Chemical Management in HealthCare

A recent paper by Byrns, Nelson and Bradbury (The Importance of Good Chemical Management in Health Care, J. Occup. & Environ. Hyg. (2013), 10(7), D86-93) discussed their results from auditing two large hospitals for chemical management. Hospitals use a large number of chemicals from disinfectants by house keeping, sterilants by sterile processing and pharmaceuticals, especially antineoplastic drugs, by pharmacy and medical staff; and many of these chemicals pose significant risks to anyone exposed to them. The use of chemicals in the workplace, whether a hospital or in general industry is regulated by OSHA and the management of chemicals in the workplace is governed by OSHA's Hazard Communication Standard.

The goal of the HazCom standard is to inform workers of the risks of the chemicals that they use. The standard's philosophy is that if workers know and understand the risks of the chemicals they are using then they will be more careful and there will be fewer chemical related injuries. The HazCom standard includes requirements for labeling chemicals (recently revised under the Global Harmonization System), safety data sheets (SDSs), formerly MSDSs, and employee training as well as maintaining an inventory of all chemicals on-site.

Byrns et al found very poor adherence to the Hazcom standard. In the first hospital they audited they found that the facilities engineering department had 248 chemicals on-site, but there were SDSs for less than half of the chemicals (115) and only 114 of them were in the chemical inventory. On the positive side the authors found most of the workers knew which were the most hazardous chemicals, but the use of personal protective equipment was inadequate. Similar results were found with housekeeping.

Hospital 2 did not do any better in their audit. The facilities Engineering had poor control of their chemical inventory (46% of chemicals listed), the nursing and radiology had very poor control, but the sterile processing department was much better with over 90% of their chemicals listed.

On the positive side, there were no reports of serious acute exposures and the percentages of employees who said they had received training on how to use the chemicals in their workplace safely was 100% in Sterile Processing and Chemotherapy Nursing though it fell to 44% for Engineering and 0% for pharmacy.
The overall low focus on worker safety in healthcare is well documented (and well cited in the article), and the above results support this conclusion.

For comparison, ChemDAQ's informal survey at the recent IACHSMM show, which was discussed in a recent blog found that almost half of respondents (predominantly sterile processing personnel) said that they had never received training on the Hazcom standard, which indicates that the two hospitals taking part in the Byrns et al study may be been among the more progressive with regard to chemical safety.