Medical waste could be putting your staff at risk
Nurses can help influence environmental policy
One of the ironies of the nursing profession is that in striving to make life better for patients, nurses are exposing themselves to potential life-threatening infections and injuries.
For many health care workers, a hospital can be a dangerous place to work, according to environmental health experts as Susan Wilburn, RN, MPH, an official with the American Nurses Association (ANA) in Washington, DC.
There’s been a groundswell of concern over bloodborne pathogens, airborne toxins, workplace violence, and patient care-related injuries to nurses, says Wilburn, senior specialist in occupational health and safety for the ANA.
Late last year, Congress declared war on the needlestick issue by directing several government agencies, including the U.S. Centers for Disease Control and Prevention, to develop standards for the use of safer needle devices. Other occupational safety issues, such as those involving back injuries sustained from patient lifting, have also captured the profession’s attention.
In fact, the list of common workplace hazards is longer, says Hollie Shaner, RN, MS, president and co-founder of the Nightingale Institute for Health and the Environment, an Essex Junction, VT, nonprofit group.
A major culprit among health hazards found in hospitals is medical waste. As an industry, "we produce 6,700 tons of it per day," Shaner says. When incinerated, the waste releases dioxins and other toxins that find their way into the ecosystem and endanger public health.
Meanwhile, much of the risk of exposure to toxins and biological threats from medical waste and other workplace hazards affects hospital workers who happen to be in closest proximity to patients.
No matter where in a hospital you work, the risk level is about the same, notes Wilburn. "Individually, the exposure levels [to nurses] may vary. But no one department is any more or less vulnerable to bloodborne pathogens or other health risks than any other," she observes.
In the ICU where stress levels usually run high, patients are extremely ill, and the pace of work is often hectic. Bedside nurses may be particularly prone to nosocomial infections and work-related illnesses and injuries, some authorities say. Operating suites and CCUs are generally among the largest producers of medical waste, Shaner says.
Nurses not trained to be hazard-sensitive
Yet, nurses in these departments don’t always think about the potential for harm that surrounds them. Few make the effort to consider what should be done about it. "Nurses don’t think about these things because we haven’t been trained that way," says Shaner, a former critical care nurse.
Managers and administrators have a tremendous opportunity to influence environmental health policies at their facilities, and it doesn’t take reinventing the wheel to help create a safe working environment for nurses, Wilburn notes.
A few observations provided by Wilburn and Shaner are useful in making a point:
• Latex.
While protein allergens made headlines as a culprit found in powdered latex gloves, latex is also commonly found as a component part of intravenous lines. The protein was found to adversely affect 10% of nurses and has been blamed for disorders ranging from dermatitis and asthma to severe anaphylaxis.
Last year, the U.S. Food and Drug Administration ordered all medical products, including latex gloves, to be properly labeled, and most providers have stopped using latex powdered gloves. Yet, latex and other potentially hazardous materials are available in small quantities in several common medical supplies, including intravenous lines.
• Mercury.
A highly toxic metal, it is commonly used in dozens of places in hospitals. It’s found in common products from thermometers to esophageal dilators. Four grams of the metal are sufficient to contaminate a medium-sized lake, Shaner says. Yet, thermometers often end up in hospital trash bins and are easily accessible to patients, including children, and pose a threat to workers if not disposed of properly.
• Bio-hazardous waste.
The industry has made significant progress in handling syringes, body matter, and fluids through special disposal options that include the use of designated "red bags" and other containers. Yet, workers often confuse the disposal of tainted gloves and paper towels with other contaminated materials.
These items should end up in a general trash bin and not combined with more dangerous materials in special containers such as red bags. These standards are defined differently in 42 of the 50 states. Check with your hospital’s safety committee. Bio-hazardous waste represents about 15% of a hospital’s medical waste stream, according to Shaner.
Nurses can ensure safe work conditions
While documented cases of injuries or negative reactions from an unsafe health care work environment have been plentiful, changing behaviors has been another matter. This fact only redoubles the need for awareness and prevention, Shaner says. Nurses can do a great deal to ensure a safer work environment as the five following suggestions indicate:
• Appoint a nurse within the department to oversee environmental hazard controls.
The nurse can act as unit ombudsman and troubleshooter for assessing risk factors. The same individual can represent the unit on the hospital safety committee to report on the department’s particular needs and concerns. The nurse should be trained in environmental safety and must receive the hospital’s full support, Shaner says. The hospital also should be able to provide that training.
• Investigate the basis for extensive sick leaves and absences.
A pattern may emerge pointing to the source adversely affecting certain nurses. If the problem is due to an environmental cause, the research may help provide clues to possible solutions, Wilburn says.
• Adopt environmental management standards for the unit.
The U.S. Occupational Safety and Health Administration (OSHA) in Washington has published guidelines and standards for disposing of medical waste. And nonprofit groups such as the ANA and the American Hospital Association (AHA) in Chicago have guidelines for ensuring a safe work environment. For copies of ANA or AHA standards, contact your hospital’s safety committee or risk management department. (For information on how to obtain a set of OSHA guidelines, see editor’s note at the end of this article.)
• Establish a protocol for managing environmental health and safety hazards.
Extent of the protocol would vary depending on the unit’s size, number of employees, nature of the hazard, and the volume of potential risk. Protocols should specify in writing exact procedures for handling potential materials such as proper labeling and safeguards for their disposal.
• Provide for training and make environmental management a priority.
New hires and transfers should be taken on a tour of the unit. Potential health hazards, including supplies and equipment, should be specifically pointed out as a precaution. This includes knowing what an MSDS (materials safety data sheet) is and knowing where they are kept, Shaner adds.
"The procedure should be given as much importance as fire safety," Shaner emphasizes. Staff should also receive training on hazardous materials based on published guidelines and information obtained from the hospital safety committee. "Most of these safeguards are easy to implement, but they can have far-reaching implications."
[Editor’s note: The Office of Occupational Health Nursing in Washington publishes a document, Framework for a Comprehensive Health and Safety Program in the Hospital Environment. To obtain a copy, contact: The Government Printing Office, Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Telephone in Washington: (202) 512-1800. Web site: www.gpo.gov/su_docs. Refer to order no. 029-016-00149-2. Price is $4.50. Or log on to OSHA’s Web site: www.osha. gov. The agency is a department of OSHA.]
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