1. OCCUPATIONAL ASTHMA IN HEALTHCARE Thomas P. Fuller ScD, CIH, MSPH, MBA Tech Environmental, Waltham, MA

2. Risks to Asthma Posed by Indoor Health Care Environments: A Guide to Identifying and Reducing Problematic Exposures December 2006 Report by Health Care Without Harm

3. Departments in Healthcare RadiologyEndoscopyLaboratories Animal Care Centers Nursing Central Sterile MortuaryHousekeepingFacilitiesDietary

4. Jobs in Healthcare X-ray Tech., Darkroom Tech. Nurses and support staff Lab workers Animal Handlers Painters Maintenance staff BakersGroundskeepers

5. Exposure Matrix Helps identify workers and departments with exposures to Asthma causing agents.

6. Exposure Reduction Alternatives SubstitutionEliminationControl Administrative Measures –Transfers –Training –Job Rotation –Medication

7. Cases - Problems Review Materials used Observe Activities Assess Exposures – –Routes (skin, ingestion, inhalation) –Levels (concentration, quantity, existing controls) –Measures (monitoring –air, surface, biological) Controls – Engineering, Administrative, PPE Alternatives

10. Alternative Pilot Review alternative products and processes Determine selection acceptance criteria Select an alternative Implement alternative and observe changes Grade the new process/product Develop procedures and institute changes Train workers on new materials and tasks.

11. Floor Care Pilot Worker history – asthmatic response to floor wax stripping (numerous other complaints), Product and practices (monoethanolamine, sodium hydroxide, NFPA Health = 3), Every six months, general exhaust in area, OSHA exposure limits.

12. Floor Care Alternatives Replaced with cationic surfactant lactate mixture (NFPA Health rating of 1), Less volatile, No worker complaints, no general ventilation requirements, Gets floors just as clean, Slightly more expensive, No air monitoring required (per se), No OSHA limits to meet.

13. Gluteraldehyde Project 29 hospital sites with Glutaraldehyde, Worker exposures and symptoms, Lost worktime and compensation, OSHA limits and monitoring requirements, Often misused or uncontrolled.

14. Glutaraldehyde Alternatives Replaced with Ortho-opthamaldehydes, Somewhat safer, no OSHA limits or monitoring requirements, No health related symptoms reported (9 mos. after), FDA approved high level disinfectant, Slightly more expensive per bottle, Process took over 9 months, No more calls or complaints, Only two sites still use Glut.

15. Unfortunate Lessons Tricky people will switch back and revert to old products and practices when no one is looking (workers, supervisors, and managers), Despite the months and sometimes years it takes to prove that a new product works and to get it approved people and departments can get new “bad” products in without going through the review process,

16. Unfortunate Lessons People may also misuse the new “safer” product in such a manner that causes “symptoms” and then people relate those to the new product (nothing is perfect), Once a new “worse” product or method is used the first indicator to the Safety Office is often a report of symptoms !

17. Final Word! Keep fighting – it is worth fighting for.

18. Thank You.