Pak Magyartoto Tersiawan,
Artikelnya sangat menarik, namun ada beberapa judul yang tidak kelihatan,
mohon untuk dicek lagi dan dikirimkan ke mail-list,
terima kasih
>From: "Magyartoto Tersiawan" <[EMAIL PROTECTED]>
>Reply-To: [EMAIL PROTECTED]
>To: "PB List Member" <[EMAIL PROTECTED]>
>Subject: [PB] OSHA TECHNICAL MANUAL HOSPITAL INVESTIGATIONS: HEALTH HAZARDS
>{01}
>Date: Fri, 20 Jul 2001 11:47:17 +0700
>
>OSHA TECHNICAL MANUAL
>
>HOSPITAL INVESTIGATIONS: HEALTH HAZARDS
>
>Contents:
>
> I.
> II.
> III.
> IV.
> V.
> Introduction
> Typical Hazards and Health Effects
> Investigation Guidelines
> Controls and Prevention
> Bibliography
>
>
>Appendix VI:1-1. Biological Agents--Blood and Body Fluids
>Appendix VI:1-2. Chemical Agents
>Appendix VI:1-3. Physical Agents
>
>
>
> a.. INTRODUCTION.
> a.. INCIDENCE AND CAUSAL FACTORS. As of 1988, 4% of the total U.S.
>work force was employed by hospitals. The National Safety Council (NSC)
>reports that hospital employees are 41% more likely to need time off due to
>injury or illness than employees in other industries.
> A survey of 165 clinical laboratories in Minnesota showed that the
>most frequent type of injuries were needle sticks (63%) followed by cuts
>and scrapes (21%). Hospital workers frequently report stress as a
>predisposing factor for accidents. Sprains and strains (often representing
>low back injury) were the most common type of workers compensation claim in
>1983 as reported by the Bureau of Labor Statistics. See Chapter VII:1 for
>more information.
>
> b.. GUIDANCE. In 1988, NIOSH published Guidelines for Protecting the
>Safety and Health of Health Care Workers; the American Association of
>Critical-Care Nurses has published a handbook on the occupational hazards
>encountered in the critical care environment; and the NSC has a Safety
>Guide for hospital environments.
> The hazards of exposure to waste, anesthetic gases, cytotoxic drugs, and
>blood-borne diseases such as hepatitis and HIV/AIDS are the subject of
>NIOSH criteria documents and OSHA policy statements.
>
> b.. TYPICAL HAZARDS AND HEALTH EFFECTS.
> This chapter covers hospital or health care facility-specific employee
>hazards. Biological, chemical and physical agents presenting potential
>exposure to health care employees are reviewed in Appendices VI:1-1 through
>VI:1-3. These lists are not inclusive.
>
> c.. INVESTIGATION GUIDELINES.
> a.. HOSPITAL RECORDS. Hospital's OSHA 200 Log versus employee medical
>clinic care of employees-is there a possible trend in injuries and
>illnesses related to typical hazards? If available, check the hospital's
>safety program records and facility-enabling or operation equipment
>licenses, e.g., NRC radioisotope and radiation-source license.
> b.. HOSPITAL SAFETY PROGRAM.
> 1.. Note any previous health and safety inspections by local health
>departments, fire departments, regulatory or accrediting agencies, such as
>the Joint Commission on Accreditation of Healthcare Organizations (JCAHO),
>College of American Pathologists (CAP), and the American Osteopathic
>Association (AOA).
> 2.. The policies and procedures should outline the training that all
>employees must receive. General hospital training should include fire and
>electrical safety, infection control procedures, and the hazard
>communication program. The policies and procedures should also delineate
>appropriate personnel and methods for preparation, mixing, application,
>storage, removal, and disposal of any hazardous agents. Emergency
>procedures should include provisions for fires, chemical or radioactive
>spills, extensive blood or body fluid spills, release of compressed, toxic,
>and corrosive gases, and power failure.
> 3.. A safety committee and/or infection control committee should be
>established within the hospital. Periodic inspection and monitoring is the
>responsibility of the safety committee. Immunizations, other than the
>mandatory vaccination for Hepatitis B, should be offered to personnel at
>risk.
> 4.. All electrical equipment used in the hospital must be approved
>for safety by Underwriters Laboratory (UL) or another OSHA-approved body.
> 5.. Biosafety cabinets should be labeled and certified by the
>manufacturer and/or a safety officer. The cabinets should be placed in the
>room at a position where doors, windows, and traffic flow will not create
>turbulence around the face of the cabinet.
> c.. WALKAROUND: INFORMAL INTERVIEWS. The worker interviews should
>concentrate on compliance with appropriate policies and procedures. The
>employee should be able to verbalize what actions to take in the event of
>an emergency, i.e., accidental chemical or radioactive spill.
>The employee should be aware of the hazards of the products with which he
>or she works.
>
>Observe the employees' lifting practices. Observe the Walkaround Inspection
>for Health Hazards. Table VI:1-1 contains a suggested area checklist.
>
>TABLE VI:1-1. WALKAROUND INSPECTION FOR HEALTH HAZARDS
>
>
>
> Area
>
>
>--------------------------------------------------------------------------
> To check
>
>
>--------------------------------------------------------------------------
>
> Every Area
> Floor slipperiness
> Adequate marking of hazards and chemical labeling
> Handling of infectious and chemical wastes
> Spill and emergency procedures
> Use of appropriate personal protective equipment
> Adequate hand-washing facilities
> Presence of impervious containers for needles and other sharp
>objects
> Where equipped, the aerator and local exhaust ventilation for
>ethylene oxide sterilizers, along with any sampling or vapor badge records
> Where equipped, the steam autoclave drain should be free of debris
> Electrical equipment and wiring must meet electrical standards
>
> Pharmacy
> Availability of a class II type A or B biological safety cabinet for
>mixing chemotherapeutic drugs
> Accurate, clear labels on all drugs, chemicals, and biologicals
>
> Laboratory
> Uncluttered work areas, clear ventilation slots, and properly labeled
>ductwork in laboratory hoods and biological safety cabinets
> Specimen handling
> Use of pipettes (no mouth pipetting)
> Gas cylinder placement and storage
> Maintenance records for laboratory hoods and other equipment
> Centrifuge tubes with caps
> Food should never be stored in refrigerators with lab specimens
> Readily detectable vapors, fumes, or dust
> Laser or radiation hazards
>
> Operating room
> Handling of waste anesthetic gases
> Air conditioning and humidity (should be about 50%)
> Static electricity control
>
> Radiation area
> Level of radiation
> Maintenance and radiation logs
>
>
>
>
> a..
>
> a..
> b.. SCREENING SAMPLES. All sampling is based on the CSHO's
>professional judgment.
> a.. SAMPLING METHODS.
> 2.. When sampling, it is important to ensure that it is a typical
>day, i.e. normal exposure time.
> 3.. Bioaerosols can be evaluated using the ACGIH Bioaerosol
>Committee's Guidelines. These guidelines contain information on sampling,
>analysis, and recommendations for remedial actions. Hospital infection
>control personnel should assist in bioaerosol determinations, as this is
>nonroutine sampling and is specific for preidentified organisms.
>Specialized bioaerosol sampling equipment is available through the OSHA
>Health Response Team.
> 4.. Some of the most commonly found chemicals, e.g., formaldehyde,
>xylene, halothane, and acrylamide, can be screened using detector tubes.
>For nitrous oxide, passive monitors can be used to monitor exposure as
>stated in OSHA Method No. ID-166. Specific sampling for chemical agents,
>such as ethylene oxide, methyl methacrylate, ribavirin, nitrous oxide,
>halothane, and other waste anesthetic gases, can be found in the Chemical
>Information Manual.
> e.. Lasers are calibrated by the manufacturer, but the laser system
>must be checked prior to each procedure and during extended procedures.
>Classifications of lasers must coincide with actual measurement of output
>(See Figure VI:1-1). Generally, measurements are required when the
>manufacturer's information is not available, when the laser system has not
>been classified or when alterations have been made to the laser system that
>may have changed its classification. Measurements should only be made by
>personnel trained in laser technology.
> f.. Records of alignment and power density can be checked against
>the manufacturer's equipment specifications. Maximum Permissible Exposure
>(MPE) values to the eyes and skin are given in tables 5, 6, and 7 of the
>ANSI standard (Z136.1-1986) as well as the ACGIH standard. Requirements for
>measurements and criteria for calculating the MPE's are given in sections 8
>and 9 of the ANSI standard.
> g.. With regard to X-ray machines, film badges or their equivalent
>should be used for long-term monitoring. Ionizing radiation
>(x-ray)-Screening of radiation levels may be performed by using
>thermoluminescence detectors, pocket dosimeters, and Geiger-Mueller
>counters.
> h.. Electrical equipment used in the hospital must follow Hospital
>Grades under Underwriter's Laboratory (UL) Standards 498 and 544.
>Resistance measurement and leakage measurements can be determined using the
>criteria in the National Fire Protection Association's Health Care
>Facilities Handbook, Chapter 7.
>FIGURE VI:1-1. LASER CLASSIFICATIONS.
>
>
>
>
> Class 1
> The least-hazardous class. Considered incapable of providing damaging
>levels of laser emissions.
>
> Class 2
> Applies only to visible laser emissions and may be viewed directly
>for time periods of less than or equal to 0.25 seconds, which is the
>aversion response time.
>
> Class 3a
> Dangerous under direct or reflected vision. These lasers are
>restricted to the visible electromagnetic spectrum.
>
> Class 3b
> May extend across the whole electromagnetic spectrum and are
>hazardous when viewed intrabeam.
>
> Class 4
> The highest-energy class of lasers, also extending across the
>electromagnetic spectrum. This class of laser presents significant fire,
>skin, and eye hazards.
>
>
>
>
>
>
> a.. CONTROLS AND PREVENTION.
> a.. ENGINEERING. All rooms should have adequate ventilation to remove
>contaminants. If air recirculation is required, then adequate filtering
>must be installed.
> NOTE: Intensive care units (ICU's), particularly neonatal ICU's, may
>be designed without walls between patient spaces. This may allow
>aerosolized chemicals and x-ray radiation to escape to neighboring areas.
>
> b..
> c.. LOCAL VENTILATION.
> a.. General Points.
>a. Hoods should be used for specific procedures, such as mixing
>antineoplastic drugs. A scavenging system that contains a proper gas
>disposal system must be in place and operable.
>
>b. Portable suction devices may be used for direct removal of contaminants.
>Portable ventilation should be used for smoke plume removal during laser
>surgery.
>
>c. Ethylene oxide should be ventilated through a nonrecycled or dedicated
>ventilation system. For a discussion of ventilation of aeration units,
>sterilizer door areas, sterilizer relief valves, and ventilation during
>cylinder changes, see the appendix of 29 CFR 1910.1047 (Ethylene Oxide).
>Alarms for inadequate ventilation and automatic shutdown should be in
>place. Air pressure in laboratories and isolation rooms should be negative
>so that contaminated air is drawn through the exhaust vents rather than
>circulating throughout the rest of the building.
>
>d. Biological safety cabinets are primary containment devices used by
>workers when handling moderate and high risk organisms. There are three
>types of biological safety cabinets:
>
> a.. Class I: Open fronted, negative pressure, ventilated cabinet.
> b.. Class II: HEPA-filtered, recirculated air cabinet with an open front
>face.
> c.. Class III: A totally enclosed HEPA-filtered cabinet of gas-tight
>construction.
>A class-III biological safety cabinet provides the highest protection to a
>worker. The effectiveness of the biological safety cabinets is dependent on
>air flow; therefore, the front intake grill and rear exhaust grill should
>not be blocked.
>
>e. All windows must be covered or blacked out in laser surgical areas for
>protection of employees outside the surgical area.
>
>f. Installation of automatic fire and explosion detection and protection
>equipment is recommended. The type should be specific to the hazard in the
>area.
>
>g. In the morgue, local vacuum systems should be in place for power saws.
>Shields should be in place when significant splash hazards are anticipated.
>
>h. There should be a separate storage area for radioactive sources. This
>area should be adequately shielded.
>
>i. Laser systems, especially ones with high voltage capacitance, should be
>adequately covered. Also, bleeders and proper grounding should be attached
>to the system. All operating room doors to rooms that house lasers should
>contain safety interlocks, which shutdown the laser system if anyone enters
>the room.
>
>j. Mixing of Methyl Methacrylate should be done in a closed system.
>
>k. Ultraviolet lamps have been used to prevent tuberculosis transmission.
>
> a.. Administrative.
> a. Workers should receive health and safety training.
>
> b. Vaccination for rubella, measles, mumps, and influenza is
>recommended, especially for women of child-bearing age.
>
> c. Work-related stressors, such as inadequate work space,
>unreasonable work load, lack of readily available resources, inadequate and
>unsafe equipment, should be considered.
>
> d. Appropriate emergency equipment (i.e., fire extinguishers,
>showers, eye wash) should be readily available.
>
> e. Perform periodic environmental sampling when indicated.
>
> f. Replace hazardous substances with less hazardous substances
>whenever possible (i.e., plastic for glass, small packets of chemicals,
>pre-poured formalin containers). Provide appropriate containers for
>disposal of sharps, hazardous waste, personal protective equipment.
>
> g. Provide conveniently located and supplied hand washing
>facilities.
>
> h. Document and retain inventories of radioactive materials. Only
>authorized personnel should have access to storage areas.
>
> b.. Maintenance Schedules.
> a. Hospital-grade electrical equipment including anesthesia
>machines, portable x-ray machines and laser systems, biological safety
>cabinets, and exhaust ventilation systems should have a preventive
>maintenance schedule. Testing intervals of electric equipment shall be set
>by the institution.
>
> b. A specific person should have the responsibility for assuring
>proper maintenance of the portable x-ray machines. Preventive and
>corrective maintenance programs for x-ray machines are detailed in 21 CFR
>1000, Radiological Health.
>
> c. The anesthesia machine should be inspected and maintained at
>least every four months. This should be done by factory service
>representatives or other qualified personnel. Leakage of gas should be less
>than 100 ml/min during normal operation.
>
> d. The entire laser system should be properly maintained and
>serviced according to the manufacturer's instructions. Only qualified
>personnel from the manufacturer or in-house shall maintain the system.
>Maintenance may only be done according to written standard operating
>procedures.
>
> e. A written log is recommended for any detected leak and any
>service done on an ethylene oxide chamber. Sterilizer/aerator door gaskets,
>valves, and fittings must be replaced when necessary.
>
> c.. Training.
> a. All hospital staff members should have training on electrical and
>fire safety, hazard communication, and infection control by qualified
>personnel. Some educators recommend hands on training with pre- and
>post-tests.
>
> b. In the hospital, specific training regarding hazardous substances
>should be given. Only qualified personnel may handle the hazardous
>substances or operate the specified machines.
>
> d.. Warning Signs.
>a. Specific requirements regarding the warning signs to be used on
>electrical equipment are outlined in UL No. 544. This should include a
>Hospital Grade warning. Warning signs should be placed in areas where
>exposure to ribavirin, antineoplastic agent spills, ethylene oxide, or
>lasers is likely to occur.
>
>b. Contract employees should not endanger hospital employees and can be
>controlled sometimes through use of privileges contracts.
>
> a.. WORK PRACTICES.
> 1.. Hands should be washed frequently and thoroughly. Workers should
>wash immediately after direct contact with any chemical, drug, blood, or
>other body fluid.
> 2.. No eating, drinking, smoking or application of cosmetics should
>take place in the lab.
> 3.. Needles and other sharp objects should be disposed of promptly
>in impervious containers. Needles should not be clipped or recapped by
>hand. See CPL 2-2.44B.
> 4.. There should be immediate and proper disposal of biohazardous
>waste.
> 5.. Mouth pipetting is to be prohibited.
> 6.. Care should be taken not to create aerosols.
> 7.. Appropriate personal dosimetry devices should be worn when
>working with radioactive materials.
> 8.. Electrical equipment that appears to be damaged or in poor
>repair should not be used. Any shocks from electrical equipment should be
>reported promptly to the maintenance department.
> 9.. Cylinders of compressed gases should be kept secured. They
>should never be dropped or allowed to strike each other with force.
> 10.. Large pieces of broken glass should be removed with brooms and
>disposed of in a separate container. Small pieces can be removed with
>tongs. Glass should never be removed with fingers.
> 11.. Vaporizers of anesthesia machines should be turned off when not
>in use. Also, proper face masks, sufficiently inflated endotracheal tubes,
>and prevention of anesthetic spills will decrease the amount of waste
>anesthetic gases in the operating room.
> 12.. Antineoplastic drug contact requires the use of an isotonic
>wash to the body or eyes.
> b.. PERSONAL PROTECTIVE EQUIPMENT.
> 1.. Lab coats should be worn in the laboratory area and removed
>before leaving. Plastic or rubber aprons should be worn when there is a
>potential for splashing.
> 2.. Gloves should be worn when performing tasks such as handling
>hazardous chemicals, specimens, or hot materials. The type of glove should
>be selected according to the task being performed, as follows:
> a.. Latex or vinyl type gloves should be changed frequently and
>inspected for punctures before putting them on.
> b.. Double gloving to decrease the risk of exposure by penetration is
>recommended if it does not interfere with the task.
> c.. Less permeable surgical latex gloves are recommended over polyvinyl
>gloves.
> d.. Lead-lined gloves are to be worn in the direct x-ray field.
> 1.. Rubber-soled shoes should be worn to prevent slips and falls.
>Rubber-lined shoe coverings may also be used to protect against spills or
>dropped objects. Fluid-proof shoes must be worn if there is a possibility
>of leakage to the skin.
> 2.. Protective eyewear or shields should be used if splashes of a
>hazardous substance are likely to occur. Goggles that are tight-fitting may
>prevent irritation of the eyes if aerosolized chemicals are present.
>Goggles that protect the cornea, conjunctive and other ocular tissue are
>required for all personnel in the operating room during laser surgery. The
>wavelength of the laser output is the most important factor in determining
>the type of eye protection to be used. Opaque goggles are to be worn if in
>the direct x-ray field.
> 3.. Impervious or low permeability gowns should be worn when in
>contact with antineoplastic drugs, ribavirin and blood/body fluids. These
>gowns should be properly stored in the area of use if contaminated. Soiled
>gowns should be washed or discarded. Lead-lined aprons are to be worn if in
>the x-ray field.
> 4.. Respirators may be required in case of emergencies, such as
>accidental spills and/or exposure to specific chemicals, e.g., formaldehyde
>and ethylene oxide. Check for a respirator program.
> a.. BIBLIOGRAPHY.
>American Hospital Association (AHA). 1966. Housekeeping Manual for Health
>Care Facilities. AHA: Chicago.
>
>American National Standards Institute (ANSI). 1988. Standard for the Safe
>Use of Lasers in Health Care Facilities. ANSI Z136.3-1988.
>
>American National Standards Institute (ANSI). 1982. Standard for Anesthetic
>Equipment-Scavenging Systems for Excess Anesthetic Gases. ANSI Z79.11-1982.
>
>Chaff, L.F. 1989. Safety Guide for Healthcare Institutions. 4th ed.
>American Hospital Publishing: Chicago.
>
>Charney, W. and Schirmer, J. 1990. Essentials of Modern Hospital Safety.
>Lewis Publishers, Inc.: Chelsea, MI.
>
>ECRI. 1989. Ethylene Oxide: Protecting Your Employees. Hospital Hazardous
>Management. Vol. 1, Nos. 1 & 2, Contact ECRI at 5200 Butler Pike, Plymouth
>Meeting, PA 19462, (215) 825-6000.
>
>Hoeltge, G.A. 1986. Documentation of Safe Work Practices in the Clinical
>Laboratory. Clinics in Laboratory Medicine 6(4):787-798.
>
>Joint Commission on the Accreditation of Hospitals. 1986. Accreditation
>Manual for Hospitals. JCAH: Chicago.
>
>Miller, B.M. et al. 1986. Laboratory Safety Principles and Practices.
>American Society for Microbiology: Washington D.C.
>
>National Council for Radiation Protection and Measurements (NCRP). 1978.
>Radiation Protection for Medical and Allied Health Personnel. NCRP Report
>#48. NCRP: Washington, DC.
>
>National Fire Protection Association (NFPA). 1987. Health Care Facilities
>Handbook. 2nd ed. NFPA: Quincy, MA.
>
>National Institute for Occupational Safety and Health (NIOSH). 1977.
>Criteria for a Recommended Standard: Occupational Exposure to Waste
>Anesthetic Gases and Vapors. DHEW: NIOSH Publication No. 77-140. NIOSH:
>Cincinnati, OH.
>
>National Institute for Occupational Safety and Health (NIOSH). 1988.
>Guidelines for Protecting the Safety and Health of Health Care Workers.
>DHHS: NIOSH Publication No. 88-119. NIOSH: Cincinnati, OH.
>
>National Institute for Occupational Safety and Health (NIOSH). 1989.
>Ethylene Oxide Sterilizers in Health Care Facilities: Engineering Controls
>and Work Practices. DHHS: NIOSH Publication No. 89-116. July 13, 1989.
>NIOSH: Cincinnati, OH.
>
>Occupational Safety and Health Administration (OSHA). 1987. Chemical
>Information Manual. U.S. Government Printing Office: Washington, DC.
>
>Occupational Safety and Health Administration (OSHA). 1989. Enforcement
>Procedures for Occupational Exposure to Hepatitis B Virus (HBV) and Human
>Immunodeficiency Virus (HIV). OSHA: Washington, DC.
>
>Occupational Safety and Health Administration (OSHA). 1986. Guidelines for
>Antineoplastic (Cytotoxic) Drugs. OSHA: Washington, DC.
>
>Patterson, W. et al. 1985. Occupational Hazards to Hospital Personnel.
>Annals of Internal Medicine. 102:658-680.
>
>Richmond, J. 1988. Safe Practices and Procedures for Working with Human
>Specimens in Biomedical Research Laboratories. Journal of Clinical
>Immunoassay 11(3): 115-119.
>
>Rose, S.L. 1984. Clinical Laboratory Safety. J.B. Lippincott Co.:
>Philadelphia, PA.
>
>Sommargren, C.E. (ed.). 1989. AACN Handbook on Occupational Hazards for the
>Critical Care Nurse. American Association of Critical-Care Nurses,
>Occupational Hazards Task Force. AACN: Chicago, IL.
>
>Texas Hospital Association (THA) and Shared Hospital Electrical Safety
>Services. 1973. Electrical Safety Guide. THA: Austin.
>
>United States Department of Health and Human Services. 1988. Biosafety in
>Microbiological and Biomedical Laboratories. HHS: Washington, DC.
>
>Vesley, D., Hartman, M.S., and Heidi, M. 1988. Laboratory Acquired
>Infections and Injuries in Clinical Laboratories: A 1986 Survey. American
>Journal of Public Health 78(9):1213-1215.
>
>
>
>APPENDIX VI:1-1. BIOLOGICAL AGENTS--BLOOD AND BODY FLUIDS.
>
> Use or exposure
>
> Contact with blood and body fluids may occur as a result of medical
>and surgical procedures, such as labor and delivery, blood or body fluid
>collection and analysis, the handling of contaminated waste (e.g., gloves,
>linens, bandages, protective clothing, etc.) or the suctioning of airways.
>Exposure usually occurs because inadequate infection control procedures are
>in use.
> Health effects
>
> Acute: The severity of infection depends on:
>
> a.. The number of pathogens encountered;
> b.. The worker's resistance, which is affected by such things as:
>state of health, predisposing diseases, age, sex, and hereditary factors;
> c.. Portal of entry (via inhalation, ingestion, mucous membrane or
>skin contact, or direct inoculation); and
> d.. Virulence of the organism.
> Chronic: Reproductive consequences ranging from congenital anomalies
>to death of the fetus and other chronic diseases, such as cirrhosis of the
>liver and primary liver cancer, may result from some viruses including
>hepatitis B, rubella, cytomegalovirus, herpes, and human immunodeficiency
>virus (HIV).
>
> Biological agents--Refer to OSHA Instruction CPL 2-2.44B:
>Enforcement Procedures for Occupational Exposure to Hepatitis B Virus (HBV)
>and Human Immunodeficiency Virus (HIV).
>
>
>
>
>
>APPENDIX VI:1-2. CHEMICAL AGENTS.
>
>The following are specifically mentioned because of the severity of their
>health effects. This list is by no means all-inclusive.
>
> Use or exposure
>
> Ethylene oxide (EtO)
>
> A disinfectant and sterilant, it is usually used in the central
>supply area. Exposure usually occurs from improper aeration of the ethylene
>oxide chamber after the sterilizing process. It can also occur in
>outpatient surgery clinics and in the cardiac catheterization laboratory
>(29 CFR 1910.1047).
> Health effects
>
> Acute: Respiratory and eye irritation, vomiting, and diarrhea.
>
> Chronic: Altered behavior, anemia, secondary respiratory infections,
>skin sensitization, miscarriages, and reproductive problems. Carcinogen.
>
> Waste anesthetic gases such as nitrous oxide, Halothane, Enfluorane
>
> Waste gases result from poor work practices during the
>anesthetization of patients, improper or inadequate maintenance of the
>machine, and/or patient exhalation after the surgical procedure (recovery).
> Acute: Drowsiness, irritability, depression, headaches, nausea, and
>problems with coordination and judgement.
>
> Chronic: Embryotoxicity, liver and kidney disease, and cancer.
>
>
> Antineoplastic (cancer) drugs, such as Vincristine, Dacarbazine,
>Mitomycin, Cytosine Arabinoside, and Fluorouracil
>
>
> Antineoplastic drugs, used in the treatment of cancer and other
>tumors, are usually given as intravenous fluids. Mixing usually occurs in
>the pharmacy area of the hospital in a biological safety cabinet. Exposure
>may occur during preparation, administration or disposal of the drug and
>equipment.
> Acute: Severe soft-tissue damage, fetotoxicity, headaches,
>lightheadedness, dizziness, and nausea.
>
> Chronic: Chromosomal damage, teratogenesis, and carcinogenesis.
>
>
> Methyl methacrylate (MMA)
>
> An acrylic cement-like substance used to secure prostheses to bone
>during orthopedic surgery. Exposure usually occurs during mixing,
>preparation, and in the operating room.
> Acute: Eye, skin and mucous membrane irritant. Acute effects have
>varied from a decrease in blood pressure to (rarely) cardiac arrest.
>
> Chronic: Degeneration of the liver, mutagenesis, and teratogenesis.
>
>
>
>
>
> Ribavirin
>
> An antiviral drug used to treat some infants and young children with
>lower respiratory syncytial virus (RSV) infections. This drug is
>aerosolized to a respirable size of approximately 1.3 microns and is
>usually administered to the patient in an oxygen tent or face mask. This is
>when exposure can occur.
> Acute: Headaches, coughing, dry upper respiratory tract and
>dry-burning eyes.
>
> Chronic: Carcinogenesis, fertility impairment and fetotoxicity.
>
>
> Formaldehyde
>
> Used as a fixative and is commonly found in most laboratories and
>the morgue (29 CFR 1910.1048).
> Acute: Eye and respiratory irritation from the liquid and vapor
>forms. Severe abdominal pains, nausea, vomiting and possible loss of
>consciousness could occur, if ingested in large amounts.
>
> Chronic: High concentration of vapor inhaled for long periods can
>cause laryngitis, bronchitis or bronchial pneumonia. Prolonged exposure may
>cause conjunctivitis. Nasal tumors have been reported in animals. Suspected
>carcinogen.
>
>
> Toluene or Xylene
>
>
> Solvents used to fix tissue specimens and rinse stains. They are
>primarily found in the histology, hematology, microbiology, and cytology
>laboratories (29 CFR 1910.1000 Subpart Z).
> Acute: Eye and mucous membrane irritation from vapor and liquid
>forms. Dizziness, headache, and mental confusion from inhalation of vapor.
>Ingestion or absorption through the skin can cause poisoning. There is a
>potential for thermal burns as it is extremely flammable.
>
> Chronic: If the xylene or toluene contains benzene as an impurity,
>repeated breathing of the vapor over long periods may cause leukemia.
>Prolonged skin contact may cause dermatitis. Tolune has been implicated in
>reproductive disorders.
>
> Acrylamide
>
> The resin, usually found in research labs, is used to make gels for
>biochemical separations (29 CFR 1910.1000 Subpart Z).
> Acute: Eye and skin irritation.
>
> Chronic: Central nervous system disorders, i.e., polyneuropathy.
>Suspected carcinogen. Mutagen.
>
>
>
>
>APPENDIX VI:1-3. PHYSICAL AGENTS.
>
> Use or exposure
> Health
>
> effects
>
> Laser
>
> Used in the operating rooms for excision and cauterization of
>tissue. Class 3b and 4 lasers are most often used. Exposure usually occurs
>from unintentional operation and/or when proper controls are not in effect.
>The high electrical energy used to generate the beam is a potential shock
>hazard. The smoke plume during a surgical procedure and the laser's
>reaction to certain explosive or flammable agents also present hazards in
>the operating room.
> Acute: From direct beam exposure, burns to skin and eyes possibly
>resulting in blindness. Chemical by-products in the smoke plume may cause
>irritation to the eyes, nose and throat, and nausea (see OSHA Hazard
>Information Bulletins). Biological and inert particulates can also be found
>in the smoke plume but these have not been well studied for their effects.
>
> Chronic: Unknown.
>
> Ionizing radiation
>
> Portable and fixed X-ray machines are used for diagnostic
>procedures. Exposure occurs when unprotected employees are near a machine
>in operation. The degree of exposure depends on the amount of radiation,
>the duration of exposure, the distance from the source and the type of
>shielding in place.
>
> Kits containing radioactive isotopes or specimens and excreta of
>humans and animals who have received radionucleotides may pose a hazard.
>Exposure may also result from handling of radioactive spills (29 CFR
>1910.1096).
> Effects of radiation exposure are somatic (body) and/or genetic
>(offspring) in nature.
>
> Acute: Erythema and dermatitis. Large whole-body exposures cause
>nausea, vomiting, diarrhea, weakness, and death.
>
> Chronic: Skin cancer and bone marrow suppression. Genetic effects
>may lead to congenital defects in the employee's offspring.
>
>
> Magnetic radiation
>
>
> Magnetic resonance instrumentation.
> No conclusive effects are documented.
>
>
> Electrical hazards
>
>
> Exposure may occur when there is lack of maintenance to any
>electrical equipment, abuse, and lack of understanding of the equipment
>and/or its controls. Oxygen-enriched atmospheres and water may contribute
>to hazardous conditions.
> Acute: Painful shocks, respiratory inhibition, deep burns (electric
>and thermal) heart rate irregularities, death.
>
> Chronic: No documented effects.
>
>
> Ultraviolet radiation
>
>
> Ultraviolet lamps are sometimes used in biological safety cabinets.
> Acute: Skin burns, damage to the eye.
>
> Chronic: No documented effects other than cataracts.
>
>
> Compressed gases
>
>
> Compressed gases are used in many clinical laboratories. They are
>found in varying sizes and in pure or mixed states. Examples: ammonia,
>carbon dioxide, and nitrogen.
> Compressed gases can be toxic, radioactive, flammable, and
>explosive. These effects arise from the compression of the gas and the
>health effects of the chemical itself.
>
>
> Glass
>
>
> Glassware is used as bottles, beakers, flasks, test tubes, pipettes,
>and tubing. Chipped, cracked, badly etched glassware and sharp edges
>present hazards, as does broken glass.
>
> Cuts, scratches, abrasions, are potential locations for infection.
>
>
>
>
>~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>DANA MITRA LINGKUNGAN {Friends of the Environment Fund}
>Pusat Niaga Duta Mas Fatmawati, Blok B1/12
>Jl. RS. Fatmawati 39, Jakarta 12150 - INDONESIA
>Telp. : (62-21) 724 8884, 724 8885 | Fax. : (62-21) 724 8883
>Email : [EMAIL PROTECTED] | URL# http://www.dml.or.id
>
>Konperensi KMB 2001 @ http://kmb2001.dml.or.id
>FORLINK @ http://forlink.dml.or.id
>Bursa Limbah @ http://w2p.dml.or.id
>Forum KMB Indonesia @ http://forumkmb.dml.or.id
>Join Milis PB, kirim email ke mailto:[EMAIL PROTECTED]
>~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>
>
>
>--
>~~~~~~ PRODUKSI BERSIH (PB) MAILING LIST
>~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>
>Posting = [EMAIL PROTECTED]
>Berhenti = Kirim Email kosong ke mailto:[EMAIL PROTECTED]
>Berlangganan = Kirim Email kosong ke mailto:[EMAIL PROTECTED]
>Administrator = mailto:[EMAIL PROTECTED]
>Arsip = http://www.mail-archive.com/[email protected]/
>
>FORLINK @ http://www.forlink.dml.or.id
>Environmental News @ http://forlink.dml.or.id/e-news/
>Forum KMB Indonesia @ http://www.forumkmb.dml.or.id
>Bursa Limbah Indonesia @ http://www.w2p.dml.or.id
>
>~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
_________________________________________________________________
Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp
--
~~~~~~ PRODUKSI BERSIH (PB) MAILING LIST ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Posting = [EMAIL PROTECTED]
Berhenti = Kirim Email kosong ke mailto:[EMAIL PROTECTED]
Berlangganan = Kirim Email kosong ke mailto:[EMAIL PROTECTED]
Administrator = mailto:[EMAIL PROTECTED]
Arsip = http://www.mail-archive.com/[email protected]/
FORLINK @ http://www.forlink.dml.or.id
Environmental News @ http://forlink.dml.or.id/e-news/
Forum KMB Indonesia @ http://www.forumkmb.dml.or.id
Bursa Limbah Indonesia @ http://www.w2p.dml.or.id
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
