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:
- pharmacy and nursing personnel
- physicians
- operating room personnel
- environmental services workers
- workers in research laboratories
- veterinary care workers
- shipping and receiving personnel
- janitorial staff
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.
- Agents with any of the following characteristics are considered hazardous: carcinogens, corrosives, toxic or highly toxic, irritants, sensitizers, or target organ effectors.
- Provide readily available Safety Data Sheets (SDSs) for all hazardous chemicals.
- Clearly label all hazardous chemicals, such as those found in some soaps, disinfectants, and pesticides, as hazardous. [29 CFR 1910.1200(f)]
- Train workers in potential chemical hazards and controls (engineering controls, work practices, and PPE) necessary to prevent hazards in the work area. [29 CFR 1910.1200(h)(3)
Hierarchy of Controls
Workers can be protected from exposures to hazardous drugs through engineering controls, administrative controls, and personal protective equipment.
- Engineering Controls: Engineering controls include biological safety cabinets (BSC), compounding aseptic containment isolators, closed system transfer devices, and needleless systems. Engineering controls are the most effective way to control exposure to hazardous chemicals by preventing exposure from occurring.
- Administrative Controls: Administrative controls include implementing work practices, management policies, and training programs to reduce worker risk. A medical monitoring program serves as a form of secondary prevention by identifying indicators of exposure or early disease.
- Personal Protective Equipment: Employers are required to provide appropriate PPE, such as gloves, goggles, and splash aprons when employees are handling hazardous chemicals. [29 CFR 1910.132] PPE is the least effective control method because it relies on employee behaviors to prevent exposure.
Medical Services and First Aid
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
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 the 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:
- 3% did not always use anesthesia machines equipped with a waste gas scavenging system
- 35% started anesthetic gas flow before mask was applied to pediatric patient and 14% did the same for adult patients.
- 19% reported safe handling procedures were unavailable.
- 18% never received training on safe handling of anesthetic gases.
- 17% used a funnel-fill (open-air) system instead of a key-filler or other closed system to fill anesthesia vaporizers.
- 17% used high (fresh gas) flow anesthesia only for pediatric patients and 6% did the same for adult patients.
- 5% did not routinely check anesthesia equipment for leaks.
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 are initially and periodically trained
- safe-handling procedures reflecting recommended practices are in place
- anesthesia machines with scavenging systems are used (including regular inspection of anesthesia delivery equipment for leaks, periodic air and exposure monitoring prompt elimination of spills and leaks)
- medical surveillance, exposure monitoring, and other administrative controls are in place
Anesthesia care providers should seek out training, understand and follow facility procedures, ask questions, and report any safety concerns.
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