2. Mercury Exposure Mercury Vacuum CleanerMercury Spill Kit Exposure to mercury occurs through inhalation or through skin contact. If spills are not promptly cleaned up, mercury may accumulate on surfaces and then vaporize and be inhaled by unaware workers. Acute exposure: Acute inhalation of mercury vapor may result in toxicity including chills, nausea, general malaise, tightness in the chest, chest pains, dyspnea, cough, stomatitis, gingivitis, salivation, and diarrhea (ACGIH 1991; Hathaway et al.1991). Short exposure to high levels of mercury can cause severe respiratory irritation, digestive disturbances, and marked renal damage. Chronic exposure: Chronic exposure to mercury may result in weakness, fatigue, anorexia, weight loss, and disturbance of gastrointestinal function. Use mercury spill kits to help clean up small spills of 25ml or less. Kits should contain gloves, protective glasses, Hg absorb powder, mercury sponges, and a disposal bag. Healthcare employee exposure to mercury from accidental spills that can occur during repair of broken thermometers, sphygmomanometers, or during sterilization and centrifugation of thermometers in maintenance areas. Mercury can also be found in esophageal dilators, dental amalgam, laboratory reagents, and in some pressure-sensing instruments (e.g., barometers and sensors in machine rooms), as well as in electronic equipment, and in some older medical devices. When mercury is exposed to the air, as in the case of a spill, it slowly vaporizes.

3. Glutaraldehyde Exposure Healthcare workers can be exposed to Glutaraldehyde, a toxic chemical that is used as a cold sterilant to disinfect and clean heat-sensitive medical, surgical and dental equipment. It is found in products such as Cidex, Aldesen, Hospex, Sporicidin, Omnicide, Matricide, Wavicide and others. Specific applications include use as a disinfecting agent for respiratory therapy equipment, bronchoscopes, physical therapy whirlpool tubs, surgical instruments, anesthesia equipment parts, x-ray tabletops, dialyzers, and dialysis treatment equipment. Acute effects: Contact with glutaraldehyde liquid and vapor can severely irritate the eyes, and at higher concentrations burns the skin. Breathing glutaraldehyde can irritate the nose, throat, and respiratory tract, causing coughing and wheezing, nausea, headaches, drowsiness, nosebleeds, and dizziness. Chronic effects: Glutaraldehyde is a sensitizer. This means some workers will become very sensitive to glutaraldehyde and have strong reactions if they are exposed to even small amounts. Workers may get sudden asthma attacks with difficult breathing, wheezing, coughing, and tightness in the chest. Prolonged exposure can cause a skin allergy and chronic eczema, and afterwards, exposure to small amounts produces severe itching and skin rashes. Wear gloves which are impervious to glutaraldehyde such as those made of Butyl Rubber, Nitrile, and Viton ® which have been shown to provide full shift protection from glutaraldehyde. Wear splash proof goggles and/or full-face shields when working with glutaraldehyde to protect eyes. Store glutaraldehyde products in closed containers, in well ventilated areas. Post signs to remind staff to replace lids after using product. Use glutaraldehyde products in rooms that are well ventilated and large enough to ensure adequate dilution of vapor, with a minimum air exchange rate of 10 air changes per hour.

4. Formaldehyde Exposure Healthcare workers can be exposed to Formaldehyde (FAH), since it has a variety of uses in hospitals including: 1. tissue preservatives and in embalming fluids in autopsy rooms and the pathology department; 2. in kidney dialysis units and central supply as a sterilizing agent; 3. in operating rooms as a disinfectant. It is classified as a human carcinogen and is linked to nasal and lung cancer, and with possible links to brain cancer and leukemia. Formaldehyde (FAH) is a colorless, flammable gas with a strong, pungent odor. It is widely used in hospitals, in disinfectants, in carpet and furniture glues, and in a large number of other products. Special Precautions - Formaldehyde is flammable and explosive but only in higher concentrations. Formaldehyde should NEVER be stored near or used with hydrochloric acid because the two chemicals combine to form (bis) Chloromethyl Ether (BCME), a very powerful cancer-causing agent. Acute Effects - Low Exposure Levels (0.1-5 parts per million): Burning, tearing of eyes; skin irritation. Moderate Exposure Levels (10-20 ppm): Burning of eyes, nose and trachea; severe coughing; severe difficulty in breathing; and intense tearing of the eyes. High Exposure Levels (50-100 ppm): Tightening in the chest; irregular heartbeat; severe headache; pulmonary edema (fluid in the lungs); inflammation of the lungs; possibly even death. Chronic Effects – Eczema (flaking and itching skin), which may involve the eyelids, neck, hands, arms, armpits and scrotum. Dermatitis, it may range from simple reddening of the skin to severe cracking and blistering. Prolonged exposure may cause the fingernails to turn soft and brown-colored. Cancer, nasal cancer and may be associated with other respiratory cancers and cancer of the brain. Reproductive System, it can damage the genetic make-up of certain cells, which means it may cause birth defects. Medical Surveillance - when employees are exposed to levels above the STEL. Housekeeping - survey for leaks or spills (including visual inspections), proper maintenance of equipment, spill clean-up procedures, and waste disposal methods. Respiratory Protection - to be worn in work situations where engineering and work practice controls do not reduce exposure to below the STEL. Protective Clothing and Equipment - clothing which is impervious to formaldehyde, gloves, safety goggles, face shields, and other personal protective equipment may be necessary.

5. Toluene, Xylene and Acryl Amide Exposure Healthcare workers can be exposed to hazardous chemicals such as Toluene, Xylene and Acrylamide. Toluene and Xylene are solvents used to fix tissue specimens and rinse stains. They are primarily found in the histology, hematology, microbiology, and cytology laboratories. Acrylamide a resin, usually found in research labs, is used to make gels for biochemical separations. Toluene and Xylene Exposure: Acute Effect: Eye and respiratory irritation can result form exposure to the liquid and vapor forms. Severe abdominal pains, nausea, vomiting and possible loss of consciousness could occur, if ingested in large amounts. Chronic Effect: High concentration of vapor inhaled for long periods can cause laryngitis, bronchitis or bronchial pneumonia. Prolonged exposure may cause conjunctivitis. Nasal tumors have been reported in animals. Acryl Amide Exposure: Acute Effect: Eye and skin irritation. Chronic Effect: Central nervous system disorders, i.e., polyneuropathy. Acrylamide is a suspected carcinogen, and mutagen. 1 - Skin contact with chemicals should be avoided at all times. 2 - Avoid underestimation of risk. One should assume that any mixture will be more toxic than its most toxic component and that all substances of unknown toxicity are toxic. 3 - Provide adequate ventilation. The best way to prevent exposure to airborne substances is to prevent their escape into the working atmosphere by use of hoods and other ventilation devices. 4 - Follow the Chemical Hygiene Program in place. 5 - Observe the PELs, TLVs.

6. Antineoplastic and Other Hazardous Drugs Both clinical and non-clinical workers may be exposed to hazardous drugs when they create aerosols, generate dust, or touch contaminated surfaces during the preparation, administration, or disposal of hazardous drugs. Drugs are classified as hazardous if studies in animals or humans indicate that exposures to them have a potential for causing cancer, developmental or reproductive toxicity, or harm to organs. The number of workers who may be exposed to hazardous drugs exceeds 5.5 million. These workers include shipping and receiving personnel, pharmacists and pharmacy technicians, nursing personnel, physicians, operating room personnel, environmental services personnel, and workers in veterinary practices where hazardous drugs are used. Protection from hazardous drug exposures depends on safety programs established by employers and followed by workers. Factors that affect worker exposures include the following: 1 - Drug handling circumstances (preparation, administration, or disposal). 2 - Amount of drug prepared. 2 - Frequency and duration of drug handling. 3 - Potential for absorption. 4 - Use of ventilated cabinets. 5 – PPE. 6 - Work practices. The likelihood that a worker will experience adverse effects from hazardous drugs increases with the amount and frequency of exposure and the lack of proper work practices. Examples of manipulations that can cause splattering, spraying, and aerosolization include: 1 - Withdrawal of needles from drug vials. 2 - Drug transfer using syringes and needles or filter straws. 3 - Breaking open of ampoules. 4 - Expulsion of air from a drug-filled syringe. Although the potential therapeutic benefits of hazardous drugs outweigh the risks of side effects for ill patients, exposed healthcare workers risk these same side effects with no therapeutic benefit. Occupational exposures to hazardous drugs can lead to: Acute Effects: skin rashes Chronic effects: including adverse reproductive events

7. Be Safe! Tony Soares, Safety Director Compensation Solutions, Inc. tsoares@compsolutionsinc.com Tel: 1-888-201-5680 Ext. 192