Workers become ill from floor strippers
Lack of ventilation creates a hazard
While getting your floors "hospital clean," you may inadvertently be exposing workers to a hazardous chemical that can cause respiratory, skin, and eye irritation, headaches, nausea, and even kidney or liver damage.
Floor strippers often contain hazardous solvents, such as 2-butoxyethanol and ethanolamine. If these are used inappropriately and in areas with poor ventilation, the air concentration may be high enough to cause symptoms not just among the cleaning staff, but in other workers in the space.
"This would mainly be a problem in enclosed areas like a file room or library," explains Lawrence Raymond, MD, SEM, professor of family medicine at the University of North Carolina in Chapel Hill and director of occupational and environmental medicine at Carolinas Health Care System in Charlotte.
Raymond investigated a cluster of ill workers in an unventilated file room that had been treated with undiluted floor stripper. Their symptoms persisted for months.
Meanwhile, the workers using the cleaning products are often some of the least educated in the hospital and may not understand the hazards. They aren't likely to ask to see the Material Safety Data Sheet.
"They don't know enough to know they're in danger. They are just trying to do their jobs the best way they can and get the wax or sealant off," says Dawn Twenge, BSN, RN, associate health nurse at Porter Hospital in Valparaiso, IN, which also had a cluster of workers affected by chemicals in a floor stripper.
The U.S. Occupational Safety and Health Administration (OSHA) set a Permissible Exposure Limit of 50 parts per million (ppm) for 2-butoxyethanol, based on an eight-hour, time-weighted average. However, transient effects may occur at lower levels, OSHA said. The organization noted that skin absorption is a particular hazard. The National Institute for Occupational Safety and Health set a Recommended Exposure Limit of 5 ppm, as a time-weighted average, with the same notation about the risk of skin absorption.
Vapors cause headaches, dizziness
Porter Hospital had a new floor sealant that would last much longer than the old wax and keep the floors looking shiny and clean. But first, the old sealant needed to be removed.
It wasn't easy. The floor stripper should be diluted by a ratio of one part stripper to six or more parts water, but the employees figured more would work even better. They used three parts floor stripper to one part water.
As they worked in a vacant room, nurses and other employees asked them to keep the door closed so the vapors wouldn't spread into the hallway. The three-man cleaning crew began to have headaches and dizziness and their legs were shaky.
When one employee came to Twenge with his symptoms, she began to investigate. She called the product manufacturer and spoke to a toxicologist who assured her the chemicals were just irritants at that exposure level.
The employees were examined by an occupational medicine physician, who conducted blood tests and found no adverse effects.
Twenge also conducted some monitoring by simulating the work environment with the door closed and the door open. In the closed room, even with a proper dilution, the monitoring showed exposures above the permissible level for 2-butoxyethanol, Twenge says.
The hospital now has a policy that the door stays open unless nearby patients, nurses, or other employees have respiratory problems that would be aggravated by the smell. If the door is closed but the window open, the cleaning staff can use a fan for ventilation. If both the door and windows are closed, the staff must wear powered air-purifying respirators.
The hospital also began to automatically mix the floor stripper with water at the correct proportion with a chemical dilution system to prevent employees from mixing it in stronger amounts than recommended.
"I think hospitals have a specific issue because of their culture, their space, and the kind of ventilation they have," says Twenge, who advises working together with the safety officer to lessen chemical hazards. "In industry, they just turn on a big fan that sucks everything out. You can't do that here. You have patients who have asthma in the next room."
Lack of ventilation caused a problem for seven clerical workers in North Carolina the day after treatment with floor stripper.
A contractor used an undiluted product that contained 2-butoxyethanol in an unventilated room that had shelves of files from floor to ceiling. Shortly after the workers arrived the next morning, they experienced eye and respiratory irritation, dry cough, and headache.
Within a few months, six of the seven workers developed hypertension and skin lesions that were identified as cherry angiomas.
Raymond assured the workers that the spots were not malignant, but he called the episode "worrisome." Adequate ventilation is the key to safe use of the chemicals, he notes.
If a worker complains of symptoms, there may be a broader problem of exposure, he says. "When you see an individual worker, you should really look beyond that worker. It's possible he or she is more sensitive to the particular chemical, but it's also possible he or she is representative of the others [who have not complained]."
While getting your floors "hospital clean," you may inadvertently be exposing workers to a hazardous chemical that can cause respiratory, skin, and eye irritation, headaches, nausea, and even kidney or liver damage.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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