The Problem

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Many of the pesticides, cleaners, disinfectants, sterilants, floor care products (including wax strippers), and fragrances we use in health care facilities may solve one set of problems (e.g. avoiding the possible spread of infection, controlling pests, making the walls and floors look or smell pristine), but at the same time, due to their toxic nature, may cause other serious health-related problems. Not only do they put the vulnerable patient population at risk, but due to constant chronic exposures, many health care workers are at risk as well.

Disinfectants and floor care products (wax and strippers) contain toxic active ingredients such as ammonia, chlorine, phosphates, alkylphenol ethoxylates, volatile organic compounds, formaldehyde, phenolic compounds propellants, petroleum solvents, and many others. Health risks related to these toxics include eye and skin irritation, nausea, headache, difficulty in concentration, and cancer. Another health risk associated with exposure to these cleaning products is work-related asthma. Medical settings are the most common workplace where these exposures take place, and healthcare workers, including nurses, are among the professions most commonly affected with work-related asthma.

Glutaraldehyde and ethylene oxide (EtO), are additional hazardous sterilants used in hospitals. EtO is used in the healthcare industry as a sterilant for equipment or supplies that are heat or moisture sensitive. Ethylene oxide can enter the body when inhaled. The acute toxic effects in humans and animals include acute respiratory and eye irritation, skin sensitization, vomiting, diarrhea, neurological disorders, reproductive, and even death at high concentrations. Chronic effects observed in workers exposed to ethylene oxide at low levels for several years are irritation of the eyes, skin, and mucous membranes and problems in the functioning of the brain and nerves as well as cataracts. The Environmental Protection Agency (EPA) considers ethylene oxide to be a probable human carcinogen. In addition, EtO is flammable and explosive. The most serious health effect to workers exposed to glutaraldehyde is work-place asthma. It is also an irritant, symptoms of this are itching of the eyes and tearing and rhinitis. Also, glutaraldehyde acts as a contact allergen, and can cause contact dermatitis on the hands and face.

“Pesticide” is a term used to refer to an agent, usually a chemical, that is used to kill pests such as insects, weeds or rodents. There are different types and classes of pesticides that have a variety of mechanisms of action. Some have been associated with a wide variety of health effects including cancer, asthma, Parkinson's, immune system diseases, behavioral and neurological problems and reproductive effects.

Exposure to this toxic mix of chemicals can be made worse by certain conditions that may lead to a stronger than necessary dilution. If a facility has inadequate ventilation and poor indoor air quality, the exposure may be more concentrated. Housekeeping personnel, who are responsible for mixing and diluting cleaners, may be inadequately trained to do so, may speak English as a second language, and may have poor reading skills. Method of application is a factor, for example if a cleaner is sprayed rather than wiped on a surface it becomes aerosolized, leading to increased exposure.

One additional source of hazardous chemical exposure in the hospital is unavoidable, but should be mentioned, that is hazardous drugs, such as chemo therapy drugs. Health care worker exposure to these drugs has been linked to reproductive and developmental effects. In spite of this, often nurses who handle these drugs are not as careful as they should be, and do not use the precautions that have been recommended. Also, some hazardous drugs are used in other departments besides oncology, and nurses in those departments may not be aware of the precautions they should take. Examples of these include methotrexate (used in the treatment of rheumatism), and oxytocin and the interferons.

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