Concern has been expressed by staff members at Royal Perth Hospital over the use of phenol-based cleaning products at Wellington Street and Shenton Park campuses. They believe these products caused a range of symptoms including an increase in cancer incidence.
Report
Independent reviews
Frequently asked questions
What was the scope of the study?
The study, conducted by the Department of Health’s Epidemiology Branch, with guidance from occupational health and cancer research expert Professor Bruce Armstrong, investigated if there was:
- a higher incidence of cancer or death amongst Patient Support Services (PSS) staff compared to the Perth metropolitan population due to exposure to phenol-based cleaners
- any relationship between exposure to phenol-based cleaners and respiratory or skin conditions, such as asthma and eczema, existed.
What is a cancer cluster?
For a cluster to occur there needs to be a greater than expected number of cases of a particular cancer within a group of people, a geographical area or within a period of time. The prevalence of cancer in the community is high with 1 in 3 and 1 in 4 women up to the age of 75 likely to be diagnosed with cancer.
What does it mean when study talks about chance?
In epidemiology research, chance is the likelihood that something has happened unpredictably without human intervention or observable cause. It is the random variation that exists within a population.
Did the study find a cancer cluster occurring at Royal Perth Hospital?
The findings indicate no evidence of a cancer cluster, which is a greater than expected occurrence of a particular cancer within a group of people, geographical area or period of time. The study found while 213 PSS staff were diagnosed with cancer during the 25-year period the risk of cancer in Patient Support Services staff was no higher than that of the Perth metropolitan population, and the number and types of cancers diagnosed were similar to those in the Perth population.
What does cancers of unknown primary site mean?
Cancers of unknown primary site are a common cancer diagnoses. As cancer progresses, cells can lose their original tissue identity, that is where the cancer began. There were 12 people diagnosed with a cancer of unknown primary site in this study.
In the absence of any overall increase in cancer risk, and following a review of Human Resource records and a clinical review by Clinical Professor Joanna Dewar (Medical Oncologist), it appears unlikely that these cases are due to exposure to a single agent or are rare or unusual cancers.
Was there an increased risk of death in PSS staff exposed to phenol-based cleaners?
There were 184 deaths of PSS staff during the study period.
The risk of cancer deaths was statistically similar to that of the Perth metropolitan population. However, the risk of death from cancer and conditions other than cancer were higher with longer duration of PSS employment and among male PSS staff.
The increase in deaths from a broad range of diseases is unlikely to be the result of exposure to a single workplace hazard such as phenol-based cleaners. In addition, female PSS staff reported 50 per cent more hours of exposure to cleaning agents, yet lower death rates were reported for females. Other background and lifestyle factors need to be considered in explaining the health outcomes of PSS staff.
Was there a greater contributory link between phenol-based cleaners and other illnesses, i.e. asthma and skin conditions?
Analysis of the survey data found no association between asthma and exposure to phenol-based cleaners; however, the analysis did identify a link between exposure to phenol-based cleaners and some respiratory illnesses, for example chronic bronchitis and emphysema, and possibly skin conditions other than skin cancer, for example dermatitis.
How rigorous and scientifically sound are the report’s analysis and conclusions?
The investigation was complex and highly detailed. It consisted of:
- toxicology review of the chemicals in phenol-based cleaners
- cccupational cohort analysis, which included linking RPH Human Resources records to data from the WA Cancer Registry and the WA Death Registrations
- cohort survey to extend beyond cancer incidence and death.
Data analysis undertaken and report prepared by the Epidemiology Branch, under direction of the State’s Chief Health Officer, and reviewed by Professor Armstrong. Professor Armstrong is Professor of Public Health, School of Public Health at the University of Sydney and an expert in the causes of cancer and the investigation of cancer clusters.
Professor Nicholas de Klerk, Winthrop Research Professor at the University of Western Australia and highly regarded for his knowledge and expertise in occupational cohort investigations, undertook a further peer review of Professor Armstrong’s recommendations.
How is the study able to come to these conclusions with such a low response rate to the survey?
This study had 2 distinct stages.
- An occupational cohort study to assess if there was an increased risk of cancer and death and included all RPH PSS employees from 1983-2008 (n=3,248).
- A survey to assess the prevalence of health conditions and to explore whether there was a relationship between these and exposure. Close to 500 past and present PSS employees completed the questionnaire.
The majority of the conclusions, regarding the risk of cancer and death, came from the occupational cohort analysis. Few of the studies conclusions rely solely on the survey data.
The overall analysis, which utilised linked data for the entire cohort, has a sample size sufficiently large to provide reliable and accurate estimates, and had the statistical power to detect effects in the situation being investigated.
Why did the study use the Perth metropolitan population as the comparison population?
As over 98 per cent of PSS staff live in the Perth metropolitan region, and this is also the location of RPH, the Perth metropolitan population was seen as the most suitable for statistical comparison.
Why were no other employee groups chosen to participate in the study?
The analysis was limited to PSS staff, as they were the RPH employees that historically were most likely to have the highest exposure to phenol-based cleaners over the study period. Any association between the phenol-based cleaner use and ill-health would be easiest to detect in this group.
Will there be any further investigations into other employee groups?
As no evidence of an association between phenol-based cleaners and cancer diagnosed was found amongst RPH PSS staff, who were most likely to have the highest level of exposure, there will be no further studies into other staff groups.
What has RPH done to ensure exposure to phenol-based cleaners no longer occurs?
Royal Perth Hospital has ceased using phenol-based cleaning products. The hospital now uses a chemical cleaner commonly used in hospitals throughout Australia.
What other actions has RPH taken?
Royal Perth Hospital has enhanced its chemical training and risk management processes for PSS and other hospital staff. PSS staff are required to undergo chemical awareness training at induction as well as undertake annual competency training. The training provides staff with the necessary practical skills and knowledge to safely handle and manage chemical cleaners in the hospital. There has also been a reduction in the number of cleaning agents used at the hospital, and each product has undergone a risk assessment to ensure they are within the safety guidelines.
All staff are encouraged to continue to report workplace hazards and incidents to their supervisor for assessment and action using the appropriate mechanisms available through Occupational Safety and Health procedures page on SERVIO On-line. Reporting incidents and hazards allows RPH to track incidents and develop preventative strategies to ensure staff safety.
What support services are in place for staff?
The RPH Occupational Safety and Health Branch is ready to answer any questions or concerns staff may have regarding the outcome of the study and any future actions they may wish to take or support services they may need. Please call the Staff Occupational Health Branch on 9224 1925.
If needed, all staff are able to access to confidential and independent support services through the Employee Assistance Program (EAP). To make an appointment contact Converge International on freecall 1800 337 068.
What legal action are staff able to take due to reoccurring medical ailments resulting from phenol-based cleaners?
For those PSS staff who may be seeking compensation in relation to the use of phenol-based cleaning products while at RPH, there are two avenues available – lodgement of a workers’ compensation claim and a potential common law claim depending on the level of disability. PSS staff members wishing to take legal action are encouraged to seek independent legal advice. The RPH OSH Branch is able to assist staff with the lodgement of a workers’ compensation claim. Please call the Staff Occupational Health Branch on 9224 1925.
What is the next step?
Professor Armstrong suggested a further investigation to establish the reasons for PSS staff being at higher risk of illness than the general population. The South Metropolitan Area Health Service Public Health Unit will be developing a voluntary assessment scheme to allow PSS employees to have their health risk factors assessed and suggest a range of targeted interventions to address the relevant factors.