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Toxic chemicals present risks to health care workers that can’t be contained through the use of standard precautions: gloves, masks, and goggles. For example, in the case of health care workers sickened by organophosphates at a South Georgia hospital, the staff wore facemasks.
"TB masks don’t protect against chemicals. They protect against germs," notes Robert Geller, MD, FAAP, ACMT, FAACT, medical director of the Georgia Poison Center, which is part of Grady Health System in Atlanta. According to Geller, every hospital should take these basic steps to protect workers:
• Develop an exposure prevention plan. Hospitals may use advice from a regional poison center or consultants and should tailor their protection strategy to local circumstances. What is the likelihood of poisonings due to farm chemicals, insecticides, or industrial chemicals? "The protection [needed] is going to be somewhat specific to the chemical and how concentrated the chemical is," says Geller. In general, that means "some type of chemically impervious skin protection and some type of protection of the employee’s face and hands."
• Provide training of health care workers. "You can’t predict when these patients are going to come in," he says. "You have to have people who are trained to use self-protection on all shifts." Staff should be trained on how to recognize the need for protective equipment. EMS providers need to alert emergency departments (EDs) about possible chemical hazards. And don’t forget to provide training and access to protective devices to other workers who might be exposed, such as registration clerks and security guards, Geller says.
• Provide adequate personal protective equipment. Depending on the extent of the contamination, health care workers caring for chemically contaminated patients should use level C protection (i.e., full face mask and powered/nonpowered canister/cartridge filtration respirator) or level B protection (i.e., supplied air respirator or self-contained breathing apparatus.) The type of canister/cartridge should be appropriate to the agent. If the agent cannot be identified, an organic vapor/HEPA filter is recommended.
To prevent dermal absorption, chemical barrier protection appropriate to the contaminant is necessary. Latex medical gloves are of little protection against many chemicals. Staff should have one-piece scrubs made of a waterproof, chemical resistant fabric.
• Decontaminate patients. That includes sponging off the chemical and removing the patient’s contaminated clothing. Body fluids also must be contained to prevent dermal and inhalational exposure.
• Maintain adequate ventilation. To limit distant spread of the contaminant, the ED’s ventilation exhaust should be directed away from the hospital’s main ventilation system.
1. Geller RJ, Singleton KL, Tarantino ML, et al. Nosocomial poisoning associated with emergency department treatment of organophosphate toxicity — Georgia, 2000. MMWR 2001; 49:1,156-1,158.