.2 Skema Toksikodinamik ......................................................................... 22

2.3 Sistem Saraf Manusia ............................................................................ 29

2.4 Respirator OV 3M ................................................................................. 51

2.5 Pengecatan Body Mobil ......................................................................... 53

3.1 Kerangka Konseptual Penelitian .......................................................... 56

4.1 Kerangka Operasional Penelitian .......................................................... 62

TESIS HUBUNGAN KADAR XYLENE DARAH DENGAN KELUHAN NEUROLOGIS PADA PEKERJA PENGECATAN MOBIL JALAN PENGENAL SURABAYA