Exposure to hazardous chemicals found and used in the surgical suite, typically during mixing and preparation, and in the operating room. Hazardous chemicals present in the surgical suite may include peracetic acid, which is used in cold sterilant machines, and methyl methacrylate (MMA), an acrylic cement-like substance used to secure prostheses to bone during orthopedic surgery.
Requirements under OSHA's Hazard Communication Standard, 29 CFR 1910.1200
One purpose of OSHA's Hazard Communication Standard (HCS) is to provide information to employees on the hazards of the chemicals they use at work. Employers are required to ensure that employees are aware of the hazards associated with the chemicals to which they are exposed in the workplace and on the precautions to properly protect themselves. The standard requires employers to:
- Develop, implement and maintain a written hazard communication program [29 CFR 1910.1200(e)];
- Maintain a hazardous chemical inventory list [29 CFR 1910.1200(a)(2)] and ensure that each container of hazardous chemicals contains an appropriate warning (i.e., that it is labeled, tagged or marked) [29 CFR 1910.1200(f)];
- Maintain Safety Data Sheets (SDSs) for hazardous chemicals [29 CFR 1910.1200(g)];
- Provide workers with effective training on hazardous chemicals at the time of initial assignment and whenever a new chemical hazard is introduced into their work area. [29 CFR 1910.1200(h)(1)]. For training to be effective, it needs to be conducted in a language that workers can understand, and include an opportunity for employees to ask questions to ensure that they understand the information presented to them; and
- Ensure labels, or other forms of warning, and SDSs are in English. The standard permits employers to supplement English language versions with non-English versions for the benefit of workers who speak other languages.
- For additional requirements under OSHA's Hazard Communication Standard, see 29 CFR 1910.1200. See also, Frequently Asked Questions: Hazard Communication (HAZCOM).
Some Other OSHA Requirements Associated with Exposure to Hazardous Chemicals:
- Control chemical hazards with the use of engineering controls (e.g., ventilation) or administrative controls when feasible (see, e.g., 29 CFR Part 1910.1000(e)).
- Provide and ensure employees use PPE (e.g., goggles, gloves, splash aprons, as appropriate) under 29 CFR Part 1910 Subpart I.
- Examples of when PPE is required:
- When employees remove heated items or change out detergent from cleaning equipment, such as washer/decontaminators, or ultrasonic, tunnel or cart washers that automate the dispensing of washing chemicals.
- When employees handle hazardous detergents and chemicals to clean equipment and surfaces.
- Ensure workers use caution during the use, donning, and doffing of appropriate PPE (e.g., goggles, gloves, etc.) to avoid injury, illness, and infection.
- For more information see OSHA Safety and Health Topics page - Personal Protective Equipment.
- Examples of when PPE is required:
- Medical services and first aid: Where the eyes or body of any person may be exposed to injurious corrosive materials, suitable facilities for quick drenching or flushing of the eyes and body must be provided within the work area for immediate emergency use. [29 CFR 1910.151(c)].
- In addition to the Hazard Communication Standard, employee exposure to specific hazardous chemicals might be regulated by OSHA standards specific to those chemicals, e.g., ethylene oxide [29 CFR 1910.1047].
Recognized Controls and Work Practices
- Mix methyl methacrylate only in a closed system.
- Carefully read and follow instructions and warnings on labels (e.g., when using cold sterilant machines for sterilizing equipment that cannot be autoclaved, do not open the machine until it is in a safe-to-open mode).
- Use appropriate Personal Protective Equipment (PPE) while handling or otherwise exposed to hazardous chemicals.
- Use disinfectants or other products that are not hazardous.
- Follow all SDS instructions for safe handling, storage, and disposal of hazardous chemicals.
- Hazard Communication Safety Data Sheets. OSHA QuickCard™.
- Hazard Communication Standard: Labels and Pictograms. OSHA Brief.
- NIOSH Study Provides Insight into Healthcare Worker Training and Handling of Hazardous Chemicals. National Institute for Occupational Safety and Health (NIOSH), (February 19, 2014).
- Ethylene Oxide. OSHA Safety and Health Topics Page.
- Best Practices for the Safe Use of Glutaraldehyde in Healthcare. OSHA Publication 3258, (2006).
- Also see Hospital-wide Hazards - Hazardous Chemicals and Glutaraldehyde.