Survey: Half of nurses have a high rate of chemical exposure
Exposures may be linked to cancer, asthma, birth defects
Nurses face myriad chemical hazards that may raise their risk of cancer, asthma and reproductive problems. About half of nurses (52%) have had regular exposure to at least six hazardous agents in their workplace five years or more, including anti-neoplastic agents, aerosolized medications, glutaraldehyde, ethylene oxide, waste anesthetic gases, and housecleaning agents.
Those are findings of a web-based survey of 1,552 nurses by the Environmental Working Group that asked about a range of exposures. Although it was a "convenience sample" nurses self-selected to participate in the survey it represents a unique snapshot of the exposures encountered by nurses in their workplace.
It asked nurses about 11 different hazards, including ionizing radiation. The American Nurses Association, Health Care Without Harm, and the Environmental Health Education Center of University of Maryland's School of Nursing collaborated on the survey.
There are no regulatory limits or monitoring requirements for many of the exposures, and the survey found that nurses do not feel their hospitals are doing enough to protect them from exposure.
"What shocked me was how few health protections there are. We looked at 11 different hazards. There are only three hazards that actually have enforceable safety limits," says Rebecca Sutton, PhD, a staff scientist with the Environmental Working Group in Oakland, CA. "The safety limits that exist are decades-old. We've got much better data these days, and these data are telling us that risks are greater than we thought and are happening at lower exposure levels."
Sutton's concerns are echoed by others. "It's disturbing to see the level of exposures and the health effects nurses are reporting," says Stacy Malkan, communications director with Health Care Without Harm of Arlington, VA, which promotes the use of alternatives to such chemicals as glutaraldehyde and ethylene oxide.
The National Institute for Occupational Safety and Health (NIOSH) is preparing to conduct a national survey of health care workers and managers to gauge the workplace exposure and compare the exposures among occupations and type of facility. It will ask about chemical hazards such as aerosolized medication, surgical smoke, anti-neoplastic agents, sterilants and disinfectants, as well as lifting, violence, stress, and work hours.
"With this focus on health care, we're trying to ask detailed questions so we can better understand the hazards," says Jim Boiano, MS, CIH, research industrial hygienist with NIOSH's surveillance branch in Cincinnati. NIOSH conducted hazard surveillance surveys in the early 1970s and 1980s, but they were not specific to health care and therefore didn't have health care-specific questions, he says. NIOSH is soliciting comments on its survey questionnaire and expects to conduct the survey in 2009. (Editor's note: More information on the survey may be available at www.cdc.gov/niosh.)
Other studies have found higher rates of occupational asthma among health care workers, such as nurses and respiratory therapists. And some say it's common sense that nurses have hazardous exposures. "Hospitals have a distinct smell. Well, it isn't cookies baking. It's chemicals," says Nancy Hughes, RN, MS, director of the American Nurses Association's Center for Occupational and Environ-mental Health in Silver Spring, MD. Hughes calls the NIOSH study long overdue.
Occ health not taken seriously
The Environmental Working Group study revealed some troubling connections that suggest a possible link between the hazardous exposures and cancer and birth defects:
- 41% of the 1,500 nurses said they had exposure to antineoplastic agents. Those who prepared or administered the drugs at least once a week for at least 10 years (high exposure) had cancer rates that were 42% higher than nurses with low or no exposure. Children born to nurses who reported high exposures during pregnancy were 67% more likely to have birth defects.
- Children of nurses with at least weekly exposure to waste anesthetic gases during pregnancy had rates of musculoskeletal birth defects that were eight times higher than nurses with lower or no exposure.
- About half (52%) of nurses reported exposure to glutaraldehyde, and about 20% had high exposures. Those with the highest exposure had a rate of asthma that was 46% higher than those with lower or no exposure.
- Only 38% of the nurses said they felt "chemical exposure concerns are a significant part of the occupational health program at my institution." Only 46% agreed that "occupational health is taken seriously at my place of employment."
"The sorts of hazards we examined were not a part of their education in health and safety in the hospital," says Sutton, adding that "there are plenty of actions that administrators can take right now to start protecting nurses."
For example, substitutes are available for some products such as glutaraldehyde or volatile housekeeping disinfectants. Ventilation systems can reduce exposure to waste anesthetic gases.
The survey, which was conducted online from March 2005 to March 2006 and received responses from all 50 states, is also a mechanism to raise awareness, says Sutton.
"Our report is unique in that we look at a broad range of chemicals and a broad range of health effects," says Sutton. "However, it is in line with previous research that has linked some of these exposures to increased miscarriage or cancer."
While more research is needed, nurses should become more aware of the chemicals they encounter in their work and should become involved in efforts to seek substitutes, says Hughes.
(Editor's note: The survey on Nurses' Health and Workplace Exposures to Hazardous Substances is available at www.ewg.org/sites/nurse_survey/analysis/summary.php. CleanMed 2008, a conference on "environmentally sustainable health care," will be held in Pittsburgh May 20-22, 2008. More information is available at www.cleanmed.org/2008/home.html.)
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