Healthcare workers who prepare or administer hazardous drugs or who work in areas where these drugs are used may be exposed to these agents in the workplace. Some examples of hazardous drugs include those used for cancer therapy, some antiviral drugs, hormone agents, and bioengineered drugs.
Healthcare employees are also exposed to hazardous chemicals, such as pesticides and disinfectants.
About 8 million U.S. healthcare workers are potentially exposed to these hazardous drugs and chemicals. At-risk workers include:
Exposure to hazardous drugs can result in adverse health effects in healthcare workers. In fact, published studies have shown that workplace exposures to hazardous drugs can cause a variety of health effects, such as:
As the graphic to the right shows, acute health effects usually occur rapidly as a result of short-term exposures, whereas chronic health effects generally occur as a result of long-term exposure and last longer.
Here are some examples of health effects from hazardous drugs:
The health risk depends on how much exposure a worker has to these drugs and how toxic they are.
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OSHA has identified worker exposure to hazardous drugs as a problem of increasing health concern. When hazardous drugs are used in a healthcare facility, employers are required to implement a written program that meets the requirements of the Hazard Communication Standard (HCS). This standard provides for worker training, warning labels, and access to Safety Data Sheets (SDSs).
The HCS ensures employee awareness of the hazardous chemicals they are exposed to in the workplace.
Workers can be protected from exposures to hazardous drugs through engineering controls, administrative controls, and personal protective equipment.
If the eyes or body of any person may be exposed to harmful corrosive materials, suitable facilities for quick drenching or flushing of the eyes and body must be provided within the immediate area for emergency use. [29 CFR 1910.151(c)]
Engineering and administrative controls such as an appropriate anesthetic gas scavenging system are the first line of defense and the preferred method of control to protect employees from exposure to anesthetic gases. A recent report from the Centers for Disease Control and Prevention found there is widespread use of these scavenging systems to control anesthetic gases during medical procedures. However, many other recommended controls are lacking in many facilities. Here are the results of the study:
When precautionary practices are not followed, anesthesia care providers and bystanders are at risk of exposure. Ensuring proper precautionary measures are followed requires diligence on the part of both employers and healthcare workers.
Employers need to ensure the following:
Anesthesia care providers should seek out training, understand and follow facility procedures, ask questions, and report any safety concerns.
Ethylene oxide (EtO) is used extensively by hospitals and other industries as a sterilizing agent.
EtO is a colorless, odorless gas which is both flammable and highly reactive. Most importantly, you cannot smell EtO until it reaches a temperature of 51.3 degrees Fahrenheit (10.7 degrees Celsius), the gas smells like ether.
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.
Human and animal studies consistently show that EtO can be hazardous to human health.
Short-term (acute) exposures to EtO can cause the following health issues:
Long-term (chronic) exposure over many years may cause the following:
Formaldehyde is used as a disinfectant or sterilant. It is commonly used as a preservative in medical laboratories and mortuaries. Formaldehyde is also used to prepare viral vaccines, as an embalming agent, a tissue fixative, and in the sterilization of medical equipment. Paraformaldehyde, a solid polymer of formaldehyde, can be heat vaporized for the gaseous decontamination of laminar flow biologic safety cabinets. Additionally, formaldehyde is often found mixed in water and referred to as formalin.
Healthcare workers may be harmed by exposure to formaldehyde. It can irritate the skin, throat, lungs, and eyes. Repeated exposure to formaldehyde can possibly lead to cancer. The level of exposure depends on the dose, duration, and the work being done.
Glutaraldehyde is a toxic chemical that is used as a cold sterilant to disinfect and clean heat-sensitive medical, surgical, and dental equipment. Glutaraldehyde is also used as a tissue fixative in histology and pathology labs and as a hardening agent in the development of x-rays.
Glutaraldehyde is used in a limited number of applications, rather than just as a general disinfectant. Specific applications include:
Mercury is naturally occurring and exists in several forms. High mercury exposure results in permanent nervous system and kidney damage.
Employee exposure to mercury from accidental spills can occur during repair of broken thermometers, sphygmomanometers, or during sterilization and centrifugation of thermometers in maintenance areas. Mercury can also be found in some pressure-sensing instruments (e.g., barometers and sensors in machine rooms), as well as electronic equipment, and some older, medical devices. When mercury is exposed to the air, as in the case of a spill, it slowly vaporizes.
If spills are not promptly cleaned up, mercury may accumulate on surfaces and then vaporize and be inhaled by unaware workers. Mercury can also be absorbed through the skin.
A wall-mounted blood pressure unit in a doctor's office examination room failed spilling mercury on the tiled floor. The facility closed the room and hired a contractor to clean up the mercury. After cleanup, air sampling results indicated that mercury was still present. When facility staff called the State Health Department for advice, the Department conducted further air sampling and located additional beads of mercury. In all, it took the contractor several days and three cleaning cycles to completely remove all the mercury and decontaminate the office.
Acute (short term) exposure: Acute exposure to high levels of mercury can cause severe respiratory irritation, digestive disturbances, and marked renal damage. Acute inhalation of mercury vapor may also result in health issues, including:
Chronic (long term) exposure: Chronic exposure to mercury may result in the following:
The anesthetic gases and vapors that leak into the surrounding room during medical procedures are considered waste anesthetic gases. Healthcare professionals who work in hospitals, operating rooms, dental offices, and veterinary clinics, are potentially exposed to waste anesthetic gases and are at risk of occupational illness.
The waste anesthetic gases and vapors of concern are:
Exposure to these gases can occur through leakage of the patient's anesthetic breathing circuit during the delivery of anesthetic and through exhalations of patients recovering from anesthesia.
Some potential effects of exposure to waste anesthetic gases include the following:
Employers and employees should be aware of the potential effects and be advised to take appropriate precautions.
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