Health Care Providers Can Do No Harm with Fragrance Chemicals?

transparent-hospitalTo many people, the word “fragrance” means something that smells nice, such as perfume. We don’t often stop to think that scents are chemicals. Fragrance chemicals are organic compounds that volatilize, or vaporize into the air, which is why we can smell them. They are added to products to give them a scent or to mask the odor of other ingredients. The volatile organic chemicals (VOCs) emitted by fragrance products can contribute to poor indoor air quality (IAQ) and are associated with a variety of adverse health effects.

Exposure to fragrance chemicals can cause headaches; eye, nose, and throat irritation; nausea; forgetfulness; loss of coordination; and other respiratory and/or neurotoxic symptoms. Many fragrance ingredients are respiratory irritants and sensitizers, which can trigger asthma attacks and aggravate sinus conditions.

Fragrance chemicals are the number one cause of allergic reactions to cosmetics — not only to the primary users, but also to those who breathe in the chemicals as secondhand users. Phthalates in fragrances are known to disrupt hormones and are linked in animal studies to malformations of the penis, as well as adverse effects on the developing testes.

Fragrances in Health Care

In health care facilities, fragrance can come from a number of sources:

  • scented cleaning products
  • fragrance-emitting devices and sprays
  • workers, patients, and visitors who are wearing perfume, cologne, or aftershave
  • scented cosmetics, skin lotions, or hair products
  • clothes that have been laundered with scented detergents, fabric softeners, or dryer sheets.

Indoor air quality can be greatly improved in health care facilities by adopting a hospital-wide fragrance-free policy that includes a fragrance-free policy for employees, maintenance products, and non-employee hospital occupants.

Hospitals can also choose personal care products and cleaners that are free of chemical fragrances. For information about choosing safer personal care products, see (advanced search option enables you to search for products without fragrance).

What Hospitals are Doing

Health care facilities around the world are reducing their use of hazardous chemicals and materials. For example:

High-priority chemicals and materials include:

  • Mercury
  • PVC (vinyl plastic) and phthalates
  • Brominated flame retardants
  • Glutaraldehyde and ethylene oxide
  • Pesticides
  • Volatile organic compounds in building materials
  • Hazardous ingredients in cleaning products

What Health Care Facilities Can Do

To address this problem in a comprehensive way, leading health care institutions are creating internal chemical policies to avoid the worst chemicals and to address the problem of untested chemicals in products.

Kaiser Permanente, the largest non-profit health system in the U.S., has a policy to avoid chemicals linked to cancer, reproductive problems, and genetic mutation, and asks its vendors about toxicity testing of chemicals used in products. System-wide policies guide hospitals in their purchasing decisions.

For information, examples, and guidance for a health care facility, see Guide to Choosing Safer Products and Chemicals: Implementing Chemicals Policy in Health Care (pdf).

While the health care sector can do its part to reduce people’s exposure to hazardous chemicals, government policies also must be updated.

The Need for Government Reform

While the health care sector can do its part to reduce people’s exposure to hazardous chemicals, government policies also must be updated. Due to weak laws, chemical companies do not provide basic health and safety data for the majority of chemicals on the market. Even with clear evidence of harm, it is extremely difficult to stop the use of a chemical.

For stronger public health protections, laws must be changed to require better health data on chemicals, to eliminate the worst chemicals and untested chemicals, to protect communities at highest risk, and to provide incentives for the development of safer chemicals.

Forward-thinking legislators and governments are already moving in this direction.

Efforts to Reform Policies in the United States

Reform efforts are underway in the United States. At the federal level, Senator Frank R. Lautenberg of New Jersey introduced the Safe Chemicals Act of 2011, which would strengthen the nation’s system for managing chemical safety to better protect human and environmental health.

Over 300 organizations representing millions of Americans have come together to create theSafer Chemicals, Healthy Families coalition in support of common sense limits on toxic chemicals. The coalition includes health professionals, parents, advocates for people with learning and developmental disabilities, reproductive health advocates, environmentalists, businesses, and many others from across the country. Health Care Without Harm is a founding member of the coalition. Safer Chemicals, Healthy Families is working closely with Senator Lautenberg to ensure passage of the Safe Chemicals Act.

In 2012, twenty-eight states are considering toxic chemical legislation. Highlights include:

  • At least 13 states, including Alaska, Connecticut, Florida, Illinois, Maryland, Massachusetts, Michigan, Minnesota, New York, New Jersey, Oregon, Vermont, and Washington, will consider policies to identify and ultimately reduce exposures to chemicals of concern, including prioritizing chemicals for state action and requiring manufacturers of consumer products to disclose the chemicals in their products.
  • Oregon will consider legislation requiring the state to reduce toxics through its procurement process.
  • Georgia, Massachusetts, and New York are considering policies to improve the safety of cosmetics, including a restriction on the use of formaldehyde.
  • At least eight states, including Alaska, California, Connecticut, Maryland, Michigan, New Jersey, New York, and Washington, will consider legislation banning specific flame retardants.
  • Legislators in other states have introduced individual chemical restrictions, such as lindane in Michigan and perchloroethelyene in Vermont.

For updates on state efforts to reform chemical policies, see the Safer States website.

European Union’s REACH

The European Union has adopted a major law that regulates chemicals, called REACH — for Registration, Evaluation and Authorization of Chemicals. REACH requires manufacturers to provide health and safety data for tens of thousands of chemicals, and will move the market toward safer alternatives.

Find more information about REACH from The International Chemical Secretariat.

For more information about safer cleaning products, see the Women’s Voices for the Earth Safe Cleaning Products Initiative

Nurses Safer Chemicals Toolkit


The Toxic Substances Control Act is the federal law governing chemical manufacturing in the United States. When the law was enacted in 1976, it grandfathered in approximately 62,000 existing chemicals, which the Environmental Protection Agency (EPA) was not required to test for the potentially harmful and carcinogenic health impacts. Because of the way the law is written, the EPA’s authority is limited in mandating testing and research on chemicals; only about 200 of the pre-existing chemicals have been tested since 1976, and only five have been successfully restricted (PCBs, chlorofluorocarbons, dioxin, asbestos, and hexavalent chromium).

In the past several years, The Centers for Disease Control National Health and Nutrition Exam Study have begun to measure the presence of toxic chemicals in the blood, urine, and breast milk of thousands of Americans and found them to be ubiquitous in all of us. Unfortunately our bodies have become repositories for poisonous environmental chemicals which have been linked to several rising health trends including an increased prevalence of various cancers in both adults and children, doubled rates of asthma in the last 20 years, increases in pediatric neurological disease and disability such as attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder, and reduced fertility in both men and women.

Because of their science-based practice, nurses understand the connection between the environment, human health, and disease. Workplace exposures handling dozens of chemicals, drugs, and cleaning agents also make nurses increasingly vulnerable to incurring health risks associated with long-term exposure to these chemical agents.

Members of Health Care Without Harm and the Nurses Workgroup have been integral in partnering to address the health risks of hazardous chemical exposures and the need for an updated federal chemical policy. Please review the resources and information below and join the Nurses Workgroup to promote education and policy reform to protect workplaces and communities from harmful chemical exposures.

Nurses & Chemical Exposures


Body Burden Studies


Posters & Presentations


Nurses in the News


From a Yellow Canary of the 21st century, living in our disabling biosphere

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