1. Environmental Services Professional Training Course

2. Acknowledgments
This course was developed for the District of Columbia Hospital Association (DCHA) in collaboration with the District of Columbia Department of Health and the Food and Drug Administration. The Food and Drug Administration, Division of Facilities Planning, Engineering and Safety generously provided time, personnel, and resources for this project. The District of Columbia Department of Health provided funding to pay for the course materials. The author wishes to thank all those who graciously gave their time to provide comments and technical assistance during the development of this course.

3. Table of Contents Course Objective Pre-Test
1.0 Overview of Occupational Hazards
2.0 Microorganisms & Infectious Agents
3.0 Infectious Waste
4.0 Cleaning for Health
5.0 Hazardous Material Safety
6.0 Needlestick and Injury Prevention
7.0 Spill Response
8.0 Regulated Medical Waste Transportation Requirements
9.0 Definitions
Post-Test

4. Course Objective
This study program will provide environmental services professionals and other infectious waste handlers with the information they need to do their jobs safely. Program participants will become familiar with the requirements of the Occupational Safety and Health Administration’s (OSHA’s) Bloodborne Pathogens and Hazard Communication Standards, as well as the Department of Transportation shipping regulations for infectious wastes. Successful completion of the post-test will demonstrate knowledge in the following areas:
Occupational hazards associated with handling infectious waste, disinfecting contaminated surfaces, and responding to infectious materials incidents
Infection control on the job
Material Safety Data Sheets and hazards associated with the use of chemical disinfectants
Selection of proper personal protective equipment
Housekeeping and spill response procedures
The American Hospital Association’s infectious waste reduction initiative sponsored by the EPA
Requirements for packaging and transporting infectious or regulated medical waste
Participants who successfully complete the course receive a Certificate of Training.

5. Pre-Test
This test is to help the participant know where he/she stands at the beginning of the course.
1. A hazard is anything that has the potential to cause injury or harm. Circle one: True False
2. An employee with a fever should always come to work. Circle one: True False Only if the fever < 100 degrees
3. Diarrhea is often a sign of infection.
Circle one: True False
4. Infections are caused by tiny organisms called germs.
5. Can disinfectants be used on surfaces to kill germs?
Circle one: Yes No Sometimes, depends on the germ.
6. Handwashing is the single most important thing one can do to prevent the spread of infection.
7. If you get stuck by a needle, all you have to do to prevent yourself from getting sick is to wash your hands.
8. The law requires your employer to provide you with information about the chemical hazards in your workplace.
9. It doesn’t matter what dumpster you put medical waste in as long as it is kept in a red bag.
10. You can’t get sick from a needlestick.

6. Occupational Hazards

7. 1.0 Overview of Occupational Hazards
Environmental services professionals at hospitals and other health care facilities face many hazards in the workplace every day. Listed below are some of these hazards:
When they enter patient rooms, they may become exposed to infectious diseases.
They risk exposure to bloodborne pathogens from dirty needles that are occasionally thrown away in the biohazard and general waste streams.
They work with chemicals that are often corrosive and dangerous if not handled properly.
They are a category of worker at risk of latex allergy from ongoing latex exposure.
They may become injured from slips, trips, and falls, or heavy lifting.
All of the hazards listed above can be controlled by establishing warning systems, engineering and administrative controls, and safe work practices,. To ensure hazard control in the workplace, the Occupational Safety and Health Administration (OSHA) has established many laws that employers must comply with to provide a safe working environment for their employees.

8. Microorganisms & Infectious Agents

9. 2.0 Microorganisms & Infectious Agents
Webster’s dictionary defines the word “microorganism” as an animal or plant of microscopic size. An animal or plant of this size is too small to be seen by the naked eye and can only be seen with a special instrument called a microscope. There are many different kinds of microorganisms. Some of them are able to make people sick and are often called germs. A hospital laboratory has many microscopes on hand for technicians to use so that they can identify the germs that make people sick. Germs come in many shapes and sizes and are sometimes called infectious agents. There are six different types of infectious agents recognized by the Centers for Disease Control (CDC) and they are listed below:
1. Bacterial agents - examples include Tuberculosis (TB), Staphylococcus (staph), or Legionella (Legionnaires’ disease)
2. Fungal agents - examples include Aspergillus (mold) and Tinea (ringworm)
3. Viral agents - examples include Hepatitis B Virus, Hepatitis C Virus, HIV (AIDS),
4. Parasitic agents - examples include Giardia and Trichomoniasis
5. Prions - examples include Kuru and Creutzfeldt-Jakob Disease (CJD or mad cow disease)
6. Rickettsial agents - examples include Rocky Mountain spotted fever and Lyme Disease
Although only a few examples have been provided for each of the infectious agents listed above, there are many more that make people sick.

10. In order for an infectious agent to make a person sick, it must first come into contact with that person. This contact is called an exposure. Following are examples of exposures that can occur in a health care facility:
EXAMPLE 1
Infectious bacteria would be found in the spit of a patient with Tuberculosis (TB). If such a patient coughs, the TB bacteria get into the air with the spit and can infect anyone in the room who is not wearing a mask (N-95 respirator). Coming into contact with the TB bacteria is an example of how a person could be exposed to TB and become sick with Tuberculosis.
Tuberculosis is a disease that doctors are having a hard time treating and many people who get this disease die. Environmental services professionals in the health care setting must protect themselves by wearing masks when they enter TB isolation rooms. In a 1995 publication, CDC researchers reported the results of a study that found the annual risk of contracting TB was higher for hospital housekeepers than nurses.

11. EXAMPLE 2
Infectious virus would be found in the blood of a patient with Hepatitis B (HBV) liver disease. If a environmental services professional is stuck by a needle that was used to draw blood from a patient with HBV liver disease, the environmental services professional becomes exposed to the Hepatitis B virus.
Hepatitis is a disease that attacks the liver and eventually kills the patient. Environmental services professionals in the health care setting must protect themselves from needlestick injuries by wearing puncture resistant gloves when they handle red bags or sharps containers. In a 1999 alert published by the CDC, the government reported that six to thirty percent of unvaccinated workers can get HBV after a single needlestick exposure. This means that if 100 environmental services professionals are each stuck with a needle contaminated with blood containing Hepatitis B virus, then six to thirty of those professionals will get sick with Hepatitis. There are two ways to reduce the rate of HBV transmission from needlestick injuries and they are:
1) To get a Hepatitis B vaccination, and
2) To report all needlestick injuries to the infection control nurse and accept post-exposure treatment.

12. The primary goal of a health care facility cleaning program is to prevent the spread of infectious agents among patients and healthcare workers. Environmental services professionals play an important role in achieving this goal by protecting themselves in the following ways:
Wearing puncture resistant gloves while handling any form of hospital waste to include biohazard bags, infectious waste containers, and trash bags of any color
If puncture resistant gloves are worn, wash gloves between patient rooms to avoid transfer of microorganisms from one patient to another
Wear proper personal protective equipment when cleaning up spills of potentially infectious material
Use an antibacterial soap to wash gloves immediately after contact with blood and/or body fluids, soiled linen, or contaminated equipment
Immediately report needlestick and other sharps-related injuries to the infection control staff
Follow any recommendations made by the infection control staff after a potential exposure to prevent infection
Participate in OSHA bloodborne pathogen training
Follow recommended infection prevention practices to include receiving the hepatitis B vaccination
Wash hands immediately after removing gloves
Wash hands before and after eating, smoking, applying cosmetics, or preparing food
Stay home to rest when feverish and sick with a cold, flu, or other infection

13. Infectious Waste

14. 3.0 Infectious Waste
The Environmental Protection Agency (EPA) states that infectious waste can produce an infectious disease. For a waste to be infectious it must contain enough infectious agent to make a person sick if exposed to the waste material. The person must come into contact with the waste material for an exposure to take place. Infectious waste is classified according to the following categories:
Isolation wastes are those made in isolation rooms where patients with infectious diseases are cared for.
Cultures and stocks of infectious agents and associated biologicals are wastes generally made in the laboratory and may include specimen cultures, discarded vaccines, culture dishes, and devices used to transfer, inoculate, and mix cultures.
Human blood and blood products are wastes that can be found anywhere in the health care facility but most often they are found in the laboratory, operating rooms, and labor and delivery areas - these wastes include blood, serum, plasma, and other blood products.
Pathological wastes are wastes generally found in the pathology labs and autopsy suites - these wastes include tissues, organs, body parts, and body fluids that are removed during surgery and autopsy.
Contaminated sharps are wastes that can be found anywhere in the health care facility but most often they are found in areas where patients are treated and the laboratory - these wastes include hypodermic needles, syringes, glass pipettes, broken glass, and scalpel blades.

15. Contaminated carcasses, body parts, and bedding are wastes that can be found in a medical research laboratory where animals are exposed to infectious microorganisms while researchers try to find out what causes and cures diseases.
Miscellaneous wastes are those items that are probably contaminated with infectious microorganisms - they include contaminated materials found in the dialysis units, surgery and autopsy suites, and laboratory areas.
If an item has come in to contact with blood or body fluids, it is considered contaminated and probably infectious, therefore, it should be treated as infectious waste. All infectious waste must be disposed of properly in accordance with a federal law known as the OSHA Bloodborne Pathogens Standard. Proper disposal means the following:
All needles and other contaminated sharps must be placed in a closable, puncture-resistant, leakproof, red or biohazard-labeled container.
All other infectious wastes must be placed in closable, leakproof, red or biohazard-labeled bags or containers.
Biohazard Label

16. According to Health Care Without Harm, a non-profit organization, “hospitals produce approximately 2 million tons of solid waste per year.” Of this amount, ten to fifteen percent is categorized as infectious and the rest is general waste made up of paper and paper board, plastics, food waste, metal, glass, wood and other materials. All of the solid waste is sent to landfills or incinerators for disposal. Neither method of disposal is ideal. Landfills threaten our local drinking water supplies by leaking toxic liquids and incinerators threaten global air supplies by emitting toxic contaminants. The problem with incinerators is worse than the problem with landfills because contaminants from incinerators travel all over the world and can never be collected and contained once they are released whereas toxic liquids leaking from landfills can be collected and treated locally to remove the harmful properties.

17. According to the CDC, only one category of infectious waste needs to be incinerated to protect the public health and that is pathological wastes. Although pathological wastes make up only 2% of the hospital solid waste stream, some hospitals send up to 100% of their solid waste in red bags to a medical waste incinerator causing unnecessary harm to our global environment.
Only about 10% of the waste is actually infectious ……..
If 100% of hospital solid waste is disposed of in red bags…...
And 2% of the waste is pathological, requiring incineration.

18. According to the EPA, medical waste incinerators are the fourth largest known releasers of mercury to the environment. The reason for this is that mercury waste is being improperly disposed of in biohazard bags along with other solid wastes that are not considered infectious. The mercury waste comes from patient and laboratory thermometers, blood pressure devices, dilation and feeding tubes, batteries, and fluorescent lamps. Mercury cannot be destroyed by incineration. It is instead released through the incinerator smokestack and then deposited back to land or sea. It eventually gets into fish and then people eat the fish. When people eat contaminated fish they can get mercury poisoning. In people, mercury is toxic. It causes damage to the brain, kidneys, and lungs. When pregnant women eat mercury contaminated fish, their babies are born mentally retarded. Thirty nine states have issued over 1,600 warnings against eating mercury contaminated fish found in their waterways.
In addition to mercury, medical waste incinerators release dioxin to the atmosphere. Dioxin is a name used to describe a class of toxic chemicals that cause cancer, birth defects, and a number of other conditions in humans. It is formed when IV bags, tubing, and other PVC plastics are burned in an incinerator as medical waste. It is released from the incinerator smokestack and travels great distances where it enters the food chain much like mercury. According to the EPA, medical waste incinerators are the second largest source of dioxin pollution of our environment and food supply.
Because of all of the environmental health problems caused by medical waste incinerators, the American Hospital Association and the EPA have reached an agreement to work together to reduce the amount of waste within the hospital system by half by the year 2010.

19. A number of actions can be taken to reduce the amount of solid waste within the hospital system that is sent in biohazard bags to medical waste incinerators for disposal. They are as follows:
Work with hospital administrators to develop policies that support biohazard bag reduction efforts.
Provide information to all hospital staff about the toxic contaminants created by medical waste incineration.
Educate staff about different categories of infectious waste and teach them to place only infectious wastes in biohazard bag containers.
Place and maintain biohazard bag containers only in those areas where infectious wastes are likely to be made.
Place and maintain special biohazard-labeled containers in areas where pathological wastes are likely to be made and teach staff to only place pathological wastes in them.
Keep pathological wastes separate from the other infectious wastes.
Send only pathological wastes to a medical waste incinerator for disposal.
Make alternative arrangements to properly treat and dispose of all other infectious waste (e.g. autoclaves, microwaves, chemical treatment).

20. Cleaning for Health

21. 4.0 Cleaning for Health
The goal of a health care facility cleaning program is to prevent the spread of infectious agents among patients and healthcare workers and to maintain a healthy indoor environment. A healthy indoor environment is one that is free of hazardous pollutants. Cleaning is the process of removing these pollutants from the environment and disposing of them properly. There are several types of indoor pollutants that can make us sick and they are listed below:
Organic Pollutants - these are chemical compounds. Examples include: formaldehyde, pesticides, and disinfectants.
Inorganic Pollutants - these include particles and inorganic gases. Examples include: asbestos, lead, and carbon monoxide gas.
Radiation - pollutants include both ionizing (e.g. radon) and non-ionizing (e.g. electromagnetic fields) types.
Complex Mixtures - examples include soot and tobacco, both of which contain organic and inorganic matter.
Biological Contaminants - referred to as bio-pollutants. Examples include bacteria, viruses, algae, fungi, ragweed, mites.
Biological contaminants are the most hazardous pollutants found in the indoor healthcare facility environment. They are living organisms, or come from living organisms, and can be found under certain environmental conditions:
1. There must be a comfortable home or reservoir in which to hang out which is just about anyplace, and
2. They need nourishment just like us in the form of food (organic matter) and water.

22. Aspergillus is a fungus found in dust and is an example of a common biological contaminant that lives well in soil, water and decaying material. In health care facilities, it may be found in the building ventilation system at air intake and exhaust ducts in areas where organic matter (dust) and water are present. Air vents in patient bathrooms make ideal homes for this deadly organism which can become airborne and infect patients. Immuno-compromised patients are especially at risk of infection by this bio-pollutant which causes pneumonia and kills the patient at least 50% of the time. By keeping air vents clean and free of dirt and debris, environmental services professionals control environmental conditions so that this organism can’t grow or multiply.

23. Another deadly biological contaminant found in the healthcare facility is a bacteria named Vancomycin-resistant enterococci. (VRE). The reason why this bacteria is deadly is because it cannot easily be killed by antibiotics and many patients die once they become infected with it. Patients may become infected with VRE by touching contaminated surfaces such as bedrails, sinks, faucets, and doorknobs, or coming into contact with health-care workers who do not wash their hands. If someone comes into the hospital carrying the VRE bacteria, then whatever that person touches may become contaminated with VRE. Deadly VRE can survive for weeks on environmental surfaces. Every year thousands of patients die after becoming infected with the VRE bacteria during a hospital stay. Environmental services professionals play a key role in controlling the spread of VRE throughout the healthcare facility by washing hands and wearing gloves properly, and diligently cleaning and disinfecting all environmental surfaces.
Surfaces with regular hand-contact are called high touch surfaces. High touch surfaces in patient care areas include items such as telephones, doorknobs, bedrails, light switches, faucets, and wall areas around the toilet. These surfaces must be cleaned and disinfected daily to protect the patient and reduce the spread of nosocomial diseases such as VRE.

24. Nosocomial diseases are illnesses that patients acquire during their stay in the hospital. Another example of a nosocomial disease is diarrhea caused by the bacteria, Clostridium difficile. Patients get this infectious disease by coming into contact with environmental surfaces contaminated with Clostridium difficile. Patients’ bathrooms tend to be heavily contaminated areas so they must be thoroughly cleaned and disinfected by environmental services professionals to prevent the spread of this disease.
Clostridium difficile

25. The primary goal of a health care facility cleaning program is to prevent the spread of nosocomial disease among patients and healthcare workers. Environmental services professionals play an important role in achieving this goal. Daily cleaning reduces the amount of microorganisms in the patient care environment. Cleaning is removing all foreign material (e.g., soil, organic material) from surfaces and it should be done before disinfecting. The following guidance is provided to improve the general cleaning and disinfecting process:
When selecting a disinfectant for use, choose the least toxic and most effective cleaning product you can find.
Always clean from least soiled to more soiled areas and from top to bottom in the patient rooms.
Always change the disinfecting solution when it appears dirty (usually after every 3-4 patient rooms).
Use a clean cloth or mop head each time a bucket of detergent/disinfectant is emptied and replaced with fresh, clean solution.
Dusting reduces potential food for Aspergillus and prevents infection in hospitalized patients and allergies in employees.
Dust can be removed without making patients sick by using a chemically treated cloth/mop or a cloth dampened with approved disinfectant.
When dusting, it is important NOT to shake the cloth/mop because dust and fungal spores will then get in the air. If patients breathe in these spores, they may get sick and die.
While dusting ceilings and vents, report any stains and/or wet areas immediately for repair. Fungus will start to grow on wet ceiling tiles within 72 hours.

26. Special care areas (e.g., operating rooms, isolation rooms, and protective environments for immuno-compromised patients) need additional attention during the cleaning and disinfecting process. Consider the following strategies for process improvement:
Use a bucket method for cleaning each special care area, where a clean cloth is dipped into a bucket filled with approved disinfectant and items are cleaned and left wet for ten minutes.
Daily cleaning should include the washing and disinfecting of walls around light switches, doorknobs, and other high touch surfaces.
Use CLEAN mops and CLEAN mop water for cleaning and disinfecting the floor in each special care or isolation room.
When a patient is discharged from a special care area, throw away all disposable items, change any cubicle curtains, and disinfect all surfaces including chairs, tables, ledges, call lights, telephones, sinks, showers, and toilets.
Avoid the use of cleaning equipment that produces mists.
If a vacuum is needed to clean the floor in a special care area, use one with a clean HEPA filter on the exhaust. Keep the door to the special care area closed when vacuuming.
It can not be emphasized enough. Environmental services professionals play a key role in preventing the spread of infectious agents among patients and healthcare workers. Diligent housekeeping keeps microorganisms and other bio-pollutants under control and reduces the spread of nosocomial disease. The environmental services professional must look for and report to management conditions that may promote the growth of microorganisms.

27. Management staff must work cooperatively with environmental services professionals and maintenance personnel to maintain a healthy indoor environment. The following basic control measures are suggested for maintaining healthy indoor environments at health care facilities:
Follow a schedule for all cleaning and maintenance activities.
Remove dirt and debris from all environmental surfaces on a daily basis and clean and disinfect as appropriate.
Vacuum carpet regularly and deep clean with an effective extraction method at least once a month.
Clean and disinfect air ducts before dirt and dust have a chance to build up.
Clean, disinfect, and dry surfaces within 24 hours after a flood.
Immediately remove and dispose of materials wet with sewage-contaminated water. Clean, disinfect, and dry any contaminated surfaces.
Do not allow water to accumulate and stagnate anywhere in the indoor environment.
Routinely clean all indoor humidifiers with a disinfectant such as diluted bleach (1:9) or hydrogen peroxide (3%).
Maintain relative humidity below 60 percent.
Clean and disinfect bathrooms daily.
Clean and disinfect cooling towers routinely.
Clean or replace air filters routinely.
Have fabrics cleaned professionally every six months (drapery and upholstery).

28. Hazardous Material Safety

29. 5.0 Hazardous Material Safety
Environmental services professionals routinely use chemical disinfectants to clean surfaces and kill infectious agents in patient rooms and other areas of the health care facility. If not handled properly, these chemicals can cause serious injuries such as eye damage, respiratory problems, chemical burns, or severe skin irritation. To prevent such injuries, the OSHA Hazard Communication Standard requires all health care employers to provide information and training to their employees about the hazards associated with the chemicals in their workplace. Specifically, employers must tell their employees about the requirements of the OSHA Hazard Communication Standard, any operations in their workplace where hazardous materials are present, and the location and availability of the health care facility’s written hazard communication program, including the list of chemicals in use by the facility and the required Material Safety Data Sheets (MSDS) provided by the chemical manufacturers. Employers must also provide training to their employees on the following topics:
Ways or how to detect the presence or release of a hazardous chemical in the workplace;
The physical and health hazards of the chemicals in the workplace and the measures that can be taken by environmental services staff to protect themselves from these hazards, including safe work practices, emergency procedures, and personal protective equipment to be used; and
The facility’s hazard communication labeling system, the hazard information provided by the MSDS, and how personnel can obtain and use the hazard information on the MSDS.

30. In order to understand the hazard information provided by the MSDS, environmental services professionals must first learn something about the nature of chemicals. Chemicals are made up of single or multiple elements. Oxygen in the air that we breathe is a chemical made up of a single element - two molecules of oxygen (02). Water is a chemical made up of two elements - two molecules of hydrogen and one molecule of oxygen (H20). The most common chemicals in use are made up of three elements - carbon, hydrogen, and oxygen. Chemicals also come in different forms - solids, liquids, gases, or vapors, and can even be radioactive.
H-3, also known as Tritium, is an example of a radioactive material which is made up of three hydrogen molecules. It is often used by scientists in biomedical research laboratories.
Isopropyl alcohol, ethylene oxide, formaldehyde, ether, and glacial acetic acid are examples of some of the chemicals used everyday in healthcare facilities.
Chemicals change from one form to another depending on temperatures and pressures. Water turns to ice when the temperature drops below 32 degrees F. When water is heated to the boiling point, it evaporates and turns into a vapor. Some chemicals evaporate at or below room temperatures becoming airborne vapors.

31. Gasoline is a common chemical that becomes an airborne vapor at and below room temperature. It is very flammable with a flash point of -45 degrees F. This means that at 45 degrees below zero, gasoline will give off enough vapor to catch on fire in the presence of a spark or flame. In addition to being flammable, gasoline vapors are very dangerous because they are harmful to human health.
Any chemical can be harmful to human health. How harmful a chemical is depends on how much of it gets into the body and how toxic it is. Chemicals can enter the body in one of four ways:
They can be inhaled (breathed in);
They can be ingested (swallowed);
They can be absorbed through the skin or eyes; or
They can be injected.
When a chemical enters the body, an exposure has taken place. A few chemicals are highly toxic and can cause death immediately or soon after exposure. More commonly, however, chemicals cause sudden, short term exposure effects such as burning of the eyes, skin, or lungs or chronic, long term exposure effects such as cancer or birth defects.

32. Formaldehyde is an example of a chemical that may cause both long and short term exposure effects. It is suspected to cause cancer so it is called a suspected carcinogen. It is also considered a corrosive. If a material has a pH of less than 3 or greater than 12, then it is considered corrosive and it could irritate, burn and/or destroy human skin upon contact. It is very important to wear Personal Protective Equipment (PPE) when working with corrosive material.
OSHA has set guidelines for safe levels of exposure to many airborne contaminants including mists, gases, vapors, dusts, and fibers. These are known as Permissible Exposure Levels or PELs. The American Conference of Governmental Industrial Hygienists (ACGIH) has also set guidelines for safe levels of exposure to many contaminants. These are known as Threshold Limit Value-Time Weighted Average (TLV-TWA) concentration levels or TLVs. If a safe exposure level has been identified by OSHA or the ACGIH for a particular material, then it will be provided on the MSDS.

33. Unsafe levels of exposure may occur in the work place at any time in the event of a spill or release of a hazardous material. It is therefore very important that workers know where hazardous materials are stored or used and how to detect a spill or release in their work place. Some hazardous materials have warning properties that alert the worker to a potential exposure in the event of a release. Examples of warning properties include odor, headache, burning or tearing eyes, or coughing.
Not all hazardous materials have warning properties and in some cases the warning properties do not occur until after the employee has been exposed to a dangerous amount of material. In such cases, employers may install alarm systems that go off when levels of exposure are immediately dangerous to life and health. Ethylene oxide is a toxic gas that is used in many healthcare facilities to sterilize surgical instruments. It is considered a carcinogen and a reproductive hazard. Because it doesn’t take much of it to cause permanent damage or death, many hospitals have installed alarm systems in and around the sterilizer areas to alert workers in the event of a release. Some hospitals have eliminated the use of ethylene oxide altogether. They have found a less hazardous material to use in their sterilizers. Using a less hazardous material to do the same job is known as “substitution.”
If a substitute material cannot be found to do the job, a toxic or other hazardous material can be used safely in the work place as long as precautions and procedures are in place to protect the worker from exposure. Safe work practices or precautions for using a particular chemical may be found in the MSDS or on the product label. Below are some common precaution statements found on product labels:
Use with adequate ventilation;
Keep away from sources of ignition (e.g. heat, flame);

34. Wear chemical splash goggles;
Wear rubber gloves to avoid skin contact.
Gloves, coveralls, goggles, face shields, aprons, and respirators are all examples of Personal Protective Equipment (PPE). If properly and consistently used by the worker, PPE can provide excellent protection against chemical hazards. The MSDS will state what type of PPE the worker needs to wear to prevent exposure while handling the material. If an exposure does occur, the MSDS also provides health hazard and emergency first aid information.
To summarize, the OSHA Hazard Communication Standard requires chemical manufacturers to assess the hazards of the chemicals they make. For every chemical found to be hazardous, manufacturers must develop a Material Safety Data Sheet (MSDS) and provide it to people and organizations that purchase their products. Employers such as hospital organizations are then required by the OSHA Hazard Communication Standard to train their employees on the hazard information provided by the MSDS.
BEAUCOUP is a common chemical used by environmental services professionals in the health care industry. The manufacturer has generously provided a MSDS for your review. You will find it at the end of this chapter. Please take it out of your binder and use it to answer the following questions:
1. What is the name of the product?_______________________
2. Who makes the product?______________________________
3. What is the product used for?__________________________
4. What hazardous ingredients are in the product? ___________
__________________________________________________

35. 5. Has OSHA set a guideline for safe exposure to any of the ingredients in this product? Yes or No
6. If OSHA has set a guideline for safe exposure to one of the ingredients in the product, what is the name of the ingredient and what is the Permissible Exposure Level? ________________
____________________________________________________
7. What does the product look like? ______________________
8. Is the product corrosive? Yes or No
9. Is the product flammable? Yes or No
10. Is the product reactive? Yes or No
11. What type of PPE should you wear when you use this product?______________________________________________
_____________________________________________________
12. What do you do if you get this product in your eye? ______
13. What phone number can you call if there is a medical emergency and you need more information about this product? _
14. What does MSDS mean? ____________________________

36. ECOLAB Ecolab Inc. Ecolab Center St. Paul, Minnesota 55102
MATERIAL SAFETY DATA SHEET Page 1 of 2
MEDICAL EMERGENCIES ONLY (24 Hour Service): 1‑800‑328‑0026
Medical Calls from Outside of the USA: 1‑651‑222‑5352
PROFESSIONAL PRODUCTS ECOLAB INC.
370 WABASHA STREET NORTH
ST. PAUL MN 55102
Product Information: 1‑800‑242‑5362 Issue Date: July 9, 1999
1.0 IDENTIFICATION
1.1 Product Name: BEAUCOUP
1.2 Product Type: Phenolic Detergent Disinfectant EPA 303‑223
1.3 Hazard Rating: Health: 2 Fire: 0 Reactivity: 0
2.0 HAZARDOUS COMPONENTS (mg/m3)
CAS No. % PEL TWA
2.1 o‑Phenylphenol 90‑43‑7 3 No No
2.2 o‑Benzyl‑p‑chlorophenol 120‑32‑1 4.5 No No
2.3 p‑t‑Amylphenol 80‑46‑6 1.5 No No
2.4 Isopropyl alcohol 67‑63‑ *
(2‑propanol, IPA)
*(ACGIH STEL = 1230)
STEL = ACGIH short term exp. Limit (l5 min.) PEL = OSHA 8 hr ave in air TWA = ACGIH 8 hr average C = ceiling limit in air, do not exceed
3.0 PHYSICAL DATA
3.1 Appearance: Reddish brown liquid; floral/phenolic odor
3.2 Solubility in Water: Mixes with Water in all proportions
3.3 pH: 12 ‑ 13 (100%); 9.5 ‑ 10.5 (use solution)
3.4 Initial Boiling Point: > 212 deg F
3.5 Specific Gravity: 68 deg F
4.0 FIRE AND EXPLOSION DATA
4.1 Special Fire Hazards: None
4.2 Fire Fighting Methods: Product does not support combustion
5.0 REACTIVITY DATA
5.1 Stability: Stable under normal conditions of handling. Product separates upon freezing; restore by stirring at room temperature.
5.2 Conditions to Avoid: Do not mix with anything but water.
6.0 SPILL OR LEAK PROCEDURES /USE PROPER PROTECTIVE EQUIPMENT
6.1 Cleanup: Dike or dam large spills. Pump to containers or soak up on inert absorbent. Flush residue to sanitary sewer.
6.2 Waste Disposal: Consult state/local authorities for limits on chemical waste disposal.
Note: Substances Subject to SARA 313 Reporting Are Indicated by “#”

37. ECOLAB Ecolab Inc. Ecolab Center St. Paul, Minnesota 55102
MATERIAL SAFETY DATA SHEET Page 2 of 2
Product: BEAUCOUP
PROFESSIONAL PRODUCTS ECOLAB INC.
MEDICAL EMERGENCY ONLY, 24 HOUR SERVICE:
7.0 HEALTH HAZARD DATA
7.1 Effects of Overexposure to Concentrate:
Eyes: Causes eye damage, possible chemical burns.
Skin: Causes skin irritation, possible chemical burns.
If Swallowed: Harmful. May damage mucosal tissue. Large doses
may cause circulatory shock, respiratory depression, convulsion.
If Inhaled: Vapor or mist may cause irritation.
8.0 FIRST AID
8.1 Eyes: Flush at once with cool running water. Remove contact lenses and continue flushing for 15 minutes, holding eyelids apart so as to rinse entire eye. CALL A PHYSICIAN IMMEDIATELY.
8.2 Skin: Immediately flush skin with plenty of cool running water for at least 15 minutes. Wash contaminated clothing before reuse.
8.3 If Swallowed: Rinse mouth at once; then drink 1 or 2 large glasses of water. DO NOT induce vomiting. NEVER give anything by mouth to an unconscious person.
8.4 If Inhaled: If affected, move to fresh air.
IMMEDIATELY CALL THE MEDICAL EMERGENCY NUMBER, , A POISON CONTROL CENTER, OR A PHYSICIAN
9.0 PROTECTIVE MEASURES
9.1 FOR CONCENTRATE:
Eyes: Wear chemical splash goggles. For continued or severe exposure, wear a face shield over the goggles.
Skin: Wear rubber gloves.
9.2 USE SOLUTIONS: Avoid contact with use solutions. These may also be hazardous. Use protective equipment as necessary.
10.0 ADDITIONAL INFORMATION/PRECAUTIONS
10.1 Purpose of 7/9/1999 issue: System conversion and editorial update. Replaces May 12, 1998 issue.
KEEP OUT OF REACH OF CHILDREN
The above information is believed to be correct with respect to the formula used to manufacture the product. As data, standards and regulations change, and conditions of use and handling are beyond our control, NO WARRANTY, EXPRESS OR IMPLIED, IS MADE AS TO THE COMPLETENESS OR CONTINUING ACCURACY OF THIS INFORMATION.

38. Needlestick and Injury Prevention

39. 6.0 Needlestick and Injury Prevention
The National Institute of Occupational Safety and Health (NIOSH) published an alert in November 1999 to provide current scientific information about the risk of needlestick injury and the transmission of bloodborne pathogens to health care workers. According to this alert, it is estimated that 600,000 to 800,000 needlestick and other percutaneous injuries occur annually among health care workers in the United States. About half of these injuries go unreported. Data suggests than at an average hospital, approximately 30 needlestick injuries occur per year for every 100 beds. Of the reported needlestick injuries, approximately 41% occur for the following reasons:
Improperly disposed sharp;
Disposal-related causes;
Collision with health care worker or sharp; and
Cleanup.
In an article published in the Journal of Occupational Medicine in January of 1991, researchers provided data from a study of housekeepers’ injury experiences in medical laboratories at a major university. They reported an incidence rate of forty six injuries per 100 housekeepers per year. 37% percent of the injuries were cuts and punctures and seventy percent of these were attributable to glass, needles, or cutting instruments. 65% of the housekeepers surveyed indicated that they did not always report their injuries.
To reduce the risk of needlestick and other injuries, the following control measures are recommended to protect the environmental services professional:
Always wear whatever personal protective equipment is necessary to do the task safely to protect your skin, work clothes, and mucous membranes from contact with potentially infectious materials (e.g. gloves, masks, face shields, gowns, and aprons).

40. A gown or apron should be worn if there is a possibility of contact with infectious materials on your work clothes.
A mask and goggles or eye protection should be worn if there is a possibility of contact with infectious materials in your eyes, nose, or mouth.
Gloves should be worn to protect your hands from contact with chemicals and potentially infectious materials.
Wear puncture resistant gloves when performing high risk tasks (e.g., changing out needle boxes, cleaning up broken glass, handling infectious waste containers).
Locate puncture resistant leak-proof containers for sharps and needle disposal in areas where they are convenient and likely to be used by health care providers.
Ensure that sharps and needle disposal containers are emptied before they become full.
Report to management any sharps containers that are mounted too high or are not easily accessible to health care providers.
Report to management any needles or other sharp items not properly disposed of by the health care providers.
Use a brush and dust pan to pick up broken glass which may be contaminated with blood or other body fluids.
Handle contaminated laundry including sheets as little as possible. Do not shake out these items. Hold them away from your body and place in the linen hamper without pressing down on them.
Carry red bags or other containers of medical waste away from your body.
When cleaning up contaminated areas, minimize splashing, spraying, and spattering.

41. Bandage any cuts on your hands before putting on gloves.
If latex gloves are worn, always wash and remove them after cleaning a patient’s room or any other potentially contaminated area.
Dirty gloves should never be worn after the cleaning job is done - wearing them around the hospital contaminates surfaces and spreads disease among the patients.
Always wash hands after removing gloves and whenever they are dirty.
Always wash hands in between patient rooms.
Follow safe work practices (e.g., do not eat, drink, smoke, apply lip balm, or handle contact lenses where there might be exposure to blood or other potentially infectious materials).
Keep food and drinks away from areas where blood or other potentially infectious materials are present.
Report needlestick injuries and other potential bloodborne pathogen exposures to the infection control staff at your health care facility.
Follow any recommendations made by the infection control staff after a potential exposure.
Ask the infection control staff at your health care facility about the free Hepatitis B vaccine that is provided to environmental services professionals.

42. Spill Response

43. 7.0 Spill Response
Environmental services professionals routinely respond to calls for assistance in cleaning up spilled materials on the patient wards and other areas of the hospital. The spilled materials often consist of human body fluids such as urine, blood, and feces that may or may not be infectious. Regardless of whether or not the material is actually infectious, any human body fluid must be considered potentially infectious and the environmental services professional should receive training on the following topics:
The health care facility emergency response plan for hazardous materials spills (e.g. notification, personal protective equipment (PPE), spill response and equipment maintenance procedures, etc…);
The different types of micro-organisms potentially found in their workplace to which they are susceptible (e.g. E. coli, MRSA, VRE) along with definitions and symptoms of exposure;
Spill site security and control;
The measures that environmental services professionals can take to protect themselves to minimize their risks of exposure during cleanup operations to include wearing proper PPE;
Contaminated surface cleaning procedures;
Disinfectant selection and effective decontamination procedures;
Proper disposal procedures for potentially infectious waste materials;
Removing PPE, decontamination and/or disposal procedures; and
The health care facility exposure control plan for bloodborne pathogens and employee health and medical surveillance program.

44. Do environmental services professionals require special training to clean up hazardous material spills in the hospital environment?
OSHA’s Hazardous Waste Operations and Emergency Response Standard (HAZWOPER) requires that workers be trained to perform their anticipated job duties without endangering themselves or others. A hazardous material spill that poses a significant safety or health hazard to individuals in the immediate area requires clean up by employees who have received some degree of HAZWOPER training.
A spill that presents a minor safety or health hazard to individuals in the immediate area is considered “incidental” and may be safely cleaned up by employees who have not received HAZWOPER training. An incidental spill is a release of hazardous material which does not have the potential to become an emergency within a short time frame. Incidental releases are limited in quantity, exposure potential, or toxicity and present minor safety or health hazards to employees in the immediate work area or those assigned to clean them up. An incidental spill may be safely cleaned up by an employee who is familiar with the hazards of the material.
It is up to management personnel to decide whether or not a spill is incidental.

45. The properties of the hazardous material (e. g
The properties of the hazardous material (e.g. toxic, flammable, corrosive, radioactive, etc…) and the particular circumstances of the spill itself, such as amount of material, location of spill, ventilation, etc., will determine whether or not employees can safely clean up the spill. Additionally, there are factors that may lessen the hazards associated with the spill and its clean up, such as the knowledge of the employee in the immediate work area, the response and personal protective equipment (PPE) at hand, and the pre-established standard operating procedures for responding to spills of the hazardous material. In some cases, there may be some engineering control measures that employees can activate to assist them in controlling and stopping the hazardous material release (e.g. turning off a valve, turning on a fan).
These considerations (properties of the hazardous material, the circumstances of the spill, and the mitigating factors in the work area) combine to define the spill as incidental or one that would require an emergency response. The definition is facility-specific, a matter of policy, and is a function of the health care facility emergency response or contingency plan.
Potential spills of hazardous materials in the health care facility can be defined as follows:
1. Spills that are clearly incidental regardless of the circumstances,
2. Spills that may be incidental or may require an emergency response depending on the circumstances, and
3. Spills that clearly require an emergency response regardless of the circumstances.

46. Spills that are Clearly Incidental
Example: If a hazardous material in a laboratory is always stored in very small amounts, such as pint sizes down to test tubes, and the hazardous material does not pose a significant safety and health threat if spilled in the immediate vicinity at these amounts, then the risks of having a release that escalates into an emergency are minimal. In this example, incidental spills may occur and employees will be able to clean up the spills safely if they have been trained in accordance with the Hazard Communication Standard.
Spills That May Be Incidental or Require an Emergency Response Depending on the Circumstances
Example: A release of mercury in a plant that manufactures mercury thermometers may not require an emergency response because of the advanced knowledge of the personnel in the immediate vicinity and the equipment available to handle the release. However, the same size spill inside a patient exam room may require an emergency response by specially trained personnel. The health care facility’s emergency response plan in this case would call for evacuation of all individuals from the exam room and notification of the spill response team or the hazardous material contractor.
Spills that Require an Emergency Response Regardless of the Circumstances
There are spills of hazardous materials that pose a significant threat to health and safety that, by their very nature, require an emergency response regardless of the circumstances surrounding the release or the mitigating factors. An employer must determine the potential for such an emergency and plan response procedures accordingly. Response procedures should be provided in the health care facility’s emergency response plan.

47. An emergency response includes, but is not limited to, the following situations:
1. The response comes from outside the health care facility (e.g. local fire department);
2. The release requires evacuation of all employees in the area;
3. The release poses, or has the potential to pose, conditions that are immediately dangerous to life and health (IDLH);
4. The release poses a serious threat of fire or explosion;
5. The release requires immediate attention because of imminent danger;
6. The release may cause high levels of exposure to toxic substances;
7. There is uncertainty that the employee in the work area can handle the severity of the hazard with the PPE and equipment that has been provided and the exposure limit could easily be exceeded; and
8. The situation is unclear, or data are lacking on important factors.
Can you think of an example of a spill or release requiring an emergency response?

48. Medical Waste Transportation

49. 8.0 Regulated Medical Waste Management, Disposal, and Transportation Requirements
There is a great deal of concern about the proper management of health care facility wastes. Environmental services professionals are responsible for picking up the waste at each point of generation and transporting it to the designated place of disposal or storage at the facility. If certain wastes are mishandled or improperly disposed of, health care facilities may be subject to fines. Some of the waste generated in the health care setting could be infectious and transmit disease if improperly handled or disposed of. It is important that environmental services professionals receive training on the following topics:
The health care facility waste management plan
The different types of waste streams at the facility for which they will be responsible
The definition and/or designation of infectious waste including where it is likely to be generated and how it is to be segregated from the other waste streams
Proper segregation, containment, and labeling of wastes in the health care facility
Department of Transportation (DOT) shipping regulations for infectious and/or regulated medical waste transported off-site for treatment/incineration; and
State or local regulations for medical and/or infectious waste disposal

50. OSHA regulates infectious waste in the workplace by enforcing the requirements of the Bloodborne Pathogens Standard. When environmental services professionals pick up infectious waste at each point of generation in the healthcare facility (e.g. patient rooms, operating rooms, pathology labs, etc…) and transport it to the designated place of treatment or storage at the facility (e.g. sani-pak, loading dock etc...) they must do so in accordance with OSHA regulations. This means the waste must be properly segregated at the time of pick up with needles and contaminated sharps in a closable, puncture-resistant, leakproof, red or biohazard-labeled container and all other infectious waste contained in closable, leakproof, red or biohazard-labeled bags or containers.
The infectious waste may or may not be treated on-site at the health care facility prior to shipment off-site for final disposal. If the waste is treated on-site at the facility so that it no longer poses the hazard of an infectious substance, then it is no longer considered infectious and may be transported off-site as general waste to a solid waste disposal facility (e.g. landfill, transfer station) regulated by state or local authorities. If the waste is not treated on-site, then it is considered infectious and a DOT hazardous material, and it must be transported off-site in accordance with DOT shipping regulations for hazardous materials.
DOT regulations require that all infectious substances, including regulated medical waste, be prepared for shipment off-site by trained personnel. Specifically, personnel must receive initial and recurrent training (every two years) that meets the DOT training requirements in the following three subject areas:
General awareness/familiarization training to enable the employee to recognize and identify regulated medical waste as defined by DOT;

51. Function-specific training to familiarize the employee with the DOT shipping requirements related to the job that he/she performs; and
Safety training concerning the specific hazards associated with regulated medical waste, safe handling of packages containing regulated medical waste, and the emergency response procedures and information required by DOT for every regulated medical waste shipment in the event of an accidental release.
DOT requires that personnel be tested after receiving the training on the three subject areas.
A record of current training must be kept by the health care facility for each employee that prepares regulated medical waste for shipment off-site to a treatment facility. The record shall include:
The employee’s name;
The most recent training completion date;
A description, copy, or the location of the training materials used to train the employee;
The name and address of the person who provided the training; and
Certification that the employee was trained and tested.
In accordance with DOT shipping regulations, regulated medical waste must be shipped in packages that are properly labeled and marked. Please take a moment to review the DOT brochure entitled, “Infectious Substances.”
A shipping paper must also be prepared for every regulated medical waste shipment that leaves the health care facility. A description of the regulated medical waste shipment must be included on the shipping paper as well as the name of the health care facility and an emergency response telephone number.

52. The description of the waste shipment on the shipping paper must include the following information:
The proper shipping name, Regulated Medical Waste;
The hazard class, 6.2;
The identification number, NA 3291; and
Packing group, II.
The total quantity of the medical waste being shipped off-site for treatment must also be entered on the shipping paper. Please see the example on the following page which shows how to fill out a shipping paper for a load of untreated regulated medical waste that is being transported from a health care facility.
It is important for environmental services professionals to understand that untreated regulated medical waste is considered an infectious substance and a DOT hazardous material. It must be transported from the health care facility in accordance with DOT shipping regulations. If untreated regulated medical waste is improperly disposed of in the general solid waste stream and transported off-site to a transfer station or landfill, the healthcare facility will be subject to fines levied by the local government and the federal DOT.
$25,000.00

53. Definitions

54. 9.0 Definitions
Immuno-compromised patients - patients who are unable to fight off disease-causing germs
Special care area - a room that needs special cleaning to keep germs from entering or leaving the area (e.g. operating rooms, isolation rooms, protective environments for immuno-compromised patients)
Germicide - an agent (usually chemical) that destroys microorganisms (germs)
Spore - a sleeping or resting germ
Bactericide - a germicide used to kill bacteria
Fungicide - a germicide used to kill fungus
Tuberculocide - a germicide used to kill Tuberculosis (TB)
Disinfectant - a germicide that kills all microorganisms on surfaces but does not necessarily kill their spores
Sterilant - a germicide that kills all microorganisms including their spores
Antiseptic - a germicide that kills microorganisms on skin (e.g.hands, arms, etc..)
HEPA filter - high efficiency particulate air filter: a filter that can remove very small particles, > 0.3 microns in size, from the air with % efficiency
Radioactive Material- a substance that gives off radiation (waves or particles) that may be harmful causing injury, illness, or death depending on the type and amount of radiation absorbed by the individual exposed to the material

55. Personal Protective Equipment (PPE) - equipment that acts as a barrier between the worker who wears it and the hazard; includes protective eyewear, face shields and masks, gloves, boots, hats, clothing, and respirators.
Threshold Limit Value-Time Weighted Average (TLV-TWA) - airborne concentration of a given substance that nearly all workers may be repeatedly exposed to day after day without adverse health effects, according to the American Conference of Governmental Industrial Hygienists
Permissible Exposure Level (PEL) - the airborne concentration of a given substance that nearly all workers may be repeatedly exposed to day after day without adverse health effects, according to the Occupational Safety and Health Administration
pH - a measure of the acidity or alkalinity of a substance, numerically equal to 7 for neutral substances like water, the higher the pH (>7), the more alkaline the solution, the lower the pH (<7), the more acidic the solution
Percutaneous - passed through the skin
Red bag - plastic bag red in color used for the disposal of infectious waste
Occupational Safety and Health Administration (OSHA) Definition of Regulated Medical Waste - liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials
Soaked - saturated to the point of dripping

56. OSHA Definition of Other Potentially Infectious Materials - the following body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult to differentiate between body fluids, any unfixed tissue or organ from a human, HIV-containing cell or tissue cultures, organ cultures, HIV or HBV containing culture medium or other solutions, and blood, organs, or other tissues from experimental animals infected with HIV or HBV
District of Columbia Definition of Infectious Waste - any waste or combination of wastes of a solid, liquid, contained gaseous, or semisolid form which because of its infectious characteristic, as established by the Mayor, may: 1) Cause, or significantly contribute to an increase in mortality or an increase in serious irreversible, or incapacitating reversible, illness; or 2) pose a substantial present or potential hazard to human health or the environment when improperly treated, stored, transported, or disposed of, or otherwise managed.
Department Of Transportation (DOT) Definition of Infectious Substance - a living microorganism, or its toxin, that causes or may cause disease in humans or animals
DOT Definition of Regulated Medical Waste - a waste, or reusable material, that contains an infectious substance and is generated in the diagnosis, treatment, or research of humans or animals
Prion - infectious protein