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Course 772 - Introduction to Safe Patient Handling

Safety guides and audits to make your job as a safety professional easier

Other Hazards

Introduction

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.

Hazardous Chemicals

Ethylene Oxide

Ethylene oxide (EtO) is a flammable, colorless gas at temperatures above 51.3 degrees F (10.7 degrees C). It 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. click on the button to see more information on the consequences of short- and long-term exposure to ethylene oxide.

Short-term exposure to EtO gas may result in:

  • respiratory irritation and lung injury,
  • headache, nausea, diarrhea, vomiting,
  • shortness of breath, and cyanosis.

Long-term exposure has been associated with the occurrence of:

  • cancer, reproductive effects,
  • mutagenic changes,
  • neurotoxicity, and sensitization.

1. What does it mean if you can smell ethylene oxide?

a. You should leave the area within 15 minutes
b. It is normal to smell ethylene oxide
c. You are being exposed to toxic levels of the gas
d. You are smelling something else because it's odorless

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Updated 1/15/2022

Formaldehyde

Formaldehyde is classified as a human carcinogen. 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).

Short-term exposure to formaldehyde can be fatal. Long-term exposure to low levels of formaldehyde may cause respiratory difficulty, eczema, and sensitization. More information

Glutaraldehyde

Glutaraldehyde is used as a cold sterilant to disinfect and clean heat-sensitive equipment such as dialysis instruments, surgical instruments, suction bottles, bronchoscopes, endoscopes, and ear, nose, and throat instruments. It is a colorless, oily liquid with a pungent odor. Hospital workers use it most often in a diluted from 1% to 50% mixed with water. More information

The following health effects have been reported in hospital workers exposed to glutaraldehyde:

  • Throat, nose, and lung irritation
  • Asthma, asthma-like symptoms, and breathing difficulty
  • Burning eyes and conjunctivitis
  • Rash-contact and/or allergic dermatitis
  • Hives, headaches, and nausea

2. Which of the following chemicals is classified as a human carcinogen?

a. Dihydrogen Oxide
b. Ether
c. Formaldehyde
d. Gluteraldehyde

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Hazardous Drugs

haz drugs

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.

Both clinical and nonclinical workers may be exposed to hazardous drugs when they create aerosols, generate dust, clean up spills, or touch contaminated surfaces during the preparation, administration, or disposal of hazardous drugs.

Exposure Routes

There are four major routes of entry chemicals can follow:

  1. inhalation (breathing),
  2. absorption (skin contact),
  3. ingestion (eating), and
  4. injection.

Inhalation, skin contact, or absorption are the most likely routes of exposure. However, ingestion from hand to mouth contact and unintentional injection through a needle-stick or sharps injury are also possible.

Click on the button to see an example of how an healthcare employee might be exposed to toxins while performing normal tasks.

Case Study

A patient-care assistant working on an oncology floor developed an itchy rash approximately 30 minutes after emptying a commode of urine into a toilet. She denied any direct contact with the urine, wore a protective gown and nitrile gloves, and followed hospital policy for the disposal of materials contaminated with antineoplastic drugs. The rash subsided after 1 to 2 days. Three weeks later, she had a similar reaction approximately 1 hour after performing the same procedure for another patient.

Upon investigation, it was found that both hospital patients had recently been treated with vincristine and doxorubicin. The patient-care assistant had no other signs or symptoms and reported no changes in lifestyle and no history of allergies or recent infections. After treatment with diphenhydramine (intramuscular) and oral corticosteroids, her symptoms disappeared. Although the cause could not be definitely confirmed, both vincristine and doxorubicin have been associated with allergic reactions when given to patients. The aerosolization of the drug present in the urine may have provided enough exposure for symptoms to develop.

3. Which of the following is NOT listed as one of the three most likely routes of exposure to hazardous drugs when handling patients?

a. Inhalation
b. Absorption
c. Skin contact
d. Injection

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Developing a List of Hazardous Chemicals

haz drugs
It is necessary to identify all hazardous chemicals a worker may encounter in the facility.

The OSHA 1910.1200, Hazard Communication standard requires employers to develop a hazard communication program appropriate for their unique workplace. An essential part of the program is the identification of all hazardous chemicals a worker may encounter in the facility. All employers with hazardous chemicals in their workplaces must:

  • have appropriate chemical container labels
  • safety data sheets (SDSs) for their exposed workers, and
  • training for all exposed workers on how to handle the chemicals appropriately.

All labels are required to have pictograms, a signal word, hazard and precautionary statements, the product identifier, and supplier identification.

All labels are required to have pictograms, a signal word, hazard and precautionary statements, the product identifier, and supplier identification.

The SDS is the best source of information such as the properties of specific chemicals; the physical, health, and environmental health hazards; protective measures; and safety precautions for handling, storing, and transporting chemicals.

Employers must provide employees with effective information and training on hazardous chemicals in their work area at the time of their initial assignment, and whenever a new chemical hazard the employees have not previously been trained about is introduced into their work area.

For more information on OSHA's hazardous communication standard, see OSHAcademy course 705 Hazard Communication Program.

4. What is the best source of information on chemical properties; the physical, health, and environmental health hazards; protective measures; and safety precautions for handling specific chemicals?

a. NIOSH/CDC regulations
b. OSHA Publications
c. Safety Data Sheets (SDS)
d. Third-party consultants

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Assess the Hazards in the Workplace

Evaluate the workplace to identify and assess hazards before anyone begins work with hazardous drugs.

Click on the button to see a list of items that should be assessed when determining hazards.

  • total working environment
  • equipment (i.e., ventilated cabinets, closed-system drug transfer devices, glovebags, needleless systems, and PPE)
  • physical layout of work areas
  • types of drugs being handled
  • volume, frequency, and form of drugs handled (tablets, coated versus uncoated, powder versus liquid)
  • equipment maintenance
  • decontamination and cleaning
  • waste handling
  • potential exposures during work, including hazardous drugs, bloodborne pathogens, and chemicals used to deactivate hazardous drugs or clean drug-contaminated surfaces
  • routine operations
  • spill response
  • waste segregation, containment, and disposal

Make sure to regularly review the current inventory of hazardous drugs, equipment, and practices, seeking input from affected workers. Have the safety and health staff or an internal committee perform this review.

5. When should an assessment of hazardous drugs be conducted?

a. As scheduled by safety and health staff
b. Before and after each use of the hazardous drug
c. Before anyone begins work with hazardous drugs
d. Initially and annually thereafter

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Handling Drugs Safely

handling drugs
Implement a program for safety handling hazardous drugs at work.

Implement a program for safety handling hazardous drugs at work. Establish work policies and procedures for handling specific hazardous drugs.

Provide training for:

  • handling hazardous drugs safely
  • cleaning up spills
  • using all equipment and personal protective equipment (PPE) properly

Review the program annually on the basis of the workplace evaluation.

Use and Maintain Equipment Properly

Make sure to develop workplace procedures for using and maintaining all equipment that functions to reduce hazardous drug exposure.

These include:

  • ventilated cabinets
  • closed-system drug-transfer devices
  • needle-less systems
  • PPE

6. Review the hazardous drug handling program ____.

a. continuously
b. weekly
c. monthly
d. annually

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Waste Anesthetic Gases

gases
Waste anesthetic gases are small amounts of volatile anesthetic gases that leak during the delivery of anesthesia.

Waste anesthetic gases are small amounts of volatile anesthetic gases that leak from the patient’s anesthetic breathing circuit into the air of operating rooms during delivery of anesthesia. These gases may also be exhaled by patients recovering from anesthesia.

Waste anesthetic gases include both nitrous oxide and halogenated anesthetics such as:

  • halothane
  • enflurane
  • isoflurane
  • desflurane
  • sevoflurane
  • methoxyflurane (no longer used in the United States)

The halogenated anesthetics are often administered in combination with nitrous oxide. Nitrous oxide and some of the halogenated anesthetics may pose a hazard to hospital workers.

7. Which of the following is a waste anesthetic gas that might be exhaled by patients recovering from anesthesia?

a. Nitrous oxide
b. Oxygen
c. Carbon Dioxide
d. Helium

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Updated 1/15/2022

Radiation

xray
Exposure to radiation from portable and fixed X-ray machines used for diagnostic procedures is a potential risk.

Exposure to radiation from portable and fixed X-ray machines used for diagnostic procedures is a potential risk. Exposure occurs when unprotected employees are near a machine in operation. The degree of exposure depends on:

  • amount of radiation
  • duration of exposure
  • distance from the source
  • type of shielding in place

The health effects of radiation exposure are somatic (body) and/or genetic (offspring) in nature. The effects may be acute (short-term) or chronic (long-term)

  • Acute: Erythema and dermatitis. Large whole-body exposures cause nausea, vomiting, diarrhea, weakness, and death.
  • Chronic: Skin cancer and bone marrow suppression. Genetic effects may lead to congenital defects in the employee's offspring.

Most control methods to prevent or reduce exposure to radiation involve engineering controls which take advantage of the energy absorption and scattering qualities of lead. Click on the button to see examples of possible solutions to the risk of exposure to radiation.

  • Equip X-ray rooms with a barrier wall with a lead-platted glass window so technician can step behind barrier wall to take the x-ray, and avoid radiation exposure.
  • Lead plated glass is also used as a barrier to protect against radiation exposure when procedures must be done close to the patient.
  • Lead strips provide some protection from radiation exposure for employee running fluoroscopy procedures.
  • Lead aprons and lead gloves offer some protection for employees and patients and should be worn in the direct x-ray field. Opaque goggles are to be worn in the direct x-ray field.

8. Most control methods to reduce exposure to radiation involve the absorption and scattering qualities of _____.

a. silver
b. lead
c. water
d. wood

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Updated 1/15/2022

Latex Allergies

What is a latex allergy? - AAAAI Video

An allergy to latex (also known as rubber or natural latex) 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.

Click on the button to see a partial list of common products containing latex. You can prevent an allergic reaction by avoiding these products.

  • Dishwashing gloves
  • Some types of carpeting
  • Some disposable diapers
  • Blood pressure cuffs
  • Stethoscopes
  • Intravenous tubing
  • Syringes
  • Respirators
  • Electrode pads
  • Surgical masks
  • Dental dams

Click on the button to see examples of mild, serious, and life-threatening symptoms of exposure to latex.

Mild

  • Itching
  • Skin redness
  • Hives or rash

Serious

  • Sneezing
  • Runny nose
  • Itchy, watery eyes
  • Scratchy throat
  • Difficulty breathing
  • Wheezing
  • Cough

Life-threatening

  • Anaphylaxis – develops immediately after latex exposure in highly sensitive people, but it rarely happens the first time you're exposed. Signs and symptoms of anaphylaxis include:
    • Difficulty breathing
    • Hives or swelling
    • Nausea and vomiting
    • Wheezing
    • Drop in blood pressure
    • Dizziness
    • Loss of consciousness
    • Confusion
    • Rapid or weak pulse

To reduce exposure to latex-containing products, the employer must ensure that appropriate personal protective equipment (PPE) is readily accessible and issued to employees. Click on the button to see examples of appropriate PPE for employees who are allergic latex gloves.

  • Hypoallergenic gloves
  • Glove liners
  • Powderless gloves

Some alternatives to latex include synthetic, low protein, and powder-free gloves. Powder-free gloves may reduce systemic allergic responses.

9. _____ gloves may reduce allergic reactions to latex.

a. Blue
b. Powder-free
c. Hospital-safe
d. Allergy-free

Check your Work

Read the material in each section to find the correct answer to each quiz question. After answering all the questions, click on the "Check Quiz Answers" button to grade your quiz and see your score. You will receive a message if you forgot to answer one of the questions. After clicking the button, the questions you missed will be listed below. You can correct any missed questions and check your answers again.

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