New OSHA Compliance: Training Healthcare Staff on Hazardous Chemicals

To better protect workers from hazardous chemicals, the U.S. Department of Labor’s OSHA has revised its Hazard Communication Standard to align with the United Nations’ Globally Harmonized System of Classification and Labeling of Chemicals (GHS). While the original Hazard Communication Standard, HCS 1983, was commonly referred to as the “Employee Right to Know,” the revised standard now provides for the “Employee Right to Understand.” With the goal of increasing worker comprehension about the hazards in their work environment, the revised standard requires companies to employ the use of a standardized format for Safety Data Sheets (SDSs), as well as new labeling elements for chemicals. OSHA is rolling out this change in phases over the next several years, culminating in a final deadline of June 1, 2016.

New Requirements Aimed at Healthcare Worker Safety

The first compliance deadline is December 1, 2013. By this time, all facilities must provide training on new chemical label elements and safety data sheets.  In response to this rule, HealthStream has teamed up with MAXCOM to offer 19 GHS specific training modules that focus on every class of chemical an employee might come across in their working environment.

To address the enormous amount of chemicals used in hospitals, OSHA amended the rule to allow chemical training to be provided by groups of chemicals. They write, “where there are large numbers of chemicals, or the chemicals change frequently, you will probably want to train generally based on the hazard categories.”

Hazardous Chemicals Are Common in Health Care Facilities

Chemicals in use in the healthcare environment may be hazardous due to potential for toxicity, corrosiveness, and reactivity.  In addition to the usual routes of exposure by inhalation, ingestion, skin and eye contacts, a health care provider can also inadvertently self-inject a toxic drug intended for a patient.

These groups of chemicals include:

• Chemical disinfectants commonly used in health care facilities are often corrosive and/or toxic.  Glutaraldehyde, sodium hypochlorite, iodine, phenols, formaldehyde, and quaternary ammonium compounds are all corrosive.  In addition to being corrosive and toxic, some disinfectants such as quaternary ammonium compounds (benzalkonium chloride, Zephiran chloride, Rodalon)  also cause contact dermatitis.  Glutaraldehyde solution has to be freshly prepared every 2 weeks, and due to its volatile characteristic employees often inhale its vapors.  Formaldehyde used for cold sterilization of instruments and as a disinfectant not only has noxious odor but also causes dermatitis and has been shown to cause nasal and other cancers in experimental animals.
• Freons such as Freon 12 (dichlorodifluoromethane), Freon 11 (fluorotrichloromethane), and Freon 22 (chlorodifluoromethane) are routinely used in pathology laboratories (to prepare frozen tissue sections), in aerosol cans as a propellant, as a refrigerant gas, and mixed with ethylene oxide (a sterilant).  Freons can freeze the skin and eyes and cause depression of the central nervous system resulting in dizziness, convulsions, and irregular heartbeat. 
• Methyl Methacrylate, commonly used in operating rooms for securing surgical prostheses to bone, has to be mixed just before a procedure often resulting in inhalation of the product.  Methyl methacrylate affects the central nervous system, is an irritant and may cause low blood pressure and cardiac arrest.  The product also has been linked to birth defects, though not cancer.
• Peracetic Acid (PAA) or Peroxyacetic Acid is used to sterilize medical instruments, and also present in laboratories, and patient care units.  PAA is a severe irritant, and have been linked to skin papillomas (wart-like tumors), and liver, kidney, and heart problems.
• Solvents (such as Dioxane, Xylene, and Benzene) used mostly as cleaning agents in housekeeping are central nervous system depressants and irritants.  Chronic exposure to solvents have been linked to effects on blood formation, kidneys, liver, birth defects, and cancer.
• Anesthetic Gases exposure usually occurs in operating rooms, labor, delivery and recovery rooms; and ER.  Gases often leak from the instruments, and in the recovery room are present due to the exhaled breath of post-operative patients.  Effects of anesthetic gases on health care employees are similar to the one experienced by patients.  Although short-term exposure only causes dizziness and disorientation, long term exposure may cause cancer, birth defects, and liver and kidney damage.
• Ethylene Oxide used to sterilize equipment also exposes employees in surgery units and central supply.  Ethylene oxide is a corrosive, causes destruction of red blood cells, and inflammation of lungs.  It is also a carcinogen and a fire hazard.
• Cytotoxic Drugs (such as cyclophosphamide, chlorambucil, and melphan) used for treatment of cancer, also cause cancer and damage to the reproductive system of health care employees.  Accidental injection of a drug such as mitomycin-C can cause loss of function of a hand; and drugs such as mustine hydrochloride and doxorubicin  are powerful vesicants (corrosives).  Exposure to the smallest amount of bleomycin can cause severe allergic reaction.
• Pesticides ( Mecoprop, Metolochlor), Rodenticide ( Bromaldiolane and Diphacinone) and Fungicide such as Mancozeb are routinely used by hospitals as a biocide.  Most are toxic to the nervous system, damage kidneys and liver, and cause allergic reactions.

Safer Substitutes

Less hazardous products can be substituted for many though not all hazardous chemical products in health care facilities. For example:

• For Ethylene oxide in most instances: safer hydrogen peroxide 7.5% solution, peracetic acid or a mixture of hydrogen peroxide and peracetic acid.  Even hypochlorite (bleach)is effective in some disinfection systems.  Please note that the substitutes are not suitable for flexible GI endoscopes.
• For Glutaraldehyde: Ortho-phthalaldehyde (OPA) in Cidex (contains only 0.55% glutaraldehyde)
• For common toxic chemicals such as chloroform: dimethoxyethane (DME), Ethyl lactate, methyl tert-butyl ether or methylene chloride; benzene can be replaced by benzotrifluoride (BTF), dimethoxyethane (DME);  acetone can be substituted by ethyl lactate, or N-methyl pyrrolidone (NMP) etc.
• For toxic chemicals such as formaldehyde: dimethoxymethane (DEM); Phenol  by polyethylene glycol (PEG), and pyridine by isopropyl alcohol.
• For flammable chemicals such as ethyl ether: methyl tert-butyl ether (MTBE), n-octyl tetrahydrofurfuryl ether (n-OTE)
• Waste anesthetic gases can be controlled by a scavenging system.
• For powerful pesticides containing pyrethroids: UV light traps; pheromone traps can be substituted for Cockroach pesticides etc.

Although heath care facilities will never be free of hazardous chemicals, it is increasingly possible to use safer alternatives and better procedures to prevent exposure.

MAXCOM’s GHS Training Library provides a basic overview of the hazards associated with every class of chemical a healthcare employee could typically be exposed to and how an exposure to these chemicals could affect him/her in the course of performing their everyday workplace duties. Additionally, this training provides valuable information about the degree of risks or hazard levels associated with chemicals specific to a healthcare environment, and finally employees are provided details about the information contained within each section of the new Safety Data Sheet, GHS label elements and the pictograms recently adopted by OSHA.