Post on 22-Jan-2021
transcript
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?
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?