From the Massachusetts Nurse Newsletter
April 2006 Edition
- The chemicals and their health effects
- Web sites for fragrance-free information
- Model for a fragrance-free policy
- Sample of fragrance survey
- How to advocate for a fragrance policy in a health care setting
Common health effects from exposure to synthetic fragrance
According to the Environmental Protection Agency, the following health problems have been associated with fragrance exposure: asthma, Reactive Airway Disease (RADS), difficulty breathing, coughing, fatigue, eye irritation, sinusitis, rhinitis, inflammation of mucous membranes, skin problems including dermatitis, immune system damage, nausea, vomiting, abdominal pain, changes in blood pressure, cancer, and even death in severe cases due to respiratory failure.
Effects on the brain and nervous system include: convulsions, headaches/migraines, depression, dizziness, irritability, confusion, panic attacks, anxiety, memory loss, impaired concentration, drowsiness, insomnia, impaired vision, ataxia, stupor, spaciness, giddiness, slurred speech, twitching muscles, tingling in the limbs, and loss of muscular coordination. 1991 EPA Study by Larry Wallace. “Identification of Polar Volatile Organic Compounds in Consumer Products and Common Microenvironments.”
Fragrance chemicals and their related health problems
Acetone-dryness of the mouth and throat; dizziness, nausea, lack of coordination, slurred speech, drowsiness, and in severe cases coma; it acts primarily as a CNS depressant. Benzene-irritation of the eyes and respiratory system; decrease in white blood cells, headaches. impaired judgment, and menstrual disorders. Phenol-eye, nose, and throat irritation, abdominal pain; cardiac arrhythmias and failure, cardiovascular collapse, chromosomal aberrations and damage; cold sweats, collapse, confusion, headaches, hemolytic anemia, profuse sweating, and ringing in the ear. Toluene-skin, eye, and respiratory irritant, CNS depressant, liver and kidney disorders, and toxic brain dysfunction. Benzyl acetate-skin, eye, respiratory and gastrointestinal irritant, vomiting, diarrhea, tissue damage, and abnormal EEG’s. Limonene-skin and eye irritant and sensitizer; stomach irritant, albumin and blood in urine; and many CNS effects. 1,2
- Harte, J. et.al. Toxics A to Z: A Guide to Everyday Pollution Berkeley: University of California Press, 1991.
- Wilson, C. Chemical Exposure and Human Health: A Reference to 314 Chemicals with a Guide to Symptoms and a Directory of Organizations. Jefferson, NC: McFarland, 1993.
Canadian Centre for Occupational Health & Safety
Chemical Injury Information Network
Environmental Health Network maintained by Barbara Wilkie. Fragrance policies for Brigham & Women’s Hospital and Kaiser Permanente and information on how to advocate for fragrance labeling and legislation
Environmental Health Nursing, University of Maryland, School of Nursing
“Fragrance Free! Creating a Safe Health Care Environment” Massachusetts Nurses Association on-line CEU program, in process
Fragranced Products Information Network, maintained by Betty Bridges, RN
Health Care Without Harm
National Institute of Building Sciences Indoor Environmental Quality Project 2005: Recommendations from the Access Board
Not Too Pretty–Cosmetics and Health
Policy: Knowing that fragrance use significantly compromises indoor air quality and prevents access for some individuals, it is the policy of (name of your health care facility) to restrict the use of fragrance and fragrance products. This policy applies to all who use this facility including staff, patients, and visitors.
Definitions: Fragrance refers to a scent that is perceptible by others. It includes but is not limited to personal caret products such as perfume, cologne, aftershave products, hair care products, soaps, lotions, powders, deodorants; laundry products such as detergents and dryer sheets; cleaning products; and, air “fresheners” that contain fragrance. Fragrance products: any product that contains fragrance or scent.
Procedure: All staff will attend a brief training on the adverse health effects of fragrance. Staff will have an opportunity to share concerns and ask questions.
A pamphlet describing the issue and stating acceptable fragrance free personal care, laundry and cleaning products will be distributed. Health concerns that arise from infractions of the policy are to be directed to health services. Noncompliance issues are to be directed to the appropriate administrator.
Patients and visitors: Patients and visitors will receive a pamphlet explaining the reasons for and how to comply with the fragrance free policy. Signage that reads “Welcome. This is a Fragrance Free Health Care Environment. For the health and comfort of all who use this facility, kindly avoid using fragrance” will be posted at all entrances. Noncompliance issues are to be directed to the appropriate administrator.
Brigham and Women’s Hospital in Boston, all hospitals in Halifax, Nova Scotia and many other health care facilities throughout Canada restrict fragrance use. Other policies that can serve as models are on web sites listed at the end of the article.
(Name of your health care facility) is considering having a policy that reduces the use of fragrance. By answering this short survey, you can help us in this decision.
Staff _______ Patient ______ Visitor_____
1. Do you experience any ill effects from fragrance? Yes ____ No_____
2. If yes, please describe briefly _________________________________________
3. If you are a staff member, has your ability to work ever been affected by fragrance in your work area? Yes ______ No _______
4. If yes, please describe briefly _________________________________________
5. What do you think about a fragrance policy?
Thank you for taking time to help us make your health care facility healthier!
Jane Doe, MD
Director, Health Services
- Find and work with "like-minded" individuals; there is power in numbers. Create a support team so that you are not alone, thus minimizing burnout. Remember it takes time to implement a policy that affects so many people and in such a personal way. Contact the author for information and support.
- Locate the person/people who has/have authority to implement the policy.
- Set up a meeting with the person/people with the relevant authority. Decide who should attend the meeting and be prepared. Know what you want, what you are willing to do, and know what you want from them.
- Bring scientific documentation; an example of a fragrance policy in use, an example of a model policy; and, a list of key resources including books, articles, and professional web sites such as references used in this article.
- Emphasize a win-win outcome. Better air quality enhances staff health and productivity and makes the facility accessible for those with health problems related to fragrance.
- Consider conducting a simple anonymous survey about the issue if administrators do not think that fragrance is a problem. See Table 3 for a sample survey.
- Agree on dates for creating a draft of a fragrance policy, reviewing the draft, and implementing the policy. You may want to begin with just one area; if so, consider choosing the newborn nursery or pediatrics since people may be more open to change if it is for an infant or child.
- Develop brochures for educating staff, patients and visitors. Develop a sign that welcomes all to your facility; post signs at all entrances. A suitable sign can be downloaded at www.hcwh.org.
- Review the policy on a regular basis and revise as needed.
Anderson, R. & J. Anderson. “Acute Toxic Effects of Fragrance Products.” Archives of Environmental Health March-April, 1998. 53 (2), 138-146.
Anderson, R. & J. Anderson. “Toxic Effects of Air Freshener Emissions.” Archives of Environmental Health Nov-Dec, 1997. 52 (6) 433-438.
Anderson, R. & J. Anderson. “Respiratory Toxicity of Fabric Softener Emissions.” Journal of Toxicology and Environmental Health Part A 2000. 60:121-136.
Jackson, N. ANA’s Green Meeting Guide 2004 www.ana.org
Kosta, L. Fragrance and Health 1998. Human Ecology Action League. Atlanta, GA.
Kosta, L. “Fragrance control and health care facilities: An interview with Marlene Freeley, R.N., M.S., Director, Occupational Health Services, Brigham and Women’s Hospital, Boston, Massachusetts.” The Human Ecologist Winter, 2002, 13-17.
Pitts, C. Get A Whiff Of This. 2003. Self published ISBN: 1-4140-0845-7
Pontus, C. Powerpoint Presentation on Fragrance and Health. Massachusetts Nurses Association. Christine Pontus, RN, MS, COHN-S, Associate Director, Massachusetts Nurses Association, firstname.lastname@example.org
Sattler, B. and Jane Lipscomb, eds. Environmental Health and Nursing Practice NY: Springer, 2003