In putting together a "surprise" for the IPAC-Canada and APIC conferences it dawned on me that while Lee & I have talked around the various areas that one should consider with respect to determining the safety profile of a disinfectant chemistry we have not gotten into the nitty-gritty of PPE. In my travels, I have had many a HCW tell me they use "the CANCER wipe" and that they would NEVER use the wipe without gloves (goggles and in some cases even masks). However, try as a I may, I have been unable to find a wipe commercially branded under that name.
It is true that some of the chemicals used in the manufacturing of disinfectants such as phenols and 2-Butoxyethanol are listed by governing bodies as being carcinogens. It is also true that some chemistries are known sensitizing agents, are known to cause occupational asthma and are known skin, eye or respiratory irritants. In fact, it is the toxicity (safety) profile that determines what PPE needs to be worn when working with disinfectants. In later blogs we'll delve into more detail of how safety profiles are determined. For the purposes of this blog, I want to focus on the concept of HMIS Ratings (Hazardous Materials Identification System) and Precautionary Statements found on EPA or Health Canada registered disinfectants and how they should be interpreted to ensure the safe (and economic) use of disinfectants.
HMIS ratings as you may have surmised help identify the risk of the product in terms of health concerns, flammability and physical hazards which in turn determine what type of PPE a user needs to wear and if there are any specific needs in terms of storage or handling of the disinfectant. On a MSDS they are represented by a numerical rating system generally as "X/X/X" and are rated from 0 (minimal risk) to 4 (severe hazard). The health risk is represented by the first number and helps determine what PPE (gloves, goggles and/or respiratory protection) is needed. For OBVIOUS reasons, the lower the number the better! A disinfectant with a HMIS rating of 0/0/0 would be considered pretty benign and safe for the user to handle without any form of PPE.
To help illustrate safety differences between disinfectant chemistries the following table summarizes HMIS ratings and PPE requirements for the most commonly used disinfectant wipes:
The need or lack thereof for PPE varies widely. You'll also note that while a MSDS may indicate that no PPE is required, the EPA label may specify that the product can in fact cause eye irritation or even irreversible eye damage. In my books, that means eye protection should be worn.
The economic impact to facilities with respect to Occupational Exposure to chemicals is very real. A 2010 report by the CDC highlighted that the most common active ingredients responsible for illnesses were Quats (38%), glutaraldehyde (25%), and sodium hypochlorite (18%). The majority of the types of injuries associated with the use of disinfectants were: 222 as eye injuries, 130 neurologic injuries (headaches etc) and 121 respiratory injuries. Of particular interest (at least to me) is that only 15% of the time did the injured worker wear eye protection.....how many products listed above require eye protection when using? How often do you see HCWs (EVS, nurses, clinical therapists etc) wearing eye protection?
The economic burden of occupational injuries and illnesses are sizable, at least as large as the cost of cancer. Particularly if you know what the cost per claim is. In the US, the cost per claim for eye injuries, neurologic injuries and respiratory injuries are $118,024, $85,012 and $64,495 respectively. Using the numbers from the CDC study that equates to $26,201,328 for eye injuries, $11,051,560 for neurologic injuries and $7,803,895! That's a whopping $45 MILLION spent over a 5 year period in just 4 US states!
Employers have a legal responsibility to provide a safe working environment. The use of disinfectants has a direct and very costly impact on worker safety. In an era where we are constantly talking about the bottom line and focusing on the cost of HAIs, perhaps we should also be considering the cost of Occupational illness and cost of PPE. Choosing an effective disinfectant with the safest HMIS profile will save your facility a considerable amount of money - particularly when the cost of a pair of gloves can be more than the cost of the wipe the HCW is using to clean and disinfect!