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Course 772 - Introduction to Safe Patient Handling

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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.

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.

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 where glutaraldehyde is used in operations such as:

  • cold sterilization
  • high-level disinfection
  • tissue fixing
  • preservation (e.g., for microscopy or histology)
  • process of x-rays

Hazardous Drugs

haz 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.

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.

The following list of activities may result in exposures through inhala¬tion, skin contact, ingestion, or injection:

  • expelling air from syringes filled with hazardous drugs
  • administering hazardous drugs by intra¬muscular, subcutaneous, or intravenous (IV) routes

Exposure Routes

Exposures to hazardous drugs may occur through inhalation, skin contact, skin absorption, ingestion, or injection. Inhalation and skin contact and absorption are the most likely routes of exposure, but unintentional ingestion from hand-to-mouth contact and unintentional injection through a needle-stick or sharps injury are also possible.

Case Report

A 41-year-old 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.

Generating a List of Hazardous Drugs

The OSHA hazard communication standard [29 CFR 1910.1200] 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 drugs a worker may encounter in the facility. Compliance with the OSHA hazard communication standard entails:

  1. evaluating whether these drugs meet one or more of the criteria for defining hazardous drugs
  2. posting a list of the hazardous drugs to ensure worker safety

For more information on OSHA’s hazardous communication standard, click here for OSHAcademy course 705.

Recommended Procedures

Assess the Hazards in the Workplace

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

As part of this evaluation, assess the following:

  • 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, in¬cluding 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.

Handling Drugs Safely

handling drugs

Implement a program for safety handling hazardous drugs at work and review this program annually on the basis of the workplace evaluation. Make sure to establish work policies and procedures specific to the handling of hazardous drugs.

Also, establish procedures and provide training for:

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

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

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.

Radiation

xray

Potential Hazard

One potential hazard involves the exposure to radiation from portable and fixed X-ray machines as they are used for diagnostic procedures.

Potential health effects of radiation exposure are somatic (body) and/or genetic (offspring) in nature.

  • 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.

Radiation 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

Possible Solutions

  • 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.

Latex Allergies

latex

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.

Potential Hazard

Workers exposed to latex gloves and other products containing natural rubber latex may develop allergic reactions such as skin rashes; hives; nasal, eye, or sinus symptoms; asthma; and (rarely) shock.

Possible Solutions

The employer shall ensure that appropriate personal protective equipment, in the appropriate sizes, is readily accessible at the worksite or is issued to employees. Hypoallergenic gloves, glove liners, powderless gloves, or other similar alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided.

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

VIDEO

Instructions

Before beginning this quiz, we highly recommend you review the module material. This quiz is designed to allow you to self-check your comprehension of the module content, but only focuses on key concepts and ideas.

Read each question carefully. Select the best answer, even if more than one answer seems possible. When done, click on the "Get Quiz Answers" button. If you do not answer all the questions, you will receive an error message.

Good luck!

1. Exposures to hazardous drugs may occur through _____.

2. Which is NOT the MOST likely route of exposure to hazardous drugs?

3. These gases may also be exhaled by patients recovering from anesthesia.

4. The degree of radiation exposure depends on ____.

5. _____ gloves may reduce allergic reactions to latex.


Have a great day!

Important! You will receive an "error" message unless all questions are answered.