1. Fuller, Thomas P. ScD, MSPH, MBA


Knowledge about chemical dangers is essential to nurses' safety.


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Inadequate hazard communication (training workers about toxic chemicals they may be exposed to) is the second most cited Occupational Safety and Health Administration (OSHA) violation in health care in the United States. From October 2012 through September 2013, health care and social assistance facilities were assessed nearly $125,000 in penalties. With the alignment of OSHA's Hazard Communication Standard with the Globally Harmonized System of Classification and Labeling of Chemicals in December 2013, along with training requirements that went into effect, we can expect a sharp increase in enforcement citations for nurses and other workers using hazardous chemicals without proper training.

Figure. Thomas P. Fu... - Click to enlarge in new windowFigure. Thomas P. Fuller

As an occupational health and safety consultant, I've found that many hospitals aren't yet compliant with the new OSHA global harmonization requirements. Nurses are regularly exposed to new hazardous chemicals and are often unaware of the risks involved or of how to protect themselves.


According to OSHA, in 2009 nursing homes and hospitals were ranked 6th and 7th, respectively, as the most hazardous places to work in America, with numbers of nonfatal occupational injuries and illnesses just below those from police work and iron foundries. Many of these injuries result from exposure to toxic chemicals.


Many nurses do not know what a safety data sheet (SDS; formerly known as a material safety data sheet or MSDS) is, how to decipher the information it contains, or where to find SDSs in their workplaces. Without this knowledge, they are more likely to be accidentally exposed to hazardous chemicals. Hospitals that don't train nurses in the new Hazard Communication Standard are in violation of the new OSHA regulation for toxic and hazardous material identification and classification. For their own safety, nurses need to ensure that their employers comply with the OSHA directive.


Several reports have been published about nurses who became ill from treating patients exposed to hazardous chemicals. EMS Village reported a case in which the nurses who treated a patient contaminated with a pesticide subsequently suffered respiratory distress, emesis, diaphoresis, nausea, and hallucinations. In an Emergency Medicine Journal study of EDs by George and colleagues, it was found that many facilities don't have adequate information on hand or proper training to safely and effectively respond to chemical emergencies.


In health care settings, nurses are commonly exposed to hazardous levels of chemicals used in cleaning products, sterilants, medications, and pesticides. A 2009 biomonitoring study by the American Nurses Association and Physicians for Social Responsibility found that all 20 of those nurses surveyed had toxic chemicals associated with health care in their systems. Numerous associations for nurses and other workers in health care settings have endorsed the adoption of the new globally harmonized standard.


According to OSHA, the new standard will affect about 90,000 establishments, save 43 lives, and prevent 585 injuries to workers a year. The purpose of this system is to harmonize the classification, labeling, and SDS information of hazardous chemicals worldwide so that the same set of rules applies. Labels will now include simplified signal words such as "warning" for less severe hazards and "danger" for those that are more severe. Pictograms representing different kinds of hazards, such as unstable explosives, flammables, oxidizers, gases under pressure, corrosives, and aquatic toxicity, will be on each chemical label.


The alignment of OSHA's Hazard Communication Standard with the Globally Harmonized System will protect employee health and make work environments safer. It may also reduce the costs and time needed to comply with multiple classification systems. Nurses need to be familiar with the new system to ensure their own safety and to provide timely and effective medical response. Employers are responsible to ensure that all workers using, or in contact with, hazardous chemicals are trained in accordance with the OSHA law.