After chemical spill, WA hospital revamps policies
Plan for internal emergencies, experts say
It was 9 p.m. when housekeepers at Providence St. Peter Hospital in Olympia, WA, received a call about a spill of formalin, a fixative that is 10% formaldehyde. They wondered if there was some special precaution they should take, but when they called their manager, he told them just to clean it up.
Four of the employees soon became nauseous and began vomiting, requiring emergency department treatment. One of them was admitted with more severe symptoms and has had lingering effects.
The failure to follow proper procedures for handling hazardous materials led to a $45,000 fine from the Washington Department of Labor and Industries (L&I). As a result of the incident, the hospital revamped its policies and procedures and educated employees.
Yet Providence St. Peter isn’t alone in its failings. This mistake highlights the need for hospitals to train employees about how to handle hazardous spills — whether they are in environmental services or clinical care, says Paul Penn, MS, CHEM, CHSP, president of EnMagine, a Diamond Springs, CA-based consulting firm that specializes in planning and training in emergency management for health care.
Anyone who works with hazardous materials needs to know how to respond, including employees in nursing, radiology, and materials management, he says . "If they’re not trained to clean up a spill, they should be at least trained to the first-responder awareness level," Penn adds.
The U.S. Occupational Safety and Health Administration (OSHA) requires employers to have a written hazard communication program that includes worker training, warning labels, and access to Material Safety Data Sheets (MSDS) on the chemicals.
According to OSHA, "Employers should provide employees with effective information and training on hazardous chemicals in their work area at the time of their initial assignment and whenever a new physical or health hazard that employees have not been previously trained about is introduced into their work area."
OSHA issued a draft Model Training Program for Hazard Communication to assist employers in designing their training. (More information is available at www.osha.gov/dsg/hazcom/MTP101703.html.)
Beyond the MSDS information
Hospitals have MSDS safety information on their hazardous chemicals. But that is just the beginning of what employees need to properly handle or clean these substances. Hazardous chemicals can lead to an internal emergency — one that needs a response plan, just as hospitals have plans to deal with external emergencies.
In the Providence St. Peter case, the Washington L&I issued six willful violations and 18 serious violations, and noted, "The employer did not ensure that appropriate procedures were implemented in the event of an emergency."
Employees beyond the cleanup crew were exposed to the formaldehyde spill, the agency said. "An administrative decision was made to have the night shift environmental services supervisor clean up the spill and for employees in the area to continue their work," the citation stated. "Proper spill cleanup procedures were not followed, and decontamination took days while employees continued working in the area."
Meanwhile, proper personal protective equipment (PPE) wasn’t available to the housekeepers. According to Carter Wright, communications director of Service Employees International Union Local 1199NW, the housekeepers wore surgical masks, which are completely ineffective against chemical agents.
"There wasn’t a ventilation system. There were no appropriate cleaning materials available," he says.
The spill occurred in the sterile processing area of an outpatient surgery center. Formalin had leaked from a five-gallon container onto the floor. According to hospital policy, the housekeepers should have called an outside contractor to clean the spill, which is why the PPE wasn’t available, says Deborah Shawver, public relations director.
Now, the hospital’s employees have a clear protocol to follow. Employees in nursing, pharmacy, and the laboratory, and operating engineers, have been trained to clean minor spills using proper materials and PPE — for example, a few drips of a substance that would not pose a threat of injury.
If larger spills occur, they must call the Orange Team — a new hazardous material spill response team that has been specially trained to handle hazardous substances. The team is available 24 hours a day, seven days a week. If the spill is beyond its capabilities, the team calls an outside contractor.
Meanwhile, all employees who work in departments with hazardous materials received additional training. Large containers of Formalin were replaced by smaller ones, limiting the potential for large spills.
A better policy on spills
L&I lowered its initial, proposed fine of $107,000 and lauded the hospital for its response to the incident. "The employer agreed to go above and beyond fixing this problem and making sure it doesn’t happen again," says L&I spokesman Robert Nelson.
The hospital also set up "Right-to-Know" stations in every department so employees would be able to readily access information on hazardous materials.
"Every department has always had this list in the department," Shawver explains. "But creating a special Right-to-Know station makes it more prominent. It raises consciousness and awareness.
"We made a lot of improvements," she says. "I think people are well aware of what they need to do in case of an emergency. We take employee safety very seriously here. When we discovered that this had occurred, we responded very quickly and very comprehensively."
Those new policies are consistent with OSHA standards, Penn adds. "OSHA says that if you are in a role where you may encounter a hazardous material spill, you should be trained to take the appropriate actions to protect yourself or others," he says.
Penn also notes that hospitals focus on preparing their emergency department to decontaminate patients contaminated by hazardous materials — but don’t put as much emphasis on the potential for serious incidents within the hospital itself. Yet a major spill in a hospital could force the transfer of patients or other disruptions to service, he says.
"Hospitals, unlike other industries, don’t generally have the luxury of just telling everyone to get out," he says. "I believe that hospitals have a greater responsibility to have a robust preparedness to prevent small incidents from becoming emergencies."
It was 9 p.m. when housekeepers at Providence St. Peter Hospital in Olympia, WA, received a call about a spill of formalin, a fixative that is 10% formaldehyde. They wondered if there was some special precaution they should take, but when they called their manager, he told them just to clean it up.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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