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TESIS

HUBUNGAN KADAR XYLENE DARAH DENGAN KELUHAN NEUROLOGIS PADA PEKERJA PENGECATAN MOBIL

JALAN PENGENAL SURABAYA

ARIE ARIZANDI KURNIANTO

UNIVERSITAS AIRLANGGA

FAKULTAS KESEHATAN MASYARAKAT

PROGRAM MAGISTER

PROGRAM STUDI KESELAMATAN DAN KESEHATAN KERJA

SURABAYA

2016

ADLN - Perpustakaan Universitas Airlangga

TESIS HUBUNGAN KADAR XYLENE... ARIE ARIZANDI KURNIANTO

ii

TESIS



Oleh :


NIM. 101324253007



PROGRAM MAGISTER


SURABAYA

2016



iii



TESIS

Untuk memperoleh gelar Magister Keselamatan dan Kesehatan Kerja

Program Studi Keselamatan dan Kesehatan Kerja

Fakultas Kesehatan Masayarakat

Universitas Airlangga

Oleh:


NIM. 101324253007



PROGRAM MAGISTER


SURABAYA

2016



iv

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


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.



v

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


Oleh :


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



vi

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.


Arie Arizandi Kurnianto



vii

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.


Penulis



viii

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



ix

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.



x

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



xi

DAFTAR ISI

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

BAB 1. PENDAHULUAN

1.1 Latar Belakang ............................................................................ 1

1.2 Kajian Masalah ............................................................................ 6

1.3 Rumusan Masalah ....................................................................... 11

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

1.5 Manfaat Penelitian ...................................................................... 12

BAB 2. TINJAUAN PUSTAKA

2.1 Xylene ......................................................................................... 13

2.2 Biomonitoring Xylene ................................................................. 26

2.3 Sistem Saraf Manusia .................................................................. 28

2.4 Keluhan neurologis ..................................................................... 30

2.5 Pengecatan Mobil ........................................................................ 51

BAB 3. KERANGKA KONSEPTUAL

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

3.2 Hipotesis Penelitian ..................................................................... 58

BAB 4. METODE PENELITIAN

4.1 Jenis Penelitian ............................................................................. 60

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

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

4.4 Kerangka Operasional ................................................................. 62



xii

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 ............................................. 80

5.5 Uji Hubungan antara Faktor yang Berhubungan dengan Keluhan

Neurologis ................................................................................... 82

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 .......................... 95

6.4 Analisis Hubungan antara Karakteristik Individu dengan Keluhan

Neurologis .................................................................................. 97

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



xiii

DAFTAR TABEL

NO JUDUL TABEL HALAMAN

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

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

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

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

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

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

5.1 Hasil Pengukuran Kadar Xylene di Kawasan Pengecatan Mobil Jalan

Pengenal Surabaya .................................................................................... 74

5.2 Distribusi Frekuensi Jumlah Pekerja Berdasarkan Lokasi Kerja di

Kawasan Pengecatan Mobil Jalan Pengenal Surabaya ............................. 74

5.3a Deskripsi Kadar Xylene Darah Responden di Kawasan Pengecatan Mobil

Jalan Pengenal Surabaya ............................................................................ 75

5.3b Distribusi Frekuensi Hubungan Kadar Xylene Darah Responden dengan

Keluhan Neurologis di Kawasan Pengecatan Mobil Jalan Pengenal

Surabaya ..................................................................................................... 75

5.4 Distribusi Karakteristik Responden di Kawasan Pengecatan Mobil Jalan

Pengenal Surabaya ..................................................................................... 76

5.5 Distribusi Frekuensi Faktor Pekerjaan Responden di Kawasan Pengecatan

Mobil Jalan Pengenal Surabaya ................................................................. 79

5.6 Distribusi Frekuensi Keluhan Neurologis Responden di Kawasan

Pengecatan Mobil Jalan Pengenal Surabaya .............................................. 80

5.7 Distribusi Frekuensi Pekerja Bedasarkan Lokasi Kerja dengan Keluhan

Neurologis Responden di Kawasan Pengecatan Mobil Jalan Pengenal

Surabaya.. .................................................................................................. 82

5.8 Hasil Uji Chi-square antara Faktor Karakteristik Pekerja terhadap Keluhan

Neurologis pada Pekerja Pengecatan Mobil Jalan Pengenal Surabaya ...... 83

5.9 Uji Hubungan Faktor yang Berhubungan dengan Keluhan Neurologis

Responden di Kawasan Pengecatan Mobil Jalan Pengenal Surabaya ........ 85

5.10 Ringkasan Hasil Uji Regresi Tentang Faktor yang Berhubungan dengan

Kadar Xylene Darah Pekerja di Kawasan Pengecatan Mobil Jalan


5.11 Hasil Analisis Regresi Linier Tentang Faktor yang Berhubungan dengan

Kadar Xylene Darah Responden di Kawasan Pengecatan Mobil Jalan


5.12 Ringkasan Hasil Uji Regresi Tentang Faktor yang Berhubungan dengan

Keluhan Neurologis Responden di Kawasan Pengecatan Mobil Jalan


5.13 Hasil Analisis Regresi Linier Tentang Faktor yang Berhubungan dengan

Keluhan Neurologis Responden di Kawasan Pengecatan Mobil Jalan




xiv

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



xv

DAFTAR LAMPIRAN

Lampiran 1. Lembar Penjelasan Penelitian

Lampiran 2. Surat Persetujuan Sebagai Responden Penelitian

Lampiran 3. Kuesioner Penelitian

Lampiran 4. Surat Perizinan Penelitian

Lampiran 5. Dokumentasi Penelitian

Lampiran 6. Hasil Uji Statistik



xvi

DAFTAR LAMBANG DAN SINGKATAN

Daftar Arti Lambang

& = dan

≥ = lebih dari sama dengan

> = lebih dari

< = kurang dari

% = persen

/ = per-

Daftar Singkatan

APD = Alat Pelindung Diri

K3 = Keselamatan dan Kesehatan Kerja

PPLDC = Perhimpunan Pengusaha Las, Dodog dan Cat

SOP = Standard Operating Procedures

TLV = Threshold Limit Value

TWA = Time Weighted Average

STEL = Short Time Exposure Limit

OEL = Occupational Exposure Limit

WHO = World Health Organization

-



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