Environmental Health

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Hazard Communication/ Right-to-Know
Environmental Health Safety 4-6783 www.stonybro
ok.edu/ehs/healthcare
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Training Outline

• Hospital Safety Information
• Environment of Care
• Respiratory Protection
• Injury/Illness Reporting
• Reducing SB Medicine Staff Exposures
• Contaminated Sharps Injuries
• Formaldehyde (Formalin) Safety
• Glutaraldehyde/OPA Safety
• Hazardous Drugs (HD) Safety
• Ethylene Oxide (EtO) Safety
• Waste Anesthetic Gases (WAG) Safety
• Ergonomics Policy
• Environmental Awareness
• Transporting Infectious and Diagnostic Specimens
• Hazard Communication/Right to Know

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Environment of Care (EOC)

• Management Plans
• Each reference card has critical information
• Posted in all patient care areas
• Please review you are responsible for knowing
  information on cards

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Top 12 Ways to Insure EOC Compliance

• Always wear your Stony Brook ID badge.
• Know proper procedure for Major Chemical Spill
  response.
• Call University Police at 911 or 631-632-3333
  from cell phone. (Off sites call 911)
• Know the location of your departments Emergency
  Management Manual and Plan.
• Know location of your units disaster kit for
  power outages (flashlights, batteries, extension
  cord, duct tape, glow sticks).
• Know how to shut off the oxygen supply valve.

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Top 12 Ways to Insure EOC Compliance

• 6. Report building issues to Plant Operations
  at 4-2400.
• Know proper fire response procedures (RACE).
• Know locations of nearest fire alarm pull
  stations and how to use a fire extinguisher
  (PASS).
• 9. Secure your personal belongings.
• Know how to access Safety Data Sheets, SDS,
  on-line (formerly referred to as MSDS).
• Adhere to no smoking policy.
• 12. Report building related issues. (Tech Park
  Contact Facilities Manager, 4-4380)

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Respiratory Protection

• SBUH requires all hospital employees, who come
  in contact with patients with known or suspect
  TB, other airborne pathogens or hazards, be
  annually fitted with a hospital approved N95
  respirator.
• If you experience significant weight gain or
  loss, dental or facial surgery, or other
  condition that may affect respirator fit, you
  must be re-fitted, even if it is within a year of
  your last fit test.

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N95 Respirator- User
Instructions

• Prior to wearing a respirator you must be
  medically cleared by Employee Health, and
  trained/fit tested by EHS.
• Only wear the Type, Make, Model and Size
  respirator you were fitted with (e.g., N95, 3M
  1860S). Keep fit test card with respirator
  information in your ID badge.
• Read user instructions.
• Inspect your respirator and conduct the User Seal
  Check prior to each use.
• Before you enter an isolation room that requires
  a respirator, put on your respirator in the
  corridor (not in the ante-room or patient room).
• For TB exposure, discard the N95 respirator when
  soiled or damaged. For SARS or smallpox
  exposure, discard after each use, unless directed
  otherwise.

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N95 - No Interfering Facial Hair

• Anyone with interfering facial hair cannot be fit
  tested or wear a N95 respirator because it
  prevents a good seal around the face.
• A small goatee or mustache that fits inside the
  respirator may be OK, but a full beard or
  substantial stubble is not.

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Do I need to Wear a Surgical Mask over the N95
Respirator?
N95 Respirators

• Typically no.
• The hospital approved N95 respirators (3M 1860
  and the Moldex/Inovel 1500 series) are both rated
  as surgical masks.

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N95 Annual Respirator Fit Testing

• For Residents Fit testing will take place the
  day of Orientation. (If you are not able to get
  fit tested at Orientation, you can be fit tested
  at one of the open monthly sessions).
• Open monthly fit testing schedule is provided in
  the Hospital weekly announcements and on the
  Hospitals intranet under Hot Topics.

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Injury/Illness Reporting

• Report any work related injury/illness to your
  supervisor.
• If necessary, seek medical attention at Employee
  Health and Wellness. If life threatening or off
  hours, go to the ED.
• Complete an Employee Injury/Illness Report and
  fax to 9-706-4230.
• Contact the Accident Reporting System (ARS) at
  888-800-0029.

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Contaminated Sharps Injuries
How can we prevent future injuries?
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Reducing Contaminated Sharps Injuries

• Use a device with a safety, if available.
• If you are unsure how to use a device, seek
  guidance.
• Actively participate in trials of new safety
  devices.
• Limit distractions and conversations -- Don't
  disturb a colleague while they are using a sharp.
• Avoid multiple attempts during phlebotomy, ABGs,
  IV catheter insertions, CV catheter placement,
  and lumbar punctures.
• Use blunt tip needles in OR.
• Use extreme care when suturing.

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Reducing Contaminated Sharps Injuries

• Take your time, don't rush.
• "Cool off" after interpersonal conflict.
• Avoid passing.
• Immediately discard used sharp in sharps
  container.
• When a sharps containers is ¾ full, have someone
  contact Hospital Custodial Services at 4-1455.
  (Off-sites call Bob Weniger at 4-4066).
• Report all injuries and complete an Employee
  Injury/Illness Report and Sharps Injury Log.

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Formaldehyde/Formalin Safety -human carcinogen-

• When using specimen containers with formalin
• Minimize length of time containers are open
• Avoid spillage
• Clean up any spillage immediately
• Wear PPE nitrile gloves

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Glutaraldehyde and Cidex OPA eye, skin,
respiratory tract irritant
Glutaraldehyde and Cidex OPA Safety

• How to minimize exposure
• Use appropriate ventilation GUS
• Wear PPE (gloves, gown and eye protection).
• Pour carefully.
• Keep containers closed when not in use.
• Use Glute-out neutralizer prior to drain disposal
  and for spills.

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Glutaraldehyde and Cidex OPA eye, skin,
respiratory tract irritant
Hazardous Drugs (HD) Safety

• Look for HD Precautions sign on in-patient room
  doors
• Wear appropriate PPE
• Anticipation of hand exposure wear double
  nitrile gloves, change out after 30 minutes
• For chemo and for anticipation of body splash
  wear chemo gown
• Avoid crushing or cutting HD tablets
• Review HD Management policy, EC0048

Hazardous Drug - as defined by NIOSH (National
Institute of Occupational Health Safety), any
drug identified by at least 1 of the following 6
criteria carcinogenicity, teratogenicity or
other developmental toxicity, reproductive
toxicity in humans, organ toxicity at low doses
in humans or animals, genotoxicity, or new drugs
that mimic existing HDs in structure or toxicity.
Include drugs for cancer chemotherapy, antiviral
drugs, hormones, some bioengineered drugs and
other miscellaneous drugs and are identified on
NIOSHs List of Antineoplastic and Other
Hazardous Drugs in Healthcare Settings.
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Ethylene Oxide (EtO) Safety

• EtO is a flammable, colorless gas used to
  sterilize surgical equipment
• Central Sterile Supply (CSS) uses EtO in closed
  system sterilizers/ aerators
• 2 EtO abators works automatically and interface
  with sterilizer/aerators
• CSS has gas alarm system with master alarm panel
  outside EtO room with visual and audible alarms
• 3 separate EtO monitors, in EtO Room and by each
  abator

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Waste Anesthetic Gases (WAG) Safety

• WAG nitrous oxide and halogenated anesthetics
  (e.g., halothane, enflurane, isoflurane,
  desflurane).
• exposure from leakage of patient's anesthetic
  breathing circuit during delivery of anesthetic
  and exhalations of patients recovering from
  anesthesia
• Use anesthesia delivery units with gas scavenging
  as per manufacturers instructions.
• Face masks used for administrating inhaled
  anesthetics should be available in variety of
  sizes, pliable, provide effective seal to prevent
  leakage, and positioned on the patients face
  properly.
• Wear PPE during spills of liquid anesthetic
  agents (gloves, goggles, face shields)

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Ergonomics PolicyEHS is responsible for
managing the Ergonomics Program, in consultation
with Employee Health Wellness

• Ergonomics
• science of human work focusing on designing work
  stations, tools tasks for safety, efficiency
  comfort.
• Musculoskeletal Disorders (SDS) result from
  bodily reactions due to bending, climbing,
  crawling, reaching, twisting, overexertion, or
  repetitive motion. Injuries can occur to
  muscles, nerves, tendons, ligaments, joints,
  cartilage, and spinal discs in back, neck
  shoulder, elbow, wrist or hand.

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Ergonomics Policy

• Reporting Employees need to report work related
  injuries to their supervisor.
• Incident Trending when a trend of MSD injuries
  is identified in an area, a hazard assessment
  will be conducted.
• Response Controls may be used to reduce hazards
  
• Training General ergonomics awareness will be
  provided by EHS during Orientation,
  recertification classes and online.

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Environmental Awareness
What happens to waste that is poured down the
drain?
It goes to the Sewage Treatment Plant at the
University and then into the Long Island Sound.
Sewage Treatment Plant at the University
Remember Do not put any hazardous waste down
the drain.
Long Island Sound Port Jefferson, NY
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What is Chemical Hazardous Waste?

• Chemical hazardous waste can include medications,
  cleaning products, paints, solvents, acids/bases.
• Most hazardous wastes have been identified
  throughout the Hospital and are being collected.
• If you are unsure whether you are generating a
  hazardous waste or are disposing of a new
  chemical product, complete a Waste Determination
  (Admin PP EC0045).
• If you have any questions, contact EHS at
  4-6783.

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Common Chemical Waste Containers
You might see the following 4 waste disposal
containers on the units
HW

• Pharmacy Return Box all unused or expired drugs
• Black 2-gallon container Partially Used Drugs
  with a label.
• Locked Box (Critical Care areas) Epinephrine,
  Propofol (Diprivan), Eptifibatide (Integrilin)
  and Nitroglycerin
• Chemo container (Oncology areas) Chemotherapy
  waste.

HW
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Regulated Medical Waste (Red Bag Waste)

• Place the following in Red Bags
• All waste generated in diagnosis, treatment or
  immunization of humans
• Cultures and stocks
• Human pathological waste excluding teeth
• Human blood and blood products
• Waste products must be saturated with blood or
  bodily fluids so that when squeezed produces free
  flowing fluid or flecks

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Sharps Waste
Place in Sharps Containers

• Needles
• All Syringes with needles
• Syringes without needles that have come in
  contact with blood or body fluids
• Pipettes
• Slides and cover slips
• Scalpel blades
• Glass test tubes
• Disposable staples
• Explanted orthopedic hardware

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Transporting Infectious Substances

• All Infectious Substances and Biological
  Specimens must be packed and shipped by specially
  trained employees.
• Hazardous materials MUST be properly labeled and
  packed for shipment.
• Training is required and available from EHS
  (4-6783).

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Hazard Communication/RTK - OSHA PESH

• OSHA
• Occupational Safety Health Administration
• Oversees Hazard Communication Standard in the
  private sector

• PESH
• Public Employees Safety Health Bureau
• Oversees Hazard Communication (RTK) Standard for
  public employees at the state and local level

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Required Departmental Postings

• Employers must post a sign in every workplace
  to inform employees that they have a right to
  hazard information.

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Employer Responsibilities

• Notify you about your right to request
  information
• Provide information within 72 hours
• Maintain information
• Provide education and training

• Maintain records on exposures
• Maintain labeling system
• Provide hazard information to non-employees

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Employee Rights

• Submit written requests for information
• Refuse to work with a toxic substance if no reply
  received within 72 hours
• Obtain access to Universitys written Hazard
  Communication, Right to Know program

• Can not be forced to waive any rights under the
  Law as a condition of employment
• Can file complaints with Department of Labor or
  NYS Attorney General

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Revised Haz Comm Standard

• Hazard Communication Standard has aligned with
  the UN Globally Harmonized System of
  Classification and Labeling of Chemicals (GHS)
• Provides common approach to classifying chemicals
  and communicating hazard info on labels and
  safety data sheets (SDS)
• Improves quality and consistency of hazard
  information, making it safer for workers by
  providing understandable information on handling
  and safe use of hazardous chemicals

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Changes
Major changes to Haz Comm Standard
NEW

• New Hazard classifications
• New Labeling requirements
• Signal words (Danger or Caution), pictograms,
  hazard statements, precautionary statements
• Standardized Safety Data Sheets (SDS)

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Previous Labeling - NFPA Safety Diamond
Flammability

• Assign a number to reflect the degree of hazard
  to the worker
• RATING SYSTEM 0-4
• The higher the number, the higher the hazard!

Health
Reactivity
Special Hazard
Label all secondary containers with product and
hazard information!
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New GHS Labeling
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New Pictograms and Hazard Classes on Labels and
Safety Data Sheets
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Safety Data Sheets (SDS) Your Guide to
Workplace Safety

• Material Safety Data Sheets are now called Safety
  Data Sheets (SDS)
• SDS will be uniform, with the same 16 sections in
  the same order
• SDS will have
• Signal word (Danger or Warning)
• Hazard Pictograms
• Hazard Statements
• Precautionary Statements

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Accessing SDS Chemical Inventories

• SDS and departmental inventories are available
  on-line at Hospital intranet, Inside SBUMC,
  under RESOURCES or go to http//asa-msds.campus
  .stonybrook.edu/

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Accessing Pharmaceutical SDS

• On the Hospital Intranet page, scroll down to
  Resources.
• Select drop down for Drug References and Select
  MicroMedex.
• Type in the name of the drug in the search field
  and click Search.
• Scroll down and click on the "Toxicology and
  Exposure Information" section.
• Click on MSDS.

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Why are SDS important to me?
Safety Data Sheets (SDS)
Look for the red arrows throughout the MSDS
sections.

• Provides details on
• Hazards
• How to be protected from injury or illness
• What PPE to wear
• Safe work practices
• Exposure controls

• 3. What to do if a spill occurs
• 4. What to do if a co-worker or I get exposed
• First aid

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Review of a Sample SDS
SDS Review

• Formalin Solution, neutral buffered, 10
• Sigma Aldrich

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SDS Review

• 16 sections
• Identification
• Hazards Identification
• Composition/Ingredients
• First Aid Measures
• Fire Fighting Measures
• Accidental Release Measures
• Handling Storage
• Exposure Controls Personal Protection

• 9. Physical Chemical Properties
• 10. Stability Reactivity
• 11. Toxicological Info.
• 12. Ecological Info.
• 13. Disposal Info.
• 14. Transport Info.
• 15. Regulatory Info.
• 16. Other Info.

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Section 1 - Identification
SDS Section 1
In case of an emergency.
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Section 2 - Hazards Identification
SDS Section 2
How can this product harm me if improperly
handled?
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2. Hazards ID Pictograms, Hazard Statement,
Precautionary statement
You need to know how this chemical could harm
you, if not handled properly
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SDS Section 3
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Section 4 First Aid Measures
SDS Section 4
What do I do if this chemical get on my skin, in
my eyes, or if I breathe it in?
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Section 5 Firefighting Measures
SDS Section 5
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SDS Section 6
What do I do for a release or spill ?
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Spill Kits for Minor Chemical Spills

• Glutaraldehyde Spill Kits
• Located near GUS stations and areas where
  glutaraldehyde/Cidex OPA used
• Chemotherapy Spill Kits
• Located in areas where chemotherapy are prepared
  and administered
• Formalin Spill Kits
• Located in labs and areas using formalin
• Battery Acid Spill Kits
• Located in powered industrial truck charging
  areas and other non-alkaline battery areas.

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Chemical Spill Response

• Minor spills of less than a gallon can be cleaned
  up by trained staff using a spill kit (chemo
  spills lt 50 ml).
• Major spills over 1 gallon, call University
  Police at 911 (cell 631-632-3333).
• Offsites call 911

If at any time during clean up of a minor spill,
you need assistance, call 911 (631-632-3333).
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Section 7 Handling Storage
SDS Section 7
How should I handle and store this product safely?
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Section 8-Exposure Controls Personal Protection
SDS Section 8
How much can I be exposed to without experiencing
problems?
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Section 8 Personal Protection
What must I wear to protect myself gloves,
goggles, respirator?
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Section 9 Physical Chemical Properties
SDS Section 9
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Section 10 Stability Reactivity
SDS Section 10
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Section 11 Toxicological Information
SDS Section 11
How can this product harm me?
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Section 12 Ecological Information
SDS Section 12
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Section 13 Disposal Considerations
SDS Section 13
How should I dispose of this product safely?
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Section 14 Transport Information
SDS Section 14
What must I do if I need to ship this product?
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Section 15 Regulatory Information
SDS Section 15
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Section 16 Other Information
SDS Section 16
Codes used in Section 3