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Healthcare facilities include hospitals, clinics, dental offices, out-patient surgery centers, birthing centers, and nursing homes. In addition to the medical staff, large healthcare facilities employ a wide variety of trades that have health and safety hazards associated with them. These include mechanical maintenance, medical equipment maintenance, housekeeping, food service, building and grounds maintenance, laundry, and administrative staff.
Safety issues
There are numerous health and safety issues associated with healthcare facilities. The table below outlines many of these hazards.
| Hazard Category | Definition | Examples found in the hospital 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), methicillin resistant staphylococcus aureus (MRSA) hepatitis B virus, hepatitis C virus, tuberculosis |
| 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 such as cytotoxic agents, pentamidine ribavirin |
| Psychological | Factors and situations encountered or associated with one's job or work environment that create or potentiate stress, emotional strain, an/or other interpersonal problems | Stress, workplace violence, shiftwork, inadequate staffing, heavy workload, increased patient acuity |
| Physical | Agents within the work environment that can cause tissue trauma | Radiation, lasers, noise, electricity, extreme temperatures, workplace violence |
| Environmental, Mechanical/Biomechanical | Factors encountered in the work environment that cause or potentiate accidents, injuries, strain, or discomfort | Tripping hazards, unsafe/unguarded equipment, air quality, slippery floors, confined spaces, cluttered or obstructed work areas/passageways, forceful exertions, awkward postures, localized contact stresses, vibration, temperature extremes, repetitive/prolonged motions or activities, lifting and moving patients |
Environmental concerns
The healthcare industry is affected by multiple federal environmental statutes. In addition, the industry is subject to numerous laws and regulations from state, tribal, and local governments designed to protect and improve the nation's health, safety, and environment.
Healthcare facilities' 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, including:
- Wastewater discharges;
- Stormwater permits (municipal separate storm sewer systems, such as those from hospitals, and construction activities are subject to stormwater permitting requirements); and
- Oil pollution prevention requirements (for hospitals that have a total aboveground oil storage capacity exceeding 1,320 gallons or an underground storage capacity exceeding 42,000 gallons).
EPA regulates facilities that generate, transport, treat, store, or dispose of hazardous waste. Under federal hazardous waste laws, most healthcare facilities are hazardous waste generators.
Community right-to-know laws establish reporting obligations (such as Tier I and Tier II forms) for facilities that store or manage specified chemicals, including many chemicals commonly found at healthcare facilities.
Healthcare air emissions come from air conditioning and refrigeration, boilers, medical waste incinerators (if on site), asbestos, paint booths, ethylene oxide sterilization units, emergency generators, anesthesia, laboratory chemicals, and laboratory fume hoods. Under the Clean Air Act, states develop plans to identify sources of air pollution and to determine what reductions are required to meet federal air quality standards.
Healthcare facilities may be subject to the Toxic Substance Control Act through:
- Lead hazard reduction regulations;
- Hexavalent chromium regulations;
- Polychlorinated Biphenyls (PCB) hazard reduction regulations; and
- Asbestos hazard reduction regulations.