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Published on: December 21, 2019
[Pleural mesothelioma due to asbestos exposure in operating room]
Pietro Gino Barbieri1, Michela Sarnico2, Paola Paglierini3
1già Servizio Prevenzione e Sicurezza Ambienti di Lavoro e Registro Mesoteliomi Maligni Provincia di Brescia, Azienda Territoriale Sanitaria di Brescia; pietrogino.barbieri@gmail.com.
Background:
the malignant mesothelioma is a neoplasm caused by the exposure to asbestos in a wide majority of cases; however, in a significant number of these cases, it is not possible to highlight it and, as a consequence, a specific category named 'Asbestos Exposure Unknown' was adopted by the 2003 guidelines of the Italian National Mesothelioma Register (ReNaM).
Objectives:
to present a new occurrence of asbestos exposure in a case of mesothelioma diagnosed in a nurse who worked in the operating room, for which the exposure was initially classified as 'Unknown'.
Design, Setting And Participants:
case study.
Methods:
in-depth studies were carried out on the tasks performed by the nurse. Samples of anti-heat protective gloves, used in the Eighties in operating rooms, were analysed using the Scanning Electron Microscopy (SEM).
Results:
pleural mesothelioma was diagnosed at age 56 and caused patient's death at 59 years. It was possible to confirm that the gloves used for the sterilization of surgical instruments during the years and up to 1990 were made of chrysotile asbestos and that they have been the sole sure cause of the nurse's professional exposure, which lasted 4 years. A possible family exposure has been hypothesized in the washing of parents work clothes. The case was re-classified as 'certain professional cause'; the occupational origin of the tumour has not been recognized from the Italian Workers' Compensation Authority (Inail).
Conclusions:
this case-report suggests: a. the need to carry out any possible thorough analysis of the circumstances and of the sources of the exposure, every time this exposure is first classified as unknown, according to the ReNaM guidelines; b. to consider at least likely a professional asbestos exposure in case of frequent use of anti-heat protective gloves for surgical instrument sterilization.
Insights
A nurse developed malignant mesothelioma due to asbestos exposure from operating room gloves. This case highlights the importance of investigating unknown asbestos exposure sources, like protective gear, to ensure proper classification and recognition of occupational disease.
Area of Science:
- Occupational Health
- Oncology
- Environmental Science
Background:
- Malignant mesothelioma is frequently linked to asbestos exposure, but the source remains unknown in a significant number of cases.
- The Italian National Mesothelioma Register (ReNaM) established the 'Asbestos Exposure Unknown' category in 2003 due to difficulties in identifying exposure origins.
- Identifying occupational asbestos exposure is crucial for diagnosis, treatment, and compensation.
Purpose of the Study:
- To report a case of mesothelioma where asbestos exposure was initially unknown.
- To investigate and confirm the source of asbestos exposure in a healthcare worker.
- To emphasize the need for thorough investigation of 'unknown' asbestos exposure categories.
Main Methods:
- A case study approach was employed, focusing on a nurse diagnosed with mesothelioma.
- Detailed analysis of the nurse's job tasks was conducted.
- Scanning Electron Microscopy (SEM) was used to analyze anti-heat protective gloves from the operating room.
Main Results:
- The patient was diagnosed with pleural mesothelioma at age 56 and died at 59.
- Analysis confirmed that gloves used for surgical instrument sterilization up to 1990 contained chrysotile asbestos, identified as the sole confirmed source of occupational exposure over 4 years.
- Despite re-classification to 'certain professional cause', the Italian Workers' Compensation Authority (Inail) did not recognize the occupational origin.
Conclusions:
- Thorough investigation of exposure circumstances is vital when asbestos exposure is initially classified as unknown.
- Frequent use of anti-heat gloves for surgical instrument sterilization should be considered a likely source of professional asbestos exposure.
- This case underscores the challenges in occupational disease recognition and compensation.
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