Environmental Health & Safety

Hazard Communication Program for Strong Memorial Hospital

Prepared by: Environmental Health & Safety
(Revised 2022)

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SECTION 3: CHEMICALS - HAZARDS AND EMERGENCY RESPONSE

COMMON CHEMICALS / HAZARDOUS DRUGS
This section is designed to provide information of common chemicals used by medical staff in a clinical setting. This section might not include all chemicals used in specialty medical areas but it is designed to cover the majority of chemicals encountered. Those chemicals used that are not listed need to be reviewed by the supervisor so the hazards and means of protection can be established and explained to the employees.

Some chemicals in this section present potential reproductive hazards to personnel working with them. The University's Reproductive Policy should be consulted prior to the use of these chemicals.

Radionuclides, including radioactive iodine and implanted radioactive seeds, are not covered under this program. Contact the Radiation Safety Unit at 275-3781 for information on the hazards and safety precautions for these materials.

Chemicals common to medical care personnel
The chemicals and chemical groups medical staff most commonly comes in contact with are the following:
Information on chemicals/groups can be found in the University's Chemical Inventory/SDS System MSDSOnline or the manufacturer's website. A brief summary of the chemicals/groups follows:
1. Antineoplastic Agents
  Strong Memorial Hospital Policy 7.10 entitled Hazardous Drug Agent Handling Policy can be found in the SMH Policy Manual. This policy is designed to inform nurses and other staff on the precautions and safe handling procedures necessary to properly administer these agents. The policy has information regarding the routine use, administration, clean-up of spills, and disposal of excreta from patients being treated with these agents. The policy covers all antineoplastic agents used at SMH.
2. Disinfecting Agents
  Disinfecting Agents are used by employees to disinfect instruments, contaminated surfaces and other items to prevent the spread of organisms and infection. Some cold disinfecting agents contain chemicals such as glutaraldehyde, which may have adverse health effects associated with them. High Level Disinfectants (HLDs) containing chemicals such as aldehydes (e.g. glutaraldehyde, o-phthalaldehyde), should be used in well-ventilated areas.
  
  These areas must be pre-approved by Infection Prevention and EH&S. The potential for skin contact or breathing vapors should be minimized.
  
  When performing duties with the potential of creating splashes or sprays, proper eye protection must be worn to prevent eye contact with the chemicals. Appropriate gloves and gowns / lab coats must be used to minimize dermal exposures. Disinfecting agents should be sprayed onto a cloth whenever possible instead of spraying directly on surfaces to minimize the amount of chemical aerosolized.
3. Housekeeping Chemicals
  Housekeeping Chemicals are used by staff for spot cleaning or by Environmental Services or Patient Care Technicians. Environmental Services maintains SDSs for all of the chemicals they use in SMH. In general the majority of chemicals used by Environmental Services are low hazard. Gloves are to be used to prevent dermal exposure. For those tasks where the risk of eye exposure is possible, safety glasses, goggles, or a face shield is required. The most hazardous chemicals, such as floor strippers, are used infrequently and require special precautions.
4. Anesthetic Gases
  Anesthetic Gases can be found in the operating rooms, labor & delivery, emergency department, outpatient clinics, dental surgery, and recovery rooms and may be found much less frequently in other areas. Anesthetic gases used include nitrous oxide, halothane, sevoflurane, and isoflurane.
  Anesthetic gases can be released and cause exposures by the following pathways: during hook-up and check-out of the system, gas seeping out of a patient's mask which does not fit properly, leaks in hoses fittings and other parts of the delivery system, gas escaping from scavenging systems (designed to capture excess and exhaled gas), and when a post-operative patient exhales gas into the room. The hazards associated with exposure to anesthetic gases are listed below.
  1. Nitrous Oxide
    Acute exposure by inhalation to high concentrations of nitrous oxide can cause central nervous system depression, drowsiness, lightheadedness, confusion, hysteria, anesthesia and unconsciousness. Chronic occupational exposure has been linked to neurologic problems, bone marrow depression, and kidney and liver disorders. Spontaneous abortions and fetal malformations have been reported in dentists and their assistants and linked to Nitrous Oxide exposure. Skin and eye exposure with liquid nitrous oxide can cause frostbite.
  2. Halogenated Anesthetic Gases
    These gases include Halothane, Sevoflurane, and Isoflurane. Acute exposure to these gases can cause respiratory depression, muscle relaxation and central nervous system effects including stupor, delayed response time and loss of consciousness. Waste anesthetic gases are considered chronic low-level health hazards. Suspected health effects include hepatic and renal diseases. Studies of health care workers have linked exposure to waste anesthetic gases with spontaneous abortions, fetal malformations, infertility and sterility when scavenging systems were not in use.
5. Compressed Gases/ Cryogenic Gases
  Compressed Gases, including cryogenic gases, can present both a physical and health hazard to personnel. Regardless of the chemical composition of the compressed gas, any cylinder or other container with pressurized contents presents a significant physical hazard if the gas is released uncontrollably. Read the label of the compressed gas cylinder to determine the contents and the possible health hazard it may present to you (e.g. simple asphyxiant, central nervous system depressant, corrosive, etc.).
  Cylinders also present a hazard to ankles, feet and toes when they are dropped or tipped over. All cylinders shall be fastened to a sturdy object with straps, chains or other devices. Two points of contact is preferred. All cylinders not being used are required to have a protective cap covering the cylinder valve. There is a training module on MyPath: EHS Compressed Gas Cylinder Training for Medical Care Personnel.
6. Mercury
  Elemental Mercury or silver mercury can be found in many types of medical care equipment including thermometers, Cantor tubes, Coulter counters and sphygmomanometers. Although most mercury containing items are no longer used at SMH, some isolated locations may still be using them because of special needs.
  Mercury is an odorless chemical that generates vapors at room temperature. The main route of mercury exposure is the inhalation of mercury vapors. Skin contact and ingestion of elemental mercury should also be avoided. Short-term exposure to high levels of mercury can cause severe respiratory irritation, digestive disturbances and renal damage. The health hazards associated with chronic exposure to relatively low levels of mercury vapor are significant and include central nervous systems effects, tremors, irritability, emotional instability, gingivitis, anorexia and weight loss. Mercury is also nephrotoxic and can cause sensitization dermatitis. Care should be taken to avoid exposure to mercury vapors and keep all areas free of mercury contamination.
  The proper clean up and disposal of mercury in the event of a spill is outlined in 20.10 Disposal of Mercury and Batteries on PolicyStat. Nurses are responsible for the clean-up of broken thermometers following the guidelines listed in the document. The amount of mercury in a thermometer is not enough to cause adverse health effects but must be properly cleaned up. Larger spills or releases of mercury such as a blood pressure manometer or a cantor tube are cleaned-up by emergency responders. Upon recognition of a broken manometer or other large source of mercury the nurse should relocate patient (if possible) and contact Public Safety (x13) for response by the University Spill Team. Quick response and clean up by properly trained staff limits the exposure to mercury vapors and prevents lingering problems of contamination. EH&S Occupational Safety Unit monitors mercury vapor levels in areas where spills of "mercury" manometers occur to verify the clean-up procedures removed all the mercury released from the spill. Consult the EH&S Mercury Spill Cleanup Proceduresy for more information.
7. Isopropyl Alcohol
  Isopropyl Alcohol is commonly used in medical applications as both an antiseptic and a disinfectant. In addition to being flammable, isopropyl alcohol can cause irritation to the eyes, nose and throat. It can cause defatting of the skin, which leads to irritation, drying and cracking. Contact dermatitis has also been noted. Exposure to high concentrations has a narcotic effect with symptoms of drowsiness, headache, staggering and unconsciousness.
8. Formaldehyde and Formalin Solutions
  Formaldehyde and Formalin Solutions are used in some patient care areas to fix tissue samples. Formaldehyde is prepared in aqueous solutions ranging in concentration up to 37%. Formaldehyde is considered a carcinogen by OSHA, NTP, IARC and ACGIH. A number of cancers have been associated with exposure to formaldehyde. However the strongest associations found concern nasal and nasopharyngeal cancer. Chronic exposure can result in lung cancer or reproductive effects.
  
  Acute exposure to formaldehyde can cause severe irritation of the skin, throat and nose. High levels can cause tissue damage and severe respiratory tract injury. Formaldehyde is also a pulmonary sensitizer. Specimen containers containing formaldehyde solutions should be handled carefully. Proper protective equipment should be worn and proper ventilation is required when there is a potential for exposure. In the event of a spill of a specimen container, soak up the spilled liquid with paper towels and place the debris in a sealed container for disposal as hazardous waste.
  
  EH&S has a written Formaldehyde Program and a Formaldehyde Spill Cleanup Protocol for Patient Care locations.
9. Prescription Drugs
  Prescription drugs and other pharmaceutical agents in a liquid form can present an opportunity for chemical exposure. Prescription drugs in solid form can present a potential for exposure if the materials are cut, crushed, or powdered. The hazards to personnel vary based on the concentration of the active ingredient and the route of exposure. The SDS for these liquid chemical agents and those agents that may be crushed or powdered must be made available in accordance with the OSHA Hazard Communication Standard and are available from the SMH Pharmacy.
10. Pentamidine
  Pentamidine is a drug that is administered primarily in aerosol form to patients being treated for Pneumocystis carinii pneumonia. Acute irritation has been noted in staff members exposed to the aerosol. Staff members administering Pentamidine should make efforts to minimize the release of aerosolized Pentamidine and limit the amount of time spent in the room where the drug is administered. Refer to the SMH's Pentamidine Policy, available on the web and SMH Policy Manual.
  The chronic health effects and reproductive effects are unknown at this time so care should be taken to minimize exposure to the drug.
11. Ribavirin
  Ribavirin is a drug used in aerosol form to treat lower respiratory tract infections caused by respiratory syncytial virus (RSV), and other diseases. Refer to the SMH Ribavirin Policy on Sharepoint for the proper administration of Ribavirin and precautions that are to be observed.
  Health care workers treating patients with Ribavirin in aerosolized form, without respiratory protection for a prolonged period, have complained of severe headache, eye irritation, coughing and upper respiratory tract irritation. Lung irritation, wheezing and shortness of breath has been noted in people with asthma. Ribavirin has also been found to be teratogenic and/or embryo lethal in studies on rodents. Currently there is no data on reproductive effects in humans. Pregnant employees or employees planning pregnancy should use the recommended procedures and personal protective equipment to limit exposure.

CLOSING COMMENTS

Information on chemicals is readily available to personnel through the University's Chemical Inventory / SDS System, Chematix. Product labels and SDSs contain valuable information on using chemicals safely, first aid and emergency procedures. In the event of a spill, call Public Safety at x13 and request the assistance of the University Chemical Spill Team. Should an exposure occur, personnel are to use the appropriate first aide. The Poison Control Center (800-222-1222) can provide useful information for further medical treatment that may be needed. Document the exposure by completing an Employee Incident Report.

If this guide raises questions, problems, or if you have suggestions for improvement, please contact Environmental Health & Safety at 275-3241

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QUESTIONS?
Contact the EH&S Occupational Safety Unit at 275-3241 or e-mail EH&S Questions.

This page last updated 10/6/2023. Disclaimer.

Environmental Health & Safety

Hazard Communication Program for Strong Memorial Hospital

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