Protecting and preserving health at work while handling chemicals in a hospital setting

1. 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

2. 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 :

3. 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

4. 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 :

5. 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

6. Properties
Uses
Exposures
Monitoring
Compliance with
29 CFR 1910.1048

7. 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 :

8. 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 :

9. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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.

17. 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

18. 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

19. 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)

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

31. 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.

32. 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

35. 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

36. Thank You