The incorrect handling of hazardous substances often poses a potential health risk to employees and patients in hospitals and in everyday medical practices. Especially in these areas where sick people are treated, comprehensive hygiene precautions are required. The disinfectants and cleaning agents used for this purpose, as well as medical products and substances for treatments, often contain chemicals that can cause irritation, skin burns, allergies and other health problems.
Hazardous substances
In medical practices and clinics, agents are used on a daily basis that are classified as hazardous substances under the Hazardous Substances Ordinance. These include substances for medical treatments and operations such as anaesthetic gases to CMR substances contained in agents for treatment as well as in agents for disinfecting hands. They have different effects on human health. Depending on the substances used, they can cause irritation or burns to the skin, for example. There are further risks if toxic substances are handled, if they are flammable or carcinogenic.
Hazardous substances – definition
According to GefStoffV § 2 Para. 1, hazardous substances are dangerous substances and mixtures (1) and substances, mixtures and products that are explosive (2). Also substances, mixtures and articles from which hazardous substances may be produced or released during manufacture or use (3). Hazardous substances also include substances that do not meet criteria (1) to (3), but which may endanger the health and safety of employees due to their physico-chemical, chemical or toxic properties and the way in which they are present or used at the workplace. This also applies to substances to which an occupational limit value has been assigned. Hazardous substances can be hazardous to the environment and harmful to the organism.
Hazardous substances in medical departments
Disinfectants and cleaning agents and various products and substances that may contain hazardous substances are used extensively in everyday practice and clinic work. The following is a list of possible hazardous substances that are used for medical purposes, for example:
Possible hazardous substances in clinics and medical practices:
- Medicines such as antibiotics, steroids, cytostatics
- Dental amalgam and nitrous oxide
- Disinfectants such as ethanol, 2-propanol, alkylamines, peroxides, glutaraldehyde, formaldehyde
- Flammable liquids
- Formaldehyde as a sterilization gas
- Inhalation anesthetics such as nitrous oxide, isoflurane, sevoflurane, desflurane
- Bone cements
- Plastic dressings
- Laboratory chemicals such as xylene, formaldehyde, iodine, methanol, reagents
- Medical products such as support bandages with polyurethanes
- Medical gases such as oxygen and nitrogen
- Nanoparticles and ultrafine particles
- Flue gases
- Room scenting
- Cleaning agents such as surfactants, ethanol, 2-propanol, glycol ether
- Nitric oxide
- Materials used in dentistry: methacrylates in dentures and prostheses, strong acids and alkalis, e.g. hydrofluoric acid and sodium hypochlorite
Employees are often not always aware of the potential health risks associated with the use of these agents during routine work. In particular, cleaning staff are exposed to greater risks when cleaning and disinfecting agents are used intensively. Certified hand and skin disinfectants should be used for the health service, which are also provided with hazard warnings.
Health hazards in clinics and in everyday practice
Dermal hazard – skin diseases possible:
- Allergies: Ingredients of surface and instrument disinfectants, preservatives and fragrances
- Hand eczema: frequent hand washing, prolonged wearing of gloves, insufficient skin care
Inhalation hazard – respiratory diseases possible:
- Respiratory tract irritation: Disinfectants with formaldehyde, glutaraldehyde and peracetic acid
- Exposure: spray disinfection due to aerosols or fumes of substances, possible limit value exceedances of formaldehyde, excess inhalation anesthetics
Hazardous Substances Ordinance
The Hazardous Substances Ordinance regulates the obligations for handling hazardous substances and the details for this implementation are set out in the technical rules.
According to this ordinance, hazardous substances must be classified, labeled and packaged accordingly. This and other government regulations specify the measures required to ensure that employees are not put at risk when handling hazardous substances at the workplace. The CLP Regulation sets out rules for hazardous substances on how these individual aspects are to be implemented. According to this regulation, for example, hazardous substances must be labeled according to certain defined hazard symbols. When working with carcinogenic, mutagenic or reprotoxic (CMR) hazardous substances such as formaldehyde or CMR drugs, maternity protection must also be observed.
Under the Hazardous Substances Ordinance, employers such as doctors are obliged to assess the risks to their employees and document the appropriate measures. They must take appropriate protective measures and always inform employees about the risks and possible preventive measures. Employees should be able to inform themselves about the handling of the individual hazardous substances, such as via information in the manufacturers’ safety data sheets.
Hazardous substance management
Hazardous substance management is important in order to minimize potential risks when handling chemicals. Procurement, use, storage and proper disposal should therefore be clearly regulated. The tasks of hazardous substance management also include the assessment of hazards. These include, for example
- Create a list of hazardous substances used and generated during the processes
- Information on possible hazards of substances such as safety data sheets and technical information
- Assess the type of exposure such as oral, inhalation, dermal as well as its duration, frequency and intensity
- Check whether possible occupational limit values exist
- Classify possible hazards according to their severity according to an action plan
In addition, suitable protective measures must be taken depending on the hazard of a substance, whereby the suitable measures are subject to an order of priority:
- Stop principle: avoid hazardous substances or replace them with less dangerous ones
- Determine technical, organizational and personal protective measures such as protective equipment and ensure their use
- Employees are continuously informed about hazards and preventive measures
- Involve employees in decisions
- Regularly review health and safety standards.
Hazardous substances in clinics and medical practices: Important questions and answers
Hazardous substances are omnipresent in medical care. From disinfectants to special medicines, there are numerous substances used in the healthcare sector. Here are five frequently asked questions on this topic:
1. which specific hazardous substances are used in gastroenterology and nephrology?
Various hazardous substances are used in gastroenterology and nephrology. For example, contrast agents are used in gastroenterology, which are required for certain imaging procedures. Dialysis fluids are used in nephrology, which can also be considered hazardous substances.
2. how is the labeling of hazardous substances in the health service carried out in accordance with European standards?
Hazardous substances in the healthcare sector are labeled in accordance with the European CLP Regulation (Classification, Labeling and Packaging). This regulation defines uniform symbols, signal words and safety instructions to minimize the risk for employees and patients. The labeling provides information about the type of hazard, the correct handling and the necessary protective measures.
3. what measures are required to ensure the safe handling of disinfectants?
The safe handling of disinfectants requires careful handling. This includes
- Wear personal protective equipment such as gloves and safety goggles.
- Follow the dosing instructions.
- Store in a safe place, away from heat and fire.
- Avoid contact with skin and eyes.
4. Are there special regulations for handling hazardous liquids in medical practices and clinics?
There are special regulations for handling hazardous liquids. These include, for example:
- Use leak-proof containers for storage.
- Training of personnel in the safe handling of chemicals.
- Regularly check the storage conditions.
5. What role do CMR drugs play with regard to hazardous substances in the health service?
CMR drugs (carcinogenic, mutagenic, reprotoxic) are particularly dangerous. They can cause cancer, damage the genome or impair reproduction. Strict precautions must be taken in the health service to minimize contact with such substances.
Conclusion: The safe handling of hazardous substances in the healthcare sector is crucial to protect employees and patients. Comprehensive training, clear labeling and regular inspections are essential to minimize risks and ensure a safe working environment.
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