Chemical Exposure
Dangerous substances a
daily part of nurses’ lives

By Barbara Tone, RN
Photo: PhotoDisc
October 4, 1999

From antibacterial soaps to chemotherapeutic agents, chemicals are a daily part of nurses’ lives. Over the years, a host of chemicals have been gradually added to the healthcare environment, bringing new technology to patients and new risks to those who care for them.

There are 159 known primary skin or eye irritants used in hospitals and 135 chemicals that are potentially carcinogenic, teratogenic, mutagenic, or a combination of all three, according to data collected by the National Institute for Occupational Safety and Health (NIOSH) in 1985. “There are so many thousands of chemicals in use everywhere, and the number being used far outweighs the government’s ability to test them,” said Lawrence Mazzuckelli, a NIOSH toxicologist.

With all these chemicals lurking in the environment, how risky is it to work in health care? The answer, in some cases, is that nobody knows, and in other cases, that it depends.

Comprehensive data on chemical injuries and illness is difficult to find because the healthcare industry is regulated by a wide variety of local, state, and federal agencies and organizations. What is certain is that the risk of work-related chemical injury or illness is real.

Some of the most common chemical exposures are from latex, sterilizing agents, and chemotherapeutic agents. Gases and vapors encountered in the OR can also be a problem.

Chemotherapeutic agents

The risks associated with oncology drugs are one of the biggest unknowns in health care. Mixing and administering chemotherapeutic agents poses hazards to nurses, pharmacists, and anyone else responsible for handling these drugs.

“We have absolutely no idea what the risks are,” said Dominic Solimando, MA, a licensed pharmacist and director of oncology drug information for a New York-based cancer information Web site, www.cancereducation.com. “We have a lot of data from patients, and we know that a secondary cancer is one of the side effects of chemotherapy. The assumption has been made that any risk or exposure will lead to cancer, but nobody really knows.”

A study published in the July 15, 1999, issue of the American Journal of Health-System Pharmacy found measurable amounts of antineoplastic agents in 75 percent of samples taken from work surfaces in pharmacies and 65 percent of samples taken from the floor in areas where the drugs were administered. And a study last year in Cancer Nursing found that contamination could easily occur during drug handling and that staff members were not always aware they had contaminated themselves.

“It is very important to be aware of the potential hazards,” said Bonnie Rogers, DrPH, RN, FAAN, associate professor and director of the occupational nursing program at the University of North Carolina, Chapel Hill, and immediate past president of the American Association of Occupational Health Nurses. “Particularly with pregnant women and those in childbearing years, we need to exercise caution. Some of the experimental drugs don’t even have a name, just a series of letters and numbers. You can’t even look them up.”

Fortunately, the risks can be managed. “I don’t think this needs to be treated with fear,” said Mary Jo Santicky, RN, associate for membership and leadership for the Oncology Nursing Society. “I think it needs to be treated with a healthy respect, but I’m more afraid to sit in a room with someone who smokes.”

Latex allergies

Latex products present additional hazards for nurses. Experts estimate that 8 to 12 percent of healthcare workers, especially those who frequently use latex gloves, are sensitive to latex.

Following the 1987 recommendation for universal precautions, latex reactions made their way into the spotlight with the Food and Drug Administration receiving more than 1,000 reports of adverse reactions in the ensuing four years, including 15 deaths. In 1997, NIOSH issued an alert on latex sensitivity, prompting many healthcare institutions to take steps to decrease the number and severity of these reactions, including substituting unpowdered latex and non-latex gloves and reassigning latex-sensitive personnel to areas where the use of latex gloves is limited.

Disinfectants and sterilizing agents

Disinfectants and sterilizing agents are another common chemical hazard for nurses. In recent years, glutaraldehyde, a sterilant, has been blamed for a variety of symptoms ranging from mild dermatitis to respiratory and neurological problems. “I have nasal sores, daily diarrhea, hives, skin that looks like an alligator, and I can’t walk to the second story of my house without stopping on the landing to catch my breath,” said Carolyn Berg, RN, a former urology nurse from San Diego who says she has been unable to work for more than a year because of glutaraldehyde exposure. “I was never informed I was working with a toxic substance,” she said.

Once kept in open basins in closed rooms, poured and regularly splashed, glutaraldehyde now is recommended for use with ventilation hoods, personal protective equipment, and closed containers.

Toxic smoke

In addition to coming into contact with sterilants such as glutaraldehyde, nurses who work in the OR must contend with substances unique to that environment, such as laser smoke. According to NIOSH reports, research studies show that laser and electrosurgery smoke can contain toxic gases and vapors, dead and live cellular material, and viruses.

Unfortunately, not all facilities are aware of the danger. “I lecture all the time on the hazards of surgical smoke. There are so many who don’t even know there is a hazard,” said Kay Ball, RN, FAAN, a perioperative consultant and educator and past president of the Association of periOperative Registered Nurses.

Reducing risk

Today, nurses have access to many protections, both engineering and work practice. Biological safety cabinets, special ventilation systems, detailed procedures, gloves, gowns, and goggles are just a few of the barriers to injury. When used consistently and properly, these protections can reduce and, in many cases, eliminate the hazardous effects of workplace chemicals.

And hospitals are also concerned about the problem. “Hospitals are a place where lots of treatments and interventions involve all sorts of materials and supplies. All have procedures for acquisition, storage, administration, and disposal,” said Marjorie Beyers, PhD, RN, FAAN, executive director of the American Organization of Nurse Executives. “People who know these procedures are protected, and orientation and testing for competencies is very important.”

Still, not everyone exercises appropriate caution. “It’s part of the psychology that permeates any profession,” said NIOSH’s Mazzuckelli. “There is a tendency to think that the stuff you’re working with couldn’t be harmful or you wouldn’t be working with it.”

Much of the responsibility for preventing chemical exposure falls on individual nurses who must adhere to procedures for handling all hazardous materials to decrease or eliminate risk. “We have to start recognizing that the healthcare environment is a hazardous place,” said Susan Wilburn, MPH, RN, senior specialist for occupational safety and health for the American Nurses Association.

“We need to begin education about these issues in medical and nursing schools,” Rogers said. “We have to learn when to say, ‘This risk isn’t appropriate.’ There shouldn’t be a nurse or physician out there who thinks it is acceptable to have risks that can’t be controlled.”