Chemical Hazards of Being in the Medical Field

This article is the second part of a multi-part series of hazards within the medical field. Catch up on part one.

The healthcare industry includes establishments that provide medical care in hospitals, clinics, doctor’s offices, nursing, residential care, and social assistance such as family and childcare services. 

According to the Bureau of Labor Statistics, the United States added 431,000 jobs in March 2022, but the healthcare industry added just 8,300 jobs. Overall employment of physicians and surgeons is projected to grow 3% from 2021 to 2031, slower than the average for all occupations. 

Despite limited employment growth, an average of nearly 23,800 openings for physicians and surgeons are projected year over year over the decade. Most of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force altogether.

Chemical risk in hospital settings is a growing concern that health professionals and supervisory authorities deal with daily. Exposure to chemical risk varies depending on the hospital department involved and might originate from multiple sources, such as the use of sterilizing agents, disinfectants, detergents, solvents, heavy metals, dangerous drugs, and anesthetic gasses. 

The following article breaks down the various chemical hazards in the medical field. 

Cleaning Agents

Hospital housekeeping on floors, windows, bathrooms, carpets, and other surfaces throughout the hospital waiting areas requires multiple cleaning products. Therefore, hospital environmental service workers and housekeeping staff are at the highest risk of exposure. 

The primary route of exposure to cleaning agents is the inhalation of aerosolized droplets or vapors of skin exposure. Several cleaning agents have known sensitizers and can lead to dermatitis upon repeated skin exposure. “Wet work,” or exposure to water during cleaning procedures, can increase the risk of skin irritation and absorption. 

Also, cleaning products containing corrosive chemicals can cause severe burns if splashed on the skin or the eyes. There are currently no exposure guidelines for cleaning agents. However, OSHA, ACGIH, and NIOSH may have occupational exposure limits for specific ingredients.

Ethylene Oxide

Ethylene oxide (EtO) is a flammable colorless gas used to sterilize medical equipment that cannot tolerate heat, moisture, and abrasive chemicals such as optical, rubber, and plastic instruments and devices.

Staff working in central supply, those who change EtO cylinders, and workers in other areas where sterilization occurs are at the highest risk of exposure to EtO. The principal route of exposure is inhalation. 

EtO is a known human carcinogen and reproductive toxin. Acute health effects include irritation of the eyes and upper respiratory system, depression of the central nervous system, headache, and nausea. 

Formaldehyde

Formaldehyde (CH20) is a potent, colorless gas commonly used in hospitals, medical laboratories, dental offices, and pediatric practices as a preservative, sterilizer, and disinfectant.

Exposure to high levels of formaldehyde may trigger severe allergic reactions such as difficulty breathing, asthma attacks, respiratory irritation, headaches, and watery/burning eyes. Formaldehyde is a skin irritant and a cancer-causing agent, and if ingested can be fatal.

According to the Department of Health and Human Services (DHHS), formaldehyde may “reasonably be anticipated to be a carcinogen.”

Glutaraldehyde

Glutaraldehyde C5H8O2 is a high-level cold disinfectant for heat-sensitive medical equipment, primarily endoscopes. It is typically found in a 2% concentration in liquid disinfectants under the brand names Cidex, Metricide, or Sporicidin. 

Unlike sterilization procedures performed in a central location, disinfection of medical instruments is often performed throughout the hospital and in hospital clinics, including endoscopic units, operating rooms, ICU, and dialysis wards where quick turnaround times are needed to meet patient demands. 

Exposure to glutaraldehyde may cause throat and lung irritation, asthma and difficulty breathing, dermatitis, nasal irritation, sneezing, wheezing, burning eyes, and conjunctivitis. The level of exposure depends upon the dose, duration, and work being done.

Mercury

Mercury (Hg) is a naturally occurring metal. Metallic mercury is a shiny, silver-white, odorless liquid. When heated, it becomes a colorless, odorless gas.

Mercury is highly toxic, especially when metabolized into methylmercury, and is harmful if absorbed through the skin and fatal if inhaled. Around 80% of the inhaled mercury vapor is absorbed in the blood through the lungs.

Some of the common uses of mercury found in healthcare facilities are thermometers, blood pressure monitors, esophageal dilators, cantor tubes and Miller-Abbott tubes, feeding tubes, dental amalgam, laboratory chemicals, medical batteries, and mobile hot food servers. 

Mercury exposure harms the nervous, digestive, respiratory, immune systems, and kidneys. Adverse health effects from mercury include tremors, impaired vision and hearing, paralysis, insomnia, and emotional instability. 

‍

Methyl Methacrylate

Methyl Methacrylate (MMA; C5H8O2; CAS No. 80-62-6) is a clear liquid with a distinctive, sharp, fruity odor. Chemically, it is an unsaturated ester monomer produced in large volumes and used widely to make polymers that bond tightly to various other substances.

MMA is found in various industrial and consumer applications, including dental and surgical cement. But other uses include surface coatings, injection molding and extrusion, transparent impact-resistant plastic sheets, and cosmetic products. 

Methyl methacrylate irritates the skin, eyes, and mucous membranes in humans, and an allergic response to dermal exposure may develop. Research has found respiratory effects in humans following acute and chronic inhalation exposures.

Surgical Smoke

Surgical smoke is an irritant of human mucous membranes (eyes, nose, throat, respiratory tract) consisting of various gasses and particulates, which can damage the lungs and respiratory tract.

Surgical smoke is a byproduct of heat-generating instruments in a hospital setting, including electrosurgery, laser and ultrasonic scalpel, radiofrequency ablation, and power tools. These instruments are used for cutting, cauterizing, and burning biological tissue during open, laparoscopic, or minimal access surgical procedures. 

The MHA Board of Trustees recently called on all Massachusetts hospitals to eliminate surgical smoke from their facilities by 2024 by implementing a nationally recognized smoke evacuation program.