Healthcare

Other Hazards

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Chemicals Hazardous Drugs Emergency Response Hazards Radiation Latex Allergies

In addition to infectious disease, ergonomic, and workplace violence issues, workers in healthcare settings encounter a number of other workplace hazards. These include chemicals (e.g., sterilants), hazardous drugs (e.g., antineoplastic drugs), materials that cause allergic reactions (e.g., latex), and physical agents (e.g., radiation). Several common examples of these "other hazards" are discussed below.

Chemicals

Ethylene Oxide

Ethylene oxide (EtO) is a flammable, colorless gas at temperatures above 51.3 ºF (10.7 ºC) that smells like ether at toxic levels. It can be found in fumigants and sterilants and presents an opportunity for healthcare worker exposure during operations such as EtO sterilization of surgical equipment.

29 CFR 1910.1047, Ethylene oxide. OSHA Standard.
- Appendix A, Substance safety data sheet for ethylene oxide (Non-mandatory)
- Appendix B, Substance technical guidelines for ethylene oxide (Non-mandatory)
- Appendix C, Medical surveillance guidelines for ethylene oxide (Non-mandatory)
- Appendix D, Sampling and analytical methods for ethylene oxide (Non-mandatory)
OSHA's Small Business Guide for Ethylene Oxide. OSHA Publication 3359, (April 2009). Provides guidance to help employers understand the EtO standard, with particular emphasis on how to monitor the quality of the air in workplaces where EtO is processed, used, or handled. Air monitoring is an important activity that can help alert employers when unsafe levels of EtO are present in the air so they can take steps to reduce employee exposure.
Hospitals. OSHA eTool. Focuses on some of the hazards and controls found in the hospital setting and describes standard requirements as well as recommended safe work practices for employee safety and health.
Ethylene Oxide (EtO): Understanding OSHA's Exposure Monitoring Requirements. OSHA Publication 3325, (2007).
Ethylene Oxide. OSHA Fact Sheet, (2002). Answers common questions about EtO.
Ethylene Oxide Sterilizers in Health Care Facilities - Engineering Controls and Work Practices. U.S. Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication Number 89-115 (Current Intelligence Bulletin 52), (July 13, 1989).
For additional information, see OSHA's Ethylene Oxide Safety and Health Topics Page.

Formaldehyde

Formaldehyde can be used as a disinfectant or a sterilant. It is often found mixed in water and referred to as formalin. Formaldehyde can be used to prepare viral vaccines; as an embalming agent; as a tissue fixative; and in the sterilization of medical equipment (e.g., surgical instruments, hemodialyzers). Paraformaldehyde (a solid polymer of formaldehyde) can be heat vaporized for the gaseous decontamination of laminar flow biologic safety cabinets.

29 CFR 1910.1048, Formaldehyde. OSHA Standard.
- Appendix A, Substance technical guidelines for formalin
- Appendix B, Sampling strategy and analytical methods for formaldehyde
Hospitals. OSHA eTool. Focuses on some of the hazards and controls found in the hospital setting and describes standard requirements as well as recommended safe work practices for employee safety and health.
Controlling Formaldehyde Exposures During Embalming. U.S. Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication Number 98-149 (Hazard Control 26), (October 1998). Discusses a local exhaust ventilation system that can be used to reduce exposures during embalming.
Formaldehyde. OSHA Fact Sheet, (April 2011). Provides an brief overview of formaldehyde, its harmful effects, routes of exposure, and some provisions of OSHA's formaldehyde standard.
Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. Healthcare Infection Control Practices Advisory Committee (HICPAC). Provides an overview and information on the mode of action, microbicidal activity, and uses of Formaldehyde, Gluteraldehyde, and Hydrogen peroxide.
AST Recommended Standards of Practice for Handling and Care of Surgical Specimens. Association of Surgical Technologists (AST), (2008). Standard of Practice V discusses procedures for working with formalin preservative solutions.
For additional information, see OSHA's Formaldehyde Safety and Health Topics Page.

Glutaraldehyde

Glutaraldehyde is a colorless, oily liquid with a pungent odor. It is often mixed with water for use. Exposure can occur in healthcare facilities when glutaraldehyde is used in operations such as cold sterilization / high-level disinfection; tissue fixing / preservation (e.g., for microscopy, histology); and in the processing of x-rays.

Hospitals. OSHA eTool. Focuses on some of the hazards and controls found in the hospital setting and describes standard requirements as well as recommended safe work practices for employee safety and health.
Best Practices for the Safe Use of Glutaraldehyde in Health Care. OSHA Publication 3258, (2006). Provides information on the health effects and uses of glutaraldehyde and control measures to reduce exposure.
Glutaraldehyde: Occupational Hazards in Hospitals. U.S. Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication Number 2001-115, (May 2001). A brochure that discusses glutaraldehyde health effects, worker exposure, and control measures.
Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. Healthcare Infection Control Practices Advisory Committee (HICPAC). Provides an overview and information on the mode of action, microbicidal activity, and uses of Formaldehyde, Gluteraldehyde, and Hydrogen peroxide.

Additional Resources

Green and Clean: How Hospitals Can Protect Patients and Workers by Using Earth-Friendly and Sustainable Products/Practices. OSHA and The Joint Commission and Joint Commission Resources (JCR) Alliance, (January 2013). JCR developed an article that discusses the importance of adopting sustainable products and practices for cleaning, sanitizing, and disinfecting healthcare facilities. The article also provides requirements for selecting green cleaning products.
Cleaning and disinfecting environmental surfaces in health care: Toward an integrated framework for infection and occupational illness prevention. American Journal of Infection Control (AJIC), (2015). An integrated framework was developed to guide more comprehensive efforts to minimize harmful cleaning and disinfecting exposures without reducing the effectiveness of infection prevention.

Hazardous Drugs

Drugs are classified as hazardous if studies in animals or humans indicate that exposures to them have a potential for causing cancer, developmental or reproductive toxicity, or other organ system damage. Hazardous drugs, such as those used for cancer chemotherapy, antiviral treatments and hormone regimens, pose a serious hazard to healthcare workers. These effects can be irreversible even with low-level exposures.

Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings. U.S. Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication Number 2004-165, (September 2004). Increases awareness among healthcare workers and their employers about the health risks posed by working with hazardous drugs and to provide them with measures for protecting their health.
List of Hazardous Drugs in Healthcare Settings Allows Healthcare Workers to Minimize Exposure and Reduce Health Risks. U.S. Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication Number 2011-189, (August 2011). Hazardous drugs include drugs used for chemotherapy, antiviral drugs, hormones, and some immunosuppressant drugs-all of which may have damaging effects on the body. When these drugs must be prepared and administered, there are workplace best practices that can minimize potentially harmful exposure.
For additional information, see OSHA's Hazardous Drugs Safety and Health Topics Page and NIOSH's Hazardous Drug Exposures in Health Care Workplace Safety and Health Topics Page.

Waste Anesthetic Gases

Waste anesthetic gases include nitrous oxide and various halogenated anesthetics (e.g., halothane, enflurane, isoflurane, desflurane). Exposure to these gases can occur through leakage of the patient's anesthetic breathing circuit during delivery of anesthetic and through exhalations of patients recovering from anesthesia.
Anesthetic Gases: Guidelines for Workplace Exposures. OSHA, (May 18, 2000). Provides guidelines and controls to help reduce occupational exposure to waste anesthetic gases.
Waste Anesthetic Gases - Occupational Hazards In Hospitals. U.S. Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication Number 2007-151, (October 2007). Discusses exposures, health effects, and control measures.
For additional information, see OSHA's Waste Anesthetic Gases Safety and Health Topics Page.

Emergency Response Hazards

During the provision of emergency response care, healthcare workers may be exposed to chemical, biological, physical, or radioactive hazards. These hazards could be encountered singly or in combination with other hazards, could be a hazard that has never been or is rarely seen by the healthcare provider (e.g., anthrax), and could involve a large number of affected individuals that stresses available resources.

Hospitals. OSHA eTool. Focuses on some of the hazards and controls found in the hospital setting and describes standard requirements as well as recommended safe work practices for employee safety and health.
Emergency Preparedness and Response. OSHA Safety and Health Topics Page.
- Response and Recovery Workers. Provides information on medical response to emergencies.
Hospitals and Community Emergency Response -- What You Need to Know. OSHA Publication 3152, (1997). Protecting health care workers who respond to emergencies involving hazardous substances is critical. Health care workers dealing with emergencies may be exposed to chemical, biological, physical, or radioactive hazards.
OSHA Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances. OSHA, (January 2005). Provides hospitals with practical information to assist them in developing and implementing emergency management plans that address the protection of hospital-based emergency department personnel during the receipt of contaminated victims from mass casualty incidents occurring at locations other than the hospital. Covers topics such as victim decontamination, personal protective equipment, employee training, and includes several informational appendices.

Radiation

Ionizing (e.g., x-rays, nuclear medicine)

Ionizing radiation has enough energy to remove an electron from an atom (creating an ion). The main types of ionizing radiation are alpha particles, beta particles, gamma rays, and x-rays. Sources of ionizing radiation in healthcare include x-ray machines, radioactive isotopes, and radio nucleotides.

Hospitals. OSHA eTool. Focuses on some of the hazards and controls found in the hospital setting and describes standard requirements as well as recommended safe work practices for employee safety and health.

Non-ionizing (e.g., lasers)

Non-ionizing radiation does not have enough energy to remove an electron from an atom, but may cause an atom to vibrate or move around in a molecule. Examples of non-ionizing radiation include microwaves, infrared radiation, and visible light. A source of non-ionizing radiation in healthcare is a laser.

Lasers produce an intense, highly directional beam of light. In healthcare, lasers may be used as scalpels, probes, or in certain imaging techniques. Hazards may be associated with the laser beam (e.g., burns due to absorption of laser energy), the equipment (e.g., high voltage), or products produced during laser use (e.g., laser plume).

Laser/Electrosurgery Plume. OSHA Safety and Health Topics Page.
Laser Hazards. OSHA Safety and Health Topics Page.

Latex Allergies

Latex, also known as rubber or natural latex, is derived from a milky fluid found in rubber trees. Latex allergy is a reaction to certain proteins found in natural latex. Latex allergy may cause allergic reactions ranging from sneezing or a runny nose to anaphylaxis, a potentially life-threatening condition. Healthcare workers exposed to rubber gloves and other latex-containing medical devices are at risk of developing latex allergy.

Hospitals. OSHA eTool. Focuses on some of the hazards and controls found in the hospital setting and describes standard requirements as well as recommended safe work practices for employee safety and health.
Home Healthcare Workers: How to Prevent Latex Allergies. U.S. Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication Number 2012-119, (February 2012). Latex products are made from natural rubber, and sensitivity can develop after repeated exposure. Limiting exposure to latex can help prevent allergic reactions for both home healthcare workers and their clients.
For additional information, see OSHA's Latex Allergy Safety and Health Topics Page and NIOSH's Occupational Latex Allergies Workplace Safety and Health Topics Page.