Hospitals go to 'green clean' to reduce asthma
Cleaners cause one-fourth of work-related asthma
That "clean" smell in your hospitals may make your employees sick. Cleaning products have been linked to about one-quarter of work-related asthma cases among health care workers, according to surveillance in four states. Glutaraldehyde and formaldehyde were associated with another 19% of asthma cases.1
Housekeepers aren't the only ones at risk. Nurses have among the highest rates of work-related asthma.2 Patients with asthma also may be affected by the airborne cleaning and disinfecting chemicals.
Those concerns have influenced hospitals to seek less toxic alternatives. For example, at North Bronx Healthcare Network in New York City, complaints about skin irritation, headaches, and other ailments dropped dramatically after switching to "greener" products.
In 2004, the two-hospital network had 15 chemical-related incidents among environmental services workers, resulting in 56 lost days. In 2007, four incidents involved no lost time.
"'First, do no harm.' Even in our world [of environmental services], that's something you should keep in mind," says Peter Lucey, associate executive director for logistics and support services.
North Bronx Healthcare turned to Green Seal (www.greenseal.org), a nonprofit organization that certifies "green" products, to find less toxic alternatives. Several other organizations also promote healthier hospitals and provide resources, including Health Care Without Harm, Sustainable Hospitals, and Hospitals for a Healthy Environment.
Health care workers themselves are becoming more aware of the asthma triggers in hospitals. One recent study found that 21% of adult asthmatics report a worsening of their symptoms in the workplace.3
The National Institute of Occupational Safety and Health (NIOSH) has not yet released its most recent Work-Related Lung Disease surveillance report. But the new data show that nurses remain among the top occupations suffering from work-related asthma despite a reduction in the use of powdered latex gloves, which were an asthma trigger for many health care workers, says Margaret Filios, RN, SM, occupational/environmental safety and health specialist with NIOSH in Morgantown, WV.
"There's been growing awareness of this issue among the nursing profession," says Filios.
Too much cleaning
Amid the many chemicals in the health care environment that can cause skin or respiratory reactions, cleaning agents represent a significant hazard as a potential trigger of asthma. NIOSH-sponsored surveillance in California, Massachusetts, Michigan, and New Jersey found that cleaning agents are the most common cause of work-related reactive dysfunction syndrome (RADS).4
The hazard is compounded by ignorance about the risks of using the products. The inappropriate mixing of cleaning agents led to about one-quarter of the RADS cases, the NIOSH study found. Cleaners also sometimes fail to dilute cleaning concentrates sufficiently, under the misguided notion that a stronger solution would provide better cleaning.
That's one reason North Bronx Healthcare switched to an automatic dispensing system (J-Fill, JohnsonDiversey; Sturtevant, WI), which dilutes the cleaning concentrates to the correct ratio. The health system also uses an auto-scrubber, a riding cleaning machine that dispenses floor cleaner, washes the floor with circular pads, and vacuums up the excess, reports Lucey. It cleans the floor more quickly that an employee with a mop and keeps employees away from the harsh chemicals.
Although MSDS sheets should be available for cleaning products and disinfectants, few employees read them. Hospitals need to raise awareness among housekeeping staff, nurses, and others about the dangers of mishandling chemicals, says Anna Gilmore Hall, RN, CAE, executive director of Health Care Without Harm, an Arlington, VA-based international coalition of health care facilities, environmental groups, nursing, medical, and labor organizations.
"Frankly, a lot of people don't realize how dangerous chemicals are," says Hall. "They assume that because they're on the market that they've had a lot of testing and everyone concluded that they're not dangerous. A little sometimes can be OK, but a lot can be very detrimental."
Here are some things to keep in mind in the quest for safer cleaning products:
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Cleaning products may be exacerbating the asthma of employees and patients alike. North Bronx Healthcare began seeking safer cleaners because of the high rate of asthma in New York City. "Asthma rates, depending on the age group, are double that in New York City as they are in the rest of the country and the highest incidence of asthma is here in the Bronx, New York," says Lucey. "This is like asthma central."
Some employees may not even realize that the workplace is worsening their asthma, and they may not report occupational exposures. But making a switch will have a broad impact, says Hall. "Common sense tells you that if people are having asthma attacks triggered by cleaners, if you reduce the triggers, you're going to reduce the numbers of attacks," she says. -
"Green" products are not necessarily more expensive.
With proper dilution of the concentrate, a "green" all-purpose cleaner that North Bronx Healthcare uses costs just 10 cents a gallon, says Lucey. "What people have to look at is end-use cost, not what the product costs on the shelf," he says.
A dispensing system not only prevents spills of concentrate, it also halts overuse of the product which ultimately adds to cleaning costs, Lucey adds. -
Not all alternatives are better.
There is no regulation of the word "green," so not every product that claims to be environmentally safer meets the same criteria, says Hall. Several organizations certify or list products that meet a standard, including: Green Seal (www.greenseal.org); Center for a New American Dream (www.responsiblepurchasing.org/purchasing_guides/cleaners/); the Toxic Use Reduction Institute (www.cleanersolutions.org); and Hospitals for a Healthy Environment (www.h2e-online.org/directory/search.cfm).
"The challenge we have is to make sure the alternatives we use are the best alternatives and we don't just assume that because someone says this is a green product that it's going to address the problems," says Hall. -
Alternative cleaning equipment or flooring can reduce the need for chemicals.
Eliminating the hazard is better than seeking an alternative. Some hospitals have switched to flooring types that don't require strippers. (For an example, see www.newdream.org.) Microfiber mops and cloths clean more thoroughly and don't require as much cleaning solution, says Hall.
References
1. Pechter E, Davis LK, Tumpowsky C, et al. Work-Related Asthma Among Health Care Workers: Surveillance Data From California, Massachusetts, Michigan, and New Jersey, 1993-1997. Am J Ind Med 2005; 47:265-275.
2. Delclos GL, Dimeno D, Arif AA, et al. Occupational risk factors and asthma among health care professionals. Am J Respir Crit Care Med 2007; 175:667–675.
3. Saarinen K, Karjalainen A, Martikainen R, Prevalence of work-aggravated symptoms in clinically established asthma. Eur Respir J 2003; 22:305-309.
4. Henneberger PK, Derk SJ, Davis L, et al. Work-related reactive airways dysfunction syndrome cases from surveillance in selected U.S. states. J Occup Environ Med 2003; 45:360-368. n
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