Chemicals in the Healthcare Workplace: What Will They Do to You?
By: Kelly D. Ogle, BSDH, MIOP, CMPM, CHOP®
Director of OSHA and HIPAA Services
…this time she found a little bottle…and round the neck of the bottle was a paper label, with the words “DRINK ME” beautifully printed on it in large letters. It was all very well to say “Drink Me,” but the wise little Alice was not going to do that in a hurry. “No, I’ll look first,” she said, “and see whether it’s marked ‘poison’ or not.” However, this bottle was not marked “poison,” so Alice ventured to taste it… – Lewis Carroll’s Alice’s Adventures in Wonderland
Unfortunately, no hazard icons with red diamond outlines were on Alice’s bottle label. We all know what happened to Alice next; she shrunk to ten inches tall! Ingesting an unknown liquid had an interesting outcome for this storybook character, perhaps, but it is strictly an ill-advised practice for a real-life healthcare employee!
How Do You Get Exposed?
It is doubtful that anyone in the practice would swig a chemical product straight from its container, but ingestion can occur if chemicals are sloshed, splashed, splattered, sprinkled, aerosolized or spilled. This is true of chemicals in liquid, powder or gel form. Swallowing a hazardous chemical product is one way of getting it into the system, but don’t forget that some chemicals can be just as hazardous if they are inhaled or absorbed through soft tissues (such as the eyes, nose or mouth) or the skin (intact or broken skin). Chemicals can also be easily transferred from the hands to the face—or to anywhere else on the body. Bear in mind that when it comes to chemical exposure, there may be short-term as well as long-term effects for the exposed employee.
In the course of your daily routine, it is easy to overlook ways that you could be exposed to injurious chemicals. Did you
- prick yourself with a syringe after drawing up some medication to administer to a patient?
- get in a hurry pouring a product from the manufacturer’s container into smaller containers to distribute and did you spill some?
- accidently breathe in a chemical?
- spray disinfectant on an exam table, dental chair or countertop?
- pour a chemical down the sink?
- splash sterilant onto your skin when opening a container of soaking instruments?
- walk through a spill and maybe get some on your clothes?
- fail to read the SDS for the spilled chemical and follow proper protocol to clean it up?
- neglect to wear gloves and other appropriate PPE when you handled a chemical product?
- wash your hands after you handled that product?
Chemical exposure can occur in many varied and unremarkable ways!
Hazard Controls for Chemical Ingestion/Absorption
The outcome for someone who ingests (or otherwise absorbs) chemicals in a medical or dental setting is highly subject to the chemical ingested or absorbed, of course. Unlike Alice, healthcare workers can benefit by reading—and heeding—the chemical label provided by the product manufacturer and by using the right PPE and any other appropriate measures to handle that product. The label the product came with includes hazard(s) identification, outlining specific organs that are targeted and at risk when someone is exposed to that product. Also unlike Alice, an employee further benefits from their employer’s thorough hazcom training.
Employees have a right to know how the chemicals present in their work environment will affect them and what they can do to protect themselves from those chemical hazards. OSHA requires employee hazard training on the specific chemicals used in the workplace. During the training, it is not enough to just mention in passing that all chemicals have SDSs and where the SDS binder is kept. Employees need to know about the specific chemicals they work with and what injuries those can cause. The most egregious hazardous chemicals present should be named and their hazards should be discussed; this should be followed by time allowed for questions. Beyond that, it is appropriate to mention that less hazardous chemicals (e.g., rubbing alcohol) are also present and that their information is also included in the SDS binder, which is available to all employees. Our recommendation: It would not hurt to have SDSs on the egregious chemical products at the training session for review. SDSs for extremely hazardous products could even be copied and handed out (or highlighted on PowerPoint presentation slides) so employees can see for themselves what they are up against. A list of some particularly hazardous healthcare chemicals is on page 4.
Some Particularly Hazardous Healthcare Chemicals
So, what will certain chemicals do to you if they are absorbed or taken internally? The list of chemicals used in healthcare is far too great to include all of them, but below is a list of ten examples of hazardous products in fairly wide use in healthcare, along with the hazards associated with their use. For your own personal safety, be sure to review the chemical information specific to the chemical inventory in your workplace!
- Adrenaline (A.K.A. Epinephrine)
Hazards: Can cause transient/moderate anxiety, feelings of over-stimulation, restlessness, headache, tremor,
weakness, shakiness, dizziness, sweating, increased heart rate, palpitations, paleness, nausea, vomiting, diffi-
culty breathing, high blood pressure, cardiac arrhythmias, cerebral bleeding, and can adversely affect a fetus
Hazards: Extremely flammable, pressurized container may burst; suspected of damaging fertility or the unborn child; may cause drowsiness or dizziness; may cause central nervous system or organ damage through prolonged or repeated exposure; causes skin irritation; may be fatal if it is swallowed and enters airways
- Cefozolin for Injection
Hazards: Causes eye irritation; may cause allergic skin reaction or asthmatic symptoms or breathing difficulties if inhaled; may cause damage to organs through prolonged or repeated exposure, including the gastrointestinal system, liver, kidneys, blood and skin
- Chloroacetic Acid
Hazards: Can cause target organ effect on the central nervous system, heart, skeleton, muscles, and kidneys; toxic by ingestion; toxic by skin absorption; corrosive, causes severe skin burns and eye damage
Hazards: Can cause eye damage/irritation; may cause cancer; has flammable aerosol
Hazards: Fatal if swallowed; causes damage to organs through prolonged or repeated exposure; harmful if inhaled; causes skin irritation; may cause allergic skin reaction; may cause respiratory irritation, drowsiness or dizziness; causes eye irritation
- Ethyl Alcohol (A.K.A. Ethanol)
Hazards: Highly flammable; can cause eye damage/eye irritation; targets the central nervous system, kidneys, liver, and blood; causes drowsiness or dizziness and damage to organs through prolonged or repeated exposure
Hazards: Acutely toxic if swallowed or inhaled; causes severe burns and eye damage; may cause allergic skin reaction, allergy symptoms or breathing difficulties if inhaled
Hazards: Fatal if inhaled; may damage fertility or the unborn child; causes damage to organs through prolonged or repeated exposure
- Surgical Instrument Cleaner
Hazards: Causes eye irritation, mild skin irritation; suspected of causing cancer