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The causes of occupational asthma are sometimes difficult
to pinpoint because so many triggers exist outside the
workplace. Animal dander, mold, pollen and smoke can
set off asthmatic reactions. Health department definitions
recognize two types of occupational asthma: Immunological
asthma can develop over a period of time when a person
becomes sensitized to an agent in the workplace, and
irritant-induced asthma can occur after an intense exposure
to an irritant present in dust or fumes. Some people
can experience a reaction when others in the same environment
don't, and reactions are sometimes delayed.
A nurse could have a psychological reaction as well,
said Jean Randolph, RN, COHN-S, manager of employee
health at Children's Healthcare of Atlanta and a member
of the Association of Occupational Health Nurses.
Her system employs 5,500 workers at two hospitals and
22 clinics. Some workers complain about the floor stripper
chemicals, she said, but she doubts that cleaning chemicals
can cause asthma. Chemicals used in hospitals are carefully
screened, she said. To avoid mishandling of products,
her hospitals switched to premixed solutions in drums
with automatic dispensing systems. This eliminates the
possibility of a worker who can't read the label mixing
a solution incorrectly, she said. Her skepticism isn't
unique.
Nurses can have a difficult time proving their sickness
is caused by something at work, said Cynthia Spry, MA,
MS, RN, that's why it's important to document incidents
of exposure. "Nurses will complain to each other,
but they need to document," Spry said. "The
thing administration responds to is data."
Spry, an international clinical consultant for Advanced
Sterilization Products, a Johnson & Johnson company,
does believe cleaning products are mishandled, mixed
incorrectly, put into unlabeled spray bottles or overused.
Despite stringent guidelines for using sterilizers,
she said, ethylene oxide, a known carcinogen, and glutaraldehyde,
a known irritant sensitizer, represent other potential
hazards for nurses. It's important to read the product
literature and to make sure instruments are properly
aerated after sterilization, she said, no matter how
rushed a nurse is.
"You should wear gloves, you should wear a gown,
you should wear goggles and nurses do that," Spry
said. "Today, we're so short staffed and so short
of time they may take shortcuts."
Alternative sterilants are on the market, and Spry
believes that, in time, hospitals will stop using glutaraldehyde.
Organizations like Health Care Without Harm, Sustainable
Hospitals and the Nightingale Institute for Health and
the Environment are pushing for changes in health care,
and hospitals are responding.
The University of California, Davis Medical Center
reduced its floor-cleaning chemical use by 90 percent
when it switched to microfiber mops, said Eugene Labrie,
manager of environmental services. The hospital, which
employs more than 7,000, tossed its old buckets and
string mops as a time-saving measure, he said, but another
benefit has been a drop in chemical use.
When a few hospital workers complained about floor
buffing, Labrie said, he arranged the buffing schedule
in their units to be done during the hours when they
aren't working.
Such simple, no-cost changes in procedures can go a
long way to curtailing chemical exposure risks. Brannen
recommends switching from spraying cleaning solutions
to wiping down surfaces with solution applied with a
cloth.
Most importantly, she said, nurses need to learn what
is used around them and advocate for safer alternatives.
At Tulare District Hospital in California, nurses circulated
a survey among themselves to find out how many experienced
headaches, wheezing and chest pains at work, said Karen
Roberts, RN, a clinical manager in the ICU/cath lab.
Nurses responded with comments such as "I'm fine
until I come to work, then I get sick," and "I
do better on my days off."
The nurses planned to ask the hospital to look into
the causes for their symptoms."Nurses shouldn't
be afraid to ask, 'What's in this?' " Brennan said.
" 'Why are we using this stinky stuff that's making
me sick?' "
One way to get information about hazardous chemicals
is through the OSHA-required Material Safety Data Sheets.
Products used by housekeepers probably won't show up
on a nursing unit's MSDS, Brannen said, but nurses have
a right to information about everything used in their
workspace-even if it means hunting it down in other
departments.
Contact Donna Hemmila at dhemmila@prodigy.net
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