Like bloodborne pathogens, hazardous chemicals can be present throughout a health care facility. Although it takes time to check each department, room, and closet, it really is one of the most effective ways to find materials that may otherwise be missed.

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Health Care Hazmats: There's More On Site Than Just Bloodborne Pathogens

Health care employees and emergency first responders are taught to understand the importance of universal precautions and how to apply them to a variety of situations. These lessons, backed by a facility's plans, procedures, and protocols, help to prevent employee exposure to bloodborne pathogens and keep employees safe. But bloodborne pathogens aren't the only hazardous materials that health care employees face. Cleaning and sanitizing products, preservatives, and even some pharmaceutical medications are among the harmful materials that health care employees may face each day.

Identifying and communicating these workplace hazards, as well as teaching employees how to prevent injuries from them, is just as important as a resilient bloodborne pathogens plan.

Identifying Chemical Hazards
Like bloodborne pathogens, hazardous chemicals can be present throughout a health care facility. Although it takes time to check each department, room, and closet, it really is one of the most effective ways to find materials that may otherwise be missed. Facilities with safety teams can help to minimize the amount of time that it takes to perform this audit by incorporating those team members into the audit process.

While it is important to look at all of the chemicals in each area, it can help to have a checklist of products that are already known to be on site. If the audit reveals that chemicals are used and stored in places where they weren't expected to be, it may signal the need for additional training or a review of policies and procedures on the storage, handling, and use of a product.

Sanitizing, disinfecting, and cleaning chemicals are likely to be found throughout the facility. Quaternary ammonium chlorides (Quat), phenolic compounds, and alcohol-based solutions are among the most common forms of chemicals used to kill bacteria, viruses, and other pathogens. Because many varieties of each of these products exist, it is important to know the particular brands and styles that are being used to verify that proper precautions are being taken during their use and that everyone knows how to prepare and use them properly.

Aldehydes and other chemicals used to sterilize equipment, prepare vaccines, and process x-rays may be limited to laboratory or departmental use, but they can still present inhalation and other hazards to employees in the area. Corrosive chemicals such as acetic acid and sodium hydroxide also may be present. Properly identifying these chemicals facilitates training and enables the proper personal protective equipment (PPE) to be chosen to protect employees who may need to handle these products.

Although some health care centers are mercury-free, some still have blood pressure cuffs and other instruments that contain mercury. When it is contained in a device, mercury does not present a hazard, however, if a mercury-containing device breaks, employees need to be aware of mercury hazards and know what procedures need to be taken to isolate the area and contact responders to begin the cleanup process.

Certain pharmaceuticals, such as chemotherapy drugs, nitroglycerin, and arsenic, also need to be considered, as well as any gases used for anesthesia. These products are sometimes overlooked because they are beneficial to patients with particular illnesses or diseases, but they can still be hazardous to employees if they are not stored and handled properly.

Written Plans
OSHA's Hazard Communication Standard (29 CFR 1910.1200) and Joint Commission Standard EC. 3.10 are both applicable in health care facilities. Each requires facilities to have a written plan that identifies hazardous materials that are used on site and documents the procedures and policies that will be used to prevent employee exposure.

This plan should be comprehensive and contain an inventory of all hazardous materials used, stored, and handled. An accurate inventory is essential because without it, procedures cannot be put into place to protect employees and employees cannot be properly trained.

Establishing procedures for handling and disposal of waste materials should also be part of the plan and part of training programs. Many chemicals cannot be flushed or dumped into sinks or drains because they cause a variety of environmental issues. Like wastes that contain bloodborne pathogens, chemical, pharmaceutical, radiological, and other forms of hazardous waste need to be safely stored and handled prior to disposal.

Plans also need to outline procedures to be followed in the event of a spill, release, or other emergency involving any of the hazardous materials used or handled on site. For some spills, cleanup may simply involve wearing appropriate PPE. For others, ventilation systems may need to be shut down or isolated and areas may need to be evacuated. Understanding the hazards of each chemical and knowing its location or locations helps to keep these procedures in perspective and prevent exposure.

Plans, procedures, and policies that are not properly communicated and understood are worthless. Educating all health care employees—from custodial staff to surgeons—is essential to ensuring safety and minimizing the risks associated with working around hazardous chemicals. Safe material handling procedures and policies should be incorporated into orientation training and continued on a routine basis. At a minimum, employees need to understand the risks associated with any hazardous materials that they may encounter and be aware that hazardous materials are present in multiple areas of the facility. They also must be taught what procedures need to be followed to safely handle hazardous materials in a manner that prevents injury and illness.

Following the established policies and procedures that are outlined in the facility’s plan is important because improper use, handling, storage, or disposal of a hazardous materials or wastes can have severe unintended consequences. Without proper training, employees may unknowingly handle materials incorrectly or underestimate the severity of a hazard.

Training also needs to include instruction on what to do in the event of a spill, release, or other emergency involving a hazardous material. Even if the only action that they should take is to report the incident or pull an alarm, knowing exactly what to do when something unexpected happens can help prevent exposure and minimize the scope of an incident.

The health care industry is constantly evolving, but the need to properly protect these employees from all known hazards remains unchanged. The ability to identify hazardous materials, coupled with the knowledge of how to use, store, handle, and dispose of them safely, minimizes the chance of exposure and harm.

This article originally appeared in the December 2015 issue of Occupational Health & Safety.

About the Author

Karen D. Hamel CSP, CIT, WACH, is a regulatory expert, trainer and technical writer for HalenHardy. She has more than 25 years of experience helping EHS professionals meet regulatory requirements and industry standards. Karen is a Certified Safety Professional (CSP), Certified Instructional Trainer (CIT), Walkway Auditor Certificate Holder (WACH), OSHA-Authorized Outreach Trainer for General Industry, Community Emergency Response Team (CERT) Trainer and Hazmat Technician. She also serves on the Blair County, PA LEPC. 

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