Common Toxic Exposures in Health Care:

What every nurse should know

Barbara Sattler, RN, DrPH, FAAN

Professor, MPH Program

University of San Francisco

bsattler@usfca.edu

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The quality of the ENVIRONMENT is a major determinant of human health. Yet… most nurses do not learn about air, water, food, soil, waste, and products in terms of their impacts on human health. … not to mention climate change, radiation (other than medically-related)…

Institute of Medicine Report: Nursing Health and the Environment (1995) Integration of EH into Nursing;

• Education

– Nursing education

– CE

– Patient

• Research

• Clinical Practice – EH in Patient Care – Greening our work

settings

• Policy / Advocacy – In our institutions – Locally, state,

national

Standard 16

ANA Scope and Standards of Professional Practice:

NEW!

ENVIRONMENTAL HEALTH STANDARD

Biomonitoring: New Tool for Environmental Health

http://www.ewg.org/sites/humantoxome/

Charlotte Brody, RN Body Burden Studies

Chemicals found in Charlotte:

214 tested 87 found

Charlotte Brody, RN Body Burden

Chemicals found in Charlotte

number: associated with:

• 54 Birth defects and dev delays

• 53 Immune toxicants

• 52 Cancer

• 37 Brain and nervous system

• 23 Reproduction and fertility

• 16 Hormone activity

• 10 Gastrointestinal (including liver)

Hazardous Chemicals in Health Care: A Snapshot of Chemicals in Doctors and

Nurses

12 Doctors

8 Nurses

62 Chemicals (including congeners)

BPA

Perfluorinated compounds

Phthalates

PBDEs

Triclosan

BPA – EDC, repro toxicant, breast and prostate Ca, brain fx, obesity, thyroid disfx

Perflourinated compounds – EDC, Immunotoxicant, liver/pancreatic tumors (animal)

Phthalates – reproductive development

PBDE – neurotoxicant (brain fx, memory, behavioral problems)

Triclosan – thyroid disfx, EDC, cardiotoxic

At least 24 chemicals were found in any given person studied.

OSHA has left us alone

National Nurses Survey

• Exposures to 11 chemicals or hazardous agents, including – Glutaraldehyde – Ethylene Oxide – Medications – Medical devices such as mercury and ionizing

radiation – Anesthetic Gases – Natural Rubber Latex – Hand and Skin Disinfection Products – Housekeeping Chemicals

Survey Findings ~ Housekeeping Chemicals

• 92% reported exposures

• 47% higher rates of asthma

Survey Findings ~ Personal Care Products

• 97% reported on-the-job exposures

• 1/3 of all products contain one or more ingredients linked to cancer

• 40% contain “fragrances” (associated with allergic reactions and cancer risks)

Survey Findings ~ Latex

• 64% percent of more than 1,500 nurses reported high (at least twice per week) exposure for five years or more.

• Nurses with frequent, long-term exposures to latex (at least weekly for at least ten years) reported 39 percent higher rates of asthma than other nurses.

Survey Findings ~ Hand & Skin Disinfection

• 96% reported exposures

• 39% higher rates of asthma

Nurses’ Survey Finding ~ Sterilization & Disinfectant Agents

• 52% reported on-the-job exposures

• 46% higher rates of asthma in those most highly exposed

Survey Finding ~ Anesthetic Gases

36% reported exposures

Up to seven times higher rates of birth defects in their children (central nervous system, cardiovascular, genitourinary, and musculoskeletal)

Survey Findings ~ Medications

• 95% reported exposures

• 14% higher rates of cancer

Asthmagens:

- • Antibiotics,

- Laxatives,

- Antihypertensives,

- Antituberculars,

- H2 blockers

Survey Findings ~ Medications Antiretroviral Meds: Suppress HIV virus

• 47%

• 19% higher rates of difficulty conceiving

Survey Findings ~ Medications Chemotherapeutic Agents

• 41% reported exposures

• 42 percent higher rates of cancer than other nurses.

Survey Findings ~ Housekeeping Chemicals

• 92% reported exposures

• 47% higher rates of asthma

Perfumes and Fragrances

Go Fragrance-free

Over 70% of all antibiotics in the US are used in animal feed

Antibiotics

• Cattle

• Hogs

• Chickens

• Farmed Fish

Many the same as those for human use

• Virginiamycin

• Tetracyclines

• Penicillin

• Streptomycin

• Bactrican

• Salinomycin

• Lasalocid

• Monensin

• Bambermycin

• Arsenicals

Arsenic in poultry

Used for:

Growth promotion

Pigmentation

“Prophylaxis” - compensate for growing conditions

55% of raw, supermarket chicken had detectable arsenic.

Banned in Europe

• > 70% of broiler chickens are fed arsenic.

Antimicrobials in furniture

Conserving our armament of antibiotics

Purchasinig Decisions:

• Meats and poultry raised without ABX

• Furnishings without antimicrobials

• Judicious use of antimicrobials at home and in the hospital (soap versus antimicrobials)

PBDEs (flame retardants) = neurotoxicants Choose PBDE-free

Movie: Toxic Hot Seat

DEHP in IV bags and tubing (di-ethylhexyl phthalates)

DEHP Leaches into IV fluids

Choose DEHP-free products

www.noharm.org

PVC Plastics

Green Team Logos

Close the loop prevent exposures in the community

https://practicegreenhealth.org/pubs/epp/planbatteryrecycling.pdf

Blue Wrap Recycling?

Alliance of Nurses

for Healthy

Environments (ANHE)

Bringing Science and Passion to the Environmental Health Movement

www.enviRN.org

Alliance of Nurses for Healthy Environments Bringing Science and Passion to the Environmental Health Movement

• Work Groups:

– Education – Practice – Research – Policy/Advocacy

• Committees – Climate Change – Fracking

Welcome to www.enviRN.org A Virtual Community of Nurses

• Educating [curriculum / e-Text]

• Resources

• Practice recommendations

• Advocacy

A “power-tool” for the nursing community and healthy environments

iPhone App

RN

What do we want to tell pregnant women about preventing unnecessary exposures?

Prenatal Environmental Health Questionnaire

www.enviRN.org go to assessment

ANHE: Free Monthly Calls Talk with Nurses from around the Country

Practice Workgroup Calls:

3rd Tues of the month at 12noon PST

(240) 454-5720 (No ID/password necessary)

Check the homepage of enviRN.org for updates and for all other workgroups

Safe Chemical Act www.saferchemicals.org

Where’s the Evidence National Library of Medicine

• Tox Town - Interactive guide to environmental health risks and potentially toxic substances for the public; explore a city, town, port, or the US-Mexico border for potential environmental health hazards and how to manage them

http://toxtown.nlm.nih.gov • Household Products Database – Health and safety information

on over 7,000 brand name products including personal care, cleaning, gardening, auto care, pests, crafts, etc.

household.nih.nlm.gov • ToxNet suite of programs: http://toxnet.nlm.nih.gov/

http://toxtown.nlm.nih.gov/

ToxTown’s CITY

ToxTown’s Hospital

householdproducts.nlm.nih.gov

Skin Deep

www.cosmeticsdatabase.com

Cancer treatment centers built without materials linked to cancer

Pediatric clinics free of chemicals

that trigger asthma

Hospitals with healthy food, fresh air, sunlight

Imagine a hospital that is carbon

neutral.

IMAGINE

QUESTIONS?