Looking towards the front part of the conference room, the projector has presentations on cue and the lecturers are reviewing their notes. At least 40 people in uniforms are waiting. It was announced that the topic for today is chemicals.
Could this be a déjà vu of my days in high school, sitting in my Chemistry class? The dreamlike sequence was: We were being told that matter is anything that occupies space and has mass. We were shown examples of matter in three different phases: the water in the beaker as liquid, the spoon as solid, and the released air from a balloon as gas. The next days became a tedious memorization of the periodic table of elements. I was happy with my easy codes Al for aluminum, Au for gold and Au for silver. But the rest of the elements are tongue-twisters and where they are found in the periodic table is an unsolved crossword puzzle for me.
Snap back to reality. It is a work day in March 2013 and I am at St. Paul Hospital Tuguegarao preparing for the afternoon’s forum on chemicals in health care. I sit among the hospital staff in different uniforms representing their work areas. The slides for presentation, the scribbled notes, and what the people will be hearing are all about chemicals.
What was taught is applied chemistry, but not another science subject though. The forum focused on how chemicals are being used in a health care set-up and its effects on people. The opening slide showed the vicious cycle of chemicals with text “the risks of hospital chemicals” which stirred the interests of nurses, midwives, medical technologists, housekeeping staff and others in the audience.
Ruth Stringer, International Science and Policy Coordinator of Health Care Without Harm gave a run-down of hazardous chemicals found in hospitals. Ingredients of disinfectants may include glutaraldehyde, triclosan, ethylene oxide, sodium hypochlorite, and silver. Intravenous bags, tubings, catheters and other plastic medical supplies may contain polyvinyl chloride (PVC), di(2-ethylhexyl)phthalate (DEPH), and bisphenol A (BPA). Formaldehyde is another chemical that laboratories use for preservation of specimen to study.
The quicksilver mercury, which is encased in old types of thermometers and sphygmomanometers, is neurotoxin. No less than the Philippine Department of Health has prescribed year 2010 for the complete phase-out of these medical devices. However, some dental clinics still have not shifted from mercury dental amalgams to the composite resin fillings.
The list could go on and a three-hour forum would not be enough to give details for every chemical. Hence, the speaker picked glutaraldehyde to discuss since most of the hospital staff can identify with it. Using some sense organs as science tool will surmise that glutaraldehyde is a colorless pungent liquid. Its primary purpose in hospitals is for cold sterilization of surgical instrument and scopes. Some hospital also uses glutaraldehyde formulations for infection control procedures.
Glutaraldehyde is a respiratory irritant and linked to occupational asthma and asthma-like symptoms such as throat and nose irritations, sneezing, breathing difficulty, and wheezing. Other health concerns with glutaraldehyde are hand stains, rash and dermatitis from direct skin contact with the liquid while its inhalation can also cause headaches, nausea and eye irritations.
The irony is that hospital workers themselves are at high risk to health hazards of glutaraldehyde. These are the doctors, nurses, and other hospital staff who work in areas with glutaraldehyde exposures like the operating room, endoscopy unit, gastroenterology and cardiology departments, dialysis unit, intensive care unit, and sterilization room. Patients who are supposed to be taken cared in these special areas are also at risk.
The other speaker, Michael Ravago, President of Philippine Society of Endoscopy Nurses and Assistants validated the issues and concerns on glutaraldehyde. Being a nurse supervisor assigned to the endoscopy unit of a tertiary private hospital in Metro Manila, he shared their experience with glutaraldehyde. Aside from reported staff illnesses from chemical exposure, patients also forwarded complaints about the strong irritating smell inside the unit. Soon after, they began to observe discoloration and damage at the distal end of the scope.
The general sentiment of the participants during the open forum is how to minimize the negative effects of toxic chemicals considering that they have to deal with these until alternatives are available. The speakers offered recommendations:
• Wearing appropriate personal protective equipment;
• Improving ventilation system in work areas;
• Using disinfectants wisely. Regular good cleaning is enough for some application;
• Choosing non-chemical and least toxic disinfection where possible;
• Requiring full disclosure of product ingredients from suppliers; and
• Setting-up a green purchasing policy
The forum ended like a usual class wrap-up. Participants get up from their seats. A group buzzes about the day’s inputs, some exchange opinions and afterthoughts, while some went to the speakers to ask more questions.
The topic for the day has been well discussed. But there is still homework for HCWH-Asia’s Safer Chemicals campaign. The goal is to pilot two hospitals for chemical substitution and management. Research is underway for the feasibility of introducing chemical products with lesser harm for the people and the environment.
Library work (I mean, surfing the internet at this day and age) will be online searching for materials related to glutaraldehyde, tabbing and bookmarking different web sites, downloading pdf files of product literatures, clicking on the http links to material safety data sheets, and all the other cursor works that did not come in handy when I had my Chemistry class.
The work continues beyond the day’s topic.
Note:
Health Care Without Harm-Asia is currently cooperating with KEMI (Swedish Chemicals Agency) and SAICM (Strategic Approach to International Chemicals Management) for the campaign on “Chemical Substitution and Management in the Health Care Sector”. The project aims to (1) identify the hazardous chemicals used in health care, (2) introduce safer alternatives, and (3) document case studies from two pilot hospitals in the Philippines. This experience will later on be used for broader dissemination and for future policy recommendations on chemicals management.
Ayeth Enrile, SAICM Project Coordinator, Safer Chemicals Campaign, HCWH-Asia
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