Breathless? Respiratory hazards gain scrutiny
Why is asthma more common among HCWs?
The high rate of asthma among health care workers has prompted federal officials to take a closer look at respiratory hazards in health care facilities.
Among nonsmoking hospital workers, the prevalence of asthma is 14.4%, twice as high as the general population of nonsmokers.1 Although surveillance of occupational asthma has been difficult, researchers are trying to determine the factors that may lead to higher risk in health care facilities. Meanwhile, asthma is a growing health problem nationally, with more than 17 million Americans now suffering from the disease.
This summer, the Occupational Safety and Health Administration issued fact sheets on ethylene oxide and formaldehyde. (See editor’s note for more information.) The National Institute for Occupational Safety and Health (NIOSH) also launched several studies related to asthma in health care workers, ethylene oxide, and other respiratory hazards.
"NIOSH is responding to a variety of information sources that are suggesting that respiratory hazards are a possible increasing problem among health care workers," says Lee Petsonk, MD, senior medical officer in the division of respiratory disease studies at NIOSH in the Morgantown, WV, research office. "We’re initiating a study looking at what exposures are occurring in the health care industry that might be hazardous."
While the study is a comprehensive one, respiratory hazards will receive scrutiny alongside needle safety and ergonomics, he says.
Asthma is a particularly difficult occupational injury to track because there are so many potential irritants in health care facilities as well as in the home and outdoor environment. "It’s so difficult to tease out what is occupational and what is not occupational," says Gabor Lantos, MD, PEng, MBA, president of Occupational Health Management Services in Toronto and an occupational health consultant. In a training seminar on respiratory hazards in health care, Lantos outlines dozens of potential hazards ranging from aerosolized viral particles and anesthetic gases in the operating room to cleaning solutions used to strip wax on floors.
To get a better handle on asthma among health care workers, a NIOSH-sponsored researcher is developing a targeted asthma questionnaire and investigating links between occupational exposure and asthma. This link is important to establish because it’s possible that people with asthma have a greater interest in health care professions — leading to a higher prevalence in that occupation, Petsonk says.
"The survey will also allow us to see if there were any specific associations with any chemical exposures in health care settings," says George Delclos, MD, MPH, associate professor and director of the Southwest Center for Occupational and Environmental Health at the University of Texas School of Public Health in Houston.
In previous studies, latex has been associated with occupational asthma in health care workers.2 However, the reduction in the use of powdered latex gloves may have reduced that sensitivity, Petsonk says.
Glutaraldehyde, a sterilizing agent, also has been associated with respiratory symptoms.3 In fact, earlier this year, the United Kingdom’s National Health Service withdrew Cidex, a John-son & Johnson glutaraldehyde product, from its facilities in favor of Cidex OPA, an alternative that is glutaraldehyde-free. Complaints about skin and respiratory problems among health care workers prompted the change.
To validate the asthma questionnaire, Delclos, a pulmonologist and occupational medicine specialist, will administer it to a sample group along with interviews by an industrial hygienist and allergy and pulmonary function tests. He will then administer the asthma survey to a larger population of physicians, nurses, and respiratory therapists, as well as occupational therapists, which is considered a low-risk group.
Delclos says, "We’re looking to answer three questions: What is the prevalence of asthma in selected groups of health care workers? How do the prevalence rates in these four groups compare to one another? What occupational exposures are associated with asthma in these populations?
Educate workers about symptoms
Education is the first step toward preventing occupational asthma, Petsonk and others emphasize. Employees must be able to recognize the early respiratory symptoms and minimize exposures to hazardous substances, he says. Employee health professionals should have a mechanism for referring the employees to a specialist for an assessment, he says.
"When there’s a potential exposure that’s ongoing or predictable (such as in sterilization of equipment), then perhaps those individuals should be part of a formal health monitoring program," he says.
Health care workers also need to be educated about respiratory protective equipment, Lantos emphasizes. "Your typical surgical mask does not protect the wearer from anything — not from infectious materials, not from volatile substances, not from glutaraldehyde," Lantos says. "People have a false sense of security from wearing the surgical mask. It has absolutely no role to play in industrial hygiene."
Lantos tells employees, "If you think you’ve got a respiratory hazard, speak to someone who knows what the right kind of respirator is."
Ventilation is an important aspect of protection, he notes, as are work practices. For example, housekeeping staff should rotate their work so they are not continually using the harsh solvents.
"Just simply being aware [of the symptoms of occupational asthma] is the most important thing," Delclos says. Employee health professionals can play a role in identifying employees at risk for occupational asthma, he says.
(Editor’s note: Facts sheets on ethylene oxide and formaldehyde are available at http://www.osha.gov/OshDoc/toc_fact.html.)
References
1. National Institute for Occupational Safety and Health. Work-Related Lung Disease Surveillance Report. December 1999; DHHS (NIOSH) No. 2000-105.
2. Vandenplas O, Delwiche JP, Evrared G, et al. Prevalence of occupational asthma due to latex among hospital personnel. Am J Respir Crit Care Med 1995; 151:54-60.
3. Di Stefano F, Siriruttanapruk S, McCoach J, Sherwood Burge P. Glutaraldehyde: An occupational hazard in the hospital setting. Allergy 1999; 54:1,105-1,109.
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