Job-Exposure Matrix for chemical substances at Hospital del Mar, a pilot study

Abstract

Introduction: Job-exposure matrices (JEMs) are useful tools for estimating group-level exposure to hazardous agents. Their utility has been well established in international studies, such as FINJEM and JEM Soignances, which have been validated in hospital settings. In Spain, however, their application in the healthcare sector remains limited. This study aimed to develop a JEM focused on inhalation-related chemical risks at Hospital del Mar (Barcelona), to identify potentially exposed homogeneous job groups (HJG), and to estimate the overall prevalence and distribution of exposure by risk levels.

Method: A descriptive, exploratory study was conducted using the qualitative methodology outlined in NTP 937 by the Spanish National Institute for Occupational Safety and Health. Six chemical agents were evaluated: formaldehyde, tamoxifen, cyclophosphamide, cisplatin, sevoflurane, and desfluran selected for their common use in hospital settings and inhalation toxicity. The study population included 4,834 workers distributed across 46 HJGs.

Results: Of the 46 HJG analyzed, exposure was identified in 10, involving 1,502 workers (31.1%). Most cases (22.5%) presented a low risk, mainly due to anaesthesic gases (sevoflurane and desflurane), as well as formaldehyde and cytotoxic agents in the pharmacy department. A moderate risk (8.6%) was found, associated with the handling of tamoxifen, cyclophosphamide, cisplatin, and formaldehyde in units such as the day hospital, acute care, and surgical block. No high-level exposures were detected.

Conclusions: The results show the presence of chemical risks in specific hospital areas. The developed JEM is a useful tool to guide preventive actions, prioritize resources, and plan control strategies.