DEHP, chemcial exposures present a health risk to patients

By Evelyn I. Bain M Ed, RN, COHN-S, Associate Director, Occupational Safety and Health Specialist

The MNA has been a member of Health Care Without Harm (HCWH), the campaign for environmentally responsible health care, since 1997. Included in it’s membership are the ANA, many nursing specialty and other heath care organizations. The initial organizing focus of HCWH was medical waste incinerators and their role in environment contamination with dioxin. As time moves along, the role of hospitals and health care in general in environmental contamination appears to be much more complex than the basic issue of medical waste and medical waste incineration. Many materials, considered staples in the health care industry, can have very detrimental effects on the environment, the health of nurses and other workers in the industry and even our patients. Marketing of medical products and equipment promotes the availability and user friendly aspects. Yet, very little research or attention has been given to the adverse effects these products or their chemical components may pose.

Mercury, polyvinyl chloride (PVC), plasticizers such as DEHP used to soften plastics, natural rubber latex and needles and sharp instruments have become action items for the HCWH campaign. The good news is that alternatives exist and are in satisfactory use in many settings.

The Sustainable Hospitals Project (SHP) located in Massachusetts at the University of Massachusetts, Lowell, is belatedly doing much of the groundwork around product selection and identification of safe and appropriate alternatives. The SHP website at http://www.sustainablehospitals.org or e-mail at shp@uml.edu, has fact sheets and product information on alternative products.

DEHP is the focus of this article, reprinted with permission of the Intravenous Nurses Society. DEHP has been identified as a probable human carcinogen by the US Environmental Protection Agency. Alternative IV bags that are not processed with DEHP are available, although seldom used in the United States, they are utilized frequently in other countries.

First, Do No Harm Plasticizer Alert

Health Care Without Harm (HCWH) is an international coalition that campaigns to reform the environmental practices of the health care industry. In May, The Intravenous Nurses Society joined the 178 member organizations including the ANA, the ONS, the American Public Health Association and Physicians for Social Responsibility, which support the work of HCWH.

In June, Health Care Without Harm released a new examination of the extent of human exposure and potential health risks associated with di-ethylhexyl-phthalate or DEHP. DEHP is the primary phthalate plasticizer used to make PVC medical devices, such as blood bags, intravenous bags and medical tubing, soft and flexible. Health Care Without Harm commissioned the University of Massachusetts, Lowell Center for Sustainable Production to review the published literature on DEHP.

The resulting report highlights the findings of more than 100 studies including 30 that demonstrate that the use of PVC for respiratory and intravenous therapies, transfusion and hemodialysis fluids result in exposure to DEHP. The Lowell report also describes more than 40 for your studies on how exposure to DEHP affects health.

Cancer drugs Taxol and Taxotere and other medications with formulations that accelerate the leaching of DEHP presently carry warnings against using PVC bags or tubing for their administration. But the FDA has no published criteria on the amount of phthalates or the level of leaching from PVC medical products that would mandate a Taxol-like warning. The FDA does limit the amount of plasticizer to no more than 30 percent of materials content in food containers. PVC medical products used to contain blood and intravenous solutions all contain more than 30 percent plasticizer by weight.

The Lowell report includes studies that indicate that blood transfusion recipients, dialysis patients and mechanically ventilated infants may be exposed to DEHP at levels substantially higher than cancer patients might receive from Taxol administered through PVC IV equipment. The lack of explicit FDA policy results in greater-than-Taxol DEHP exposures without Taxol-like warning to patients or health care providers.

As a result of the Lowell report’s findings, Health Care Without Harm has petitioned the FDA to require a warning label on all PVC medical devices that may leach DEHP and to encourage the availability of PVC-and DEHP-free alternative products.

For a free copy of the DEHP Report, the Health Care Without Harm petition to the FDA and a critique of C. Everett Koop’s report on the safety of DEHP contact Health Care Without Harm at 703.237.2249 or go to their website at www.noharm.org