Hazardous Materials

Healthcare organizations use a wide variety of hazardous substances including disinfectants, sterilizing agents, solvents, chemotherapeutic drugs, compressed gases, and hazardous wastes� The Occupational Safety and Health Administration (OSHA), Environmental Protection Agency (EPA), Department of Transportation (DOT), and accreditation organizations including the Joint Commission require healthcare organizations to properly receive, handle, manage, and dispose of hazardous material in an effective manner� Organizations should develop and implement comprehensive written plans that protect staff, patients, and visitors� Organizations must adhere to the requirements of the OSHA Hazard Communication Standard, the EPA Resource Conservation and Recovery Act (RCRA), and DOT Hazardous Materials Regulations� Healthcare organizations should work to consolidate hazardous material management plans with requirements of accreditation, licensing, and regulatory agencies� Using an integrated approach would improve hazardous material safety and disposal efforts�

The OSHA Hazard Communication Standard requires organizations to maintain a Safety Data Sheet (SDS) for each hazardous substance used in the workplace� Refer to the SDS and in some situations, the container label, for information on special storage requirements� Typical storage considerations may include factors such as temperature, ignition control, ventilation, segregation, and identification� Properly segregate hazardous materials according to compatibility� For example, never store acids with bases or oxidizers with organic materials or reducing agents� Corrosives and acids will corrode most metal surfaces including storage shelves or cabinets� Store flammable and combustible materials in appropriate rooms or approved cabinets�

Identify and mitigate risks associated with selecting, handling, storing, transporting, using, and disposing of chemicals, dangerous medications, and hazardous gases or vapors� Label hazardous materials and wastes to identify the contents and provide hazard warnings�

BOX 6.1 HAZARDOUS MATERIAL MANAGEMENT SUGGESTIONS

• Conduct an inventory and control of all materials used, stored, or generated • Provide adequate space and equipment for handling and storing hazardous materials • Monitor and document correct disposal of hazardous gases and vapors • Develop work area and emergency response procedures to address specific hazards • Use protective equipment when responding to hazardous materials spills or releases • Maintain hazardous wastes manifests, permits, and licenses • Ensure proper labeling of all hazardous materials and wastes

BOX 6.2 THE JOINT COMMISSION HAZARDOUS MATERIAL & WASTE CATEGORIES

• Hazardous chemicals • Hazardous medications and drugs • Radiation hazards (ionizing and nonionizing) • Dangerous gases and vapors

Toxic substances can enter the body through the skin, respiratory system, mouth, and eyes� Some substances can also damage the skin or eyes directly without being absorbed� A person can inhale or swallow inorganic lead, but it does not penetrate the skin� Sometimes a chemical substance can enter through more than one route� Exposures to hazardous materials can cause stress on the body if inhaled, absorbed, or ingested� Exposure effects depend on concentration, duration of exposure, route of exposure, physical properties, and chemical properties� Other chemicals, physical agents, and the general health of the person exposed can influence the effects exerted by a hazardous substance� Train workers how to safely handle, store, use, and segregate hazardous materials and waste products� The OSHA Hazard Communication Standard, 29 CFR 1910�1200, specifies education and training for users of hazardous chemicals�

BOX 6.3 CHARACTERISTICS OF HAZARDOUS SUBSTANCES

• Corrosiveness: Any substance with the ability to degrade the structure or integrity of another substance, object, or material� Examples include acids and alkalis�

• Ignitability: Any material that can too readily burn or ignite, including some chemicals that can auto-ignite upon contact with the air�

• Reactivity: Any substance with the ability to readily combine with other chemicals to produce a sudden or violent release or heat/energy�

• Toxicity: Any material with the capability of causing illness or death in man, animals, fish, or plants, or capable of damaging the environment�

BOX 6.4 EXPOSURE CONSIDERATIONS

• Concentration of hazardous substance • Duration of exposure • Available ventilation • Temperature of the chemical • Temperature of the surrounding air

BOX 6.5 HAZARDOUS MATERIAL EXPOSURE TERMS

• Air Contaminant Standards: A term used by OSHA to describe hazardous materials regulated by specific substance standards or exposure tables of 29 CFR 1910, Subpart Z�

• Permissible Exposure Limit (PEL): The maximum allowed OSHA exposure for workers working 8 hours during a 40-hour week�

• Short-Term Exposure Limit (STEL): The exposure allowed for a one-time excursion (normally measured in a 15-minute period)�

• Ceiling: The maximum amount of an airborne concentration exposure� • Threshold Limit Value (TLV): A voluntary time-weighted average (TWA) expo-

sure limit published by the American Conference of Governmental Industrial Hygienists (ACGIH)�

• Air Contaminants: Hazardous substances regulated by 29 CFR 1910, Subpart Z� • OSHA Additive Formula: The method described in 29 CFR 1910�1000 for use

in determining exposure effects of a substance containing two or more hazardous ingredients�

Consider a substance as hazardous if regulated by OSHA in 29 CFR 1910, Subpart Z� Treat any substances included in the latest edition of the ACGIH Documentation of the Threshold Limit Values and Biological Exposure Indices as hazardous. Any substance confirmed or suspected to be a carcinogen by the National Toxicology Program (NTP) and published in their latest edition of the Annual Report on Carcinogens would also be hazardous� Finally, any substance listed by the Annual Report for Research on Cancer and in the latest edition of IARC Monographs is also considered to be hazardous�

Some substances or agents may affect the reproductive health of women or men� These risks may manifest as chemical, physical, or biological hazards� Reproductive hazards can include lead, radiation, and even viruses� Reproductive hazard exposure can occur by inhalation, skin contact, and by ingestion� Potential health effects include infertility, miscarriage, birth defects, and child developmental disorders� Organizations must work to limit exposures by the use of workplace engineering controls, proper work practices, and good hygiene practices� Current scientific evidence suggests that chronic exposure to anesthetic gases increases the risk of congenital abnormalities in offspring among female workers� While more than 1000 workplace chemicals may cause reproductive effects in animals, most physical and biological agents in the workplace that may affect fertility and pregnancy outcomes remain unstudied� The inadequacy of current knowledge coupled with the ever-growing variety of workplace exposures pose a potentially serious public health problem� The Effects of Workplace Hazards on Female Reproductive Health, National Institute for Occupational Safety and Health (NIOSH) Publication No� 99-104, addresses exposure, prevention, and reproductive hazards for female workers and their unborn babies� The Effects of Workplace Hazards on Male Reproductive Health, NIOSH Publication No� 96-13, identifies steps to reduce or prevent workplace exposure to male reproductive hazards�

BOX 6.6 IDENTIFYING AND EVALUATING HAZARDOUS SUBSTANCES

• Determine hazardous properties, including toxicity and health hazards • Identify purpose, quantities, and locations using the substance • Implement proper storage procedures, including flammable material locations • Make SDSs readily available for each substance • Adhere to compliance and regulatory requirements of OSHA, DOT, and EPA • Develop written plans as required by compliance agencies and accrediting organizations • Require the use of personal protective equipment (PPE) when handling hazardous

materials • Evaluate possible use of less hazardous substances • Create detailed spill containment plans and properly train response teams • Conduct and document personal and area monitoring as required by OSHA standards • Provide education and training for all workers with any potential exposures

BOX 6.7 HEALTHCARE REPRODUCTIVE HAZARDS

• Nitrous oxide • Ethylene oxide • Toluene • Xylene • Some aerosolized drugs • Cadmium

(Continued)

Published by ACGIH, TLVs represent the opinion of the scientific community for the purpose of encouraging exposure at or below the level of a published TLV� The values serve as guidelines and not standards� TLVs help industrial hygienists make decisions regarding safe levels of exposure to various chemical or physical agents found in the workplace� TLVs serve as health-based values established by committees that review existing published and peer-reviewed literature in various scientific disciplines including industrial hygiene, toxicology, and occupational medicine� ACGIH bases TLVs solely on health factors and not economic issues or any technical feasibility�

The physical properties of a chemical substance include characteristics such as vapor pressure, solubility in water, boiling point, melting point, molecular weight, and specific gravity� Chemical properties describe the reactivity of a substance with other chemicals� Reactive substances can burn, explode, or give off hazardous vapors when mixed with other chemicals or when exposed to air or water� Reactive substances can create fire and explosive hazards� Oxidizing chemicals easily release oxygen that can fuel fires when stored near flammable substances� Oxidizers cause other materials to burn, even though most oxidizers won’t burn themselves� Ensure storage is away from heat sources because warming causes oxygen release that can create the perfect environment for a fire� Corrosive chemicals can eat through other materials including human skin� Irritants such as ammonia possess corrosive characteristics that attack mucous membranes in the nose and mouth�

According to NFPA 30, Class I flammable liquids possess a flash point of less than 100 degrees Fahrenheit (38 degrees Celsius), while combustible liquids possess a flash point of 100 degrees Fahrenheit or more� Please note the Global Harmonized System (GHS) may define flammable liquids using different criteria� Vapor is simply the gaseous state of material� We can smell some vapors and some possess no odor� Vapors combine with the oxygen in the air, forming a mixture that will ignite easily and burn rapidly, often with explosive force� Vapor density relates to the ratio of the weight of a volume of vapor or gas to the weight of an equal volume of clean but dry air� SDSs contain vapor densities for the chemical substances� Knowing the vapor density can tell you how a vapor will act� A vapor density less than 1�0 will tend to rise and spread out� This reduces the hazard� A vapor density of 1�0 or more will tend to sink to the lowest point on the ground� These vapors can then travel along the ground, sometimes for long distances, and find ignition sources� This makes chemicals with high vapor densities particularly dangerous� Consider an ignition source as anything that causes something to burn� Common ignition sources include sparks from tools and equipment; open flames such as torches, smoking materials, and pilot lights; hot particles and embers generated while grinding or welding; and hot surfaces such as electric coils and overheated bearings� Flowing liquid chemicals can create static electricity� Grounding ensures that an electrical charge goes to the ground rather than building up on the drum of flammable or combustible material� Bonding refers to a process that equalizes the electrical charge between the drum and the transfer container� This prevents the buildup of electrical charges on one of the containers� Ignition temperature refers to the minimum temperature at which a chemical will burn and continue burning without the need for an ignition source� The main

BOX 6.7 HEALTHCARE REPRODUCTIVE HAZARDS (Continued)

• Ionizing radiation • Lead • Solvents

difference between flammable and explosive refers to the rate of combustion or the speed at which a material burns� A fire results from a rapid release of energy� An explosion occurs when an instantaneous release of energy involves an extremely rapid rate of combustion�

We can express airborne concentrations in terms of milligrams of substance per cubic meter of air (mg/m3) or parts of substance per million parts of air (ppm)� Asbestos and other airborne fibers can be measured using fibers per cubic centimeter (f/cc) or fibers per cubic meter (f/m3) of air� OSHA requires consideration of feasible administrative or engineering controls to reduce exposure risks� When these controls prove ineffective, organizations must use PPE or other protective measures to protect employees� Ensure the use of any equipment and/or technical measures receive approval from a competent industrial hygienist or other technically qualified person� 29 CFR 1910, Subpart Z, contains Tables Z-1, Z-2, and Z-3, which cover exposure limits for substances not covered by a specific standard�

OSHA Standard 29 CFR 1910�151 requires employers to provide suitable facilities for quick drenching of the eyes and body for individuals exposed to corrosive materials� OSHA does not specify minimum operating requirements or installation setup requirements� American National Standards Institute (ANSI) Standard Z358�1 recently underwent revisions led by the efforts of the International Safety Equipment Association (ISEA)� Approved by ANSI, the standard became known as ANSI/ISEA Z358�1� Organizations should ensure flushing fluids remain clear and free from foreign particles� For self-contained units, manufacturers provide suggested fluid replacement guidelines� Preservatives can help control bacteria levels in flushing fluids� A preservative’s performance depends upon several factors, including the initial bacterial load of the water and a potential bio-film in the station� Self-contained eyewash stations should be drained completely, disinfected, and rinsed prior to refilling� Always inspect and test the unit if you doubt its dependability� Identify problems or concerns and establish regular maintenance procedures� Consult the manufacturer’s operating manual and ANSI/ISEA Z358�1 for assistance in performing test procedures, maintenance operations, and training� Personal eyewash bottles can provide immediate flushing when located in hazardous areas� However, personal eyewash equipment does not meet the requirements of plumbed or gravity-feed eyewash equipment� Personal eyewash units can support plumbed or gravity-fed eyewash units but cannot serve as a substitute�

The Compressed Gas Association (CGA) promotes safe work practices for industrial gases and develops safe handling guidelines� OSHA regulates the use and safety of compressed gases in the workplace� Refer to 29 CFR 1910�101 for complete information on inspecting gas cylinders� The DOT regulates the transportation of compressed gases by rail, highway, aircraft, and waterway� Store compressed gas cylinders in cool and dry areas with good ventilation� Storage areas should meet fire-resistant standards� Never store compressed gas cylinders at temperatures higher than 125°F� Do not store cylinders near

BOX 6.8 BASIC REQUIREMENTS FOR EYEWASH AND SHOWER FACILITIES

• Valves must activate in 1 second or less� • The facilities must be 10 seconds from the hazard� • They must be located in a lighted area and identified with a sign� • Train workers on equipment use and appropriate PPE� • Activate plumbed units weekly� • Maintain self-contained units according to manufacturers’ specifications�

heat, open flames, or ignition sources� Properly label all cylinders and never remove valve protection caps until securing the cylinder for use� Comply with OSHA 29 CFR 1910�101-105 and DOT 49 CFR 171-179 standards when handling compressed gases� Refer to ANSI Z48�1 and CGA pamphlet C-7 for marking cylinders� When not in use, close and properly secure valves� Use appropriate lifting devices to transport gas cylinders� Refer to the appropriate SDS for information about cylinder content� Inside of buildings, separate oxygen and flammable gas cylinders by a minimum of 20 feet� Cylinders can be stored in areas with a fire-resistible partition between the oxygen and flammable materials�

OSHA requires the development of a written hazard communication plan� The plan must address container labeling, SDS availability, and training requirements� Employers must identify the person responsible for each plan element� Organizations must make the plan available on all shifts� The plan must direct the actions taken to communicate appropriate hazard information to all affected or exposed individuals�

The Globally Harmonized System (GHS) is the international approach to hazard communication� This global system provides criteria for classifying chemical hazards and standardizing labels and SDSs� Development of the GHS required a multiyear endeavor by hazard communication experts from different countries, international organizations, and stakeholder groups� OSHA recently modified the Hazard Communication Standard (HCS) to adopt the GHS approach� Since 1983, OSHA has required employers to communicate hazardous materials information to employees� The original performance-oriented standard allowed chemical manufacturers and importers to convey information on labels and SDSs in a variety of formats� The GHS requires the use of a standardized approach when classifying hazards and conveying the information to individuals with a need to know� It requires providing detailed criteria for determining what hazardous effects a chemical poses� It also requires standardized labels assigned by hazard class and category� This will enhance both employer and worker comprehension of the hazards resulting in safer use and handling� The harmonized format of the SDSs will enable employers, workers, health professionals, and emergency responders to access the information more efficiently and effectively� OSHA will require training on new label requirements and SDS format by December 2013� OSHA will require complete compliance in 2015�

The definitions of hazard will change to provide specific criteria for classification of health and physical hazards, as well as classification of mixtures� These specific criteria will help to ensure that evaluations of hazardous effects remain consistent across manufacturers� This will result in more accurate labels and SDSs� Chemical manufacturers and importers must provide a label that includes a harmonized signal word, pictogram, and hazard statement for each hazard class and category� Precautionary statements must also be provided� Finally, the SDSs will contain a specified 16-section format� The GHS does not address harmonized training provisions� However, the revised Hazard Standard requires retraining of all workers within two years of the publication of the final rule� The parts of the OSHA standard not related to the new system such as the basic framework, scope, and exemptions remain unchanged� OSHA did modify some terms to align the revised standard with language used in the GHS� The term “hazard determination” changed to “hazard classification” and “Material Safety Data Sheet” changed to “Safety Data Sheet�” Evaluation of chemical hazards must use available scientific evidence concerning such hazards� The revised standard contains specific criteria for each health and physical hazard with instructions about hazard evaluations and determinations� It also establishes both hazard classes and hazard categories� The standard divides the classes into categories that reflect relative severity of the effect� The original standard did

not include categories for most of the health hazards covered� OSHA included general provisions for hazard classification and Appendixes A and B to address criteria for each health or physical effect�

Under the original standard, the label preparer provided the identity of the chemical and the appropriate hazard warnings� The preparer determined the method to convey the information� The revised standard specifies what information to provide for each hazard class and category�

The revised standard requires the printing of all red borders on the label with a symbol printed inside� Chemical manufacturers, importers, distributors, or employers who become aware of any significant information regarding the hazards of a chemical must revise labels within six months of becoming aware of the new information� Employers can label workplace containers with the same label affixed to the shipped containers� Employers can also use label alternatives including those described in NFPA 704, Hazard Rating and the Hazardous Material Information System (HMIS)� However, information supplied on alternative labels must meet requirements of the revised standard with no conflicting hazard warnings or pictograms�

The information required on the SDS remains essentially the same as the original standard� The original standard required specific information but did not specify a format for presentation or order of information� The revised standard requires presenting the information on the SDS using

BOX 6.9 NEW LABELING REQUIREMENTS

• Pictogram: This method uses a symbol plus other graphic elements, such as a border, background pattern, or color, to convey specific information about the hazards of a chemical� Each pictogram consists of a different symbol on a white background within a red square frame set on a point (a red diamond)� The system requires the use of nine pictograms� However, OSHA requires the use of only eight pictograms under the revised standard�

• Signal Words: This requirement consists of using a single word to indicate the relative level of severity of hazard to alert the reader of a potential hazard� The signal words used include “danger” and “warning�” Use danger for severe hazard and warning for less severe hazards�

• Hazard Statement: This requirement consists of a statement assigned to a hazard class and category that describes the nature of the hazards of a chemical� It also includes as appropriate, the degree of hazard�

• Precautionary Statement: This phrase describes recommended measures to minimize or prevent adverse effects that could result from exposure to a hazardous chemical� It also applies to the improper storage or handling of a hazardous chemical�

BOX 6.10 REQUIRED SDS INFORMATION

• Section 1� Identification • Section 2� Hazard(s) identification • Section 3� Composition/information on ingredients • Section 4� First-aid measures • Section 5� Firefighting measures • Section 6� Accidental release measures

(Continued)

consistent headings in a specified sequence� Appendix D specifies the information required under each heading� The SDS format remains the same as the ANSI standard format�

OSHA plans to retain the requirement to include the ACGIH TLVs on the SDS� OSHA found that requiring TLVs on the SDS will provide employers and employees with useful information to help them assess the hazards presented by their workplaces� OSHA will also require the inclusion of PELs, and any other exposure limits used or recommended by the chemical manufacturer, importer, or employer preparing the SDS� The revised standard provides classifiers with the option of relying on the classification listings of the IARC and NTP to make classification decisions regarding carcinogenicity, rather than applying the criteria themselves� OSHA also included a nonmandatory Appendix F in the revised standard to provide guidance on hazard classification for carcinogenicity� Part A of Appendix F includes background guidance provided by GHS based on the Preamble of the IARC “Monographs on the Evaluation of Carcinogenic Risks to Humans”� Part B provides IARC classification information� Part C provides background guidance from the NTP “Report on Carcinogens�”

Consider the GHS as a living document with expectations of relevant updates on a two-year cycle� OSHA anticipates future updates of the Hazard Communi cation Standard to address minor terminology changes and clarify the final rule text; also, there will likely be additional rule-making efforts to address major changes�

The OSHA Hazard Communication Standard (29 CFR 1910�1200) requires employers to provide employees with information and training on hazardous chemicals used in their work areas� Employers must conduct training at the time of their initial assignment and upon the introduction

BOX 6.11 HAZCOM-MANDATED TRAINING TOPICS

• Existence and requirements of the OSHA Hazard Communication Standard • Components of the local hazard communication plan • Work areas and operations using hazardous materials • Location of the written hazard evaluation procedures and hazard communication plan • Location of the hazardous materials listing • Location and accessibility of the SDS file

BOX 6.10 REQUIRED SDS INFORMATION (Continued)

• Section 7� Handling and storage • Section 8� Exposure controls/personal protection • Section 9� Physical and chemical properties • Section 10� Stability and reactivity • Section 11� Toxicological information • Section 12� Ecological information • Section 13� Disposal considerations • Section 14� Transport information • Section 15� Regulatory information • Section 16� Other information, including date of preparation or last revision

Note: OSHA does not mandate inclusion of sections 12 to 15 in the SDS

of a new hazardous substance� Training must address the methods and observations used to detect the presence or release of the chemical� It must also address physical and health hazards, protective measures, labeling, and an explanation of the SDS� Employers must inform employees of the hazards of nonroutine tasks and the hazards associated with chemicals in unlabeled pipes�

Acetone can be used as a chemical intermediate or as a solvent cleaner in fingernail polish remover, paint-related products, and in the chemical production of ketone substances� It possesses a vapor density twice that of air� Inhalation of acetone can result in slight narcosis to respiratory failure at extremely high concentrations� In the event of accidental contact, skin should be washed and affected clothing removed immediately� In case of eye contact, eyes should be rinsed for 15 minutes� Acetone should be stored in safety cans and cabinets that meet OSHA and NFPA 30 requirements� Workers should wear splash goggles and chemical protective gloves made of butyl� For respiratory protection, use air-purifying respirators equipped with organic vapor cartridges set to the manufacturer’s maximum-use concentration�

Acryl amide, a resin usually found in research labs, is used to make gels for biochemical separations� It can cause eye and skin irritation� Long-term exposure could result in central nervous system disorders� Consider acryl amide as a suspected carcinogen and mutagen�

Ammonia is used as a liquid cleaning agent and as a refrigerant gas� Concentrated solutions of ammonia can cause severe burns� Workers should avoid skin contact with ammonia by wearing protective clothing� Workers handling concentrated solutions should wear rubber gloves and goggles or face shields� Provide adequate ventilation in areas where ammonia gas is released from concentrated solutions� Never store ammonia with deodorizing chemicals because the reaction can produce harmful byproducts such as chlorine gas� The OSHA PEL is 50 ppm based on an eight-hour TWA�

Cadmium is a soft, blue and white metal or grayish-white powder and is commonly used as an anticorrosive for electroplated steel� Exposures occur mainly in gas meter refurbishing, aircraft repair, and in shipyard industries� Certain materials and products such as paints, batteries, and phosphate fertilizers also contain cadmium� Healthcare safety personnel must remember that the presence of cadmium can occur in lead molds used in radiation medicine� Treat cadmium as a potential lung carcinogen� Breathing in high levels can cause severe damage to the lungs� Short-term effects of exposure include weakness, fever, headaches, chills, sweating, and muscular pain� Long-term effects can include kidney damage, emphysema, and bone deterioration� Cadmium exposure can also cause anemia, discoloration of teeth, and loss of the sense of smell� OSHA requires establishment and implementation of a written plan for cadmium if exposure levels exceed the PEL�

Chlorine is commonly used for sanitizing counter and tabletop surfaces� Household bleach commonly used as a disinfecting solution is a mixture of 1/4 cup chlorine to a gallon of water� Chlorine should be mixed fresh daily and used for disinfection on noncritical surfaces such as those in water

tanks and bathrooms� It is also used as a laundry additive, a sanitizing solution for dishwashing, and a disinfectant for floors� Chlorine-based substances should not be mixed with materials containing ammonia because the reaction will produce a toxic gas� Mild irritation of the mucous membranes can occur at exposure concentrations of 0�5 ppm� The OSHA PEL for chlorine is a ceiling of 1 ppm according to 29 CFR 1910�1000, Table Z-1� Chlorine possesses an odor threshold between 0�02 and 0�2 ppm, but a person’s sense of smell is dulled by continued exposure�

Iodine works as a general disinfectant and can be used with alcohol for use as a skin antiseptic or with other substances for general disinfecting purposes� Exposure can include irritation of the eyes and mucous membranes, headaches, and breathing difficulties� Crystalline iodine or strong solutions of iodine may cause severe skin irritation because it is not easily removed and may cause burns� The OSHA PEL sets a ceiling for iodine at 0�1 ppm according to 29 CFR 1901�1000, Table Z-1�

Isopropyl alcohol, a widely used antiseptic and disinfectant, is used to disinfect thermometers, needles, anesthesia equipment, and other instruments� The odor of isopropyl alcohol may be detected at concentrations of 40 to 200 ppm� Exposure to isopropyl alcohol can cause irritation of the eyes and mucous membranes� Contact with the liquid may also cause skin rashes� The OSHA PEL is 400 ppm for an eight-hour TWA� Workers should use appropriate protective clothing such as gloves and face shields to prevent repeated or prolonged skin contact with isopropyl alcohol� Splash-proof safety goggles should also be provided and required for use where isopropyl alcohol may contact the eyes�

Methyl methacrylate is used in the fields of medicine and dentistry to make prosthetic devices and as a ceramic filler or cement� It is an acrylic cement-like substance used to secure prostheses to bone during orthopedic surgery� Exposure usually occurs during mixing, preparation, and in the operating room� Symptoms from overexposure can include coughing, chest pain, headache, drowsiness, nausea, anorexia, irritability, and narcosis� Very high levels may cause pulmonary edema and death� Exposure can cause irritation to skin, which can include redness, itching, and pain� The substance may be absorbed through the skin and can irritate the eyes� Dental technicians using bare hands with methyl methacrylate molding putty developed changes in the nerve impulse transmission in the fingers� Repeated skin exposures may cause tingling or prickling sensation of the skin� Persons with preexisting skin disorders or eye problems, or impaired liver, kidney, or respiratory function may be more susceptible to the effects of the substance� OSHA recommends mixing in a closed system, if possible�

This acid is a powerful sterilant with a sharp, pungent odor� At higher concentrations (1 percent) it can promote tumors in mouse skin� A machine system containing 0�2 percent peracetic acid heated to about 50 degrees Celcius can sterilize rigid and flexible endoscopes within a 45-minute cycle time, including a rinse with water filtered through a 0�2-micrometer membrane to remove bacteria� The system uses the peracetic acid once only and is relatively expensive� Minimize odor and toxicity concerns by containing the peracetic acid within the closed machine� Peracetic acid is used to sterilize the surfaces of medical instruments and may be found in laboratories, central supply, and patient care units� It is a strong skin, eye, and mucous membrane irritant� Currently, no standards exist for regulating exposures to peracetic acid�

The EPA considers insecticides, herbicides, fungicides, disinfectants, rodenticides, and animal repellents as pesticides� OSHA considers pesticides as hazardous substances under the OSHA Hazard Communication Standard� EPA regulates pesticides under their Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) regulations� All pesticides sold in the United States must carry an EPA Registration Number� Consider these registered substances safe and effective when used according to directions� Pesticides labeled “DANGER - POISON” indicate highly toxic substances� If inhaled, ingested, or left on the skin, they may be lethal� Responsibility for the safe use of these toxic materials begins with purchase and continues until the empty container is properly discarded� The EPA Worker Protection Standard, 40 CFR 156 and 170, contains regulations that address the handling, loading, mixing, or applying of pesticides and the repair of pesticide-applying equipment� This standard affects all forestry, greenhouse, and nursery workers who perform hand labor in pesticide-treated fields� Some pesticide products require verbal warnings and posted warning signs�

Phenol solutions can prove effective for a wide range of bacteria� Some phenolic substances may also be used for intermediate-level disinfection when effective against tuberculosis (TB)� Phenol may work well for surfaces, equipment, prosthetics, bite registrations, and partial dentures� Avoid skin or mucous membrane exposures� Phenol may be detected by odor at a concentration of about 0�05 ppm� Serious health effects may follow exposure to phenol through skin adsorption, inhalation, or ingestion� The OSHA PEL for phenol is 5 ppm for an eight-hour TWA skin exposure� Workers exposed to phenol should wash their hands thoroughly before eating, smoking, or using toilet facilities�

These substances, widely used as disinfectants, do not work effectively against tuberculosis and gram-negative bacteria� Central sterile, environmental services, patient care areas, and clinical services use quaternary compounds for general low-level disinfecting tasks� These compounds may cause contact dermatitis and nasal irritation, but are less irritating to hands than other types of substances�

Most solvents remove the natural fats and oils from the skin and may be absorbed� Organic solvents pose flammability hazards� Safety personnel must properly store solvents in approved safety containers� Local exhaust ventilation and enclosure of solvent vapor sources should be used to control laboratory exposures� When selecting engineering and other controls, safety personnel must consider both toxicity and flammability risks� Toluene and xylene used in laboratories can cause eye and respiratory irritation resulting from exposure to liquid and vapor forms� Other exposure symptoms include abdominal pains, nausea, vomiting, and possible loss of consciousness, if ingested in large amounts� Most individuals can sense the odor of toluene at 8 ppm� Inhaling high levels of toluene in a short time can cause light-headed sensations and drowsiness� Toluene must be stored to avoid contact with strong oxidizers such as chlorine, bromine, and fluorine� Xylene can also be found in some maintenance departments and clinical labs� OSHA and NIOSH set xylene exposure limits at 100 ppm� Store all solvents in accordance with NFPA 30 requirements�

Many healthcare facilities use 70 percent ethyl alcohol as a topical application in local skin disinfection� Consider ethyl alcohol flammable in all dilutions where vapor may come in contact with an ignition source� The flash point of a 70 percent solution is approximately 70 degrees Fahrenheit� Ethyl alcohol can enhance the drying of the skin� Take care when using to avoid dermatitis� Dispose of ethyl alcohol after thoroughly diluting with water and only in an area with adequate ventilation� Maintain ethyl alcohol in volumes over 70 percent in a flammable storage cabinet away from patient care areas� In case of fire, use a type BC fire extinguisher�

Glutaraldehyde is used to disinfect and clean heat-sensitive medical, surgical, and dental equipment� Glutaraldehyde solutions serve as a tissue fixative in histology and pathology labs� Absorption may occur by inhalation, dermal contact, or ingestion� Use ventilation controls to prevent overexposure, which can cause allergic eczema and mucous membrane irritation� Date all solutions to ensure effectiveness against bactericidal contamination� Glutaraldehyde is used to disinfect and clean heat-sensitive equipment such as dialysis instruments, surgical instruments, suction bottles, bronchoscopes, and endoscopes� It works well to disinfect ear, nose, and throat instruments� The colorless and oily substance gives off a pungent odor� Hospital workers use it most often in a diluted form mixed with water or in a commercially prepared product� OSHA does not currently publish a PEL for gluturaldehyde� ACGIH recommends a ceiling TLV of 0�05 ppm (parts per million)� NIOSH publishes a recommended exposure limit (REL) of 0�2 ppm for gluturaldehyde vapor from either activated or inactivated solutions� Refer to the NIOSH Publication No� 2001 -115, May 2001, Glutaraldehyde: Occupational Hazards in Hospitals.