• Ethylene oxide
• Formaldehyde
• Glutaraldehyde
• Additional Resources

Other Hazards

In addition to infectious disease, ergonomic, and workplace violence issues, workers in healthcare settings encounter a number of other workplace hazards. These include chemicals (e.g., sterilants), hazardous drugs (e.g., antineoplastic drugs), materials that cause allergic reactions (e.g., latex), and physical agents (e.g., radiation). Several common examples of these "other hazards" are discussed below.

Chemicals

Ethylene Oxide

Ethylene oxide (EtO) is a flammable, colorless gas at temperatures above 51.3 ºF (10.7 ºC) that smells like ether at toxic levels. It can be found in fumigants and sterilants and presents an opportunity for healthcare worker exposure during operations such as EtO sterilization of surgical equipment.

• 29 CFR 1910.1047, Ethylene oxide. OSHA Standard.
  • Appendix A, Substance safety data sheet for ethylene oxide (Non-mandatory)
  • Appendix B, Substance technical guidelines for ethylene oxide (Non-mandatory)
  • Appendix C, Medical surveillance guidelines for ethylene oxide (Non-mandatory)
  • Appendix D, Sampling and analytical methods for ethylene oxide (Non-mandatory)
    
    
• OSHA's Small Business Guide for Ethylene Oxide [14 MB PDF^*, 87 pages]. OSHA Publication 3359, (2009, April). Provides guidance to help employers understand the EtO standard, with particular emphasis on how to monitor the quality of the air in workplaces where EtO is processed, used, or handled. Air monitoring is an important activity that can help alert employers when unsafe levels of EtO are present in the air so they can take steps to reduce employee exposure.
  
  
• Hospital. OSHA eTool.
  • Central Supply module: Ethylene Oxide Gas. Discusses EtO exposures, health effects, and control measures in central supply.
    
    
• Ethylene Oxide (EtO): Understanding OSHA's Exposure Monitoring Requirements. OSHA Publication 3325-01N, (2007). Also available as a 183 KB PDF, 32 pages.
  
  
• Ethylene Oxide [48 KB PDF^*, 2 pages]. OSHA Fact Sheet, (2002). Answers common questions about EtO.
  
  
• Ethylene Oxide Sterilizers in Health Care Facilities - Engineering Controls and Work Practices. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 89-115 (Current Intelligence Bulletin 52), (1989, July 13).
  
  
• Reducing Ethylene Oxide and Glutaraldehyde Use [368 KB PDF, 4 pages]. Environmental Protection Agency (EPA) fact sheet, (2002, November). This fact sheet provides background information on the uses and hazards of both chemicals, describes environmentally preferable alternatives, and provides detailed case study and cost information to help evaluate alternatives to EtO and glutaraldehyde.
  
  
• For additional information, see OSHA's Ethylene Oxide Safety and Health Topics Page.

Formaldehyde

Formaldehyde can be used as a disinfectant or a sterilant. It is often found mixed in water and referred to as formalin. Formaldehyde can be used to prepare viral vaccines; as an embalming agent; as a tissue fixative; and in the sterilization of medical equipment (e.g., surgical instruments, hemodialyzers). Paraformaldehyde (a solid polymer of formaldehyde) can be heat vaporized for the gaseous decontamination of laminar flow biologic safety cabinets.

• 29 CFR 1910.1048, Formaldehyde. OSHA Standard.
  • Appendix A, Substance technical guidelines for formalin
  • Appendix B, Sampling strategy and analytical methods for formaldehyde
    
    
• Hospital. OSHA eTool
  • Laboratory module: Formaldehyde Exposure. Discusses formaldehyde exposure, health effects, and some control measures.
    
    
• Controlling Formaldehyde Exposures During Embalming. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 98-149 (Hazard Control 26), (1998, October). Discusses a local exhaust ventilation system that can be used to reduce exposures during embalming.
  
  
• Formaldehyde [1 MB PDF^*, 2 pages]. OSHA Fact Sheet, (2011, April). Provides an brief overview of formaldehyde, its harmful effects, routes of exposure, and some provisions of OSHA's formaldehyde standard.
  
  
• Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. Healthcare Infection Control Practices Advisory Committee (HICPAC). Provides an overview and information on the mode of action, microbicidal activity, and uses of Formaldehyde, Gluteraldehyde, and Hydrogen peroxide.
  
  
• AST Recommended Standards of Practice for Handling and Care of Surgical Specimens [66 KB PDF, 15 pages]. Association of Surgical Technologists (AST), (2008). Standard of Practice V discusses procedures for working with formalin preservative solutions.
  
  
• For additional information, see OSHA's Formaldehyde Safety and Health Topics Page.

Glutaraldehyde

Glutaraldehyde is a colorless, oily liquid with a pungent odor. It is often mixed with water for use. Exposure can occur in healthcare facilities when glutaraldehyde is used in operations such as cold sterilization / high-level disinfection; tissue fixing / preservation (e.g., for microscopy, histology); and in the processing of x-rays.

• Hospital. OSHA eTool.
  • Healthcare Wide Hazards module: Glutaraldehyde. Discusses glutaraldehyde exposure, health effects, and control measures.
    
• Best Practices for the Safe Use of Glutaraldehyde in Health Care. OSHA Publication 3258-08N, (2006). Also available as a 263 KB PDF, 48 pages. Provides information on the health effects and uses of glutaraldehyde and control measures to reduce exposure.
  
  
• Glutaraldehyde: Occupational Hazards in Hospitals. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2001-115, (2001, May). A brochure that discusses glutaraldehyde health effects, worker exposure, and control measures.
  
  
• Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. Healthcare Infection Control Practices Advisory Committee (HICPAC). Provides an overview and information on the mode of action, microbicidal activity, and uses of Formaldehyde, Gluteraldehyde, and Hydrogen peroxide.
  
  
• Reducing Ethylene Oxide and Glutaraldehyde Use [367 KB PDF, 4 pages]. Environmental Protection Agency (EPA) fact sheet (2002, November). This fact sheet provides background information on the uses and hazards of both chemicals, describes environmentally preferable alternatives, and provides detailed case study and cost information to help evaluate alternatives to EtO and glutaraldehyde.

Additional Resources

• Green and Clean: How Hospitals Can Protect Patients and Workers by Using Earth-Friendly and Sustainable Products/Practices [146 KB PDF^*, 3 pages]. OSHA and The Joint Commission and Joint Commission Resources (JCR) Alliance, (2013, January). JCR developed an article that discusses the importance of adopting sustainable products and practices for cleaning, sanitizing, and disinfecting healthcare facilities. The article also provides requirements for selecting green cleaning products.

Hazardous Drugs

Drugs are classified as hazardous if studies in animals or humans indicate that exposures to them have a potential for causing cancer, developmental or reproductive toxicity, or other organ system damage. Hazardous drugs, such as those used for cancer chemotherapy, antiviral treatments and hormone regimens, pose a serious hazard to healthcare workers. These effects can be irreversible even with low-level exposures.

• Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2004-165, (2004, September). Increases awareness among healthcare workers and their employers about the health risks posed by working with hazardous drugs and to provide them with measures for protecting their health.
  
  
• List of Hazardous Drugs in Healthcare Settings Allows Healthcare Workers to Minimize Exposure and Reduce Health Risks. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2011-189, (2011, August). Hazardous drugs include drugs used for chemotherapy, antiviral drugs, hormones, and some immunosuppressant drugs-all of which may have damaging effects on the body. When these drugs must be prepared and administered, there are workplace best practices that can minimize potentially harmful exposure.
  
  
• For additional information, see OSHA's Hazardous Drugs Safety and Health Topics Page and NIOSH's Hazardous Drug Exposures in Health Care Workplace Safety and Health Topics Page.

Waste Anesthetic Gases

• Waste anesthetic gases include nitrous oxide and various halogenated anesthetics (e.g., halothane, enflurane, isoflurane, desflurane). Exposure to these gases can occur through leakage of the patient's anesthetic breathing circuit during delivery of anesthetic and through exhalations of patients recovering from anesthesia.
  
  
• Anesthetic Gases: Guidelines for Workplace Exposures. OSHA, (2000, May 18). Provides guidelines and controls to help reduce occupational exposure to waste anesthetic gases.
  
  
• Waste Anesthetic Gases - Occupational Hazards In Hospitals. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2007-151 (2007, October). Discusses exposures, health effects, and control measures.
  
  
• For additional information, see OSHA's Waste Anesthetic Gases Safety and Health Topics Page.

Emergency Response Hazards

During the provision of emergency response care, healthcare workers may be exposed to chemical, biological, physical, or radioactive hazards. These hazards could be encountered singly or in combination with other hazards, could be a hazard that has never been or is rarely seen by the healthcare provider (e.g., anthrax), and could involve a large number of affected individuals that stresses available resources.

• Hospital. OSHA eTool.
  • Emergency Department (ED) module: Terrorism. Potential hazards and solutions for healthcare emergency department workers exposed to biological agents, chemical agents, and mass causalities as a result of terrorist attacks or events.
    
• Emergency Preparedness and Response. OSHA Safety and Health Topics Page.
  • Response and Recovery Workers. Provides information on medical response to emergencies.
    
• Hospitals and Community Emergency Response -- What You Need to Know. OSHA Publication 3152, (1997). Protecting health care workers who respond to emergencies involving hazardous substances is critical. Health care workers dealing with emergencies may be exposed to chemical, biological, physical, or radioactive hazards.
  
  
• OSHA Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances. OSHA, (2005, January). Provides hospitals with practical information to assist them in developing and implementing emergency management plans that address the protection of hospital-based emergency department personnel during the receipt of contaminated victims from mass casualty incidents occurring at locations other than the hospital. Covers topics such as victim decontamination, personal protective equipment, employee training, and includes several informational appendices.

Radiation

Ionizing (e.g., x-rays, nuclear medicine)

Ionizing radiation has enough energy to remove an electron from an atom (creating an ion). The main types of ionizing radiation are alpha particles, beta particles, gamma rays, and x-rays. Sources of ionizing radiation in healthcare include x-ray machines, radioactive isotopes, and radio nucleotides.

• Hospital. OSHA eTool.
  • Clinical Services - Radiology module: Radiation Exposure. Provides a brief overview of radiation sources, health effects, control measures, standards, and additional information links.

Non-ionizing (e.g., lasers)

Non-ionizing radiation does not have enough energy to remove an electron from an atom, but may cause an atom to vibrate or move around in a molecule. Examples of non-ionizing radiation include microwaves, infrared radiation, and visible light. A source of non-ionizing radiation in healthcare is a laser.

Lasers produce an intense, highly directional beam of light. In healthcare, lasers may be used as scalpels, probes, or in certain imaging techniques. Hazards may be associated with the laser beam (e.g., burns due to absorption of laser energy), the equipment (e.g., high voltage), or products produced during laser use (e.g., laser plume).

• Laser/Electrosurgery Plume. OSHA Safety and Health Topics Page.
  
  
• Laser Hazards. OSHA Safety and Health Topics Page.

Latex Allergies

Latex, also known as rubber or natural latex, is derived from a milky fluid found in rubber trees. Latex allergy is a reaction to certain proteins found in natural latex. Latex allergy may cause allergic reactions ranging from sneezing or a runny nose to anaphylaxis, a potentially life-threatening condition. Healthcare workers exposed to rubber gloves and other latex-containing medical devices are at risk of developing latex allergy.

• Hospital. OSHA eTool.
  • Healthcare Wide Hazards module: Latex Allergy. Discusses latex exposures, health effects, and control measures.
    
    
• Home Healthcare Workers: How to Prevent Latex Allergies [565 KB PDF, 2 pages]. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2012-119, (2012, February). Latex products are made from natural rubber, and sensitivity can develop after repeated exposure. Limiting exposure to latex can help prevent allergic reactions for both home healthcare workers and their clients.
  
  
• For additional information, see OSHA's Latex Allergy Safety and Health Topics Page and NIOSH's Occupational Latex Allergies Workplace Safety and Health Topics Page.

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