For years, health care workers have been cautious about transmitting infections outside the workplace. Examples include pathogens, such as tuberculosis that spread through respiratory routes, or through blood or body fluids, such as hepatitis. However, we now recognize that nurses confront many noninfectious but dangerous agents at work. As in other industries with multiple hazardous exposures, workers may transport hazards from the workplace to the home and to other household members.
This type of home contamination has been dubbed paraoccupational exposures-more simply nicknamed "take-home toxins." Pediatricians, other clinicians, and researchers first recognized the problem several decades ago, but it received closer examination with the federal Workers' Family Protection Act in 1992. In addition to raising awareness, this legislation required the National Institute for Occupational Safety and Health (NIOSH) to study the issue and to convene a Workers' Family Protection Task Force that reviewed recommendations to prevent family endangerment.
As a healthy nurse who is able to work, you may not suffer any effects of toxic exposures on the job. Those at home, however, may be more vulnerable. Our family, friends, and visitors in our homes may be children, elderly persons, or those with compromised health-people with increased susceptibility to even low levels of toxins. Potential health effects may be expressed as short-term, acute conditions, such as nervous system effects caused by pesticide exposure. Alternatively, the risk of long-term effects, such as cancer, may be elevated.
Hazardous agents may reach the home by a variety of means. Those present in liquid or particle (dust or powder) form include pharmaceuticals, cleaning agents, and pesticides and can be transported via clothing, shoes, skin, hair, or even tools of the health care trade, such as stethoscopes. They can even be present on articles no longer used at work but taken home to be "recycled" for other purposes, such as containers that once held dangerous substances.
Patients with contaminted clothing or bodies are another source of exposure for nurses and, consequently, their families and friends. While we can more easily identify a patient with overt poisoning, recognizing the presence of contamination in a patient with unrelated health conditions is more difficult. Agricultural workers, for example, may have pesticides on their clothing. Workers who have recently been renovating or demolishing buildings may be contaminated with lead, other heavy metal dust, or asbestos fibers. Nurses-particularly those who work in EDs-may be the first to recognize the need for patient decontamination or the need to take specific precautions against exposure.
SUGGESTIONS
* When clothing (such as scrubs) is provided by your employer, change before going home and suggest such clothing be laundered by your employer. Keep work clothes separate from personal clothes. Launder soiled clothing separately.
* Be cautious with potentially contaminated items, such as stethoscopes, tourniquets, and other instruments.
* Be aware of the possibility of patients as potential sources of contamination.
* Resist the temptation to salvage discarded articles for other uses at home.
* Educate others, including patients and parents, on the risks of transporting toxins from their workplace to home.
NIOSH has developed publications and materials that address the issue of take-home toxins and health protection (see above). While attention has focused on industrial settings, the same principles can be applied to health care settings.
Nurses must not let their guard down when it comes to protecting themselves and others against infectious diseases. Nevertheless, it is also important to consider the many additional potential contaminants and to take steps to prevent their transmission at home.
Resources
* National Institute for Occupational Safety and Health (NIOSH). Report to Congress on workers' home contamination study conducted under the Workers' Family Protection Act (29 U.S.C. 671a). http://www.cdc.gov/niosh/contamin.html.
* NIOSH. Protect your family: reduce contamination at home. http://www.cdc.gov/niosh/pdfs/wkhmcn.pdf.
* Worker's Family Protection Task Force, NIOSH. Protecting workers' families: a research agenda. http://www.cdc.gov/niosh/docs/2002-113/pdfs/2002-113.pdf.