title: Evidence-based decision making in an endoscopy nurse with respiratory symptoms exposed to the new ortho-phthalaldehyde (OPA) disinfectant.
abstract: BACKGROUND
  ortho-Phthalaldehyde (OPA) can cause mucous irritation, respiratory symptoms and IgE-mediated hypersensitivity reactions. Very little information is available about OPA-related effects in health personnel.
  
  
  OBJECTIVE
  To report the decision-making process for the case of an endoscopy nurse complaining of cough and burning of the nose and throat during OPA exposure at work.
  
  
  METHODS
  The problem focused on the relationship between OPA exposure and the respiratory symptoms and was investigated using an evidence-based (EB) medicine paradigm.
  
  
  RESULTS
  A literature search was performed using the database Medline and the search engine Google. Papers and guidelines were assessed for their suitability in the EB case identification of suspected occupational asthma (OA). A multistep approach suggested by a guideline was considered most appropriate for practical use. The nurse shared the decision-making process and underwent evaluation of the clinical suspicion index and interventions for diagnosis of OA. Despite the high clinical suspicion index, the diagnosis of OA was excluded and any work restriction was avoided. Health surveillance follow-up showed a good clinical outcome and prompt recovery from respiratory symptoms after improvement of environmental control measures.
  
  
  CONCLUSIONS
  The case study shows that the implementation of EB guidelines provides the occupational physician with an appropriate decision-making process for the identification and management of workers with suspected OA. Screening out of OA is highly relevant because diagnosis of disease requires removal from exposure and frequently impacts negatively on worker employment.
authors.affiliation: Department of Medicine and Medical Specialties, Occupational Health Unit-Policlinico, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41100 Modena, Italy. franchi.alberto@policlinico.mo.it
authors.forename: A
authors.initials: A
authors.lastname: Franchi
authors.forename: G
authors.initials: G
authors.lastname: Franco
mesh_terms: D000328:Adult; D001249:Asthma / Q000139:chemically induced* / Q000503:physiopathology; D003657:Decision Making; D004202:Disinfectants / Q000633:toxicity*; D019723:Endoscopes; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D009722:Nurse Practitioners; D009784:Occupational Diseases / Q000139:chemically induced* / Q000503:physiopathology; D016273:Occupational Exposure / Q000009:adverse effects / Q000032:analysis; D009787:Occupational Medicine; D010366:Peak Expiratory Flow Rate; D009764:o-Phthalaldehyde / Q000633:toxicity*
chemical_list: D004202:Disinfectants; D009764:o-Phthalaldehyde