In wake of fine for chemical spill at surgery center, are you prepared?
You can learn from what facilities did right — and wrong
Providence St. Peter Hospital in Olympia, WA, has been fined $45,000 by Washington state for workplace violations related to a formalin spill last summer in the sterile processing area of the outpatient surgery center. The violations included lack of adequate equipment, such as respirators, and inadequate training for employees wiping up the liquid.
The fine initially was set at $107,000, but it was reduced as part of a settlement in which the hospital agreed to change employee training and its policy regarding the handling of potentially hazardous material spills.
At approximately 9 p.m. on July 14, 2004, about 5 gallons of 10% formalin solution spilled from a spigot that was found loosened.
Eight employees were involved in the cleanup, and several reported their throats or lungs were burning. The employees worked with their union to file a complaint with the state. One employee remains on medical leave.
"While we had policies and procedures in place to manage the cleanup of this type of spill, we did not follow these procedures as well as we should have, resulting in employee exposure to this chemical," said Jim Leonard, COO of Providence St. Peter in a prepared statement.
Changes at Providence St. Peter include the outpatient surgery center using small single-use pre-packaged containers of formalin to reduce the size of potential spills. In addition, the hospital established right-to-know stations in every department, including outpatient surgery, so employees have access to information about hazardous materials in their departments.
In the outpatient surgery center, the right-to-know station is located at the front desk. It includes a copy of the "Hazardous Materials and Waste Management" policy, a copy of the "Hazardous Material and Waste Management Plan," and a list of chemicals used or stored in the department. The Occupational Safety and Health Administration (OSHA) already requires facilities to have such materials in a central location.
Also, the hospital has contracted with a chemical specialist to clean up any future major spills. The specialist, also located in Olympia, formerly worked as a consultant for an environmental company that responded to large spills.
The most important step in being prepared for a chemical spill is to educate employees on how to handle spills, even if that education is simply telling them to evaluate the spill and call an outside team, says Paul Fitzpatrick, MHA, MT (ASCP) SC, director of laboratory services at Providence St. Peter.
At Providence St. Peter, employees were not trained to respond to such a large spill (almost 5 gallons of formalin), says Lynda Moelhman, MPH, industrial hygiene inspector at the Olympia office of the Washington Department of Labor and Industries, which investigated the hospital’s response to the spill. "They should have evacuated and called a hazmat team," she says.
Providence St. Peter now has a policy that in the event of a spill, outpatient surgery employees should evaluate the area and call the operator to launch an "orange team," which conducts assessment, containment, and cleanup of the spill.
Members of the orange team have completed a four-hour spill response course, and they are scheduled to complete another four-hour course. "We have a hazardous material and waste management plan and a spill response guide for the orange team," Fitzpatrick says.
They have appropriate personal protective equipment (PPE) available, including respirators, and they know how to use it, he emphasizes.
When the orange team was established, the appropriate policy was sent to the outpatient surgery managers and directors, and they held an education session during their staff meeting, Fitzpatrick says.
At Strong Memorial Hospital in Rochester, NY, managers in outpatient surgery provide site-specific training in hazardous agents, including most cleaning agents, liquid medicine, and anesthetic gases. In addition, the environmental health and safety department has 1½ hours of training on issues including chemicals for new employees, says Robert Passalugo, CIH, senior industrial hygienist.
Additionally, he developed a Learners Guide for Responsible Hazardous Chemical Waste Management for nurses and other medical care practitioners. "We took our hazardous communication program and included many of the agents normally used by nurses," Passalugo says. "We included a short paragraph on the hazards and precautions to be used." The guide is updated every other year, he adds.
Strong Memorial has spill kits available that include PPE. If limited quantities of material are used in surgery, paper towels, chucks (plastic-backed absorbent papers), bleach (to be diluted to 10% for blood spills), cat litter, and assorted scrapers are adequate for most materials, says Passalugo. "If the materials are stored in a closable 5-gallon container, the waste materials and the disposable PPE can be placed into the container for disposal through the institution’s hazardous waste group," he notes. Having two sets is a good idea, so you have a spare, Passalugo adds.
If your own employees respond to chemical spill, there is an entire code [1910.120(q)] on emergency response from OSHA, says Margaret Cunningham, CIH, supervisor of the Olympia office of the Washington Department of Labor and Industries.
The code is comprehensive and includes requirements for PPE, training, etc., she emphasizes.
"They just can’t say, Employees will respond. We’re ready,’" Cunningham says. (To see how to access the standard, see Sources/Resources below.)
For many chemicals found in a same-day surgery program, the same PPE used for responding to the chemical spill can be used to clean up a spill, Passalugo says. "However, I recommend double gloving and using safety glasses," he says. "A surgical mask or even an N95 [respirator] can be worn for splash protection."
Keep in mind that with formaldehyde, there’s an OSHA requirement for medical exams in the event employees are exposed, Moelhman says.
If you have contracted services, such as a cleaning service, ensure those workers are trained on what chemicals they’re using, the hazards, and where the medical safety data sheets (MSDS) are located, advises Dionne Williams, industrial hygienist with OSHA. "Some have had training, but they may not have had training on specific chemicals at that site," she says.
Sources/Resource
For more information on chemical spills, contact:
- Margaret Cunningham, CIH, Supervisor, Washington Department of Labor and Industries, 312 S.E. Stonemill Drive, Suite 120, Vancouver, WA 98684. E-mail: [email protected].
- Paul Fitzpatrick, MHA, MT (ASCP) SC, Director, Laboratory Services, Providence St. Peter Hospital, 413 Lilly Road N.E., Olympia, WA 98506-5166. Phone: (360) 493-7578. E-mail: [email protected].
- Robert Passalugo, University of Rochester, 300 E. River Road, Room 23, Rochester, NY 14623. Phone: (585) 275-3016. Fax: (585) 274-0001. E-mail: [email protected].
- Dionne Williams, Industrial Hygienist, Occupa-tional Safety and Health Administration, Washington, DC. Phone: (202) 693-2190.
- Occupational Safety and Health Administration. Web: www.osha.gov/SLTC/reactivechemicals/index.html. The web site includes links to standards and additional information. To access the code [1910.120(q)] on emergency response, go to www.osha.gov. Next to ’Site Index,” click on ’S” and then ’Standards (29 CFR). Search for ’1910.120(q).”
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