Health Effects of Chemicals used in hospitals among Healthcare Workers

Article information

J Korean Med Assoc. 2010;53(6):474-482
Publication date (electronic) : 2010 June 30
doi : https://doi.org/10.5124/jkma.2010.53.6.474
Department of Preventive Medicine, Yonsei University College of Medicine and Institute for Occupational Health, Korea.
Corresponding author: Jong Uk Won. juwon@yuhs.ac

Abstract

Healthcare workers are exposed to a variety of chemical agents used in many different areas and purposes. The chemicals could cause health problems to healthcare workers using them. Glutaraldehyde is a kind of disinfectant and used for endoscopes, catheters, and many kinds of operating apparatus. It may cause allergic contact dermatitis. Formaldehyde is another disinfectant and can be used for fixing tissues. Formaldehyde was classified to a Group 1 carcinogen by IARC and it may cause lung or nasal cancer. Ethylene Oxide gas is the most popular disinfectant these days and may be applied to many health care sets or linens. EO gas may cause allergic contact dermatitis and breast cancer or leukemia. It is also classified as Group 1 carcinogen despite limited evidence for human cancers. Anesthetics are related to genotoxicities, sister chromatid exchange, and might be related to spontaneous abortion, stillbirth or birth defects. Some of the anti-neoplastic drugs such as Busulfan, Chlorambucil, cyclophosphamide, melphalan are Group 1 carcinogens. They could cause nausea, pruritus, or decreasing leukocytes or platelets. Other miscellaneous chemical agents are heavy metals such as elementary mercury or lead and organic solvents such as toluene, xylene and acetone. Although some of these chemical agents including EO gas have occasionally exceeded to permissible level, air levels of most above chemicals in Korean hospitals were relatively low. However, we have to make every effort to reduce the exposure level of these chemicals.

References

1. Roh J, Won JU, Kim C-N, Kim U-C, Koh SB, Kim HS, et al. Study for understanding chemical usage at health care facilities and setting its control program 2006. Seoul, Korea: Occupational Safety&Health Research Institute; 135.
2. Occupational Safety&Health Research Institute. 2004 Survey of Occupational Health Service status of Health Care Facilties 2005.
3. Kiec-Swierczynska M, Krecisz B. Occupational skin diseases among the nurses in the region of Lodz. Int J Occup Med Environ Health 2000. 13179–184.
4. Shaffer MP, Belsito DV. Allergic contact dermatitis from glutaraldehyde in health-care workers. Contact Dermatitis 2000. 43150–156.
5. Ravis SM, Shaffer MP, Shaffer CL, Dehkhaghani S, Belsito DV. Glutaraldehyde-induced and formaldehyde-induced allergic contact dermatitis among dental hygienists and assistants. J Am Dent Assoc 2003. 1341072–1078.
6. Kim CW, Song JS, Ahn YS, Park SH, Park JW, Noh JH, Hong CS. Occupational asthma due to formaldehyde. Yonsei Med J 2001. 42440–445.
7. Gannon PF, Bright P, Campbell M, O.H'ickey SP, Burge PS. Occupational asthma due to glutaraldehyde and formaldehydein endoscopy and x ray departments. Thorax 1995. 50156–159.
8. Donovan J, Skotnicki-Grant S. Allergic contact dermatitis from formaldehyde textile resins in surgical uniforms and nonwoven textile masks. Dermatitis 2007. 1840–44.
9. Formaldehyde, 2-butoxyethanol and 1-tert-butoxypropan-2-ol. IARC Monogr Eval Carcinog Risks Hum 2006. 881–478.
10. Minstry of Labor. Threshold Limit Values for Chemical Substances and Physical Agents 2008.
11. Kim JH, Kim DJ, Kim HW. A Study on exposure-Worker to Formaldehyde in the Endoscopy Unit of Hospitals. Korean Ind Hyg Assoc J 2009. 19195–201.
12. Jeong K-H, Ha A-L, Lee Y-H. Formaldehyde Concentrations in Air of Histopathology Laboratories of Some Hospitals. Kosim J Health Sci 2002. 12.
13. ACGIH. Threshold Limit Values for Chemical Substances and Physical Agents and Biological Exposure Indices Cincinnati: 2099.
14. Kerre S, Goossens A. Allergic contact dermatitis to ethylene oxide. Contact Dermatitis 2009. 6147–48.
15. Rom WN, ed. Environmental and Occupational Medicine 2006. 4th edth ed. Philadelphia: Lippincott-Raven;
16. Grosse Y, Baan R, Straif K, Secretan B, El Ghissassi F, Bouvard V, Altieri A, Cogliano V. WHO International Agency for Research on Cancer Monograph Working Group. Carcinogenicity of 1,3-butadiene, ethylene oxide, vinyl chloride, vinyl fluoride, and vinyl bromide. Lancet Oncol 2007. 8679–680.
17. IARC monographs on the evaluation of carcinogenic risks to humans. Volume 97. 1,3-butadiene, ethylene oxide and vinyl halides (vinyl fluoride, vinyl chloride and vinyl bromide). IARC Monogr Eval Carcinog Risks Hum 2008. 973–471.
18. Hagmar L, Mikoczy Z, Welinder H. Cancer incidence in Swedish sterilant workers exposed to ethylene oxide. Occup Environ Med 1995. 52154–156.
19. Lucas LJ, Teta MJ. Breast cancer and ethylene oxide exposure. Int J Epidemiol 1996. 25685–686.
20. Steenland K, Stayner L, Deddens J. Mortality analyses in a cohort of 18 235 ethylene oxide exposed workers: follow up extended from 1987 to 1998. Occup Environ Med 2004. 612–7.
21. Jeong MH, Lee YW. Hematologic Effects in Workers Exposed to Ethylene Oxide. J Korean Public Health Assoc 1997. 23117–127.
22. Seo SO, Paik NW. A Study on Worker Exposure to Ethylene Oxide in Central Sterilizing Room of Hospital. Korean Ind Hyg Assoc J 1995. 568–86.
23. Eroglu A, Celep F, Erciyes N. A comparison of sister chromatid exchanges in lymphocytes of anesthesiologists to nonanesthesiologists in the same hospital. Anesth Analg 2006. 1021573–1577.
24. Choi Y-S, Kim H-s, Kang K. A Study on the Effect of Waste Anestheic Gases on the Sister Chromatid Exchanges of Peripheral Lymphocytes in Operating Room Personnel. Korean J Anesthesiol 1990. 23879–883.
25. Boivin JF. Risk of spontaneous abortion in women occupationally exposed to anaesthetic gases: a meta-analysis. Occup Environ Med 1997. 54541–548.
26. Rowland AS, Baird DD, Weinberg CR, Shore DL, Shy CM, Wilcox AJ. Reduced fertility among women employed as dental assistants exposed to high levels of nitrous oxide. N Engl J Med 1992. 327993–997.
27. Cohen EN, Gift HC, Brown BW, Greenfield W, Wu ML, Jones TW, Whitcher CE, Driscoll EJ, Brodsky JB. Occupational disease in dentistry and chronic exposure to trace anesthetic gases. J Am Dent Assoc 1980. 10121–31.
28. Guirguis SS, Pelmear PL, Roy ML, Wong L. Health effects associated with exposure to anaesthetic gases in Ontario hospital personnel. Br J Ind Med 1990. 47490–497.
29. McGregor DG. Occupational exposure to trace concentrations of waste anesthetic gases. Mayo Clin Proc 2000. 75273–277.
30. Irwin MG, Trinh T, Yao CL. Occupational exposure to anaesthetic gases: a role for TIVA. Expert Opin Drug Saf 2009. 8473–483.
31. Vellore AD, Drought VJ, Sherwood-Jones D, Tunnicliffe B, Moore VC, Robertson AS, Burge PS. Occupational asthma and allergy to sevoflurane and isoflurane in anaesthetic staff. Allergy 2006. 611485–1486.
32. Cha JY, Paek DM, Paik NW. Employee Exposures to Waste Anesthetic Gases in Hospital Operating Rooms. Korean Ind Hyg Assoc J 2006. 16193–201.
33. Rosenstock L, ed. Textboopk of Clinical Occupational and Environmental Medicine 2005. 2nd edth ed. Philadelphia: Elsevier Saunders;
34. Stucker I, Caillard JF, Collin R, Gout M, Poyen D, Hemon D. Risk of spontaneous abortion among nurses handling antineoplastic drugs. Scand J Work Environ Health 1990. 16102–107.
35. Valanis B, Vollmer WM, Steele P. Occupational exposure to antineoplastic agents: self-reported miscarriages and stillbirths among nurses and pharmacists. J Occup Environ Med 1999. 41632–638.
36. Valanis B, Vollmer W, Labuhn K, Glass A. Occupational exposure to antineoplastic agents and self-reported infertility among nurses and pharmacists. J Occup Environ Med 1997. 39574–580.
37. McDonald AD, McDonald JC, Armstrong B, Cherry NM, Côté R, Lavoie J, Nolin AD, Robert D. Congenital defects and work in pregnancy. Br J Ind Med 1988. 45581–588.
38. Fuchs J, Hengstler JG, Jung D, Hiltl G, Konietzko J, Oesch F. DNA damage in nurses handling antineoplastic agents. Mutat Res 1995. 34217–23.
39. Undeger U, Basaran N, Kars A, Guc D. Assessment of DNA damage in nurses handling antineoplastic drugs by the alkaline COMET assay. Mutat Res 1999. 439277–285.
40. Ursini CL, Cavallo D, Colombi A, Giglio M, Marinaccio A, Iavicoli S. Evaluation of early DNA damage in healthcare workers handling antineoplastic drugs. Int Arch Occup Environ Health 2006. 80134–140.
41. Sasaki M, Dakeishi M, Hoshi S, Ishii N, Murata K. Assessment of DNA damage in Japanese nurses handling antineoplastic drugs by the comet assay. J Occup Health 2008. 507–12.
42. Grosse Y, Baan R, Straif K, Secretan B, El Ghissassi F, Bouvard V, Benbrahim-Tallaa L, Guha N, Galichet L, Cogliano V. WHO International Agency for Research on Cancer Monograph Working Group. A review of human carcinogens-Part A: pharmaceuticals. Lancet Oncol 2009. 1013–14.
43. Skov T, Maarup B, Olsen J, Rorth M, Winthereik H, Lynge E. Leukaemia and reproductive outcome among nurses handling antineoplastic drugs. Br J Ind Med 1992. 49855–861.
44. Shin H-S, Lee S-H. A Study on the Handling Patterns of Anticancer Drugs and Related Symptoms in Nurses. Korean J Occup Environ Med 1996. 8228–238.
45. Kim SJ, Lee SE, Chung HW. Chromosome Aberrations and Sister Chromatid Exchanges in Peripheral Lymphocyte of Nurses Handling Anticancer Drungs. Korean J Environ Health Soc 1995. 2167–76.
46. Choi JS, Kim YH, Gong SH, Jun MH, Park JS, Kim MJ. Level of Knowledge and Compliance on Guidelines for Safe Handling of Cytotoxic Drugs by Career and Work Units in Clinical Nurses. Clinical Nursing Research 2004. 96–17.
47. Hong S-Y, Cho E-J, Yoo Y-S. Effects of Education for Safe Handling of Cytotoxic Drugs on Knowledge and Practice in Oncology Nurses. J Korean Oncol Nurs 2006. 647–53.
48. Uveges RE, Grimwood RE, Slawsky LD, Marks JG Jr. Epidemiology of hand dermatitis in dental personnel. Mil Med 1995. 160335–338.
49. Strauss RM, Gawkrodger DJ. Occupational contact dermatitis in nurses with hand eczema. Contact Dermatitis 2001. 44293–296.
50. Hwang JI, Suh MJ. Adverse Reaction to Surgical Latex Gloves. J Korean Acad Adult Nurs 1997. 9199–208.
51. Choi BM, Kim YG, Jung JT, Doggo YC. Clinical Study of Allergic Reaction to Latex Gloves in Hospital Personnel. Pediatr Allergy Respir Dis 1994. 430–37.
52. Lee BJ, Kim YK, Min KU, Kim YY. A case of occupational asthma induced by latexin a hospital personnel. J Asthma Allergy Clin Immunol 1998. 18510–517.
53. Song IH, Kim YO. Hazardness of Workplace in General Hospital (3). Chonnam Med J 1986. 33297–300.
54. Song KH, Kim DH, Lee JY. Mercury contents in Scalp Hair of Dentists and in their Dental Office. Korean J Occup Environ Med 1991. 321–31.
55. Hwang YS, Jung KC. Mercury Contents in Hair of Korea Den-tal Hygienists. J Korean Acad Oral Health 1996. 2075–86.
56. Kiec-Swierczynska M, Krecisz B. Allergic contact dermatitis in a dental nurse induced by methacrylates. Int J Occup Med Environ Health 2003. 1673–74.
57. Geukens S, Goossens A. Occupational contact allergy to (meth)acrylates. Contact Dermatitis 2001. 44153–159.
58. Villar RN, Johnston FG, Scott PM. Occupational asthma due to methyl methacrylate bone cement. Br Med J (Clin Res Ed) 1986. 2921597.

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Table 1

Carcinogenecity of anticancer drugs evaluated by IARC Working Group

Table 1