Hierarchy of Controls. Occupational health professionals use the “Hierarchy of Controls” to protect workers from potential workplace hazards. This is a set of actions that proceeds from the most protective to the least. The most protective actions are such because they do not depend on employees remembering to activate them. These include:
- Elimination - The hazard is removed altogether if it is determined to be unnecessary (e.g., the use of floor wax can be eliminated);
- Substitution - A safer substitute is used (e.g., glutaraldehyde can be replaced with a variety of safer substances -- see The Sustainable Hospitals and the Hospitals for a Healthy Environment Products & Services Directory);
- Engineering - Technology is used to protect workers (e.g., mixing hazardous chemicals in the appropriate biological safety cabinet);
- Administrative - Protective policies are put into place (e.g., employee training on safe handling practices)
- Personal protective equipment - Use of equipment that is designed to act as a barrier between employee and hazard (e.g. the use of chemo gloves, masks, and gowns when handling chemo therapy).
Integrated Pest Management (IPM). IPM is a program that helps prevent the need for and use of pesticides in hospitals and elsewhere. This is made possible by using a variety of least toxic methods and techniques such as boric acid, silica gels, nonvolatile insect and rodent baits, microbe-based pesticides and more. Resources to learn about this method of controlling pests are in the “Other Resources” section below.
OSHA and NIOSH Guidelines for Occupational Exposure to Hazardous Drugs. The Occupational Safety and Health Administration (OSHA) released guidelines on the safe handling of hazardous drugs in the 1980s (Controlling Occupational Exposure to Hazardous Drugs www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.html). More recently The National Institute for Occupational Safety and Health (NIOSH) has released an Alert that presents best practices when handling hazardous drugs, and integrating information that has been realized since the learned in the intervening year release of the OSHA guidelines. That document, Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs, is available on the NIOSH web site www.cdc.gov/niosh/docs/2004-165.
While all of the above are parts of the solution, what is ultimately needed is to up-date our country’s policies regarding chemical exposure. The Resources for up-dated, broad-based Chemical Policies/Initiatives below has some examples of what this would look like.