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Environment, health, & safety


It has happened to all of us. You are in the elevator and just before the door closes, in breezes a woman with the scent of a strong deodorant, hairspray, cigarette smoke, and heavy, cloying perfume wafting in before her. Your eyes water, your nose itches, and before you can escape, you start sneezing.

For most of us, once we exit the elevator, everything returns to normal. But for people with multiple chemical sensitivity (MCS), this is not the case. After the encounter with the fragrant woman, they may experience severe bronchospasm, extreme fatigue, and migraine, resulting in a need for immediate healthcare intervention.

The U.S. Environmental Protection Agency defines MCS as “a condition in which a person reports sensitivity or intolerance (as distinct from ‘allergic’) to a number of chemicals and other irritants at very low concentrations. There are different views among medical professionals about the existence, causes, diagnosis, and treatment of this condition.” MCS has also been called idiopathic environmental intolerance, chemical hypersensitivity, and chemical AIDS.

The U.S. Occupational Safety and Health Administration (OSHA) reports that MCS has several potential causes, including immune system anomaly, neurobiological sensitization, and allergy, although a direct cause for MCS is not known. Signs and symptoms can include vertigo, rhinitis, loss of concentration, GI problems, angina, and muscle or joint pain, which causes it to be difficult to diagnose. MCS and its symptoms often mimic chronic fatigue syndrome and fibromyalgia, further confusing matters. Avoidance of chemical triggers is the most recognized treatment; others include nutrition counseling, treatment of any underlying mental health issues, and detoxification.

Any chemical can trigger MCS, and in our industrialized society, we are surrounded by chemicals. Every day we come into contact with such substances as pesticides; tobacco smoke; cleaners; synthetic fragrances; alcohol; new paint, carpet, or furniture; gasoline; aspirin; formaldehyde; and other chemicals too numerous to list. Any and all of these can contribute to MCS.

ANA has long recognized the unique chemical hazards nurses encounter. In 2006, ANA’s House of Delegates passed the resolution “Nursing Practice, Chemical Exposure and Right-to-Know.” Calling for reduced use of toxic chemicals, use of safer alternatives, labeling and full disclosure mechanisms, and testing of chemicals in products for health effects prior to introduction to the market, this resolution provides the corner­stone of ANA’s toxic reform work. ANA provides education for nurses on the links between chemicals and human and work environment health. ANA also advocates for federal chemical reform and encourages nurses to let their voices be heard. Visit to take action on this important issue.

A little-known, yet debilitating condition

Anyone can contract MCS at any time. Gulf War veterans and September 11 first responders are notable MCS sufferers, but nurses also can fall victim due to their daily exposures to fragrances, harsh detergents, sterilants, pesticides, floor stripper, and hazardous drugs.

Enter Dorothy Paxson Barker, PhD, RN. A nurse for more than 30 years, Barker’s initial practice was ended by chronic exposure to quaternary ammonium found in workplace cleaners. With diagnoses including adult-onset asthma with reactive airway disease and MCS, she channeled her MCS experience into raising awareness of this illness along with advocating for workplace fragrance-free policies and federal chemical reform. Barker describes an MCS attack as “a severe sunburn in my lungs.” She notes that when she underwent a bronchoscopy following an MCS attack, her lungs resembled raw hamburger meat.

Some tips for nurses caring for a patient with MCS include:

  • Avoid wearing and using scented products.
  • Ensure that those who need to be in contact with the patient are fragrance-free.
  • Ensure that chemicals are not used near or around the patient.
  • Encourage your employer to purchase greener products to clean and disinfect surfaces.
  • Advocate for employers to implement tobacco-free and scent-free policies.
  • Sit on the facility’s purchasing committee to ensure only scent-free products are purchased.

Remember—what is safe for nurses improves safety for patients. For more information on ANA’s work on chemical sensitivities and workplace exposure, go to

Holly Carpenter is a senior staff specialist at ANA.

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