Chemical Hazards Risk Factors

What increases risk

Aerosolized medications

Aerosolized medications treat respiratory diseases and infections. These medications use a nebulizer or other type of aerosol generator when given to patients. Healthcare workers can be exposed to aerosolized medications during treatments.

How employers and employees can reduce exposure

Wear protective gloves and gowns to avoid skin contact with hazardous drugs. Wear appropriate respiratory protection during activities where hazardous drug aerosols are generated.

Use aerosol delivery devices with inspiratory and expiratory one-way valves and with an expiratory filter.

Anesthetic gases

General anesthesia prevents patients from feeling pain during surgery. Waste anesthetic gases (WAGs) are anesthetic gases and vapors that leak into the surrounding room during anesthesia procedures. Healthcare workers who are exposed to WAGs may have adverse health effects. Acute exposure to halogenated anesthetics can cause:

• Headache.
• Fatigue.
• Irritability.
• Drowsiness.
• Difficulties with judgment and coordination.

Long-term exposure to halogenated anesthetics may cause harmful reproductive effects and cancer.

How employers and employees can reduce exposure

• Use anesthesia machines with scavenging systems; older machines may not be equipped with such systems.
• Use closed system or low flow anesthesia instead of high flow anesthesia when administering anesthetic gases to patients, when practicable.
• Start anesthetic gas flow after applying delivery mask or airway mask to patient.
• Use a key-filler or other closed-system device when filling anesthesia vaporizers. This minimizes exposure to halogenated anesthetics from spills and vaporization.
• Provide employees initial and annual refresher training on anesthetic gas hazards and ways to minimize exposure.
• Ensure employees can easily find the anesthetic gas safe handling procedures.

Antineoplastic drugs

Antineoplastic drugs treat cancer, arthritis, multiple sclerosis, and other non-cancer medical conditions. Chemotherapy, cytotoxic, and oncology drugs are also antineoplastic drugs. NIOSH classifies most antineoplastic drugs as hazardous. Many are carcinogens with no safe level of exposure. Examples of workers who are at risk include:

• Pharmacists.
• Veterinarians.
• Veterinary technicians.
• Custodial workers.
• Nurses.
• Nursing aids.

Job tasks at most risk include:

• Preparing and administering these drugs.
• Shipping and receiving these drugs.
• Laundering linens and towels.
• Handling patient bodily waste (including animal patients).
• Cleaning areas where drugs have been handled.

Healthcare workers exposed to chemotherapy drugs have increased risk of:

• Leukemia.
• Other cancers.
• Adverse reproductive outcomes.
• Chromosomal damage.

How employers and employees can reduce exposure

• Avoid skin contact with liquid antineoplastic drugs.
• During administration or compounding activities, always wear chemotherapy gloves and a nonabsorbent gown with a closed front and tight-fitting cuffs.
• When administering, prime IV tubing with a non-hazardous drug containing liquid.
• Use supplementary engineering controls to reduce likelihood of exposure to liquid or aerosolized antineoplastic drugs. Closed system drug-transfer devices and needleless systems are two examples of engineering controls.
• When preparing antineoplastic drugs use a biological safety cabinet.
• Provide training to employees on the hazards of antineoplastic drugs and safe handling precautions to minimize exposure. Provide information and training at the time of initial job assignment and annually.
• Provide medical surveillance for employees exposed to hazardous drugs and encourage them to participate.

Chemical sterilants

Chemical sterilants treat surgical instruments and medical supplies so that patients are not exposed to pathogens. Though chemical sterilants are important for patient care, they can be hazardous to healthcare workers.

Common chemical sterilants used in healthcare include:

• Ethylene oxide (EtO).
• Hydrogen peroxide gas plasma (HPGP).
• Vaporized hydrogen peroxide.
• Immersion and vapor phase peracetic acid (PAA).

Acute exposure to EtO can cause:

• Respiratory irritation.
• Headache.
• Nausea.
• Shortness of breath.

Chronic exposure to EtO can cause:

• Cancer.
• Reproductive effects.
• Mutagenic changes.
• Neurotoxicity.
• Sensitization.

Acute exposure to HPGP and PAA may cause:

• Upper respiratory tract irritation.
• Skin irritation when there is contact with liquid solutions.

How employers and employees can reduce exposure

• Train employees on the hazards of EtO, HPGP, and PAA prior to working with these and other sterilants.
• Ensure employees have access to standard operating procedures for the safe use of these sterilants.
• Hospital employers need to use a single chamber sterilization process for EtO. For example, the sterilization and aeration take place in one unit. EPA prohibited the use of separate units in March 2010. This was done to eliminate EtO exposure while transferring the load from the sterilizer to the aerator.

High-level disinfectants

High-level disinfectants (HLDs) chemically disinfect reusable medical and dental devices. HLDs prevent healthcare-associated infections among patients.

Food and Drug Administration (FDA)-cleared HLDs contain one or more of these ingredients (this is not a full list):

• Glutaraldehyde
• Ortho-Phthaldehyde
• Peracetic acid
• Hydrogen peroxide
• Hypochlorous acid
• Hypochlorite

Acute health effects of exposure to HLDs include:

• Dermatitis.
• Mucous membrane irritation.
• Skin and respiratory tract irritation.
• Aggravation of pre-existing asthma and asthma-like symptoms such as wheezing and shortness of breath.

Chronic exposure to HLDs may cause asthma and asthma-like symptoms or reproductive effects. Research has shown hydrogen peroxide may be mutagenic in animals.

How employers and employees can reduce exposure

• Ensure employees are trained on HLD hazards. Before working in an area that uses HLDs, train employees to use best practices to minimize HLD exposure.
• Ensure spill kits are available for appropriate clean-up of HLD spills.
• Employees should wear protective gloves and water-resistant gown or outer garment when handling HLDs.

Nitrous oxide

Dental practitioners may be exposed to excessive levels of nitrous oxide when recommended controls aren't used or used properly. This includes:

• Engineering controls (e.g., patient nasal scavenging mask or local exhaust ventilation (LEV) near the patient's mouth).
• Administrative controls.
• Work practice controls.

Acute exposure to nitrous oxide may cause:

• Lightheadedness.
• Eye and upper airway irritation.
• Cough.
• Shortness of breath.
• Decreases in mental performance and manual dexterity.

Chronic exposure to nitrous oxide may cause:

• Increased risk of neurologic, renal, and liver disease.
• Increased risk of miscarriage and fertility issues.

How employers and employees can reduce exposure

• Use a soap solution to test for connection leaks every day before first use and whenever you change a gas cylinder.
• Start nitrous oxide gas flow after placing a nasal mask over the patient's nose.
• Turn off nitrous oxide gas flow before turning off oxygen flow to the patient.
• Ensure employees can easily find the nitrous oxide safe handling procedures.
• Provide initial and yearly refresher training on nitrous oxide exposure health effects and ways to minimize exposure.

Resources

CDC

Guideline for Disinfection and Sterilization in Healthcare Facilities

Environmental Protection Agency

Ethylene Oxide in Hospitals and Healthcare Facilities

Occupational Safety and Health Administration

• Anesthetic Gases: Guidelines for Workplace Exposures
• Controlling Occupational Exposures to Hazardous Drugs
• Hazardous Drugs
• Laser/Electrosurgery Plume