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When someone pictures a healthcare facility, medical staff come to mind. However, healthcare facilities may employ a variety of trades that have health and safety hazards associated with them. These include, but are not limited to, mechanical maintenance, medical equipment maintenance, housekeeping, food service, building and grounds maintenance, laundry, and administrative staff. Regardless of the occupation, healthcare workers, at large, face recognized, serious hazards.
Similarly, the healthcare industry is affected by multiple environmental statutes. Environmental requirements in healthcare settings may cover wastewater discharges, drinking water, waste, emergency planning and community right-to-know, air emissions, toxic substance control, and pesticides.
Safety and health issues
There are numerous safety and health issues associated with healthcare facilities. The table below outlines many of the hazard categories associated with these establishments. It gives the “big picture.”
| Hazard category | Description | Examples found in the healthcare environment |
| Biological | Infectious/biological agents, such as bacteria, viruses, fungi, or parasites, that may be transmitted by contact with infected patients or contaminated body secretions/fluids | Human immunodeficiency virus (HIV), vancomycin resistant enterococcus (VRE), hepatitis B virus, hepatitis C virus, tuberculosis, COVID-19, seasonal/pandemic influenza, indoor air quality |
| Chemical | Various forms of chemicals that are potentially toxic or irritating to the body system, including medications, solutions, and gases | Ethylene oxide, formaldehyde, glutaraldehyde, waste anesthetic gases, hazardous drugs like cytotoxic agents, pentamidine, and ribavirin |
| Physical | Agents within the work environment that can cause tissue trauma | Radiation, lasers, noise, electricity, vibration, confined spaces, extreme temperatures, and workplace violence |
| Mechanical/ Bio-mechanical | Factors encountered in the work environment that cause incidents, injuries, strain, or discomfort | Tripping hazards, unsafe/unguarded equipment, slippery floors, cluttered or obstructed work areas/passageways, forceful exertions, awkward postures, localized contact stresses, repetitive/prolonged motions or activities, and lifting and moving patients |
| Psychological | Factors and situations that create or increase stress, emotional strain, or interpersonal problems | Stress, workplace violence, shiftwork, inadequate staffing, and heavy workload |
Event and exposure data
Another way to look at hazards is to examine the Bureau of Labor Statistics data on “events or exposures.” Event or exposure signifies the manner in which the injury or illness was produced or inflicted. For ambulatory healthcare services, hospitals, and nursing and residential care facilities in private industry, the top five events or exposures that reflect injuries and illnesses with days away from work in 2023 to 2024 were:
- Exposure to harmful substances or environments;
- Overexertion, repetitive motion, and bodily conditions;
- Slip, trip, stumble, or fall on the same level;
- Violent acts; and
- Contact with non-running objects or equipment.
It appears that the COVID-19 pandemic may partly explain the high numbers for “exposures to harmful substances or environments” in 2023 to 2024. Even though the COVID-19 emergency declaration is over, all healthcare facilities run the risk of infection received at or brought to the healthcare facility. For that reason, healthcare workers may be exposed to infectious agents. Protecting healthcare workers is essential to the protection of patients and others from the spread of infection.
Other events or exposures included, but are not limited to:
- Struck by propelled, falling, collapsing, or suspended objects
- Transportation incidents
- Contact with other person or animal, nonviolent or intent unknown
- Slip, trip, or stumble when stepping between levels
- Fall to a lower level
- Struck, caught, or compressed by running powered equipment
- Fires or explosions
Hazards flagged by federal OSHA
The federal Occupational Safety and Health Administration (OSHA) explains that healthcare workers face a number of serious safety and health hazards. They include:
- Bloodborne pathogens and biological hazards;
- Infectious diseases like tuberculosis, methicillin-resistant staphylococcus aureus (MRSA), seasonal/pandemic influenza, and avian flu;
- Potential chemical hazards;
- Potential hazardous drug exposures;
- Allergic reactions to latex;
- Waste anesthetic gas exposures;
- Laser hazards;
- Radioactive material and x-ray hazards;
- Respiratory hazards;
- Ergonomic hazards from lifting and repetitive tasks;
- Slips, trips, and falls;
- Emergency response hazardous substance and biological agent hazards;
- Noise;
- Compressed gases;
- Electrical hazards;
- Fire hazards;
- Workplace violence;
- Hostile animals;
- Driving hazards; and
- Fatigue.
According to OSHA, some of the potential chemical exposures include formaldehyde, used for preservation of specimens for pathology; ethylene oxide, glutaraldehyde, and peracetic acid used for sterilization; crystalline silica dust generated in dentistry; and numerous other chemicals used in healthcare laboratories. Some chemicals may be reproductive hazards (substances or agents that may affect the reproductive health of women or men or the ability of couples to have healthy children).
Healthcare workers have a right to report hazards to OSHA, and the agency has a process to respond to worker complaints.
Environmental concerns for healthcare
The healthcare industry is affected by multiple federal environmental statutes. In addition, the industry is subject to numerous environmental laws and regulations from state, tribal, and local governments. Let’s take a high-level look. The table is not comprehensive, and there may be other environmental issues.
| Environmental issue | Overview |
| Water discharges | Wastewater sources include sinks, drains, showers, toilets, and tubs; photographic development drains from radiology (x-rays), other imaging, and dentistry; and stormwater. The healthcare industry is subject to various provisions of the Clean Water Act (CWA), including:
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| Drinking water | Safe Drinking Water Act (SDWA) regulations protect human health from contaminants in drinking water. A hospital, for example, would be considered a public water system if it regularly serves at least 25 of the same persons six months per year from its own water source. The hospital would be required to comply with SDWA monitoring and reporting requirements. Healthcare facilities that have their own drinking water treatment could generate hazardous or radioactive waste. |
| Waste | Under federal hazardous waste laws, most healthcare facilities are hazardous waste generators. EPA regulates facilities that generate, transport, treat, store, or dispose of hazardous waste. Important waste requirements for healthcare facilities include:
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| Emergency planning and community right-to-know | Emergency planning and community right-to-know laws establish reporting obligations (such as emergency planning notification, emergency release notification, annual Tier II reporting, safety data sheet reporting, and annual toxics release inventory (TRI) reporting) for facilities that store or manage specified chemicals, including many chemicals commonly found at healthcare facilities. |
| Air emissions | Air emissions may come from air conditioning and refrigeration, boilers, medical waste incinerators (if onsite), asbestos, paint booths, ethylene oxide sterilization units, emergency generators, anesthesia, laboratory chemicals, and laboratory fume hoods. Under the Clean Air Act (CAA), states develop plans to identify sources of air pollution and to determine what reductions are required to meet federal air quality standards. Healthcare facilities that qualify as a major source are required to have a Title V permit, and may be required to submit information about emissions, control devices, and the general process at the facility in the permit application. The CAA also sets forth a list of regulated substances and thresholds, requirements for owners or operators of stationary sources concerning the prevention of accidental releases, and accidental release prevention programs. These requirements are codified in the Risk Management regulations at 40 CFR 68. |
| Toxic substances control | Healthcare facilities may be subject to the Toxic Substances Control Act (TSCA) through, for example:
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| Pesticides | In healthcare settings, EPA regulates disinfectants that are used on environmental surfaces (housekeeping and clinical contact surfaces). Disinfectants intended for use on clinical contact surfaces (e.g., light handles, radiographic-ray heads, or drawer knobs) or housekeeping surfaces (e.g., floors, walls, or sinks) are regulated under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA). Similarly, pesticides, including insecticides, herbicides, fungicides, rodenticides, and antimicrobials, used on the healthcare facility grounds are subject to FIFRA. |
For further guidance, visit:
- EPA’s Healthcare and Social Assistance Sector (NAICS 62) webpage
- EPA’s archived sector notebook “Profile of the Healthcare Industry”
- EPA’s Health Care Guide to Pollution Prevention Implementation through Environmental Management Systems (EPA/625/C-05/003 May 2005)
- EPA’s Unused Pharmaceutical Disposal at Health Care Facilities webpage
- EPA Facilities Manual (December 2023)
- EPA’s Medical Waste webpage
- EPA’s Regulatory and Guidance Information By Topic webpage
- Guidance Documents Managed by Program Offices webpage
- EPA Laws and Executive Orders webpage
- National Service Center for Environmental Publications webpage