Friday, Dec. 21, 2007

Health hazards add to nursing shortages

Survey: Toxic chemicals in hospitals sicken workers

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Nurses around the nation are getting seriously ill from constant exposure to hazardous chemicals and are forced to quit, according to a new report.

Take, for example, Paxson Barker of Baltimore.

Barker, a registered nurse for 35 years, had to shift to a desk job after she contracted adult onset asthma. She became ill after working more than 10 years in a cardiac clinic in Houston. Constant exposure to a harsh disinfect, quaternary ammonium, in the clinic constricted Barker’s windpipe. She suffered frequent attacks of reactive airway dysfunction.

‘‘It is not that we don’t have enough nurses,” said Nancy Hughes, director of the Center for Occupational and Environmental Health at the American Nurses Association. ‘‘While part of it is that we have too many patients, we know there are a lot of disease-environment exposures to nurses who leave, so it adds to the shortage.”

Maryland hospitals reported a nurse vacancy rate of 13 percent last year, according to the state hospital association, which last month proposed a $59 million program to train more nurses.

Results released last week from the survey of 1,550 nurses, some in each state, showed that participating nurses with long-term and intense exposures to environmental hazards developed above-normal levels of cancer, asthma, miscarriages, children’s birth defects and other serious medical conditions.

In the first year of the survey, 32 percent of nurses reported frequent exposure to combinations of at least five chemicals and other hazardous agents for 10 years or more. Half of nurses reported regular exposure to combinations of at least six chemicals and other hazardous agents for five years or more.

The survey was co-sponsored by the nonprofit Environmental Working Group in Washington, D.C., and the U.S. branch of the global coalition Health Care Without Harm in Arlington, Va. It was conducted in collaboration with the nurses association and the Environmental Health Education Center at the University of Maryland’s School of Nursing.

Barbara Sattler, research associate professor head of that center, said that although the survey was a small sampling of the nation’s 2.9 million nurses, it serves as a flash point of a national problem.

‘‘The vast majority of chemical products that are even in our houses have had no pre-market testing,” Sattler said. ‘‘Our government has been a little bit asleep at the wheel.”

What’s needed is a combination of state and federal laws ‘‘and we want to make sure the hospitals have policies,” she said.

Barker, who can no longer work as a practicing nurse, agrees. She said that, in keeping within her nurse’s temperament, she is now doing scholastic research at Sattler’s center on how hospitals can prevent blood-related exposures, just part of the exposure problems for nurses.

‘‘Hopefully I will translate that research into public policy,” Barker said.

Barker sees her new job in a social context.

‘‘Nurses advocate beautifully for the patient, but do not for themselves,” she said. ‘‘They historically trust their employers. We need to turn the paradigm around so that if you protect the nurse, you protect the patient.”

Hazards aboundin hospitals

The goal of the survey, Sattler said, ‘‘was to begin to get some sense of what nurses know about and the extent that they have had some exposure to chemical hazards.” Nurses deal daily with low-level, repeated exposures to hazardous mixes of residues from medications, anaesthetic gases, sterilizing and disinfecting chemicals, radiation, latex, cleaning chemicals, hand and skin disinfecting products, and even mercury escaping from broken medical equipment, the survey revealed.

Yet, Sattler said, there are no national safety standards to protect nurses from such hazards. And without clear warnings, most hospital personnel don’t bother to inspect labels or wear enough protective clothing.

Hughes said the survey results beg for more research. ‘‘This is just a beginning and shedding light on a serious problem with a shortage of nurses,” she said.

Maryland hospitals are ahead of the curve in preventing occupational hazards from toxic cleaning materials, said Holly Carpenter, a senior staff specialist with the nurses association. She said many are following guidelines of Hospitals for a Health Environment, or H2E, an independent nonprofit formed in 1998 by the American Hospital Association and U.S. Environmental Protection Agency.

‘‘I am glad that the survey is out and it is a fabulous thing to be presented to the public,” said Joan Plisko, technical director for H2E, who said her group is working with more than 50 hospitals and health care centers in the state.

Many Maryland hospitals are now ‘‘embracing these issues to raise awareness for patients and employees,” Plisko said.

Suburban Hospital in Bethesda has a comprehensive ‘‘green” cleaning program that has also reduced hospital-acquired infections.

It’s among the Maryland hospitals that are switching to less-toxic cleaners to help avoid ‘‘sickbed days,” nurses’ slang for the days when floors are stripped, causing toxic fumes, Carpenter said.

Some other practices promoted by H2E include ‘‘pour-and-wipe” cleaning instead of aerosol cleaners; new ‘‘micro-fiber” mops and rags; safer sterilizing agents for metal tools; reduced pesticide use; and eliminating mercury in thermometers and blood pressure cuffs. The group also helps hospital workers with poor English skills by getting extra instructions on labels and environmental practices.

The nonprofit Maryland Pesticide Network is two years into a pilot project to introduce integrated pest management in health facilities to reduce pesticide use. In six hospitals, two elder care communities and two psychiatric facilities, the group is looking into the cost and health benefits of using pesticides only when other pest control means are exhausted.

Why are hospitals just now discovering integrated pest management — 45 years after Rachel Carson’s groundbreaking 1962 book, ‘‘Silent Spring,” exposed the potential dangers of pesticides?

The answer, again, is trust by health care workers, said Ruth Berlin, executive director of the pesticide group.

‘‘I think the reality is, like in homes, we rely on pest control vendors,” Berlin said. ‘‘They can say they can use [integrated pest management] but don‘t. We have laws in Maryland for [integrated pest management] in schools. Now we are doing it in hospitals.”

In the first 10 months of its new ‘‘green team,” which includes nurses, the University of Maryland Medical Center in Baltimore is free of chlorine in its cleaning products, said Leonard Taylor, senior vice president for facilities.

‘‘We are also now close to mercury-free [and] latex-free, and we are taking a hard look at our [polyvinyl chlorides] because some chemicals can leach out of those plastics and into people,” Taylor said.