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