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Brannen's organization, supported by the Environmental Protection Agency, the American Hospital Association, the American Nurses Association and Health Care Without Harm, is part of a growing movement to promote less hazardous product and application alternatives. The group provides resources on alternative cleaning and sterilizing products and is working with the EPA to start a "greener, cleaner" task force to look at floor strippers and buffing products.

Brannen acknowledges it's an enormous task to change the way an institution operates, but it's a responsibility everyone in health care should take on, including nurses.

"Thinking about this stuff should be part of our job," she said. "Health care workers should be leaders in making the environment healthy."

Nurses are more at risk for chemical exposure and poor air quality health risks than many realize, said Janice Homer, RN, who has been diagnosed with occupational asthma and speaks at conferences around the country. When they do suffer health problems, she said, many nurses are reluctant to complain. "Nurses will just keep going even if they're sick as dogs," Homer said.

In 1989, she was working as an evening charge nurse in a nursery when she noticed a burning stench from the ventilators.

"Within 20 minutes, I couldn't feel my arms and legs," she said. "I was basically high. The other nurse couldn't see. I felt like a flea that's been dipped. My arms and legs were numb."

She and two other nurses spent the night in the ER and the nursery was evacuated. They later traced the problem to a cement sealer being used in the medical office building under construction next door.

That was a life-changing event for Homer. But it wasn't until a few years later when she developed occupational asthma that she became a crusader for environmental safety for nurses. Homer attributes her illness to the buffing chemicals used to shine hospital floors and the toxic cleaning chemicals.

The number of respiratory incidents attributed to toxic agents among hospital workers has been rising. According to Department of Labor statistics, the number of incidents in hospitals per 10,000 full-time workers increased from 3.2 incidents in 1996 to 5.2 in 2001. A National Institute of Occupational Safety and Health report of work-related asthma studied 1,101 reported cases in California, Michigan, Massachusetts and New Jersey.

Registered nurses accounted for 4.8 percent of the cases. Cleaning chemicals and glutaraldehyde were the most common asthma triggers.

A Massachusetts Department of Public Health study released in January 2000 found registered nurses made up the work group with the most reported cases of occupational asthma. Poor indoor air quality, latex and cleaning products were the most frequently reported asthma triggers for nurses.

Homer attributes the increased chemical exposure problems in part to the increased concern over hospital infections. Facilities are using greater amounts and varieties of disinfectants and cleaning agents.

"I got a copy of all the products being used in one unit," she said. "There were 27."

Hospital buildings, she said, lack fresh air from open windows and may have poor ventilation systems. She also blames lack of training for housekeeping workers, particularly when hospitals use outside contractors rather than their own staff. Sometimes, workers can't read product labels or haven't been properly trained in handling the chemicals.

The hospital where Homer now works doesn't buff the floor in her unit, and she said that she hasn't had to use her inhaler in two years, an indication that her former work environment may have triggered her asthma.

Yet some are skeptical about blaming cleaning chemicals for occupational asthma.

"If nurses are reacting to chemicals on a cleaning cart, why aren't the housekeepers falling over?" said Lori Schaumlefel, RN, COHN-S, coordinator of employee health at Mercy Hospital of Folsom, a 500-employee hospital in Northern California.

Nurses could have underlying health conditions that cause their respiratory problems or have an allergic reaction to a substance without that developing into a lifelong health condition, Schaumlefel said. "In California, industrial-induced asthma is a difficult compensatory claim to prove," she said.