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Splashes, fumes cause injury to HCWs
One death from asthma reported
A laundry worker died of acute asthma after breathing bleach fumes from an open pail. Floor cleaner splashed in the eyes of housekeepers. Even bystanders suffered irritating effects of disinfecting chemicals.
An analysis of surveillance data in four states revealed 401 cases of work-related injury due to anti-microbial pesticides – cleaning or disinfecting products – from 2002 to 2007. "This is the first multi-state report looking at the magnitude from poisonings from the antimicrobial pesticides," says Geoffrey M. Calvert, MD, MPH, a team leader in the Surveillance Branch of the Division of Surveillance, Hazard Evaluations and Field Studies of the National Institute for Occupational Safety and Health (NIOSH) in Cincinnati.
While most cases involved mild symptoms that quickly resolved, there were some serious incidents, the surveillance from California, Michigan, Louisiana, and Texas showed, says Calvert. Housekeepers or janitors were the most likely to be injured (24%), followed by nursing or medical assistants (16%). A majority of the incidents involved splashes to the eyes.1
The surveillance data likely underestimates the magnitude of the exposure problem because of underreporting, says Calvert. "This could be the tip of the iceberg. We have no way of knowing what the true magnitude of these poisonings is," he says.
The fatality occurred when a 52-year-old laundry worker was exposed to fumes from undiluted bleach that was in an open pail near a running clothes dryer. The woman, a two-pack-a-day smoker, had a history of asthma and chronic bronchitis. According to the surveillance report, she complained of shortness of breath and used her albuterol inhaler before collapsing. She was not revived and died five days later in the hospital.
The case points out the hazards inherent even in common products such as bleach, says Calvert. Health care workers have a higher rate of asthma than the general population, and some of the cleaning products can exacerbate asthma, he says.
Health care workers also may not be aware of the risks of cleaning and disinfecting products, he says. For example, a nursing assistant in Michigan was pouring a germicidal cleaner into a mop bucket when some of it spilled and soaked through her pants. She changed her pants, but didn't clean her leg immediately. About 90 minutes later, she suffered from a skin irritation when the area began to itch and turn red, Calvert says.
In another case, a viricidal disinfectant splashed into the eye of a 43-year-old woman. She immediately rinsed her eyes, but the disinfectant had already done damage. She had a corneal abrasion caused by a chemical burn, says Calvert.
Substituting safer products may help reduce injuries, but Calvert notes that by their nature, anti-microbial products will be hazardous to humans, as well. "These antimicrobial pesticides are important for maintaining infection control in hospitals," he says. "There's no safe way to kill these organisms. There's no way you can do that without having an effect on humans."
To prevent exposure and injuries from anti-microbials, Calverts offers these recommendations:
Ensure employees wear eye protection when appropriate. About half (51%) of the injury events involved splashes, and only 15% of the 265 health care workers who had exposures while handling anti-microbial pesticides were wearing eye protection, according to the surveillance report. Employee health professionals should make sure employees understand the need for eye protection and wear the appropriate personal protective equipment, he says.
Raise awareness of chemical hazards. Most of the incidents involved commonly used products, including quarternary ammonium compounds, glutaraldehyde, and sodium hypochlorite (bleach). Employees need training in the safe handling of those products, says Calvert. For example, they need to know the proper dilution, the possible health effects, and the recommended personal protective equipment. Employees should be encouraged to report any incidents of exposure, he says.
Look for safety in product packaging. The design of the containers or dispensing of products can impact the potential for exposure. For example, employees using disinfecting wipes were unexpectedly splashed in the eye when the action of pulling the wipe out of the container created a small splash. Using a container with a pump dispenser can reduce spills or splashes when employees need to dilute chemicals with water in a bucket.
1. Centers for Disease Control and Prevention. Acute antimicrobial pesticide-related illnesses among workers in health-care facilities – California, Louisiana, Michigan, and Texas, 2002-2007. MMWR 2010; 59:551-556.