Dr Javeed Kakroo
The health care sector is a major consumer of chemicals including those well documented to cause serious impact on human health and the environment. Thus, a sector whose mission is to protect human health is contributing to the burden of diseases. Chemicals used in healthcare affect human health throughout the life cycle of these products.
There is a growing concern that the excessive use of chemical disinfectants in the healthcare areas can be of risk to human life. Paramedical staff is at greater risk than others as they are continuously present in the healthcare environments. The bad news is that if you work in healthcare sector, you get inevitably exposed to hazardous chemicals. Among the hazardous chemicals still used widely in hospitals are cleaning products, disinfectants, sterilant, and floor care products that contain toxic active ingredients, such as ammonia, chlorine, phosphates, alkylphenol ethoxylates, volatile organic compounds, formaldehyde, phenolic compounds, propellants, and petroleum solvents.
Recent research in some countries has shown that health-sector employees may be more at risk from the chemicals used in their own workplaces than the public. For example, health sector workers have been reported to have the highest rate of adult asthma among all major occupational groups and to be at a greater risk of developing chronic respiratory illnesses. In specific areas of the hospital, workers can be exposed to glutaraldehyde, ethylene oxide, formaldehyde, paraformaldehyde, methyl methacrylate, Freon, peracetic acid, or waste anaesthetic gases. Pesticides, rodenticides, and fungicides are also used in hospitals. Unfortunately, many chemicals which are banned in developed countries are still being used in developing countries. Today most of our hospitals use chemical disinfectants which are known to be carcinogenic. Some cancers are diagnosed up to 10 years after the sufferer has been exposed to a carcinogen at work; others can take more than 35 years to develop
Types of antiseptics used in hospitals
• 60 – 90% alcohol (Ethyl, isopropyl or “methylatedspirit”)
• 4% chlorhexidine gluconate (Hibitane®, Hibiscrub®, Hibiclens®)
• Chlorhexidine gluconate and cetrimide, in various concentrations (Savlon®)
• 3% iodine aqueous iodine and alcohol containing (tincture of iodine) products, 7.5 – 10
• Iodophors, various concentrations (Betadine® or Wescodyne®
• 0.5 – 4% chloroxylenol (Para-chloro-meta xylenol or “PCMX) various concentrations (Dettol®)
Effectiveness factors to be considered before choosing antiseptics and disinfectants
• Nature of what is to be disinfected
• Number of microorganisms and time needed (the higher the number, the longer the time)
•Concentration to be used
• Type of surface (smooth & rough)— rough surfaces require longer treatment time.
• Presence of organic materials e.g., soiled instruments.
Pregnancy Risk to mothers and growing foetus
Some substances carry specific risks to pregnant women or their unborn child. They may cause irreversible harm to the foetus, resulting in birth defects, or they may increase the risk of spontaneous abortion. Studies have shown that exposure to perchloroethylene, a solvent commonly used in dry cleaning, carries an increased risk of spontaneous abortion. Other commonly encountered substances, which can cause harm to the unborn child, include toluene a common solvent in certain Anaesthetic gases used in health care, and lead compounds.
It must be a normal practice wherein Healthcare workers must know what is the nature of chemicals they are supposed to use in the hospital including their short term and long term uses and the subsequent health hazards caused.
In India thousands of chemicals proliferated without being regulated. The quality of many such chemicals is not being verified as we have few testing agencies and usually hospital managements do not take into consideration the concerns of the clinical Microbiologists. As a result many banned chemicals are dumped in India which finally land in our hospitals.
Hospital infection control committee should regulate the use of chemicals in hospital settings. NABH and NABL should concentrate and implement regulations on the Human safety of health care workers and laboratory manpower.
The author is a Microbiologist and works at Kidney Hospital Srinagar. He can be mailed at Jkakroo@gmail.com