Group Warns that Nurses face Health Risks from Chemical Exposure

Wednesday, December 12, 2007 (SF Chronicle)
Erin Allday, Chronicle Staff Writer


The very chemicals used to keep hospitals squeaky clean and to treat patients could be harmful to nurses who are exposed to them in their daily duties, according to a study released Tuesday by an Oakland environmental group.

Nurses are exposed to a wide range of chemicals on the job - from heavy-duty cleaners and latex to chemotherapy drugs - that could have long-term effects on their health and the health of their children, say researchers with the Environmental Working Group and Health Care Without Harm, which coordinated an online survey of 1,500 nurses in the United States. But few regulations limit nurses' exposure to chemicals, and, in fact, most nurses have no idea that their work environment could be harmful, said Jane Houlihan, vice president of research for Environmental Working Group and an author of the study. "As much as we rely on nurses to protect us when we're sick, we're not protecting nurses in return," Houlihan said. "They face a diverse range of exposures in the workplace that really could pose significant health risks."

The survey was made available to nurses all over the country, and nurses with physical ailments and concerns about their working environment could have been more likely to participate in the survey, said Houlihan. But researchers hope the survey results will persuade national health officials to further study the exposure of nurses to chemicals and to develop regulations to limit it.

The survey looked at nurses' exposure to 11 common health care chemicals, including gases used for anesthesia; hand disinfectants; cleaning agents; latex; medications such as chemotherapy and antiretroviral drugs; devices containing mercury; personal care products such as shampoo and soap; and chemicals used for sterilization. According to the survey results, nurses who were exposed regularly - at least once a week - to the chemicals had increased rates of cancer, asthma and miscarriages. Nurses who were pregnant when they were exposed to certain chemicals were more likely to have children with birth defects than nurses not exposed to the chemicals. Chemical exposure seemed to have an especially large impact on the rate of musculoskeletal defects in children of pregnant nurses. Nurses with frequent exposure to sterilizing agents and anesthetic gases were seven to nine times more likely to have children with musculoskeletal defects than their unexposed peers. The results could be overstated because of the informal nature of the survey, Houlihan said.

But even if long-term exposure to chemicals isn't as harmful as the study shows, there's no question that it is unhealthy, nurses said. "The biggest problem I see is that nurses don't know they're being exposed," said Lisa Hartmayer, a registered nurse at UCSF. "It's not like nurses are saying, 'I can't go to work because of chemical exposure.' It's more like they don't feel well, and they don't know why. I think the damage is being done quietly." Hartmayer said one of the most common complaints nurses have is related to sanitary wipes they're instructed to use to clean off devices such as blood pressure cuffs and stethoscopes. Nurses might use these wipes several times a day, she said, and many of her colleagues complain of headaches, watering eyes and runny noses every time they use them. "Generally, we think the cleaner the better - the cleaner something is,the safer it is. But that's not always the case," Hartmayer said. "We use everyday cleaners that have chemicals, there's soap we use on our hands. I don't believe there's strong enough research to tell us what happens with constant exposure."

Authors of the study said Bay Area hospitals tend to be ahead of national regulations when it comes to limiting nurses' exposure to chemicals. Many Bay Area hospitals no longer use latex gloves, for example, because latex can cause allergic reactions in some people. Several Bay Area hospitals are limiting the amount of vinyl materials they use in everything from floors and walls to medical devices because chemicals used to make vinyl have been tied to cancer and birth defects. At Stanford University Medical Center and Lucile Packard Children's Hospital, newly hired nurses are given a physical that includes looking at the chemicals in their bodies. They are then offered free annual physicals to monitor their exposure to chemicals as well as other physical ailments. Both hospitals also have extensive engineering staffs to check the air quality and ventilation systems. Nurses are regularly trained in protocols for handling potent drugs. It's not just the nurses who need to be kept safe, said Beverley Tobias, director of occupational health services for the medical center and children's hospital. "We have a lot of really, really sick people. We can't have a lot of foreign elements that are going to harm them on top of what they already have," Tobias said. While government regulations are in place for a handful of chemicals common in medical facilities, the policies aren't strong enough and don't cover enough chemicals, said researchers and nurses. "I know a woman who had eight miscarriages while she was working in healthcare," said Lauri Hoagland, a nurse practitioner at a Kaiser Permanenteclinic in Napa. "There haven't been any studies, but if you work in healthcare, you know something's happening. There isn't enough information and there aren't enough rules for hospitals to follow."

Nurses' exposure to chemicals -- They include anesthetic gases, hand and skin disinfectants, cleaning agents, latex, medications such as antiretroviral and chemotherapy drugs, devices with mercury, personal care products such as shampoo and soap, and sterilization chemicals, as well as radiation.

The health effects -- Nurses who were regularly exposed to chemicals reported higher incidences of cancer, asthma and miscarriages than their peers with limited exposure. -- Nurses who were regularly exposed to chemicals while pregnant had children with higher incidences of birth defects than the children of nurses with limited exposure.

Copyright 2007 SF Chronicle