HEALTH HAZARDS
Chemical hazards Cleaning agents Mercury
Although hospital environmental service workers and housekeeping staff are at highest risk of exposure, patients, visitors and other hospital staff also can be exposed. Accidental exposures to large concentrations can occur through spills or during mixing of incompatible chemicals. Primary routes of exposure to cleaning agents are inhalation of aerosolized droplets or vapors and skin exposure. Several cleaning agents are known sensitizers and can lead to dermatitis upon repeated skin exposure. The patient and the attendant should stay away from areas ( whenever possible) where cleaning is going on. This will help keep the hospital environment clean as well as prevent exposure to chemicals. Mercury is primarily used in thermometers and blood pressure machines where it is present as metallic mercury. It is also found in dental clinics; in laboratory chemicals; in pharmaceutical products; as contaminants of cleaning products formed in the manufacture of certain ingredients; in batteries; in fluorescent, high- intensity- discharge and ultraviolet lamps; in electrical switches and relays; and as waste in plumbing. Metallic mercury and other forms of mercury can be inhaled or absorbed through the skin. Exposure is possible when mercury is spilled, during improper cleaning of a spill, during the maintenance of mercury- containing equipment, when mercury is transferred, or from inadequate ventilation to control vapor from sources and from past spills. The nervous system is very sensitive to all forms of mercury. Metallic mercury vapors are more harmful than other forms found in hospitals, because more mercury reaches the brain. The primary long- term effects from exposure to high levels of metallic, inorganic, or organic mercury are permanent damage to the brain, kidneys, the lining of the mouth and lungs, and the developing fetus. Mercuric chloride, used in some laboratory solutions, can cause cancers. Avoid touching or playing with mercury thermometers and BP apparatuses. Slips and falls Patients and attendants want to get things done very fast and rush from one place to another. Ideally different floor surfaces ( sanitary room, wards and units, operating theaters, kitchens, corridors and stairs) require different types of flooring. In their anxiety, many people slip and fall, injuring themselves. Stairways require handrails, slip- resistant coating for steps, high visibility ( clear of obstructions), nonslip markings for edges of steps and adequate illumination. Ramps should be well marked with appropriate signs. One should take care while using the ramp especially at turnings where the floor may be at an angle. While being shifted on a wheelchair or trolley, care must be taken to prevent the patient slipping off the wheelchair of trolley at these areas and causing more injury. Aerosolised medications Aerosolised delivery of medications has an advantage to the patient of direct delivery to the target organ, the respiratory tract, rather than indirectly via the mouth or as injections. Medications for asthma such as bronchodilators and inhaled corticosteroids are the most commonly used. Aerosolised mucolytics ( mucous thinning drugs) and antibiotics have been used to treat chronic lung infections. These medications may be administered by a respiratory therapist, nurse, physician or other healthcare workers, or rarely with the help of the patient’s attendant. Sometimes, if careless, the person administrating the medicine may be exposed to the same. Patient attendant administering aerosolized medications may have cumulative dosing of the same agent. The potential side effects of the various aerosolized agents are diverse, depending on the medication. Examples of potential side- effects range from stimulation of the nervous system to constricting blood vessels, to suppressing immunity. Repeated exposure to antibiotics could trigger drugresistant strains, or possible allergic reaction. Ionising radiation and general controls Ionising radiation is atomic particles or electromagnetic waves that possess enough energy to produce ions, or charged particles, when interacting with matter. Radiation cannot be seen, tasted, or smelled. The hazard level of radiation depends on the activity, energy, and the type of radiation. In hospitals, ionizing radiation is used in diagnostic and therapeutic procedures. It is produced either by a machine, such as an X- ray machine, or from radio- nuclides, which are unstable elements ( or isotopes) that emit ionizing radiation as they decay. Ionising radiation may cause different types of cancer ( including stomach, liver, colon, lung, breast, uterine and thyroid cancer and leukemia). High radiation exposures can also damage blood and tissues, including the heart, eyes, intestine, skin, and reproductive organs, depending on the type of radiation, the route of absorption, and its potency. Visitors to hospital ( especially pregnant women) should avoid going to areas where there is risk of exposure to ionising radiation.