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RNs at risk for asthma from cleaners, disinfectants
Rates higher than for other HC professionals
Exposure to cleaning products, solvents, and disinfectants continues to place nurses at risk for occupational asthma.
The switch from powered latex gloves to powder-free, low-protein and synthetic varieties has helped prevent additional cases of asthma. But a recent report from the National Institute for Occupational Safety and Health (NIOSH) and research into occupational asthma in the hospital setting indicate that nurses and other health care workers develop work-related asthma more frequently than those in other occupations.
The Work-Related Lung Disease (WoRLD) Surveillance Report 2007, compiled by NIOSH, found that:
About 10% of hospital workers suffer from asthma, as determined by the National Health Interview Survey.
Respiratory therapists have the highest "proportionate mortality ratio" due to asthma - the number of asthma deaths per 100 deaths from all causes - for the years 1990 to 1999, according to the data from the National Center for Health Statistics.
Health services accounted for more than 15% of all work-related asthma cases from 1993 to 2002, according to surveillance in California, Michigan, New Jersey and Massachusetts.1
Registered nurses alone accounted for 5% of the work-related asthma cases in the surveillance states.
"People are still exposed to things in the health care workplace that we know can exacerbate or potentially cause asthma. Some of the biggest offenders are the cleaners and disinfectants," says David Weissman, MD, director of the NIOSH's Division of Respiratory Disease Studies in Morgantown, WV.
For example, glutaraldehyde is known to cause asthma, as are quaternary ammonia compounds, which are found in many cleaning products, he says. Hospitals also must be aware of other agents that could trigger asthma, such as aerosolized medication, he says.
Hospitals need to be concerned exposures that may affect employees who have pre-existing asthma, Weissman says. "Work-exacerbated asthma is really just as important as new onset asthma because it really affects the quality of life for many people," he says.
The hierarchy of controls - engineering controls, administrative controls, and personal protective equipment - can limit exposures. But education also is critical, says Margaret Filios, SM, RN, occupational and environmental safety and health specialist and project officer for state-based surveillance in NIOSH's Division of Respiratory Disease Studies.
For example, reports of respiratory symptoms linked to floor strippers or cleaning products could lead a hospital to seek "greener" solutions. "I think we have a hard time convincing people that cleaners are creating problems for their employees," she says. "[You need to] make sure employees report to employee health if they're having a problem. We're still raising the level of awareness."
Latex drops as cause of asthma
Evidence is growing that cleaning products cause a substantial problem for nurses. A study of 3,650 physicians, respiratory therapists, occupational therapists, and nurses in Texas found that nurses involved in instrument cleaning or who had exposure to general cleaners and disinfectants had a higher prevalence of reported asthma.
About 10% of registered nurses had physician-diagnosed new-onset asthma after entry into the health care profession and 31% had symptoms of bronchial hyperresponsiveness.2
"The most important message is for health care professionals to be aware of this," says co-author George Delclos, MD, MPH, PhD, professor in the Division of Environmental and Occupational Health Sciences at the University of Texas School of Public Health in Houston. "[We need to] start thinking about how to balance the very necessary use of these [cleaning] products for the welfare of our patients to making sure it doesn't cause adverse health effects in our workers."
Delclos also demonstrated through his research that voluntary interventions in the workplace can significantly reduce the risk of asthma. He compared reported asthma and symptoms of bronchial hyperresponsiveness during three time periods that marked different use of latex gloves: Before the U.S. Occupational Safety and Health Administration's bloodborne pathogen standard became effective (pre-1992), the period from 1992 to 2000 when powdered latex gloves were commonplace, and after 2000 when the use of powdered latex gloves greatly declined.
He found a significantly increased risk from 1992 to 2000, followed by a reduction.3 "It's a beautiful example of how these types of [voluntary] interventions can work," he says.
The research also underscores the importance of employee health as a part of new product evaluation in the hospital, to assess "the sensitizing and irritant potential of the new product," he says.
1. Centers for Disease Control and Prevention. Work-Related Lung Disease (WoRLD) Surveillance Report 2007. NIOSH Publication No. 2008-143. Available at www.cdc.gov/niosh/docs/2008-143/. Accessed on Feb. 20, 2009.
2. Arif AA, Delclos GL and Serra C. Occupational exposures and asthma among nursing professionals. Occup Environ Med 2009 (online publication ahead of print) doi:10.1136/oem. 2008.042382.
3. Delclos GL, Gimeno D, Arif AA. Occupational risk factors and asthma among health care professionals. Am J Respir Crit Care Med 2007; 175:667-675.