| Washington Watch | Issues Update | Vital Signs | Health & Safety |
|
Q. I’m often short of breath during my shift—and not just because I’m running all the time. Could this be caused by something in my workplace?
A. Experts now describe the health care environment as a chemical soup—a complex mixture of medicines and sterilization agents that circulate in the air and are recycled through the heating, ventilation, and air conditioning systems. Attesting to the prevalence of this problem was the large attendance at the “train-the-trainer” program on indoor air quality held at the ANA’s 1998 Convention in San Diego, which instructed nurses about indoor air quality improvement in communities, schools, and their workplaces.
Poor air quality can cause shortness of breath, eye and respiratory irritation, rhinitis, contact dermatitis, headaches, joint pain, memory problems, difficulty concentrating, and reproductive disorders. Asthma can also result from exposure to common chemicals, including latex proteins, sterilizing and fixative agents such as glutaraldehyde, formaldehyde, ethylene oxide, aerosolized medications like pentamidine and ribavirin, and cleaning agents.
Glutaraldehyde, found in nearly all areas of the hospital, is used to clean and disinfect ear, nose, and throat instruments, dialysis equipment, surgical tools, suction bottles, endoscopes, bronchoscopes, and transducers. Exposure to this chemical can cause burning eyes, headaches, rhinitis, skin sensitization, chest tightness, asthma and asthma-like symptoms, throat and lung irritation, flu-like symptoms, hives, and a brownish-tan staining of the hands.
Avoid skin contact with glutaraldehyde by wearing heavy neoprene or nitrile gloves. Covered containers and good ventilation are also important. Some alternatives to glutaraldehyde include steam sterilization by autoclave, gas sterilization with ethylene oxide, and the use of paracetic acid in a closed system. The Occupational Safety and Health Administration (OSHA) will publish a permissible exposure limit (PEL) on glutaraldehyde later this year. The PEL is likely to encourage better monitoring of exposure levels and should provide incentives for seeking alternatives.
Laser plume smoke, another ingredient in every hospital’s chemical concoction, also poses potential health risks. Lasers reduce trauma to tissue surrounding a wound and promote healing by cauterizing small blood vessels. They do this by transferring electromagnetic energy into tissue, which releases a heated plume containing particles, gases, and tissue debris from the point of incision. Smoke extraction systems should be used to control the plume at the source.
The National Institute for Occupational Safety and Health (NIOSH) released a hazard control bulletin on laser plume smoke in 1996 (call [800] 35-NIOSH for a copy). In collaboration with other nursing and health care groups, such as the Association of Operating Room Nurses, the ANA has urged OSHA to publish a hazard information bulletin on laser smoke as well.
So how can chemical hazards be lessened? Recognizing and measuring them are the first steps. Begin by assessing the chemicals in use, the quantity and frequency of exposure, toxicity levels, and the symptoms you and your co-workers are experiencing. By law, every chemical shipped to your facility must have a warning label from its manufacturer.
After initial assessment, analyze the chemical hazards in each department and determine what standards are in place for addressing them. The OSHA Hazard Communication Standard was developed to ensure that the dangers of all chemicals produced in or imported into the workplace are evaluated, and that this information is communicated to employers and employees. In 1987, the standard was expanded to include hospitals and other health facilities, and now requires that a written standard be developed and maintained in the workplace by the employer. In addition, health care employers must train employees to adequately control and minimize exposure to chemical hazards.
The OSHA standard mandates the availability of a Material Safety Data Sheet (MSDS), which contains detailed information about chemical hazards and how to control them in the workplace. Call your supervisor or the human resources department to obtain copies of the MSDS and the Hazard Communication Plan. You can also create protocols specific to your unit.
Your employer’s written Hazard Communication Plan should include a list of all hazardous chemicals present in the facility (including those in unlabeled pipes), information about how your employer will provide warning labels, MSDSs, information and training for employees who work with hazardous chemicals, and the contact information of those responsible for ensuring that the program is carried out.
It’s important to document any health problems that you think are related to chemical exposure. If you suspect that your workplace is the culprit, have an outside occupational health professional evaluate your environment. In addition, report your symptoms to your hospital health department, which will report them to OSHA, which in turn will record them in the OSHA 200 logs, where all reported work-related injuries and illnesses are chronicled. Hazards that remain unabated in the workplace should be reported directly to OSHA.
Contact your state nurses association for more information about the OSHA standard.