A recently completed study of registered nurses at Brigham & Women's Hospital who were negatively impacted by poor indoor air quality at the facility in the late 1980's and early 1990's found that a majority of the nurses report a sustained compromise in their health status 10 years after toxic exposures were identified in their work environment.

The study, conducted by the MNA and UMass Amherst, is the first of its kind to track the long-term health effects of exposure to poor indoor air quality and sheds light on an issue that first made local and national headlines due to the courage and conviction of the nurses of Brigham & Women's to bring the issue to public consciousness (see related story on this page) a decade ago. To review the complete summary of the study results in Microsoft Word format, click here.

According to the report: a significant number of registered nurses at the hospital were exposed to poor indoor air quality as a result of a faulty ventilation system, vapors from sterilizing agents, particulate matter from natural rubber latex gloves, and other potentially toxic products including aerosolized disinfectants utilized in the healthcare environment. According to Howard Hu, M.D., there had been a "general consensus among BWH staff (managers and employees) that some degree of occupational health problems" had existed in the operating rooms for at least 10 years. However, according to Hu, there had been "a marked acceleration for health complaints associated with incident reports" starting in 1993.

Number of symptoms persist

Nurses on various floors experienced a range of symptoms and illnesses over an 11- month period, (around 1993-1994), generating concern over the general working conditions and long-term health of those working in the building. Although the hospital eventually pledged to undergo extensive and costly clean up of dust from natural rubber latex and millions of dollars in revisions to the ventilation system, most of the nurses surveyed found employment elsewhere after long periods of illness and disability.

In 2003, 10 years after these exposures, the MNA surveyed the nurses who had reported the most serious health affects and were known to the Association. The survey was designed to assess the current health conditions of these nurses, as well as health conditions experienced prior to and during the exposure period. This survey, which gathered detailed information on skin, eye, ear, nose and throat (EENT), gastrointestinal (GI), pulmonary, cardiac, neurological, immune system/autoimmune, musculo-skeletal and reproductive conditions provides a statistical summary of the symptoms that these nurses have experienced over this time period. The survey also looked at current work status.

The survey shows that 10 years after the exposure to poor indoor air quality at Brigham and Women's Hospital, many of the nurses surveyed continue to experience symptoms. While the rate of symptoms has declined from a high frequency during and immediately after the exposure, the rate of symptoms has not dropped back to pre-exposure levels. Certain symptoms continue to be present at high levels at the time of this survey.

The most frequently reported neurological symptoms among respondents today are headache 53 percent, memory loss 50 percent, mental cloudiness 47 percent, dizziness 44 percent and paresthesia 42 percent. In addition, several respondents identified other symptoms that were not addressed in the survey, especially other memory-related defects such as word searching or decrease in the ability to focus.

The most frequently reported condition associated with the immune system was multiple chemical sensitivities (MCS). In 1993-1994, 61 percent were diagnosed with MCS. Since that time period, another 29 percent have been worked up for MCS and 53 percent of the total respondents reported being currently diagnosed with MCS.

Four symptoms of pulmonary conditions are still common today; including shortness of breath 64 percent, wheezing 58 percent, cough 50 percent, and chest pressure/ tightness 50 percent.

Although most of symptoms of cardiac conditions have declined since the 1993- 1994 period, the respondents report cardiac symptoms today between 14 percent and 33 percent, as compared to 0 percent to 8 percent prior to 1993. Symptoms such as palpitation, tachycardia and rate irregularity are persistent among more than 30 percent of respondents.

Symptoms of syncope and hypotension, often associated with allergic reactions, were reported prior to 1993 as hypotension 6 percent, syncope 0 percent; in 1993-94, hypotension 22 percent, syncope 25 percent; and in the present time period, hypotension 17 percent and syncope 14 percent.

Health decline forces many to leave

Participants report that overall their health has declined since the early 1990's. At that time, 78 percent of respondents rated their health condition as excellent, but no respondents did so in 1993-1994. By 1994, those who described themselves as having poor health had increased to 44 percent. Current health conditions among survey participants shows a slight recovery since 1994, but overall health conditions are worse than reported for the early 1990's. Another result is that a large group of the surveyed nurses report their overall health as poor, requiring regular visits to primary care providers, medical specialists and alternative health care practitioners.

A major consequence of the prevalence of the symptoms is that many of these nurses have had to leave the nursing field. The majority of respondents are presently employed and 20 percent are self-employed. A majority of respondents report financial stress due to unemployment or underemployment. They also report being forced into jobs with lower pay scales. Many respondents report tremendous difficulty in maintaining employment due to their health conditions. The surveyed nurses also reported difficulty finding work where employers are willing to accommodate their disabilities.

As a result of their compromised health status, a majority of respondents report that they are financially challenged. Sixty-four percent of respondents report that their earnings are not enough to support themselves and their families; for 42 percent, earnings are not at all sufficient and for 22 percent, earnings are reported as inadequate. Almost 70 percent report that their current earnings are less than they anticipated their salaries would be as registered nurses.

According to the conclusion of the report, "In summary, from the responses reported here for these nurses, the effects of exposure to poor indoor air quality has had a lasting negative impact on their health and well being."

Brigham & Women's RNs use their experience to help others As a result of the courage, conviction and activism of a small group of unionized nurses at Brigham & Women's Hospital who were harmed by poor indoor air quality in the late 1980's and early 1990's, today thousands of nurses in Massachusetts, and thousands more across the country are safer. As the story on this page illustrates, during this time, a large number of Brigham & Women's nurses and other hospital workers began to experience a variety of symptoms and illnesses related to their exposure to poor indoor air quality at the hospital. A group affected by the problem began meeting, researching and organizing around the issue in 1993. It started as a support group to provide mutual aide and comfort, but soon grew into a full blown campaign. Among those participating in the original group, initiated by Kathy McGinn-Cutler, were Kathy Sperrazza, then chair of the MNA local bargaining unit at the Brigham, Denise Garlick, Peggy O'Malley and Marie Manion, all of them co-workers on the units hardest hit by the problems. The group soon began accessing the support of other nurses in the hospital and in the union, and MNA staff, particularly Roz Feldberg, MNA associate director, who worked with the nurses to address the work environment problems at that time. They began collecting data and doing their own research on what was happening. Later they built their case and began presenting their data to hospital management to confront them with the extent and the severity of the issue. They also presented their data and obtained opinions from the Massachusetts Coalition for Occupational Safety and Health (MassCOSH), U. S. Department of Labor, OSHA, the Massachusetts Department of Public Health, Occupational Safety and Health Program and the Massachusetts Division of Occupational Safety. Eventually the issue reached the federal government, through Senator Kennedy's office and resulted in an onsite survey by a delegation from the National Institute of Occupational Safety and Health (NIOSH) from the Centers for Disease Control in Atlanta. NIOSH prepared an eighty-page report as they addressed these nurses concern and the exposures in their work environment. They also took the issue and their experience to the local, state and national media, with their story becoming front-page news, ultimately resulting in the award-winning PBS science program, Nova, featuring an entire segment on their story and the issue of poor indoor air quality/multiple chemical sensitivity. At the same time, the nurses began educating the rest of the nursing community, both in Massachusetts and on the national level. Here in Massachusetts, they mobilized an effort to pass a resolution at the MNA Convention which led to the creation of MNA's Occupational Health and Safety Program, This began a program that has become acknowledged as one of the country's most progressive programs to advocate for health and safety issues of importance to nurses. These nurse activists and advocates have spoken before medical and nursing groups, they have conducted research and counseled other nurses and other union bargaining units on how to identify, confront and address a variety of health and safety issues in the workplace for nurses. They have testified at state and federal legislative hearings on issues related to (poor) indoor air quality and other unsafe working conditions encountered in the healthcare industry. "These nurses are true heroes and exemplars for all of us," said Karen Higgins, RN, MNA president. "They took what was a devastating personal situation and transformed it into a campaign to help others so that others wouldn't suffer a similar fate. While many of these nurses can no longer practice nursing, through their advocacy and their conviction, they have become nurses to our profession." Eventually, with the combination of their courageous tenacity and the interventions of regulatory agencies, the hospital began to make changes and improve the work environment for nurses as well as the other hospital employees.