NEW YORK NURSE: February 2008
by Joely Johnson and Nancy Webber
Many nurses work in an environment of low-level but chronic exposure to substances known to be hazardous to health. Currently, there are few safety standards to protect nurses from dangerous chemicals and, until recently, no research exploring the impact of their exposure to these risks.
A survey released in December 2007 found that nurses who reported high exposure to certain medications, disinfectants, and anesthetic gases were more likely to develop cancer or asthma, suffer miscarriages, and have children with congenital birth defects.
The groundbreaking survey was conducted online by the American Nurses Association (ANA) in collaboration with Health Care Without Harm, the Environmental Working Group, and the Environmental Health Education Center of the University of Maryland’s School of Nursing. Conducted online, the survey gathered information from 1,552 nurses in all 50 states over a one-year period starting in 2005.
The survey was not “controlled” — it was open to any nurse interested in responding. Therefore, it is not possible to draw rigorous, scientific conclusions from the data. But the startling results emphasize the need for a comprehensive study on the health effects of chemicals in the workplace.
The survey found that nurses who reported high exposure (at least once a week for 10 years or more) to antineoplastic drugs (used in chemotherapy) were 40% more likely to develop cancer. Asthma rates were up to 50% higher for nurses who reported high exposure to disinfecting and sterilizing solutions. High exposures to disinfectants and medications also indicated a 20% higher risk for miscarriage.
In addition, the children born to nurses reporting high exposures to medications during their pregnancies were up to two times more likely to have congenital defects and nine times more likely to suffer from musculoskeletal defects.
Of the literally hundreds of chemicals associated with health problems among nurses, the government has set standards for only six. For the rest, each healthcare facility decides what, if any, protective measures are needed to control staff exposure to these agents. The six include radiation, mercury, isopropyl alcohol, ethylene oxide, and platinum- and arsenic-based drugs.
Pat Rochford, an infection control nurse at Maimonides Medical Center in Brooklyn, is concerned about the proper use of glutaraldehyde, a disinfectant commonly used in American hospitals. The substance, sold under the brand name Cidex, was banned in England in 2002 due to concerns about skin problems and asthma among healthcare staff.
“It’s used everywhere,” said Rochford. “I am concerned about how difficult it is to use Cidex safely, particularly in high-volume areas.” Medical equipment can be reprocessed with Cidex dozens of times per shift. Safe use requires regular air quality monitoring and continuous checking of the solution quality.
Johnson & Johnson, the maker of Cidex, advises avoiding skin, eye, or clothing contact and only using the chemical with adequate ventilation that provides a minimum of ten air exchanges per minute. Despite these clear health concerns, there are no safety regulations regarding the use of Cidex and similar chemicals.
In 2006, the ANA House of Delegates passed a resolution urging facilities to reduce their use of toxic chemicals and calling for government-funded research on the effects of exposure to them. Until such oversight is in place, however, nurses themselves can band together to make changes. One strategy is to form a “green team.”
“These groups are formed all the time. It’s a matter of getting your hospital administrator to agree and then gathering representatives from each department who can begin to monitor situations,” said Karen Ballard, NYSNA president-elect and chair of the Health Care Without Harm Nurses Workgroup.
“We suggest that the team look at purchasing decisions,” said Ballard. “Learn about the products that come into your facility and consider replacing those that are potentially toxic. A first step might be recommending that your facility switch to unscented housekeeping products.”
Artificial fragrances are composed of hundreds of different chemicals. Long-term exposure can lead to allergic reactions involving the skin and respiratory tract.
NYSNA members who want more information on how to improve their workplace environment may contact Thomas Lowe, NYSNA Occupational Health and Safety Representative, at 888-551-3112, ext. 200, or visit www.nysna.org and click on “Workplace Health and Safety.”