Health Hazard Evaluation Report HETA 99-0035-2757, LDS Hospital/Intermountain Health Care, Salt Lake City, Utah.
On November 18, 1998, the National Institute for Occupational Safety and Health (NIOSH) received a request for a health hazard evaluation (HHE) from the Occupational Health Nurse at the Latter Day Saints/Intermountain Health Care hospital in Salt Lake City, Utah. The HHE request stated that several nurses and nurses' aides working in the bone marrow transplant unit (BMT) had experienced allergic symptoms. These included two reports of anaphylaxis and several reports of less severe symptoms, such as shortness of breath, rashes, and itching. The health effects reported by the health care workers were thought to be associated with an activity specific to the BMT: the infusing of patients with a solution containing stem cells and dimethyl sulfoxide (DMSO). The NIOSH investigation consisted of concurrent medical and industrial hygiene evaluations on December 7, 1998, and an additional medical evaluation on February 18-19, 1999. The medical evaluation included a questionnaire, private interviews with employees, and review of medical records. The industrial hygiene evaluation consisted of air, surface, and bulk dust sampling to evaluate the presence of DMSO and latex proteins in the BMT. None of the volatile chemicals known to be present in the stem cell infusion solutions, including DMSO, were detected in the air during the administration of stem cells into a patient. Natural rubber latex was not detected in air samples. A medical records review revealed rashes and respiratory symptoms to be the most commonly reported symptoms among affected employees. Since no direct dermal contact with DMSO occurs, and no chemicals could be measured in the breathing zone of the staff nurse or in the ambient environment of the room where the infusion occurred, it is unlikely that skin and respiratory symptoms are caused by exposures from the administration of stem cells. Medical questionnaires (from 64 workers) revealed that 22% of employees reported some type of chest symptom and 50% reported skin symptoms including rashes (47%) and hives (13%). Hay fever was reported by 59% of the employees and 22% reported a physician diagnosis of asthma. Pre-existing atopy and asthma in the employees who worked in the BMT could explain the upper respiratory symptoms reported by staff in the BMT. Skin symptoms (especially hand rash) are common in the nursing profession due to frequent washing and drying of the hands and the use of gloves as a part of universal precautions.