Let the Experienced Be the Best Teacher

As technicians enter the biomed field, those of us who are experienced clinical engineers and BMETs have an obligation to the new recruits. We must teach these individuals how to identify and control the exposures of hazardous chemicals/bio-hazardous wastes and their byproducts — to themselves, to equipment, to other hospital staff, to the general environment, and, most importantly, to patients.

Long gone are the days of apathy, indifference and the thought that, “If I can’t see it, it can’t affect me.” Thanks to newer technology, we encounter new chemicals at an ever-increasing rate — so quickly, in fact, that most of our MSDS (material safety data sheets) logs are not up-to-date. Products slide into the healthcare environment from so many sources that some people forget the proper steps to take to avoid toxic exposure levels produced by the new chemical or a combination of the new and the old. This is where experience plays a big role in teaching and protecting everyone, and everything, involved.

Endoscopy suites, for example, are notorious for harboring exposures above and beyond the NIOSH (National Institute for Occupational Safety and Health) recommended level of glutaraldehyde. While glutaraldehyde has been shown to be an effective disinfectant that doesn’t damage scopes, chronic exposure to the chemical can lead to health problems; as a result, some endo suites have changed their disinfecting solutions to ones containing hydrogen peroxide. Hydrogen peroxide works great — as long as your washer has stainless-steel valves and the distal tips on your scopes have the proper glue. Otherwise, you are in for a nasty surprise!

Unfortunately, when new hires go through the hospital/company orientation, they get the 10-minute video on universal precautions and another 10 minutes on hazardous materials but never any information on where they will run into the problems. We send new hires into areas without ever checking their knowledge of universal precautions or hazardous materials. We assume that they know.

But it is through experience that we learn we can be exposed to nerve gas in blood cell research, to toluene or xyelene in histology and hematology, and to various chemical mixes in chemistry labs, to name just a few. Because of our experience, we know to explain that something labeled “hot” might not signal high temperatures but rather, radioactivity.

We need to inform our new hires that the operating room has a multitude of hazards, from waste anesthetic gases — some of which cause liver problems or malignant hyperthermia in some people — to laser smoke plumes that can contain HIV. Lest we forget, RF (radio frequency), laser, blood, electrical chemical and thermal agents are also in the operating rooms.

We move into central processing and encounter steam, ethylene oxide, various cleaning agents and sharp instruments. All these present potential hazards to both new and veteran employees. We need to keep people aware of their surroundings so they don’t hurt themselves or someone else.

It’s generally not necessary to give much guidance in the radiology area; almost everyone is aware of the hazards from the radiation. But how often do we think of the chemical “soup” that is in a film processor? Many people develop allergies to those chemicals after years of working with them. While wet processors are being replaced with digital printers, these devices will continue to be a source of mercury, silver and other metals that we have to limit in the environment.

Mercury is a problem in every hospital, even those that claim to be “mercury-free.” Everyone should read up on where mercury is in hospitals as it is a long and complicated list. Go to www.h2e-online.org. and click on the two-page “List of Mercury Containing Items in a Hospital Setting.” You may find that it contains some real surprises.

Even in our own little work area we have various cleaners, solvents and other chemicals that we take for granted. Most are perfectly safe when used as directed but turn into nasty “cocktails” when mixed.

Spills of these toxic substances (both chemical and bio-hazard), should be handled by trained personnel only. Gone are the days of calling the Environmental Services department for these types of cleanups. Who better to clean up a spill than the person who made it? And who knows the chemical/bio-hazard spill best?

As experienced people we need to make sure that those entering our profession are neither ignorant nor indifferent to the hazards that we face on a daily basis. And teaching them the correct steps reminds us not to be ignorant or indifferent to them as well.

“Cradle-to-grave” management of chemicals, their byproducts and bio-hazardous wastes is essential — and required by the government — for proper handling, containment and final disposition. Manifests are the bane and boon of this cyclic function. Woe is the HazMat manager who is missing just one when the “MAN” shows up!

Remember: We have to train the new people well. After all, they will be taking care of the equipment should we need it.

Gregg Perry is a certified healthcare safety professional who serves as Hazardous Materials manager for Merrimack Valley Hospital (Haverhill, Mass.), where he has been a Safety Team member for six years. Perry also works at Technology in Medicine Inc. (Holliston, Mass.) with Dave Harrington, who assisted with this article. Harrington is a veteran educator/clinical engineer/technology manager and 24x7 contributing editor.