NIOSH: Health care workers lack training, awareness of chemical risks
Survey shows big gaps for surgical smoke, antibiotics
Health care workers exposed to hazardous chemicals in the workplace often lack training or awareness of safety measures, according to the largest-ever federally sponsored survey on health and safety practices in health care.1
Gaps were found for all types of chemical hazards, as many respondents reported that their safety training occurred more than a year before. About 11,000 health care workers completed a web-based survey with modules addressing various chemical exposures in the study conducted by the National Institute for Occupational Safety and Health (NIOSH).
About half (48%) of health care workers who administer aerosolized antibiotics said they never received safety training. Employee health professionals should be aware that secondary exposure to some aerosolized antimicrobial drugs may lead to adverse effects in health care workers. For example, inhalation of certain aerosolized antibiotics (e.g., pentamidine and colistin) can lead to decreased pulmonary function and acute respiratory symptoms in exposed health care workers.2
Only one-third (32%) of workers exposed to surgical smoke said their employers had safety procedures in place.
Even some HCWs who compound antineoplastic agents in a health care pharmacy — a high-risk activity — reported a lack of awareness of safety. "One in 10 workers didn’t know if [their employer] had procedures for minimizing exposure to the chemicals," says Andrea Steege, PhD, MPH, a study co-author and epidemiologist with NIOSH’s Division of Surveillance, Hazard Evaluations and Field Studies.
Steege notes that the surveys were sent to members of 21 professional organizations — which provide information and resources on safe work practices.
"This is probably the best case scenario for what is out there," she says of the awareness of chemical hazards. "It’s important to make sure everybody has training, knows what they’re exposed to and knows how to avoid that exposure — or to minimize it to the highest extent possible."
The findings may spur more action to improve awareness of hazardous chemicals in health care. NIOSH will release a new list of hazardous drugs this summer, with separate information for antineoplastic (chemotherapy) agents and other hazards, says Thomas H. Connor, PhD, research biologist with the NIOSH’s Division of Applied Research and Technology and an expert on hazardous drugs and occupational safety.
"We’ve gotten feedback from the end users that they needed more guidance, so we’ve tried to accommodate with these updates and changes," he says. NIOSH also is updating its alert on hazardous drugs, he says.
The survey found a high level of awareness about antineoplastic agents. Some 94% of health care workers who administer the drugs said they were aware of their employer’s safety procedures for minimizing exposures.
Compounding drugs without training?
But one-third of those administering antineoplastic drugs and 42% of those compounding them had not been trained in the past year, the survey found.
"We recommend that people get training at least every year," says Connor, who notes that new drugs and technologies are constantly emerging.
In contrast, only 25% of health care workers exposed to surgical smoke reported receiving training in the past year to reduce exposure. The Association of periOperative Registered Nurses (AORN) has worked for years to raise awareness of the hazards of surgical smoke and offers a free toolkit that includes an educational PowerPoint presentation (www.aorn.org/Clinical_Practice/ToolKits/Tool_Kits.aspx).
New technology may bring more protections, says Mary Ogg, MSN, RN, CNOR, a perioperative nursing specialist at AORN in Denver. Newer smoke evacuators are much quieter, and some are even incorporated in the surgical booms popular in minimally invasive surgery, she says.
Meanwhile, hospitals should be aware that the Hazard Communications Standard of the Occupational Safety and Health Administration requires training of workers who are exposed to hazardous chemicals, Ogg says.
And employee health professionals should be alert to symptoms of smoke exposure, she says. "The effects of surgical smoke are cumulative. If you have an employee with chronic headaches or asthma coming from the operating room, that might be an indication that they’re exposed to something in the OR," she says.
More research needed
Chemical risks and safety solutions are constantly evolving, and that may have been reflected in some of the responses to the NIOSH survey.
For example, little is known about the long-term effects of aerosolized antibiotics that are present when a patient exhales after using a nebulizer, says Shawna Strickland, PhD, RRT-NPS, FAARC, associate executive director of education for the American Association for Respiratory Care in Irving, TX.
"We’re seeing a higher use of aerosolized antibiotics because they’re so much more effective for lung diseases," but the risk differs depending on the mechanism of delivery, she says. With breath actuated nebulizers, few particles are released when the patient exhales, she says.
More research is needed on the hazards of aerosolized antibiotics and how to minimize them, she adds.
Waste anesthetic gases are typically well-controlled in the operating room. But health care workers outside the operating room may need more training and protections, says Ogg. "In the recovery room and PACU, those nurses are being exposed to waste anesthetic gases [exhaled by patients], but there aren’t any scavenger systems in that area," she says.
NIOSH issued an informational document on waste anesthetic gases in 2007 (www.cdc.gov/niosh/docs/2007-151/pdfs/2007-151.pdf).
Any employees who are working with hazardous chemicals, even on an occasional basis, should be aware of safety issues, Steege says.
- Steege AL, Boiano JM, and Sweeney MH. NIOSH Health and Safety Practices Survey of Healthcare Workers: Training and awareness of employer safety procedures. American Journal of Industrial Medicine 2014 (online in advance publication: DOI: 10.1002/ajim.22305). Available at http://onlinelibrary.wiley.com/doi/10.1002/ajim.22305/abstract.
- Le J, Ashley ED, Neuhauser MM, et al. Consensus Summary of Aerosolized Antimicrobial Agents: Application of Guideline Criteria: Insights from the Society of Infectious Diseases Pharmacists. Pharmacotherapy 2010;30(6):562-584.