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Multiple exposure

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