MedicationsMany medications and compounds uesd in personal care products have knowntoxic effects. These have been comprehensively reviewed with a detailed summaryof the evidence of environmental and personal hazards associated with thesecompounds by Daughton and Ternes. Although many medications can behazardous to workers, those most commonly identified as hazardous to healthcare workers include antineoplastics and anesthesia. Anesthetic gases have beenidentified as particularly problematic, as gases escape into the air and can beinhaled by workers.

Methods of induction have been studied in terms of workerexposure, with findings indicating that such exposures (measured byurinary metabolites) frequently exceed National Institute for OccupationalSafety and Health (NIOSH) recommended limits. Hasei and colleagues foundthat intravenous induction posed a far lower risk of exposure to health careworkers.There are also data to support the deleterious effects of exposure toantineoplastic drugs, especially an increased risk of spontaneous abortionsamong health care workers. Cytotoxicity, genotoxicity, terotogenicity, andcarcinogenicity are associated with such exposures. For the past fewdecades, awareness of the risk of antineoplastic agents has been available,including guidelines for handling them published by the Occupational Safety andHealth Administration.1Nursingfunctions of particular risk, according to NIOSH, include medicationadministration, handling contaminated linens, exposure to human wastes,handling drug containers, cleaning drug preparation areas, being involved withspecial procedures, and disposal of containers and other wastes.

 Otherresearch indicates that antineoplastics and cytostatics have been found in locationsbeyond the confines of the designated handling areas such as air vents, desks,countertops, and floors. PesticidesPesticide use, both inside and outside of hospitals and healthfacilities, is another cause for concern. Because of the special vulnerabilitiesof children and pregnant women to pesticide exposures, control of pesticide usein health care settings is particularly important. In a survey conducted byHealth Care Without Harm, all hospitals surveyed reported some regularapplications of pesticides inside the hospital building, outside on thegrounds, or both. This report, Healthy Hospitals: ControllingPests Without Harmful Pesticides, offers guidance on reducingpesticides and implementing safer integrated pest management techniques.Integrated pest management is a comprehensive approach to pest management thatemploys nontoxic and least-toxic products and processes to control pests.Beyond Pesticides, a 25-year-old organization that has been working with HealthCare Without Harm on pesticide issues in the United States, is currentlyorchestrating several hospital-based pilot programs in Maryland. They areworking with hospital environmental services to implement an integrated pestmanagement approach that will work for hospitals.

These collaborations willresult in a set of best practices for a range of facility types—small communityhospitals, inner-city university health centers, and others.