Apart from the risks of cuts and repetitive stress injuries associated with glass containers for contrast media, there are other safety concerns that can affect both patients and employees. The two main hazards in this area are latex allergies and the adverse consequences of handling glass packaging. According to the US Centers for Disease Control and Prevention,1 1% to 6% of the general population and 8% to 12% of health care workers become sensitized to latex allergens after regular exposure. When people become oversensitized and develop allergies to latex in the environment, prolonged exposure is the primary factor responsible. Health care workers appear to experience the greatest growth in developing latex allergies. Other groups at high risk consist of people with spina bifida, urogenital abnormalities, a strong family history of allergies, or a personal history of allergies. In addition, people who work in the rubber industry may experience prolonged exposure to latex, which can cause them to develop sensitivity

REDUCING EXPOSURE

The problem with latex allergies is that there really is no treatment other than pure avoidance of the substance, which can be quite a challenge in the health care community. Other than the symptomatic treatments that would be given for rhinitis or hives, for example, there is no medical intervention available. In health care environments, we are completely surrounded by latex allergens. Everything from stethoscopes to adhesive tape to the elastic bands on caps and shoe covers presents a hazard for people who are allergic to latex. Even the athletic shoes worn by most health care workers have latex soles.

Not only for our coworkers but also for our patients, it is important to do everything possible to try to eliminate latex from our environment. The new polymer packaging for contrast media is an important resource in this effort, since the entire container (including the stopper) is latex-free. Part of our goal, as health care workers, should be to encourage product developers to continue introducing new latex-free products; this will help us reduce latex exposure in our workplaces for both staff and patients. Using polymer contrast bottles helps bring us closer to maintaining a latex-free environment.

At Oakwood Hospital and Medical Center, in Dearborn, Mich, we are finding that health care consumers are becoming increasingly educated about latex allergens. We have even had patients go so far as to send us instructions, via fax, regarding which things we need to remove from the imaging suite before they arrive. Some patients have contacted various medical facilities in the area to determine which one can offer them the most latex-free environment for their diagnostic studies.

ELIMINATING GLASS

Glass is an obvious hazard in that it can cause cuts, and its weight makes it ergonomically inferior to lighter materials (especially when glass contrast bottles must be handled by the case). These are not, however, the only disadvantages associated with glass. Regulatory compliance is more challenging for glass than for polymer packaging, and disposing of empty glass bottles is far more complex and expensive.

Part of the burden of regulatory compliance is a direct result of the likelihood of injury caused by glass bottles and their metal rings. The US Occupational Safety and Health Administration (OSHA) mandates that all work-related injuries be reported. This is a new requirement that came out of the Needle Safety Act of 2000. It involves a tremendous number of staff hours for the radiology, quality assurance, and occupational medicine departments to keep track of those injuries, as well as to provide the documentation and follow-up care required by the regulations. All of those extra hours result in lost revenues and/or excess costs.

Additional expenses are incurred when glass contrast bottles are empty, since all biohazard containers are eliminated through an environmental services system and go to a waste-disposal incinerator (which typically charges the hospital by weight for the material incinerated). Unlike polymer bottles, glass containers should not be treated as regular trash. Although they may be unbroken after use, glass bottles in a trash bag could subsequently break during handling, possibly piercing the bag and injuring the person carrying it. For this reason, our facility (like many others) disposes of all glass (even if it is intact) in puncture-proof containers intended for the disposal of needles and similar objects (sharps). At many facilities, this disposal method costs up to 10 times as much, by weight, as the simple disposal of everyday refuse.

Pieces of broken glass, even if not contaminated with blood or other bodily fluids, are considered sharps by both OSHA and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Sharps must be disposed of in puncture-proof (hard plastic) containers, which are far more expensive than trash bags. When the sharps container is full, typically, it must be collected by environmental services staff or delivered by radiology personnel to a disposal location within the facility. This can adversely affect the department by keeping a room idle while the staff waits for container pickup, but the amount of time lost if a glass bottle breaks is a far larger problem.

OSHA and JCAHO standards for environmental care and facility management require removal of glass using forceps or a dustpan and broom. The technologist cannot pick up broken glass during an examination. Instead, the study must be halted until someone from environmental services arrives and cleans the room in compliance with applicable regulations. The resulting wait creates problems in workflow and delays in patient throughput, both of which are likely to decrease overall patient satisfaction.

In many facilities, staff members are simply overwhelmed by meeting all the regulatory and accreditation standards that affect their jobs, and it can seem that new restrictions are issued every day. By comparison, simply being able to throw the empty polymer contrast bottles in the trash is so simple that it is a pleasure.

Catherine M. Stevens, RT(R), is imaging coordinator, quality management and education, Department of Imaging Services, Oakwood Hospital and Medical Center, Dearborn, Mich. This article has been excerpted from Adjunct Safety Concerns Associated with Glass Packaging, which she presented at the Polymer Bottle Safety Focus Group on September 10, 2004, in Las Vegas.