HCWs have high rates of work-related asthma
NIOSH: Cleaning, sterilizing agents play a role
Health care workers continue to have among the highest rates of work-related asthma, according to a recent report from the National Institute for Occupational Safety and Health (NIOSH).
In three of the four states that conduct sur- veillance for work-related asthma — California, Massachusetts, and New Jersey — health ser- vice had the highest prevalence of work-related asthma, according to the Work-Related Lung Disease (WoRLD) Surveillance Report.
In Michigan, health services ranked after transportation equipment (the automobile industry) in work-related asthma. The report encompasses more than 2,500 cases of work-related asthma, as identified by physicians, from 1993 to 1999.1
A similar pattern emerges in asthma mortality data, which come from 19 states that collect occupational information on death certificates.
The occupation with the highest proportionate mortality rate from asthma is respiratory therapy. In fact, the occupations with the highest proportion of mortality related to asthma include clinical laboratory technicians, health diagnosing practitioners, licensed practical nurses, registered nurses, and nurses’ aides.
"There’s a lot of consistent evidence showing that the health care industry has high levels of asthma mortality and morbidity," says Michael Attfield, PhD, chief of the NIOSH surveillance branch respiratory disease studies.
Other culprits could be cleaning agents
Cleaning compounds, sterilizing agents such as glutaraldehyde, and aerosolized latex particles from powdered gloves may play a role in the hospital-related asthma, says Lee Petsonk, MD, senior medical officer in the division of respiratory disease studies at NIOSH in Morgantown, WV.
The WoRLD report provides general information on asthma triggers, attributing 20% of cases to "miscellaneous chemicals," 11.5% to "cleaning materials," and 10% to "indoor air pollutants," which could include dust and mold.
Other studies, particularly in Europe, have found an association between cleaning and sterilizing agents and asthma among hospital workers, notes Petsonk.
The United Kingdom’s National Health Service discontinued the use of glutaraldehyde in 2002 in response to reports of skin problems and asthma among health care workers.
In 2001, NIOSH issued an informational bro-chure for health care workers on the hazards of glutaraldehyde exposure. The agency also has been reviewing the recommended exposure limits for the chemical.
"We have suspicion that a lot of the high-level sterilizing and cleaning agents [are linked to respiratory problems]," says Petsonk.
"We know they’re irritating. The data are beginning to say they’re important in triggering asthma symptoms. Whether they actually cause asthma or whether they trigger asthma in people who have a [tendency] is hard to say."
Hospitals can take measures to reduce exposures that could trigger asthma. For example, respiratory therapists may administer treatment to patients in an exposure cabinet that allows them to monitor the progress without being exposed to the aerosol, Petsonk notes.
Proper ventilation is essential, as is following manufacturer instruments when handling cleaning and sterilizing agents.
"Certainly, we recognize that allergic reactions to aerosols occur," he says. "It’s prudent to try to reduce exposure to those."
1. National Institute for Occupational Safety and Health. Work-Related Lung Disease Surveillance Report 2002. December 2002; DHHS (NIOSH) No. 2003-111. www.cdc.gov/niosh/docs/2003-111/pdfs/2003-111a.pdf.
2. Di Stefano F, Siriruttanapruk S, McCoach J, et al. Gluta-raldehyde: An occupational hazard in the hospital setting. Allergy 1999; 54:1,105-1,109.
NIOSH to HCWs: Beware of glutaraldehyde exposure
The National Institute for Occupational Safety and Health (NIOSH) has cautioned health care workers to be alert to the symptoms of glutaraldehyde exposure and to report symptoms if they occur:
- Throat and lung irritation
- Asthma, asthma-like symptoms, and breathing difficulty
- Nose irritation, sneezing, and wheezing
- Burning eyes and conjunctivitis
- Rash — contact and/or allergic dermatitis
- Staining of the hands (brownish or tan)
NIOSH recommends local exhaust ventilation that provides at least 10 air room exchanges per hour. Employees should wear personal protective equipment when working with glutaraldehyde, including goggles, face shields, and gloves and aprons made of nitrile or butyl rubber. (Latex gloves do not provide protection from chemical exposure, according to NIOSH.)