Fragrance-free health care

Click here to see the petition to have fragrances/scent free health care

What are fragrances and their effects on health?

Fragrances are mixtures of thousands of chemicals intended to produce a particular scent. Fragrances are used in thousands of consumer products, including but not limited to perfumes, soap, cleaning products, air fresheners, laundry products, personal care products etc. (Caress & Steinemann, 2009). Up to 4,000 ingredients are used in manufacturing fragrances (IFRA, 2011). A single synthetic perfume may contain between 50 to 300 ingredients (Bickers et al, 2002). 95% of the ingredients contained in fragrances are petroleum-based volatile organic compounds (VOCs) that easily evaporate and disperse into the air we breathe (Kumar et al, 2006). There is no regulation requiring the manufacturer to disclose specific chemicals used to create the fragrances in their products, as this is considered proprietary information. This means that hundreds of known toxic ingredients are hidden in everyday personal care products, cleaning products, and other household products.

We all inhale chemical fragrances used in almost every consumer product, on a daily basis. Not only this, but the use of fragranced products greatly negatively impacts the air quality in our homes and workplaces. Many of these products are toxic and have harmful health effects, as evidenced by several studies (Rastogi, et al., 2001; Temesvári, et al., 2002). For instance, high levels of phthalate esters are used to maintain the longevity of scent in numerous perfumes, even though phthalate esters are known endocrine disruptors (Al-Saleh, et al., 2017). Chemical analysis has revealed some ingredients to be carcinogens, developmental toxins, or neurotoxicants. Several ingredients used to produce fragrances exacerbate or may cause many health conditions such as asthma, eczema, multiple chemical sensitivity, sinus problems and migraine headaches.

Approximately one-third of Canadians experience symptoms when exposed to perfumes, fragrances and other scented products (Sears, 2007; Steinemann, 2018). Considering the diversity of chemical products and the specific ways each individual reacts, widely varying symptoms can be expected from exposure to scented products. Infants can experience severe symptoms such as diarrhea, vomiting, or earache, and possibly cough or cold, fever, wheezing, breathlessness, and rashes (Farrow et al., 2003). In adults, symptoms are extensive and vary from one individual to another. Symptoms triggered by exposure to fragrances can encompass headaches, dizziness, difficulty concentrating, feeling dull, groggy or spacey, fatigue, watery eyes, runny, stuffy nose and sinuses, wheezing and shortness of breath, or rashes (Caress & Steinemann, 2009; Elberling et al., 2005; Silva-Néto et al., 2014; Uter et al., 2013). We have conducted a narrative literature review which explores the effects of fragrance in more detail.

Fragrance-free policies in health-care facilities

With increasing awareness of the adverse health effects of fragrances, many health-care facilities around the world are becoming fragrance-free. Policies have been implemented in several government and hospital facilities in Canada where visitors, patients, health-care professionals, and other staff members are asked to refrain from using any products containing fragrances.

Products containing fragrance may be deodorants, hairsprays, shampoos, conditioners, soap, aftershaves, perfumes, colognes, cleaning products, etc. Establishing fragrance-free environments is not a new culture. It is well-established in Ontario, Nova Scotia, Alberta, British Columbia, Manitoba, Saskatchewan, New Brunswick, Prince Edward Island, Newfoundland and Labrador, the Yukon and the Northwest Territories.

Most of our time is spent indoors where the air quality can be two to five times more polluted than outdoor air (Environmental Protection Agency-EPA, 1987). Fragrances being one of the most prevalent indoor air pollutants, indoor air quality should be kept free of any of these hazardous substances.

It is equally important that health care facilities in Québec implement fragrance-free policies to accommodate sick and vulnerable populations. No patient goes to a hospital or health-care practitioner expecting to be made sicker. No health-care worker would deliberately do anything to harm patients, colleagues and, potentially, themselves. But when health-care workers choose to apply products containing fragrance to their skin, hair or clothing, they may in fact be doing just that. One has a choice whether or not to wear perfume. The person who reacts to fragrances has no choice or warning when exposed. These products are used for social pleasure. However, those who react suffer social isolation. Access to basic services becomes difficult or impossible for these people. Cardio-respiratory patients can be made critically ill by unexpected exposure to fragrances.

As noted in the November 3, 2015 editorial of the Canadian Medical Association Journal (CMAJ): “There are many practices that are acceptable outside hospitals — but not inside. One of these is the application of artificial scents to our bodies (…) There is little justification for continuing to tolerate artificial scents in our hospitals (…) Hospital environments free from artificial scents should become a uniform policy, promoting the safety of patients, staff and visitors alike.”

Asthmagens, substances within fragrances that provoke asthma or trigger asthma attacks, are of particular concern to hospital staff. Hospitals show the highest reported rate of occupational asthma (Pechter, et al., 2005). As stated by the US Centers for Disease Control and Prevention (CDC) in their scent free policy: “Fragrance is not appropriate for a professional work environment, and the use of some products with fragrance may be detrimental to the health of workers with chemical sensitivities, allergies, asthma, and chronic headaches/migraines.”

Healthcare facilities should be a secure shelter for people who are ill; a go-to place without any second thought other than to be treated. The hospital environment should accommodate all patients regardless of their specific illness. Patients’health and well-being should be the top priority.

Therefore, all products containing fragrances, including cleaning products, need to be eliminated from the healthcare spaces. We strongly argue that fragrances have no place in a health-care setting and that good quality, fragrance-free air is a basic human right. We therefore urge all health-care workers and hospitals across Québec to become fragrance-free in accordance with the basic right to clean air.

This webpage is meant to assist you in raising awareness and encouraging the development of a fragrance-free policy in your health-care facility. Even though the task may seem daunting, there are effective ways a health-care facility can succeed, especially through learning from other hospitals that have successfully implemented such policies.

What are fragrances?

Fragrances are mixtures of several chemicals intended to produce a particular scent. A single perfume can contain up to 500 ingredients, 95% of which are petroleum-based volatile organic compounds (VOCs). Many of these are known to be respiratory irritant/sensitizers. These chemicals volatize into the air we breathe. 30% of Canadians react to these exposures and experience symptoms such as headache, nausea, cough or skin rash; up to 4% of Canadians may experience an asthma attack. Cardio-respiratory patients can be made critically ill by unexpected exposure to fragrances.
Many frequently used products contain fragrances that can be damaging to health. They include personal care products such as perfumes, cologne, shaving cream, aftershave lotions, deodorant, shampoo, conditioner, gel, mousse, hairsprays, hand and body soaps or lotions, makeup, and sunscreen. They also include laundry soaps, clothes softeners, air fresheners, scented candles, scented items for the car, incense, garbage bags, etc.

Is it common for people to develop symptoms when exposed to fragrance?

Approximately one-third of Canadians experience symptoms when they are exposed to perfumes, fragrances and others scented products. This includes people suffering from asthma and other respiratory disorders, migraine, allergies and environmental sensitivities.

What symptoms can people experience when they are exposed to fragrance?

The most common symptoms associated with fragrance exposures are:

Asthma symptoms such as wheezing, coughing and shortness of breath

Grogginess/difficulty concentrating

Runny, stuffy nose/sinus problems

Migraine headaches

Rash

Watery eyes

Fatigue

Eczema

The same fragrance can cause different symptoms in different people. Also, symptoms can vary in severity, from mildly irritating to disabling. Constant exposure can lead to prolonged disability. Anaphylactic episodes have been reported with exposure to fragrance.

Why must a health care facility go fragrance-free?

Every hospital or health care setting is committed to the health and well being of patients, staff and visitors.

No patient goes to a hospital or health care practitioner expecting to be made sicker. No health care worker would deliberately do anything to harm patients, colleagues and potentially, themselves. But when health care workers choose to apply products containing fragrance to their skin, hair or clothing, they may in fact be doing just that.

As noted in the November 3, 2015 editorial of the Canadian Medical Association Journal (CMAJ): “There are many practices that are acceptable outside hospitals — but not inside. One of these is the application of artificials scents to our bodies(…) There is little justification for continuing to tolerate artificials scents in our hospitals(…) Hospital environments free from artificial scents should become a uniform policy, promoting the safety of patients, staff and visitors alike.”

As stated by the US Centers for Disease Control and Prevention (CDC) in their scent-free policy: “Fragrance is not appropriate for a professional work environment, and the use of some products with fragrance may be detrimental to the health of workers with chemical sensitivities, allergies, asthma, and chronic headaches/migraines.”

Choosing to use only fragrance-free products, especially while at work, will improve the facility’s air quality, and in turn will benefit patients, staff and visitors.

How can I change to fragrance free?

Becoming scent-free or fragrance-free is a process. The first step is to change all your products (personal, laundry, etc.) for fragrance-free ones. If you have always used fragrances it will take many washes before your laundry becomes fragrance-free. Remember, if you use perfumes – especially strong perfume – the day before coming to work, there is a good chance that the fragrances in the products will persist into the next day. So, if you are going to an event a day before going to work, it’s a good choice to use something that will fade quickly, for instance, a pure (non petro-chemical based), light essential oil. Keeping your home fragrance free will improve air quality and support a healthy environment for your family.

Can people have a reaction to scented products? Is this even possible?

Yes! Over one million people have been diagnosed with Multiple Chemical Sensitivity (MCS) by a health professional (Statistics Canada, 2016). People suffering from this condition react to multiple chemicals at very low doses, and fragrances are a major trigger for symptoms. Due to this disability they find it hard to access health care spaces and often stay away from hospitals even when they need help. It is reported that people with MCS who do get treatment have a very hard time with the chemicals present in a hospital.

In addition to this, it is well documented that asthma is on the increase, especially in young people. It is also well known that asthma and migraine headaches have multiple triggers including chemical exposures

What are Environmental Sensitivities/Chemical Sensitivities (ES/MCS)?

Environmental Sensitivities/Chemical Sensitivities (ES/MCS) are triggered by one large exposure or by smaller exposures over time. Once a person is sensitized, they react to extremely low levels of the incitant. More exposures lead to a spreading of sensitivities, and reactions get stronger.

Reactions manifest with multiple symptoms which can affect all the systems of the body. This condition is recognized by the Canadian Human Rights Commission and other human rights organizations as a disability that, like any other disability, must be accommodated under the law.

All federal government offices are obliged to become fragrance-free if someone with ES/MCS requests a fragrance-free space as part of an accommodation for their disability.

Providing accommodation for this segment of our population will go a long way towards avoiding extreme exclusion and isolation, and preventing severe poverty.
To learn more: www.EnvironmentalSensitivities.com

Are sensitivities the same as allergies?

An allergy is a condition in which exposure to a material prompts the body’s immune system to react with mild to very severe symptoms, which can be life-threatening. Symptoms can be relieved by taking an antihistamine medication, or, in the case of severe reactions, adrenaline.
Sensitivities to things such as products containing fragrance can cause the same type and severity of symptoms as allergens. As, with allergens, it is best to avoid exposure. However, the difference with MCS is that it also involves oxidative stress, systemic inflammation, and more than one bodily system beyond the immune system, including (but not limited to): the nervous, respiratory, musculoskeletal, cardiovascular, and gastrointestinal systems. Unlike allergies, there is no medication that has been proven to relieve symptoms, although patients often report symptoms are helped by drinking sodium bicarbonate in water.

Do I not have the right to use whatever product I choose?

People have the right to smoke, too. However, many indoor and outdoor spaces are now smoke- free in order to respect everyone’s right to good air quality. Similarly, fragrances volatize into the air and are breathed in by others who may react with environmental sensitivities, asthma, allergies and other illnesses such as respiratory and heart disease. So, “in keeping with the “balance of convenience” principle, people should make adjustments to avoid adversely affecting the health of a group of people, no matter how small, especially in cases involving the workplace and shared public places” (source: www.EnvironmentalSensitivities.com).

Nobody has complained about my perfume. Why should I change?

A person suffering from exposure to fragrances may keep quiet because they feel it is an intrusion to ask you to refrain from using fragrances. However, your perfume is intruding on their health and well-being. People with these conditions do not wear a sign around their necks saying that they are sensitive to fragrances – though some do wear masks – so you have no way of knowing how many people are affected by your perfume. But once one knows that these effects do occur, one has a civic obligation to accommodate those who react to fragrances, by not using them.

Will fragrance-free products cause poor hygiene and body odour?

So many people suffer from the effects of fragrances, that many manufacturers, including some leading ones, now produce fragrance-free products. People who are fragrance-free simply do not smell of perfume, and using fragrance-free products does not cause poor hygiene or body odour, as these products are very effective.

Where will I find these fragrance-free products?

Fragrance-free items are now available in a wide range of products ranging from personal to laundry to cleaning – and even to some renovation products, such as zero VOC paints. You can find these products online, at grocery stores, pharmacies and health food stores. Remember to read labels. The ingredient list should be short, with ingredients that you can verify.

There should be no mention of scent, parfum/perfume or fragrance on the label.

What is the difference between fragrance-free, scent-free and unscented?

These are the terms generally used in industry. Even if a product is labelled “scent-free” or “unscented”,it may contain chemicals that mask/hide the smell of the product. People react to the chemicals emanating from the product, whether they are used to create a scent or to mask/ hide it. Using even more chemicals to hide the scents does not solve the problem. People who are sensitive to these chemicals will still have symptoms upon exposure. Remember, it is not the “smell” they have a problem with – it is the chemicals contained in that smell that trigger symptoms.

It is important to always read labels. Even on an unscented, scent-free or fragrance-free product, avoid the product if parfum/perfume/fragrance are listed as ingredients.

What if I wear a light scent that remains within arm slength of me? Will that be ok?

People who react to the chemicals in fragrances will react to “light” ones too. A light scent can easily contain as many chemicals as one that smells very strong. These chemicals do not only form a “scent-circle” around you. They are left behind in spaces such as elevators, washrooms, hallways, patients” rooms, etc. They are also moved around with air currents and can drift into common airspaces where everyone is then forced to breathe them in. In addition, people stand close to each other in areas such as elevators, and patients are commonly transported within the hospital using elevators. An already fragile person could have serious symptoms from these exposures. This is why “no scents is good sense” (Marsh,1998).

Is it also important to have fragrance-free, least toxic cleaning products in buildings?

Due to the number of people using fragrance-free and less toxic products, the industry has responded with environmentally friendly products for personal use, cleaning, maintenance and construction. It is important for the sake of human health and the environment that fragrance- free and least toxic strategies be adopted in health-care facilities.

Is there any scientific data to back up this information?

Yes. Please read the narrative literature review posted on the main page. Also see the list of hospitals across Canada that already have fragrance or scent-free policies.

Is it even possible to make a public building such as a hospital fragrance-free?

As the health effects of fragrances become known and enter public conversation, the idea of using products containing fragrances in a health care setting just does not make sense. Health care facilities are spaces where the most vulnerable among us, those who are ill, come to receive services and help to get better. Exposure to fragrances will, on the contrary make them worse if they are susceptible to these chemicals. A key to success is education and awareness. Then everyone can take responsibility for their personal choices.

It may not be completely possible to achieve a totally fragrance-free environment as some people who are not familiar with the policy may enter the hospital wearing fragrances. However, with time, education and awareness, these episodes will be less frequent.

Effective signage, phone voice mail messaging, pamphlets, etc., will create a momentum of awareness and change.

What can a health care facility do to ensure that patients and visitors do not wear fragrances to the hospital?

The following actions will help inform patients and visitors about the policy:

Telephone voice mail messages informing patients and visitors that they should not use perfumes, colognes and personal care products containing fragrances when visiting the hospital.

Advising patients about the policy and if required, guiding them to the website of the facility for alternatives to products containing fragrances.

Providing visible signage and readily available pamphlets about the fragrance-free policy.

Testimonies

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“Let’s Go”, Sandrina Marandola, CBC Radio 88.5 FM, (February 25, 2020) :

“Breakaway”, CBC Radio 104.7 FM, (February 28, 2020) :

The Case for Making Health-Care in Québec Fragrance-Free is supported by the following groups:

With thanks to:

The Environmental Health Clinic, Women’s College Hospital – Toronto, Ontario
Dr Lynn Marshall, President and Chair of the Board of the Environmental Health Institute of Canada, Member of the Canadian Association of Physicians for the Environment, and a Staff Physician at the Ontario Environmental Health Clinic, Women’s College Hospital, Toronto
Dr Ken Flegel, Professor of Internal Medicine, McGill University, Montréal, Québec
Dr John Molot, Staff Physician, Ontario Environmental Health Clinic, Women’s College Hospital, Toronto
Meg Sears Ph.D., Ottawa Hospital Research Institute. Chair, Prevent Cancer Now
Farah Ahmed (BDS, M.Sc)
Faisal Mirza (M.Sc, MBA, P.G.D.AE)
Michel Gaudet, Executive Director, ASEQ-EHAQ
Rohini Peris, President, ASEQ-EHAQ
Robert Morariu
Melanie Belanger, M.Sc
GreenHealthCare.ca

ASEQ-EHAQ thanks everyone involved in this project.

What are fragrances and their effects on health?

Fragrance-free policies in health-care facilities

Testimonies

Press Release

Towards a fragrance-free policy for health-care

MEDIA COVERAGE

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