Chemical hazards in healthcare

A hospital uses more kinds of chemicals than most factories. Every unit has disinfectant wipes and hand rub. Environmental services has floor strippers, bowl cleaners and sporicidal disinfectants. The operating rooms use anesthetic gases. The lab uses formalin, xylene, stains and reagents. Sterile processing uses high-level disinfectants and, in some hospitals, ethylene oxide. The pharmacy and oncology units handle drugs that are themselves hazardous to the staff who prepare and give them. And the kitchen and laundry have their own detergents, degreasers and caustic cleaners.

This lesson gives a worker's view of these hazards: what they are, where they are found, how they get into the body, and the controls that matter most. HSE-102 WHMIS Awareness covers labels and safety data sheets, HSE-312 Chemical Handling and Storage covers storage and spills in detail, and HSE-394 covers hazardous drugs, sterilants, anesthetic gases and radiation in depth.

How chemicals get into the body

• Breathing them in: fumes from disinfectants and solvents, gases that leak from anesthetic equipment or sterilizers, mists from spray bottles, and dust or aerosols from crushed or spilled drugs.
• Skin contact: splashes, wet wipes held in bare hands, contaminated surfaces, and leaks through damaged or unsuitable gloves. Some chemicals pass through intact skin into the blood.
• Eye contact: splashes while pouring, mixing or cleaning at or above eye level.
• Swallowing: contaminated hands touching food, drink or the mouth.
• Injection: needlesticks from syringes containing hazardous drugs.

The effects can be immediate, such as a burn, a cough or a headache, or slow, such as asthma, dermatitis, reproductive harm or cancer after years of low exposure. The slow effects are harder to notice and easier to dismiss, which is why exposure limits, monitoring and controls exist even for chemicals that do not seem to bother anyone.

The main chemical hazards

Two other hazards are worth a mention. Oxygen is not toxic, but it makes fires start more easily and burn much faster, so oxygen equipment must be kept away from flames and sparks and free of oil and grease. And mercury, once common in thermometers and blood pressure gauges, still turns up in older equipment and needs a mercury spill kit and careful cleanup if anything breaks.

WHMIS in a hospital

WHMIS applies to hazardous products in a hospital as it does anywhere else. Every hazardous product must have a supplier label with pictograms, signal words and hazard and precautionary statements, and a current safety data sheet (SDS) that workers can get to quickly. When a product is moved into another container, such as a spray bottle filled from a jug, the new container needs a workplace label. Workers must be trained on the products they use: what the hazards are, how to read the label and SDS, and what to do in an emergency.

Some products in hospitals are not covered by WHMIS because other laws regulate them. Drugs in their final form for patients are one example, and pest control products and consumer products are others. Hazardous drugs are still hazardous to workers, though, and Regulation 67/93 has its own requirements for antineoplastic drugs, covered in HSE-394.

Never mix cleaning products

Many injuries from cleaning chemicals in healthcare come from mixing. Bleach mixed with an acid, such as some toilet bowl cleaners and descalers, releases chlorine gas. Bleach mixed with ammonia, found in some glass cleaners and in urine, releases chloramine gases. Both can cause severe coughing, chest tightness and lung damage in a small, poorly ventilated bathroom. Mixing two disinfectants does not make them stronger; it usually makes them weaker and more dangerous.

The safest way to prevent mixing is to make it unnecessary. Northbridge uses ready-to-use products on the units and a wall-mounted dispensing system in environmental services that measures and dilutes concentrates automatically. Staff do not bring cleaning products from home, and spray bottles are always labelled.

Skin: the overlooked hazard

Healthcare workers wash and sanitize their hands many times a shift and wear gloves for hours. The result, for many, is irritant dermatitis: dry, cracked, sore skin, mostly on the hands. Cracked skin is painful, lets germs in and makes hand hygiene harder to keep up. Some workers develop allergic dermatitis to glove materials, disinfectants or other chemicals. Using the hospital's moisturizer, choosing well-fitting gloves, drying hands fully before putting gloves on, and reporting a rash early to occupational health all help. A rash that does not settle can be the first sign of an allergy that will get worse with continued exposure.

Eyewash and emergency showers

Wherever corrosive chemicals are used, such as in environmental services, sterile processing, the lab and the pharmacy, there must be an eyewash station close by and, for larger quantities, an emergency shower. Common practice is to place them no more than about 10 seconds' walk from the hazard with a clear path, and to flush eyes or skin for at least 15 minutes after a splash. An eyewash that has not been run for months may deliver a burst of rusty, contaminated water, so each one is flushed weekly and the date recorded. Daniel checks the four in the lab every Monday.

Reviewing the chemical inventory

Joanne asked each department for its list of hazardous products. She used a short script to check them for missing safety data sheets, missing workplace labels and duplicate products doing the same job.

# Hazardous product inventory review (sample of the full list)
products = [
    # name, department, purpose, has_sds, labels_ok
    ("QuatWipe Plus",        "units", "surface disinfectant", True,  True),
    ("OxyGuard RTU",         "units", "surface disinfectant", True,  True),
    ("CleanSure Q",          "units", "surface disinfectant", False, True),
    ("Hypo 5000 RTU",        "EVS",   "sporicidal",           True,  True),
    ("PeraClean 2",          "EVS",   "sporicidal",           True,  False),
    ("BowlBrite Acid",       "EVS",   "toilet bowl cleaner",  True,  True),
    ("StripMax",             "EVS",   "floor stripper",       True,  True),
    ("Formalin 10 prefill",  "lab",   "tissue fixative",      True,  True),
    ("Xylene",               "lab",   "solvent",              True,  True),
    ("GluterAid 2.4",        "SPD",   "high-level disinfect", False, False),
    ("OPA Solution",         "SPD",   "high-level disinfect", True,  True),
    ("KitchenDegreaser",     "kitchen", "degreaser",          True,  True),
]

missing_sds = [p[0] for p in products if not p[3]]
bad_labels = [p[0] for p in products if not p[4]]
print("missing SDS:", ", ".join(missing_sds))
print("label problems:", ", ".join(bad_labels))

by_purpose = {}
for name, dept, purpose, *_ in products:
    by_purpose.setdefault(purpose, []).append(name)
print("\npurposes with more than one product:")
for purpose, names in by_purpose.items():
    if len(names) > 1:
        print(f"  {purpose:22} {len(names)}: {', '.join(names)}")

acids = [p[0] for p in products if "Acid" in p[0]]
bleach = [p[0] for p in products if "Hypo" in p[0]]
print("\nmixing risk in EVS (never combine):", acids, "with", bleach)

missing SDS: CleanSure Q, GluterAid 2.4
label problems: PeraClean 2, GluterAid 2.4

purposes with more than one product:
  surface disinfectant   3: QuatWipe Plus, OxyGuard RTU, CleanSure Q
  sporicidal             2: Hypo 5000 RTU, PeraClean 2
  high-level disinfect   2: GluterAid 2.4, OPA Solution

mixing risk in EVS (never combine): ['BowlBrite Acid'] with ['Hypo 5000 RTU']

The review found two products without a current safety data sheet, two with label problems, three different surface disinfectants on the units where one would do, and two high-level disinfectants in sterile processing. Each extra product is another label to learn, another SDS to keep current and another chance of the wrong product being used. The joint health and safety committee recommended reducing the unit disinfectants to one and removing glutaraldehyde from sterile processing, since the department already had a less sensitizing alternative. That is elimination and substitution, the top two levels of the hierarchy of controls.

For supervisors: how new chemicals get in

Most of the chemicals in a hospital arrive one at a time: a sales representative leaves samples, a physician asks for a new product, a department orders a cheaper version through a different supplier. Northbridge now requires every new hazardous product to go through a short review by purchasing, infection control and the Occupational Health and Safety office before it is ordered, with the safety data sheet attached. If you manage a department, make sure products only come in through that route, and that staff know not to bring in products of their own.

When there is a spill or exposure

If a chemical splashes into someone's eyes or onto their skin, start flushing with water right away, use the eyewash or shower, and keep going for at least 15 minutes. Remove contaminated clothing. Get medical help, take the SDS or label with you, and report it. For a spill, keep people away, ventilate if it is safe to do so, and follow the spill procedure on the SDS and the department's spill plan. Small spills can be cleaned by trained staff with the right spill kit. Large spills, spills of very toxic products such as formaldehyde or hazardous drugs, and anything that makes people cough or feel unwell are called in to the hospital's spill response, a Code Brown at Northbridge.