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Dermatitis among Hospital Workers -- Oregon

In November 1981, complaints of skin and respiratory irritation were reported to the National Institute for Occupational Safety and Health (NIOSH) by members of the housekeeping staff, which cleaned and disinfected patients' rooms at a community hospital in Oregon. The cleaning solutions the workers used contained a variety of irritating and toxic chemicals, including phenol, carbitol, ammonia, alcohols, detergents, waxes, and scrubbing compounds. Phenol was the principal ingredient of a germicidal solution applied to all objects and floors, when cleaning patients' rooms.

In January 1982, investigators from NIOSH interviewed 23 of 28 housekeeping employees who used these cleaning agents; for purposes of comparison, 11 workers selected at random from a list of employees not involved in housekeeping were also interviewed (1). Limited physical examinations were performed.

The 23 housekeeping employees reported the following symptoms with significantly greater frequency than did the employees not engaged in housekeeping: cough (43% for housekeeping employees and 9% for others), history of producing phlegm (56% and 0%), itching of the external ear (61% and 0%), sinus congestion (65% and 18%), and light-headedness while at work (56% and 0%). Four housekeeping employees had severe dermatitis of the hands and feet, and another four reported past histories of dermatitis. The onset of dermatitis for each of these patients was associated with a history of exposure of the skin to cleaning agents and disinfectants while at work. In two of the employees with dermatitis, transfer from the housekeeping department and leave reportedly resulted in marked improvement. Two of 11 nonhousekeeping employees reported histories of mild skin rash, but neither had evidence of current skin disease.

Changes in work practices were recommended to reduce skin exposures and associated dermatitis, including use of protective gloves and changes in application procedures (e.g., application of the germicide with a cloth rather than by spray bottle).

In April 1982, investigators collected air samples for analysis to determine the presence of airborne chemicals released from the cleaning agents. Post-shift urine samples were also collected from housekeeping employees to test for excretion of phenol. The results of the environmental tests (performed after NIOSH-recommended changes in work practices were being implemented) revealed that the workers were exposed to assorted airborne vapors of ammonia, carbitol, isopropyl alcohol, and petroleum distillates; however, concentrations were at very low levels. Results of tests for butyl cellosolve, cellosolve, ethanolamine, ethyl alcohol, formaldehyde, and phenol, were all below the lower limits of analytical detection (2). The mean urinary excretion among 23 housekeeping employees was 26.5 mg/g of creatinine (range: nondetectable to 187 mg/g creatinine); among eight nonhousekeeping employees, the mean urinary excretion of phenol was 9.8 mg/g creatinine) (range: nondetectable to 12.2 mg/g of creatinine) (p

0.05)). Reported by US Public Health Service Region X Office, Seattle, Washington; Hazard Evaluations and Technical Assistance Br, Div of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC.

Editorial Note

Editorial Note: Workers in hospitals are exposed to a wide variety of chemicals known to be hazardous, including waste anesthetic gases (3), ethylene oxide (4), and formaldehyde (5). In this investigation, NIOSH found dermatitis, as well as an increased incidence of symptoms of respiratory irritation, among housekeeping workers in a hospital. Workers were exposed to cleaning compounds containing phenol and were excreting phenol in their urine. Phenol has previously been shown to cause contact dermatitis following repeated exposure (6,7). It is possible that, in this episode, exposure to cleaning agents containing other solvents and irritating chemicals may also have contributed to the occurrence of dermatitis. Relatively simple precautions, such as work practices that limit the dispersal of solvents in the air and wearing personal protective gear, appear effective in reducing the hazard, by reducing contact of solvents with the skin.

References

  1. National Institute for Occupational Safety and Health. Health hazard evaluation report no. HETA 82-053-1263. Cincinnati, Ohio: National Institute for Occupational Safety and Health, 1983.

  2. National Institute for Occupational Safety and Health. NIOSH manual of analytical methods. Vol 1-7, 2nd ed. Cincinnati, Ohio: National Institute for Occupational Safety and Health, 1977. (DHEW (NIOSH) publication no. 77-157).

  3. National Institute for Occupational Safety and Health. Health hazard evaluation report no. HETA 82-016-1206. Cincinnati, Ohio: National Institute for Occupational Safety and Health, 1982.

  4. National Institute for Occupational Safety and Health. Health hazard evaluation report no. HETA 81-350-932. Cincinnati, Ohio: National Institute for Occupational Safety and Health, 1981.

  5. National Institute for Occupational Safety and Health. Health hazard evaluation report no. HETA 82-205-1314. Cincinnati, Ohio: National Institute for Occupational Safety and Health, 1983.

  6. Proctor NH, Hughes JP. Chemical hazards of the workplace. Philadelphia: JB Lippincott Company, 1978.

  7. National Institute for Occupational Safety and Health. Occupational diseases: a guide to their recognition. Revised ed. Cincinnati, Ohio: National Institute for Occupational Safety and Health, 1977. (DHEW (NIOSH) publication no. 77-181).

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