Sunday, October 27, 2019

Hospital disinfectants linked to lung disease in nurses

The JAMA Network Open shared the results of this important study.
"The Nurses’ Health Study II is a US prospective cohort study of 116 429 female registered nurses from 14 US states who were enrolled in 1989 and followed up through questionnaires every 2 years since. The present study included women who were still in a nursing job and had no history of COPD in 2009, and used data from the 2009 through 2015 questionnaires. Clean and complete data used for this analysis were available in July 2018, and analyses were conducted from September 2018 through August 2019.
Exposures  Occupational exposure to disinfectants, evaluated by questionnaire and a job-task-exposure matrix (JTEM).
Main Outcomes and Measures  Incident physician-diagnosed COPD evaluated by questionnaire.
Results  Among the 73 262 women included in the analyses, mean (SD) age at baseline was 54.7 (4.6) years and 70 311 (96.0%) were white, 1235 (1.7%) black, and 1716 (2.3%) other; and 1345 (1.8%) Hispanic, and 71 917 (98.2%) non-Hispanic. Based on 368 145 person-years of follow-up, 582 nurses reported incident physician-diagnosed COPD. Weekly use of disinfectants to clean surfaces only (16 786 [22.9%] of participants exposed) and to clean medical instruments (13 899 [19.0%] exposed) was associated with COPD incidence, with adjusted hazard ratios of 1.38 (95% CI, 1.13-1.68) for cleaning surfaces only and 1.31 (95% CI, 1.07-1.61) for cleaning medical instruments after adjustment for age, smoking (pack-years), race, ethnicity, and body mass index. High-level exposure, evaluated by the JTEM, to several specific disinfectants (ie, glutaraldehyde, bleach, hydrogen peroxide, alcohol, and quaternary ammonium compounds) was significantly associated with COPD incidence, with adjusted hazard ratios ranging from 1.25 (95% CI, 1.04-1.51) to 1.36 (95% CI, 1.13-1.64). Associations were not modified by smoking or asthma status (P for interaction > .15).
Conclusions and Relevance  These longitudinal results suggest that regular use of chemical disinfectants among nurses may be a risk factor for developing COPD. If future studies confirm these results, exposure-reduction strategies that are compatible with infection control in health care settings should be developed."
To read more visit:
Dumas, O., Varraso, R., Boggs, K.M. et al (2019, October 18). Association of Occupational Exposure to Disinfectants with incidence of chronic obstructive pulmonary disease among US female nurses, JAMA Network Open. doi:10.1001/jamanetworkopen.2019.13563

Stay safe!


Tuesday, October 8, 2019

Nurses who use wheelchairs are on a roll----all over the world!

     Donna Maheady APRN, EdD  

          The exact number of nurses who use wheelchairs worldwide is unknown. However, stories found in social media posts, blogs and first person accounts suggest that numbers are increasing. 
When thinking about a nurse or nursing student who uses a wheelchair, some may ask, “After completing a program, can he or she find employment?”  Alternatively, “If injured during a nursing career, can a nurse continue to work?” The experiences of the following nurses shed light.

       In the United States

 Andrea Dalzell, diagnosed with transverse myelitis when she was 5 years old, attended the nursing program at CUNY College of Staten Island in New York. During orientation to the nursing program, Andrea met with some opposition. With the knowledge of her legal rights and support from the campus disability services office, her progression in the nursing program continued. (Apple TV Star, n.d.)
“Whether it was passing finals with the highest grades, receiving exemplary feedback from patients’ families or figuring out a way to accomplish her daily responsibilities from her chair, Dalzell has done more than just show she can be a nurse; she has proven she can be an excellent one.” (United Spinal Association, n.d., para 3).
Andrea recounts the challenges surrounding learning to perform cardio pulmonary resuscitation (CPR). She knew it would not be easy with paralysis so she took up boxing to gain the necessary strength to pass the test. After graduation from nursing school, Andrea starting working as a case manager for a long-term managed care company.
Apple, Inc. asked Andrea to participate in a commercial and give a talk about how the Apple Watch helped her during nursing school and in her work as a nurse. The Apple Watch helps Andrea with reminders from Siri, allows her to be hands free as she rolls and glances at the watch, and allows her to make a phone call if a phone is out of reach. (Apple TV Star, n.d.)

Lindsey Runkel always wanted to be a nurse. A mountain biking accident left her paralyzed so she was hesitant to include the fact that she uses a wheelchair on her application to a nursing program. Today, she is the first paraplegic nursing student at the University of Connecticut, currently doing a clinical rotation at Stamford Hospital.
Nancy Manister, director of the accelerated second-degree nursing program at UConn stated, “She met the academic standards to enter the program, and then we met with her as part of the process of figuring out what we needed to do with Lindsey for Lindsey “We really have found that she has actually needed very little in the way of accommodations.” (UConn’s first paraplegic nursing student, 2019, para 12). When faculty put Lindsey in a nursing simulation lab, she was more than capable of performing, things like hanging IV meds, palpating the patient, and taking vital signs. Lindsey continues to impress patients, fellow students and faculty. She is ready to roll with whatever comes her way.

In the Czech Republic and Scotland

Born and raised in the Prague, Czech Republic, Marie (Bartova) Scott was injured in a horse related accident after she qualified as a nurse. At the time of her spinal cord injury (T-12 paraplegia), she was employed by the U.S. government at the embassy health center in Prague.
Marie recalled that, "The understanding and support I received from the employer and colleagues will never be forgotten. It meant so much to me to know I was still a member of the team despite my reduced mobility. Adjustments to the workplace (ramps, bathroom, cupboards and work desk) helped, but, it was mostly the positive attitude of my colleagues which broke the barriers." (Maheady, 2018 para 1,2)
Marie continued to work as a staff nurse at the US embassy health center and later took on a more senior role where she could utilize her management skills. A video of Marie working in the embassy clinic is available (Helmut 1 (2016). She spent six years there before taking a maternity leave. Her husband is Scottish and they moved their family to Scotland four years ago. Marie stated, “I am now working as a staff nurse in neuro rehabilitation units and care home settings in Scotland. With our excellent care staff, I can fulfill my role and enjoy it very much. In fact, I have been told on more than one occasion that my condition is seen as a good influence to residents and their families." (Maheady, 2018 para 3, 4)

          In England

Michelle Quested was working as a staff nurse in the neonatal cardiology department at Birmingham Children’s hospital. A car accident resulted in rupture of two discs in her lumbar spine and crushed her spinal cord. After surgeries and months of rehabilitation, she returned to work as part of a team instructing nursing students in the cardiac department.
However, Michelle longed to return to a hands-on clinical position so she began working on modifications to her wheelchair. Her chair had to be narrower to facilitate ease of movement and changed from push power to battery power. She returned to work in the hospital’s neonatal cardiology ward. (Story Trender, 2017).
Reactions from children in the hospital and their parents have been positive. She reports that, “Whenever children ask me about being in a wheelchair, I tell them that I have poorly legs like they have a poorly heart, and it helps them to understand. “It does not faze them at all.” (Story Trender, 2017, line 48)

                  In Thailand

Kannika “Yew” Sriwija, was injured one month from completion of her nursing program. The injury paralyzed the lower half of her body and forced her to quit college. She spent over a year recovering and learning to live a normal life using a wheelchair.
 While in rehabilitation, she started a Facebook page to inspire others who were struggling with similar issues. She now has 39,343 followers and a video, “The stronger” on YouTube
During her treatment, she volunteered as a consultant with patients in the hospital. This experience and the support of the hospital and her doctor motivated her to continue her studies, Kannika returned to school and graduated in 2018. She is now working full-time at San Sai Hospital (City News, 2018).

Essential elements, for the success of these nurses who use wheelchairs, include motivation, perseverance, adapted equipment/technology, volunteer work and support from faculty, disability services staffers, doctors, workplace peers and administrators.

Cliché or not, if there is a will there is a way! Roll on nurses!

Apple TV Star Andrea Dalzell Fought Transverse Myelitis to Become a Nurse (n.d.) Retrieved on September 10, 2019 at
City News (2018). Inspiring story of nurse in wheelchair. Retrieved on August 1, 2019 at
Helmut 1 (2016, January 8) Paraplegic nurse, horse accident [Video file]. Retrieved on September 1, 2019 at
Maheady, D. (2018). Marie Scott moves forward as a U.S. Embassy nurse after a spinal cord injury [Blog post]. Retrieved on August 31, 2019 at
Story Trender (2017). UK’s First Frontline Nurse in A Wheelchair. Retrieved on August 31, 2019 at
UConn’s first paraplegic nursing student inspires students and faculty (2019) Retrieved on September 10, 2019 at
United Spinal Association (n.d). Andrea Dalzell: Ignoring Doubters. Retrieved on September 20, 2019 at