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Hospitalization

Hospitalization for the Chemically Sensitive Patient
Additional Considerations from the Editor
Hospital Protocol Guidelines

Hospitalization for the Chemically Sensitive Patient*
In Loving Memory of Selene Anema, RN

GENERAL CONSIDERATIONS

All members of the medical team should be fragrance-free, especially in regard to perfumes and colognes.

Please use rooms without carpet whenever possible.

Keep the use of plastic to a minimum. Use paper tape instead of plastic tape. Test Betadine, tape, and suture material 48 hours prior to surgery to observe any adverse reaction. Avoid latex gloves.

Improve the air quality. Patient may request permission to seal the air ducts. Open windows if possible. Utilize available air filters. Do not allow open containers of chemicals to sit in room. Wash down the operating room with a water and baking soda solution to remove disinfectant and pesticide odors. This patient is extremely pesticide sensitive.

Oxygen: ceramic mask is preferred over plastic.

The patient has prepared for surgery by lowering her total load of chemical exposures and increasing her intake of antioxidants, vitamins, and minerals. High levels of vitamin C before and during surgery (1 to 4 grams every 4 hours) helps to tolerate chemical overload.

Please use the bed linens brought by the patient.

Please allow the patient to use her own purified water for drinking. Also, please inform the dietecian that the patient has food sensitivities. Only pure food which does not contain preservatives, dyes, colorings, MSG, aspartame or other chemicals are allowed.

The following post-op complications may be due to unrecognized sensitivities and/or inciting agents: phlebitis, pulmonary embolism, edema, petechiae, increased drug reactivity, muscle spasm, nervousness or depression, myalgia, arthralgia, headaches, bloating.

DRUGS AND THE CHEMICALLY SENSITIVE PATIENT

Keep medications as simple and minimal as possible. 1/4 to 1/2 the usual dosage of the drug may be adequate.

DRUG REACTIONS are very common in chemically sensitive patients. Observe for symptoms such as spastic muscles, pulling parathesias, hyperesthesia or hypoesthesia, and jitteriness. Also, observe for local swelling, hives, syncope, hyperventilation, seizures, asthma, severe anaphylaxis, site inflammation, severe fatigue, increased sensitivities.

0.2 mEq/kg of magnesium over a 4 hour period daily may relieve spasms.

PRE-OP MEDICATIONS

No oral medication if possible. Avoid antihistamines and steroids if possible. Benadryl or an injection of 0.4 to 0.6 ml of IM atropine may be used to prevent excess secretions. Also, Atarax is usually safe. Usually, atropine or morphine-demerol compounds are sufficient for pain control. To alkalinize stomach contents to reduce problems with aspiration pneumonitis, use Alka Seltzer in gold foil (without aspirin).For intravenous fluids, use IV 0.45 normal saline in glass bottles, not plastic . Soft plastics such as those used for IV drips and blood bags contain phthalates, which include many toxic chemicals such as hormone disrupters. These chemicals leach into the IV solution and can cause reactions in the senstive person. Glass bottled 45 NS available from Merit Pharmaceuticals, 800-696-3748. If dextrose or Ringer's solution is used, please observe for a reaction due to its corn content. For fructose and invert sugars, contact company beforehand to check formulations and sources.

ANESTHESIA

Do not test anesthetic drugs before use. Use local anesthetics, such as preservative-free and epinephrine-free xylocaine or carbocaine whenever possible. No halogenated hydrocarbons (Fluothane, Ethrane, Penthrane). The chemically sensitive patient can get dramatically worse with gas anesthetics. If recovery does occur, can take days to return to normal state. Inhaled anesthetic is avoided if at all possible since the fluorinated hydrocarbons and nitrous oxide are known to be immunosuppressants. If required, nitrous oxide only in as limited levels as possible.

Check all drugs for preservatives. The basis for anesthesia that works well is: 1. The patient inhales 100% oxygen for 5 minutes

2. Bolus of sodium pentothal or other short-acting barbiturate is used for induction.

3. Followed by curare (a long-acting morphine compound) and a long-acting scopolamine compound. Succinyl choline chloride (Anectine) may also be used to paralyze. Sublimaze and Innovar can be used to obliterate memory. Sodium pentathol, Versed, Phentanyl (long acting opiod) are recommended drugs for induction and maintenance of anethsesia. For shorter procedures, the patient may use the Brevitol drip. Diprovan is recommended for induction and/or regional anesthesia.

SURGERY

Do not use any dyes, as discussed prior to surgery. Safe sutures: Silk, Cotton, Gut-lamb. Avoid synthetics.

POST-SURGERY

Antibiotics given intravenously provoke fewer reactions than when given orally. In-line intravenous filters should be used for higher tolerances. Post-surgery, use TENS unit or acupuncture for pain control. Vicodan may be OK for pain.

RECOMMENDED LABWORK FOR SURGERY

CBC
Urinalysis
SMA 20
Liver function

T and B Lymphocyte function (may include function of cell-mediated immunity, blastogenesis, phagocytic index, and migratory inhibitory factor). If on 2nd or 3rd day post-op, patient has a sudden purulent drainage, check serum levels of opsonins.

REFERENCES:

Rea, William, MD, Chemical Sensitivity, Volume IV.
Recommendations also from Jeffry Anderson, MD.
See Green Guide #42 on hormone disrupters (888-ECO-INFO).

* Note: Selene Anema's article was written in 1997, so the specific anesthesias have probably changed. Please use this for general recommendations only.

Selene Anema passed away in late 2008.


*Caution: The information on this page is not intended to be a substitute for a physician's care or treatment. Please consult with your doctor before acting on any of the recommendations.
For example, a large percentage of MCS/EIs have porphyria. It is important to test or determine whether or not you have acute or non-acute porphyria, and the safe and unsafe drugs for this condition. Please discuss the risks with your doctor and anesthesiologist before surgery.

Additional Considerations from the Editor

MCS Compliant Hospital. Windham Hospital. 112 Mansfield Ave.,Willimantic, Connecticut 06226. MCS person visited her husband at this hospital for 2 days. From her experience there, she has no fears of going there herself for knee replacement surgery, primarily because of the responsiveness of the staff for eliminating scents. The head nurse was allergic to Clorox, so she used Quatinary Ammonium for disinfectant. She noticed no smell from this product. In another instance, when she asked the woman in charge of information about a troublesome scent, within 15 minutes she was visited by person in charge of environment, a nurse, and maintenence staff. They discovered the problem and it was taken care of. http://www.windhamhospital.org/index-flash.htm

Healthier Hospitals. by Toni Temple. A 28 page booklet written by the combined efforts of the author, an MCS victim, and two greater Cleveland, Ohio, area hospitals. The book educates hospital administration, staff and medical personal on proper care and consideration for the special needs of MCS patients. It improves access for those hospital patients who suffer from this disability. Order from NEEDS 1-800-634-1380, booklet not available on website.

Safer Medical Tape and Bandages. Johnson & Johnson paper tape has a well tolerated adhesive. Johnson and Johnson "Steripads" are 100% cotton. Order in advance through the hospital.

Surgical Tape Safeguard. Submitted by Anonymous MCS. A safeguard for surgery is that MCS patients must convince the hospital to take allergies to surgical tape seriously. They didn't in my case, and I suffered the consequences. The last thing I heard the nurse say was something about a tape allergy, but it was ignored. The hospital needs one person who actually reads the patients history taken down at registration...and who sees to it that the staff takes it seriously. Editor's Note: It may be beneficial for the doctor who treats your MCS, to write a letter about chemicals and their serious impact on your health, to be mailed in advance for the administration, and another copy to have with you at the time of your stay.

Health Care Without Harm. Educate your own doctors and nurses and administrative staff, whether with an HMO or in private practice. http://www.noharm.org The page on pesticides and cleaning agents is http://www.noharm.org/pesticidesCleaners/issue

Healthy Hospitals Report. Click on Issues- and Healthy Hospitals. Download Healthy Hospitals report. www.beyondpesticides.org/main.html

Pest Management in New York State Hospitals: Risk Reduction and Health Promotion. Attorney General of New York State, December 1995. http://www.oag.state.ny.us/environment/hospital95.html

NIEHS's Common Air Pollutants (National Institute of Environmental Health Sciences). Educate your healthcare folks, educational facilitiy, or workplace. Print out a copy of NIEHS's Common Air Pollutants: Pesticides & Cleaners, Fragrances, and Cleaners & Disinfectants. NIEHS has listed "formaldehyde, fragrance products, pesticides, solvents, cleaning agents" under "volatile organic compounds." http://www.niehs.nih.gov/external/faq/indoor.htm

MCS/EI Hospitalization and Anesthesia - based on personal experience. http://www.immuneweb.org/articles/anesthetics.html

For more information on safe anesthetics for porphyria,
see http://members.tripod.com/~PorphBook/4.html Note especially, the information listed at the bottom of this referenced page, concerning the complexity of this situation.
 
CIIN. Chemical Injury Information Network. Hospitals & Chemical Exposures. To obtain a complete topic list of the studies and articles from Chemical Injury Information Network’s in-house library, specify the topic(s) and write to CIIN, P.O. Box 301, White Sulphur Springs, MT 59645; call 406-547-2255; or fax 406-547-2455.
E-mail request (members preferred, see instructions) http://www.ciin.org/email.htm
Library page: http://www.ciin.org/library.htm#gen%20mcs%20anchor

Fragrance Control and Health Care Facilities. HEAL. Human Ecology Action League. The Human Ecologist. "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," by Louise Kosta. Issue Number 96, Winter 2002. Order this issue or subscribe to quarterly publication. Phone: 404-248-1898 http://members.aol.com/HEALNatnl

For extended stays. It would be helpful to "code" MCS or label the patient's bed or room to alert all hospital personnel. Submitted by an MCS/EI.

Detoxification from anesthesia. Vitamin C IV, if tolerated. 25 grams in glass bottle. May administer before and after surgery. Repeat if necesary. This is most effective. Needs prescription, of course.

MCS/EI Hospital Experiences
Unfortunately, the experience I've had lately with anesthesiologists, is that my MCS issues were easily dismissed. The lack of research and education about this illness, makes our journey steep and arduous. But, we have a good chance when MCS/EIs, kindly and consistently, do what thay can to bring about awareness.
Post script: One year later, I requested the records for my surgery. The anesthesiologist reported the I had "multiple allergies." In the"Other" box on the same form, he added, "multiple phobias." He stated on the form that he would comply with patient requests. The fact is, that he did not comply with my request for no gas. He advised against a spinal block, as he was wheeling me into the operating room. I agreed to the gas. I was tired and not prepared to stand my ground. Next time, I will submit my doctor's request in writing for no gas anesthesia along with my MCS diagnosis to discourage the suggestion that I have "multiple phobias."
Editor, Mary Kempf
 
Wanted: Safe hospital suggestions. Please submit to: bhima@citlink.net Please put red lake in subject line

We all have such different sensitivities . . .
Please consult with your doctor and choose what applies to you.
 
Make your own:
 
Hospital Protocol Guidelines
Permission was granted to share this hospital protocol.
See: http://www.lassentech.com/eimcspro.html
 
MERCY MEDICAL CENTER
PROCESS STANDARD
 
MULTIPLE CHEMICAL SENSITIVITY PROTOCOL
APPROVED FOR All Patients with Multiple Chemical Sensitivities
DISTRIBUTED TO All Patient Care Areas, Admitting, Environmental Services, Nutritional Services
and Governance/Administrative Policy/Procedure Manual
 
PURPOSE To outline the management of patients with multiple chemical sensitivities.
LEVEL Independent (requires nursing order only)
SUPPORTIVE DATA Patients with a history of allergy to chemicals found in perfume, pesticides, detergents, household cleaners, etc. may have multiple chemical sensitivities.
- All supplies used to clean patient room (where the patient is to be housed) and in the care of the patient should be chemical free.
- Staff caring for the patient should not wear scented products.
- Do not use air fresheners or furniture polish in patient room.
- Use only non-toxic cleaning products: Vinegar, Bon AMI, Borax, baking soda, Planet Solutions cleaning solution.
- Use only I 00% cotton blankets, towels, sheets.
- Patient allergy is marked in demographics on patient's permanent record; this comes up on re-admission.
- Patient may have multiple food allergies.
- Rinse all equipment before taking into patient room.
 
KIT CONTENTS - FOR PATIENT CARE AREA'S USE AND EMERGENCY ROOM
• Yellow arm band . Butterfly cotton batting
• Suction kit (without gloves) . Stopcock
• Non-latex surgical gloves . Paper Tape
• Non-latex powder-free exam gloves . Butterfly for IV access
• Planet Solution cleaning solution . Velcro Tourniquet/ BP cuff
(Planet Solution catalogue included in kit) . Ivory liquid soap for staff
• IV solution 5% Dextrose in water 1000 cc . 3M Mask R-95 Dust Mist mask
• Porcelain oxygen mask, tygon tubing . Normal Saline 0.9% 1000 (glass
• 5% Electrolyte Travert Solution 1000 cc (glass bottle)
• 2 Yellow Multiple Chemical Sensitivity allergy signs
• Soda Bicarbonate solution 500 cc (IV solutions are order from Baxter)
• Codan IV administration kit (ordered from Codan Pharmaceuticals 1-800-332-6326)
• Sterile cotton sheets, towels, blankets, wash cloths, cotton pillows, gowns washed with non-perfumed detergent and no fabric softener.
 
Supplies for MCS patients may be ordered from this foundation: (catalog included in MCS kit.)
American Environmental Health Foundation 1-800-428-2343
 
KIT CONTENTS - FOR OBOR, OR, OPSC, NICU
Each unit has a latex-free cart specific to their area to which this protocol is added (refer to Unit Specific ManuaL).
 
SPECIAL PROCEDURES.
30 MIN TO 1 HR/DAY
LSU:
- Listen to the patient. Reassure the patient that you understand they are chemically sensitive and that you will work with them in providing care.
- Use all methods to minimize exposure of the patient to exhaust fumes. Avoid idling the ambulance. Turn off the motor when loading and unloading the patient.
- Refrain from wearing perfumes, cologne, or smoking while on duty.
- Remove the patient from hostile environment. If they are having a reaction, move them out into fresh air.
- Use the patient's own medical equipment whenever possible.
- Wear non-latex gloves.
- Avoid the use of IV and medications, if at all possible, until patient is transported to their destination, unless in a life-threatening situation.
 
EMERGENCY ROOM:
- Immediately contact MCS patient's physician for special instructions and review any medical alert identification the patient may be wearing or carrying, as well as any existing hospital computer records on the patient. No treatments, IVs, tests, or medications should be administered to a MCS patient without prior approval of patient's private physician, unless a life-threatening emergency exists.
- Immediately isolate MCS patient from all other patients and visitors.
- Patient should not be wait in the waiting room.
- Patient should be placed in Prompt Care Room One ASAP (remove latex products from the room and request Environmental Services to clean with approved cleaner for that purpose prior to placing patient in the room, if at all possible).
- Obtain MCS kit from Central Supply for caring for this patient.
 
PRIOR TO ADMISSION OF PATIENT TO ROOM
PATIENT SERVICES SUPERVISOR:
- Notify Environmental Services and Pharmacy of MCS and place the patient in private room.
 
ENVIRONMENTAL SERVICES:
- Remove all latex products and cubicle and window curtains from the patient room.
- Clean the patient room with Planet Solutions cleaning solution. Another recommended product is Solutions-4-You. http://www.solutions-4-you.com Do not use products with chemicals or wear latex gloves to clean the room. Hang cotton cubicle curtains. Make bed with cotton bed linen that is washed in non-perfumed detergent and no fabric softener.
- Install new sharps container in room.
- Place air filter (HEPA Plus activated carbon liner) in patient room and turn on. (Obtain filter from Central Supply with the MCS kit).
 
PHARMACY:
- Use glass bottles for IV solutions.
- Do not use any substitutions or generic drugs for the MCS patient without checking with the physician.
- Patients with MCS may react to dyes, preservatives, and artificial sweeteners and flavorings, cornstarch, or any other excipient.
- Capsules may be safer than tablet form.
- Monitor MCS patient medications by listing MCS patient under heading "Highly Allergic Code"
 
ADMISSION ASSESSMENT
- Assess all patients on admission to the hospital for allergies, and have Epinephrine available.
- Patient who has MCS should be in a private room; follow procedure for preparing room
- Obtain MCS kit from Central Supply.
- Place yellow arm band on patient; mark with Multiple Chemical Sensitivity
- Place Multiple Chemical Sensitivity sign on patient's bed and outside door.
- Place Multiple Chemical Sensitivity under "isolation" on the Patient Profile OC (prompt F4); this will print on the order sheet on receiving department.
- Patient should be provided distilled drinking water in a glass container.
- Notify Nutritional Services of the patient's special needs. Patient needs to be interviewed by Nutritional Services as soon as possible.
- Ask the patient to describe all beneficial procedures that have helped reduce the severity of reactions in the past. List this information in the medical record. Patient suggestions may include items such as administering oxygen, drinking water, eating fresh fruit, and other tolerated foods. Drinking a solution of baking soda and water (one teaspoon to 1/2 cup water). Showering or shampooing.
 
RD: DIET MODIFICATION
NUTRITIONAL SERVICES:
- Patient with MCS will require a special diet. The diet should include no processed foods of any kind, including instant oatmeal, instant mashed potatoes, and other prepackaged mixes (such as gravies, sauces and flavor packets). Use no dyes, preservatives, artificial flavorings, artificial sweeteners, or MSG. Provide patient with chlorine-free distilled water, decaffeinated coffees (which have not been processed with chemicals), and lactose-free milk. Food and drink should be provided in glass containers. Allow patient to select plain, non-processed foods from meats, vegetables, fruit, and grain list.
- On physician orders, permit patient to supply his/her own tolerated food products and dietary supplements.
- Retain patient's dietary requirements in the patient's medical record for future reference.
 
ROUTINE SAFETY
- All hospital employees and visitors are to check with the patient's nurse prior to entering patient's room.
- Patient should be isolated from other patients and their visitors at all times. In the event that the
patient must be transported elsewhere in the hospital, the patient should wear a R-95 mask.
- Staff caring for the patient should not wear perfumed products, hair spray, or perfume.
- Hospital personnel are to wash their hands with unscented or ivory soap and apply non-latex
gloves prior to touching the patient.
- No live plants and flowers are permitted in the patient's room.
- No latex balloons
- Alcohol swabs should not be used on the patient. Food grade alcohol is OK.
- Remove tops of vials before drawing up medications.
- Do not inject through any latex ports.
- Patient should bathe using products they are familiar with that do not cause a reaction.
- Petroleum products, i.e. K-Y jelly should not be used.
- Patients with MCS going to surgery alert Anesthesia well ahead of time in order for the physician to discuss what anesthesia and pain control will be used.
 
TEACHING: DISEASE PROCESS
- If patient has not been aware of Multiple Chemical Sensitivities prior to admit, alert them to the fact that they may be allergic to many things.
- If patient would like more information about Multiple Chemical Sensitivities, they may contact the following:
 
Environmental Health Network of California
P.O. Box 1155
Larkspur, California 94977-1155
Support and information line (SAIL) 415-541-5075
http://www.ehnca.org or http://users.lmi.net/wilworks
See Toxic Chemicals to submit info if you have experienced harmful effects from perfume. 
 
Chemical Injury Information Network
P.O. Box 301
White Sulphur Springs, MT 59645
(406) 547-2255
(406) 547-2455 Fax
http://www.ciin.org/
 
American Environmental Health Foundation
1-800-428-2343
(Supplies for MCS patients may be ordered from this foundation). Catalog included in MCS kit.
 
DOCUMENTATION
- Document Multiple Chemical Sensitivity in the patient's medical record, in the front of the chart, PCP, PCS, MAR, and computer profile.
- Record implementation/modification/discontinuation of protocol in PCP/PFS.
- Record evaluation of effectiveness of care in the EOSS on the NPR as related to the nursing diagnosis/patient outcome.
 
REFERENCES
* Healthier Hospitals, Toni Temple, Ohio Network for the Chemically Injured, 1996.
* The Environmental Illness Syndrome, Sherry A. Rogers, M.D., Syracuse, N.Y. 1997.
* Human Ecology Research Foundation, 8345 Walnut Hill Lane, Dallas, TX 7523 1.
 
APPROVAL Clinical Standards Development Committee ..................... 10/99
Hospital Standards of Clinical Practice Committee ...........
 
AUTHOR Cathy Carl, RN, BS, CIC
 
REVIEWED
REVISED
CONSULTING PHYSICIAN:. Jo Tillman.M.D. DATE: 9/99
11/5/99 3:25 PM
 
Thank you to all those who submited to this site.

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