The anesthetic gas and vapors that leak out and into the surrounding room during medical procedures are considered waste anesthetic gases, including nitrous oxide and halogenated agents (vapors) such as halothane, enflurane, methoxyflurane, trichloroethylene, and chloroform. Exposure to waste gases usually results from poor work practices during the anesthetization of patients, leaking or poor gas-line connections, improper or inadequate maintenance of the machine, and/or patient exhalation after the surgical procedure, while in recovery.

Potential Hazard

Potential Hazard

Exposure to blood and OPIM and life threatening BBPs such as Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV).

Possible Solutions

	Follow the requirements of the Bloodborne Pathogens Standard such as: Wear appropriate PPE as required by the Bloodborne Pathogens Standard 1910.1030	Gloves must be worn when hand contact with blood, mucous membranes, OPIM, or non-intact skin is anticipated, or when handling contaminated items or surfaces [1910.1030(d)(3)(ix)].
	Provide effective engineering and work practice controls to help remove or isolate exposures to blood and bloodborne pathogens [1910.1030(c)(1)(iv)(B),1910.1030(d)(2)(i), and OSHA Directive CPL 2-2.69.
	Minimize the hazards of exposure to BBPs in the surgery area by promoting the use of: Safer needle/other sharps devices Blunt suture needles Needleless IV connectors Proper containerization of sharps "No Pass Zone" for surgical instruments Method for passing equipment safely between surgeon and assistants
	The Bloodborne Pathogens Standard also requires:
	Discarding of contaminated needles and other sharp instruments immediately or as soon as feasible after use into appropriate containers [1910.1030(d)(4)(iii)(A)(1)].
	Sharps containers need to be available, and in close proximity to areas where sharps may be found...[1910.1030(d)(4)(iii)(A)(2)].
	Contaminated needles and other contaminated sharps shall not be bent, recapped, or removed except as noted in paragraphs (d)(2)(vii)(A) and (d)(2)(vii)(B).
	Employers must provide readily accessible handwashing facilities, [1910.1030(d)(2)(iii)] and ensure that employees wash their hands immediately or as soon as feasible after removal of gloves [1910.1030(d)(2)(v)].

For additional information, see HealthCare Wide Hazards - Bloodborne Pathogens, and Needlesticks.

 

Potential Hazard

Developing latex allergy from exposure to latex from using products that contain latex such as, gloves, catheters, tubing.

Possible Solutions 

OSHA requires:

• Employers to provide appropriate gloves for employees to wear, including "hypoallergenic gloves, glove liners, powderless gloves or other similar alternatives" to employees who are allergic to the gloves normally provided 1910.1030(d)(3)(iii). Please note that hypoallergenic gloves are not to be assumed to be non-latex or latex-free. 

Good work practice includes:

• Provide a latex-free work environment
  
  

• Use non-latex gloves and other latex-free products.
  
  

• If latex must be used, choose a low protein, powder-free glove. (Powder-free gloves seem to reduce systemic allergic responses.)

For additional information, see HealthCare Wide Hazards - Latex Allergy.

Potential Hazard

Fire, explosion, and toxicity of compressed gases. These effects arise from the compression of the gas and the health effects of the chemical itself. Compressed gases within a healthcare facility are usually either fixed piped gas systems or individual cylinders of gases.

Possible Solutions

Handle compressed gases in accordance with Compressed Gas Association Pamphlet P-1-1965 which is incorporated by reference as specified in 29 CFR 1910.6. Other guidance regarding safe handling of medical gases is included in NFPA 99 Standard for Health Care Facilities, Chapter 4 Gas and Vacuum Systems.

• 1910.101, Compressed Gases.
  
  

• 1910.103, Hydrogen.
  
  

• 1910.104, Oxygen.
  
  

• 1910.105, Nitrous oxide.

Keep cylinders of compressed gases secured. They should never be dropped or allowed to strike each other with force.

• Compressed Gas Association.

• National Fire Protection Association.

• Compressed Gas and Equipment, Technical Links Page.

• Compressed Gas Cylinder Safety, Oklahoma State University.

Static or Awkward Postures

Potential Hazard

Exposure of staff to:

• Static postures from continuously standing in one position during lengthy surgical procedures, causing muscle fatigue and pooling of blood in the lower extremities. Standing on hard work surfaces such as concrete creates trauma and pain to feet.
  

• Awkward postures from tilting head downwards for long periods of time.

Possible Solutions

	Provide stools where their use is possible.
	Use shoes with well cushioned insteps and soles.
	Provide a foot rest bar or a low stool, so employees can continually alter their posture by raising one foot.
	Use height adjustable work surfaces.

For additional information, see HealthCare Wide Hazards - Ergonomics, Awkward Postures.

 

Laser Plume

During surgical procedures that use a laser or electrosurgical unit, the thermal destruction of tissue creates a smoke byproduct. An estimated 500,000 workers are exposed to laser or electrosurgical smoke each year, including surgeons, nurses, anesthesiologists, and surgical technologists.

Potential Hazard 

According to NIOSH research studies have confirmed that this smoke plume can contain toxic gases and vapors such as benzene, hydrogen cyanide, and formaldehyde, bioaerosols, dead and live cellular material (including blood fragments), and viruses. At high concentrations the smoke causes ocular and upper respiratory tract irritation in health care personnel, and creates visual problems for the surgeon. The smoke has unpleasant odors and has been shown to have mutagenic potential. Although there has been no documented transmission of infectious disease through surgical smoke, the potential for generating infectious viral fragments, particularly following treatment of venereal warts, may exist. Researchers have suggested that the smoke may act as a vector for cancerous cells which may be inhaled by the surgical team and other exposed individuals.

Possible Solutions

• Engineering Controls: Use portable smoke evacuators and room suction systems.
  

• Work practice Controls: 
  
  

  • Keep the smoke evacuator or room suction hose nozzle inlet within 2 inches of the surgical site to effectively capture airborne contaminants.
    
    

  • Keep smoke evacuator ON (activated) at all times when airborne particles are produced during all surgical or other procedures.
    
    

  • Consider all tubing, filter, and absorbers as infectious waste and dispose of them appropriately.
    
    

  • Install new filters and tubing before each procedure.
    
    

  • Inspect smoke evacuator systems regularly to prevent possible leaks.
    
    

  • Use Universal Precautions as required by the OSHA Bloodborne Pathogens Standard [1910.1030(d)(1)].

Additional Information

• Laser Electrosurgery Plume, Technical Links Page.

• Control of Smoke from Laser/Electric surgical Procedures: NIOSH Hazard/Control, DHHS (NIOSH) Publication No. 96-128.

Potential Hazard

Exposure of employees to lasers used in the operating rooms during 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. Direct beam exposure can cause burns to skin and eyes possibly resulting in blindness. Electric shock and fire are also potential hazards when using lasers. The four classes of laser are:

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.

Possible Solutions

The OSHA Tech Manual Section VI, Chapter 1-Health Hazards recommends:

• All personnel in the operating room during laser surgery should wear goggles to protect the cornea, conjunctive, and other ocular tissue. The wavelength of the laser output is the most important factor in determining the type of eye protection to be used. Lion Lasers Skin Centre provides examples of available protective eyewear.

	Sample Laser Signs
Post Warning signs in areas where exposure to lasers is likely.	Class 4 - Laser Sign	Class 2-Laser Sign

• Maintain and service the entire laser system according to the manufacturer's instructions. Only qualified personnel from the manufacturer or in-house should maintain the system. Maintenance may only be done according to written standard operating procedures and must meet the requirements of the Lockout/Tagout Standard 1910.147.
  
  

• Adequately cover laser systems, especially ones with high voltage capacitance. Also, attach bleeders and proper grounding 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.
  
  

• Cover or black out, all windows in laser surgical areas to protect employees outside the surgical area.
  
  

• Lasers are calibrated by the manufacturer, but check the laser system before each procedure and during extended procedures. Classifications of lasers should coincide with actual measurement of output. 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. Only personnel trained in laser technology should make measurements.

Guidelines for Laser Safety and Hazard Assessment PUB 8-1.7 General Basic Safety Precautions, provides guidelines including:

• Skin Protection can best be achieved through engineering controls. If the potential exists for damaging skin exposure, particularly for ultraviolet lasers (200-400 nm), then skin covers and or "sun screen" creams are recommended.
  
  

  • Hands - Most gloves will provide some protection against laser radiation. Tightly woven fabrics and opaque gloves provide the best protection.
    
    

  • Arms - A laboratory jacket or coat can provide protection for the arms. For Class IV lasers, consideration should be given to flame resistant materials.
    
    

  • Personnel should use protective clothing when exposed to levels of radiation that exceed the Maximum Permissible Exposure for the skin.

Additional Information

• 1926.54, Nonionizing radiation.

• Laser Hazards, Technical Links Page.

• Laser Hazards. OSHA Technical Manual, Section III, chapter 6.

• Guidelines for Laser Safety and Hazard Assessment. OSHA Instruction PUB 8-1.7 (1991, August 5), 70 pages.

• Laser Hazards. OSHA Technical Manual (TED 1-0.15A), Section III - Chapter 6 (1999, January 20), 51 pages. This chapter contains information that will assist in the recognition and evaluation of laser hazards.

• The American National Standards Institute (ANSI) has developed several standards on laser hazards and non-beam hazards. They are recognized as a minimum standard for laser safety. These are available for purchase.

  • ANSI Z136.1-1993: American National Standard for the Safe Use of Lasers.

  • ANSI Z136.3-1996: American National Standard for the Safe Use of Lasers in the Health Care Environment.

Potential Hazard

Exposure to possible hazardous chemicals found and used in the surgical area, e.g., paracetic acid used in cold sterilant machines and 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.

Possible Solutions

• Mix Methyl Methacrylate only in a closed system.
  
  

• Employees should carefully read and follow instructions and warnings on labels, (e.g., when using cold sterilant machines for sterilizating equipment that cannot be autoclaved, use goggles provided and do not open machine until it is in a safe to open mode).
  
  

• Employees should follow all MSDS instructions regarding safe handling, storage, and disposal of hazardous chemicals.
  
  

• Employers should consider using disinfectants or other products that are not hazardous.
  
  

• According to the Hazard Communication Standard: Employers must inform employees of chemical hazards and have on hand Material Safety Data Sheets, (MSDS) for all hazardous chemicals used in their facilities.

For additional information, see HealthCare Wide Hazards - Hazardous Chemicals.

Potential Hazard

Staff exposure to burns or shocks from poorly maintained equipment or improperly trained staff (e.g., autoclaves, warming cabinets, defibrillators). 

Possible Solutions

A safety and health program that routinely monitors the condition of equipment and addresses work practices of employees:

• Train employees to correctly and safely use equipment.
  
  

• Maintain adequate working space and access to equipment.
  
  

• Visually inspect cords. Do not use if frayed or damaged. Equipment cords should be grounded.
  
  

• Visual inspection of equipment before using. 
  
  

  • If something doesn't look right, don't use the machine, and call for assistance.
    
    

• Ensure that all electrical service near sources of water is properly grounded [1910.304(f)(5)(v)].
  
  

• Use appropriate personal protective equipment and safe work practices for assessed hazards (e.g., when handling hot items use gloves, and don't open autoclaves or sterilizers until items are sufficiently cooled.

For additional information, see HealthCare Wide Hazard - Electrical, and PPE.

Potential Hazard

Staff exposure to trips, and falls, e.g., falling over portable equipment that easily blends into the floor or slipping on debris, (bandages, tubing, blood, IV fluids) that are spilled on the floor. Electrical cords crossing floors may also be a trip hazard.

Possible Solutions

	Walking/Working Surfaces Standard requires [1910.22(a)(1)]: All places of employment shall be kept clean and orderly and in a sanitary condition.
	Aisles and passageways shall be kept clear and in good repairs, with no obstruction across or in aisles that could create a hazard  [1910.22(b)(1)]. Provide ceiling or floor plugs for equipment, so power cords need not run across pathways.
	Mark mobile equipment with a bright color, or a tape "X", to help distinguish it from the floor and make it more visible to employees.

 

For additional information, see HealthCare Wide Hazards - Slips/Trips/Falls.