14Protecting and preserving health at work while handling chemicals in a hospital setting, Dr. K....

Protecting and preserving health at work while handling

chemicals in a hospital setting

Dr.K.Shanthi Naidu

Consultant Clinical Biochemist &

HOD – Department of Laboratory Medicine

Care Hospital

Banjara Hills, Hyderabad

Screen all chemicals and processes for reactivity

Perform a Job Safety Analysis as needed

Implement practical controls for each identified reactive hazard

Provide high-level supervision of all reactive chemistry processes

Develop and follow specific written procedures for handling reactive chemicals

& processes

Work with the smallest quantity consistent with project goals

Establish specific procedures for exceeding established “High” limits

Investigate all out-of-normal events, regardless of the presence or absence of

adverse consequences

Establish and practice emergency procedures for run-away events

Use appropriate PPE properly

Provide appropriate fire suppression equipment

High risk work should be done with direct supervision

Guidelines for reactive chemical safety :

Label all containers, pipes, reactors, and vessels.

Maintain a current, accurate chemical inventory by identity, location, and

quantity.

Obtain, use, and make available a material safety data sheet for every chemical.

Train employees to recognize, control, and avoid chemical hazards.

Develop an attitude of safety awareness.

Every work area should have a person responsible for safety.

Dispose of chemical wastes according to accepted state regulations.

Post warning signs for unusual hazards.

Develop and implement a preventative maintenance program for all chemical

operations.

Follow proper workplace procedures. Be an example tofollow.

Special Chemical Safety

Use only chemicals required for a particular process. Do notsubstitute.

Identify chemical before use.

Review and understand hazards before using a chemical (msds).

Wear proper eye protection.

Follow proper workplace procedures.

Maintain and use required safety equipment.

Food, beverages, and tobacco are not to be brought into chemical use areas.

Maintain and use adequate personal decontamination equipment.

Keep workplace neat.

Develop an attitude of safety awareness.

Know the chemicals you use

Rules for handling chemicals safely :

Color and Number Coded Label Systems

NFPA-type labels

Black = specific hazard

• OX = Oxidizer

• ACID = Acid

• ALK = Alkali

• COR = Corrosive

• W = Use no water

• Other symbols:

1. Biological hazards – blood,

body fluids and other

potentially infectious

material (OPIM)

2. Chemical hazards

3. Physical hazards

4. Radiation hazards

Different types of

Hazards

Properties

Uses

Exposures

Monitoring

Compliance with

29 CFR 1910.1048

Keep away from heat, sparks, and sources of ignition.

Keep containers closed, except when in use.

Ground all metal drums and transfer vessels.

Maintain adequate ventilation.

Use labeled and proper safety cans and cabinets.

Maintain and use vapor suppressing solvent spill control media.

Maintain and know how to use abc fire extinguishers.

Minimize quantity of flammable chemicals in work area.

Rules for handling flammable chemicals safely :

Minimize exposures with engineering controls and administrative techniques.

Provide routine medical monitoring of employees.

Develop a regular chemical monitoring program inwork areas.

Install and maintain automatic monitors and alarms.

Wash your hands after handling chemicals.

Practice good personal hygiene around chemicals.

Do not smoke or bring tobacco products into chemical work areas.

Inform your supervisor or company medical personnel of drugs or medications

you are taking if you work in a chemical use area.

Use protective shields and guards as needed.

Use proper eye, face, hand, and body protection as needed.

Rules for handling toxic chemicals safely :

So, what is “highly toxic”?

• “Highly Toxic” is indicated by

– LD50 50 mg/kg body wt by ingestion to albino rats each

weighing between 200 to 300 gms

OR

– LD50 200 mg/kg by continuous contact for 24 hrs with skin

of albino rabbits each weighing between 2 and 3 kg

OR

– LC50 200 ppm of gas or vapor inhalation (or 2 mg/L of mist,

dust, or fumes) for one hour by albino rats each weighing

between 200 to 300 gms

Laboratory Hazards

• Storage of source

• Essential points in planning work

• Handling of sources

• Monitoring

• Decontamination of working area and equipment

• Personnel decontamination – Internal contamination

– External contamination

• Surface contamination

• Surface decontamination

Types of Laboratories

• Pathology

• Chemistry

• Biology

• Radiation

1. Inherent risk to workers

2. Difficult to measure and manage

3. Safety is not an intrinsic, absolute and measureable property

4. Accidents – attributable to persons inability to recognize,

hazardous situation

L:aboratory – Hazardous place to work

Chemical Labels

• Every container of chemicals is to labeled by the

manufacturer.

• The label information

– Physical and health hazards

– Precautionary measures

– First-aid instructions

– Proper handling/storage instructions

– Name, address and emergency phone

number of manufacturer

Health Hazards on a Chemical Label

• Carcinogen

• Highly toxic agent

• Toxic agent

• Irritant

• Corrosive

• Sensitizer

• Hepatotoxin

• Nephrotoxin

• Neurotoxin

• Keep away from sparks, heat, and flame

• Do not store near combustible materials

• Store in tightly closed container

• Remove and wash contaminated clothing promptly

• Keep from contact with clothing and other combustible

materials

Common Signal Words on Labels

• Danger – Can cause immediate serious injury or death

• Warning – Can cause potentially serious injury or death

• Caution – Can cause potentially moderate injury

Typical Precautionary Measures on a Label

• Do not breathe vapors

• Use in well-ventilated areas

• Keep container closed when not in use

• Avoid contact with skin

• Wash thoroughly with soap and water after handling

Glossary of Terms*

TLV-TWA = Threshold Limit Value-Time Weighted Average. Air

concentration under which most people can work for 8 hours a day.

PEL = Permissible Exposure Limit. OSHA enforced; 8 hour airborne

concentration.

PPM = Parts per million. Method of reading concentrations.

STEL = Short Term Exposure Limit. Amount to which persons may be

exposed for 15 minutes.

IDLH = Immediately Dangerous to Life & Health. Conditions which pose

an immediate threat to life or health.

UEL = Upper Explosive Limit. Greatest amount of vapor/gas mixed with

air where combustion can occur.

LEL = Lower Explosive Limit. Least amount of vapor/gas mixed with air

where combustion can occur.

Material Safety Data Sheets (MSDS)

Detailed information about a chemical, including

– Composition, information on ingredients

– Hazards identification

– First aid measures

– Accidental Release measures

– Handling and Storage

– Exposure controls, personal protection

– Stability and reactivity

– Toxicological information

MSDS (cont’d)

Hazards Identification

– Inhalation: Respiratory tract (lungs) through inhalation

– Ingestion: Digestive tract through eating or smoking with

contaminated hands or in contaminated work areas

– Absorption through the skin or eyes: Dermatitis or

damage to the liver, kidney, or other organ systems

– Injection: Percutaneous injection of a toxic substance

through the skin

MSDS (cont’d)

Specific possible health hazards:

– Acute poisoning (rapid assimilation of substance,

i.e., carbon monoxide)

– Chronic poisoning (prolonged exposure, i.e., lead

poisoning)

– Cumulative poisons (numerous chronic exposures,

i.e., heavy metals)

– Substances in combination (synergistic effect, i.e.,

exposure to alcohol and chlorinated solvents)

Use correct protective clothing and equipment

• Eye Protection

Safety glasses – flying particles, chemical splashes, dust

Splash goggles – corrosive liquids, solvents, powders

Face Shields – high pressure systems

• Respiratory Protection – normally not needed at LUC

• Skin and Body Protection

Gloves – see the MSDS

Aprons and lab coats – strong acids and bases

Shoes – always worn in lab, closed toe and closed heel

• Hearing Protection – normally not needed at LUC

Do not

– Use damaged glassware

– Store chemicals near heat, sunlight, or other substances

with which they might react

– Store materials on floors or other places where people

could trip over them

– Leave equipment unattended when its operating (unless

it is designed to do so or you have an SOP)

– Put custodians and fellow workers in danger

L -- Label everything clearly

A -- Appropriate containers in good condition

B -- Be neat and orderly

S -- Store only what you will use

A -- Always wear protective clothing

F -- Food allowed in eating areas only

E -- Everything in its place on a shelf

T -- Time to inventory & organize

Y -- Your safety is important

Recommended Practices

LAB SAFETY

LABORATORY PROCEDURES MUST BE SITE SPECIFIC !

based on your lab needs, conditions, and equipment

Laboratory Policies and Procedures Must be: written and available

Emergency Equipment

• Fire blankets

• Fire extinguishers

• Emergency notification system

• Unrestricted means of communication

• Any other emergency equipment needed for your specific

laboratory needs

Emergency Showers and Eyewash Stations

• must be available

• showers must be tested for proper operation

with results documented

Particulate Releases

• Some procedures in the OR generate particulates into the

air (i.e., from cauterizing blood vessels, using lasers)

• These particulates can have viable organisms present

that can cause infections

• Preventive actions:

– Use suction close to point of generation

– Wear N95 respirator (medical clearance and fit testing is

required)

– Wear tight fitting safety goggles

Cleaning agents

• A number of cleaning agents are used for

equipment and the room

• Those using the cleaning agents have the

greatest potential of exposure. Before use:

– Read the product label and Observe the necessary

precautions for use

Formalin

Water solution with 40%

formaldehyde by volume or 37% by

mass is called “100% Formalin”

Exposure Limits

The odor threshold for most people is around 0.05 PPM with

highest level at 1 PPM

Maximum workplace concentration is 0.3 PPM

PPM Effect

0.5 Begin to sense eye irritation

0.5 – 1 5% to 20% report eye irritation

1 and above Greater sensory irritation

Control of Radiation Hazards in Nuclear Medicine Laboratories

• Storage of source

• Essential points in planning work

• Handling of sources

• Monitoring

• Decontamination of working area and equipment

• Personnel decontamination

– Internal contamination

– External contamination

• Surface contamination

• Surface decontamination

Spillage of mercury 1. Push small mercury beads together with a card, stiff paper, or

squeeze to form larger droplets.

2. Work from the outside of the spill area toward the center. Work over

a tray or box that is lined or covered with plastic wrap when pouring

mercury.

3. Sprinkle sulfur powder on the spill area after cleaning up beads of

mercury; a colour change from yellow to brown indicates that

mercury is still present and more cleanup is needed

4. Sprinkle zinc flakes or copper flakes to amalgamate (clump

together) any small amounts of mercury, which remain.

In case of a mercury spill you should NEVER do this:

1. Never use a vaccum cleaner to clean up the mercury – may result in

mercury fumes, which is toxic.

2. Never use house hold cleaning products to clean the spill.

3. Never use a broom or a paint brush to clean up mercury.

4. Never pour or allow mercury to go down a drain.

Disposal Procedures

• Trained persons designated to handle disposal

• Meet all required rules and regulations

• Proper collection containers

• Waste collection contracts

• Does not expose humans, animals, plants, etc upon disposal -

may include decontamination, sterilization, incineration,

autoclaving

Staying safe means that you…

• Read & understand labels on containers of chemicals

• Material Safety Data Sheets (MSDS)

• Handle chemicals with care

• Use correct protective clothing and equipment

• Emergency procedures display – retrievable document

Thank You