Chemical Management Guidelines for Healthcare Facilities

I I
I I
I I
I I
I I
I I
e10113 @
31
CHEMICAJ MANAGEMENT IN
HEALT A CIETT[ES
MINISTRY. E
ALTH
ISBN 978-983-3433-76-6
M edical Staff Safety and Health Unit
Quality in Medical Care Section
9
11111
789833 433766
Medical Development Division
Ministry of Health Malaysia
I I
I I
I I
I I
I I
!L ayou t 11/4/10 11:54 AM Page 1
GUIDELINES ON CHEMICAL
MANAGEMENT IN
HEALTH CARE FACILITIES
MINISTRY OF HEALTH
Medical Staff Safety and Health Unit

Medica l Developm e nt Division
I Layout 11/4/10 11:54 AM Page 2
Contents •
TITLE PAGE
Foreword by The Director-General of Health, Malaysi a 4
Advisors 6
Technic al Chairpers on 6
Technic al Coordinator 6
Members of The Technic al Committee 7
Scope of The Guidelines 10
Objectiv es of The Guideli nes 10
cf 1.0 Introduc tion 11
2.0 Hazardous Chemicals 11
3.0 Principles of Toxicology 12
4.0 Laws & Regulations Related to Chemicals 16
5.0 Control of Hazardous Chemic als 23
6.0 Chemic al Storage 37
7.0 Handling and Transferring of Hazardous Chemic als 39
8.0 Dispos al of Hazardous Chemic als 39
9.0 Chemic al Splash 40
10.0 Chemic al Spillage 41
11.0 Chemic al Fires 44
12.0 Emergency Respon se Plan 44
13.0 Hazardous Drugs 45

I Layout 11/4/10 11:54 AM Page 3
TITLE PAGE
APPENDIX I 49
Common Chemicals Used In Health Care Facilities and the Health Effects
APPENDIX II 55
Occupational Safety and Health Act 1994 - First Schedule
APPENDIX Ill 56
Template of a Chemic al Register
APPENDIX IV 58
Environmental Quality (Scheduled Wastes) Regulations 1989- First Schedule
cf APPE N D IX V
Steps in the Management of Hazardous Chemic als in Health Care Facilities
59
APPENDIX VI 60
Workflow for Workers Working with Chemic als
APPE N DIX VII 61

Hazardous Chemicals that Require Medical Surveillance
APPENDIX VIII 63
Choice of PPE According to Chemicals Used in the MOH Health Care Facilities
APPENDIX IX 67
Example of Chemical Safety Data Sheet
REFE R EN CE S 71
1 1: 5 4 AM P ag e 4
GUID E L IN E S ON CHEMI C A L MANAGEMENT IN HEALTH CARE FACILI TI E S
MINISTRY 0 F HEALTH
EIEEIIEEEIIE
Occupatio nal health and safety are concerned with protec ting the
safety, health and welfare of people at work. The main goal is to
foster a safe and healthy working environm ent, thus preventing
workers from sustaining work-relat ed injuries and illness es. In
health care facilities , the work force is a prime asset of the
organis ation. The workers' health and safety have a very serious
impact on the organis ation, not only on job performance but also
on the quality of services that these workers deliver to the rakyat
and patient safety, all of which will affect the credibility of the
organis ation. Cost will also increase due to lost work time, sickness
absenc es , medical care and medic al compensation paid out to
injured and ill workers. It is the responsibility of the employer and
employees to comply with the Occupational Safety and Health Act,
1994 and its Regula tions and Occupational health and safety
should therefore be an important part of clinical governance in all
Ministry of Health (MOH) facilities.
Chemic al hazards are some of the more dangerous and commo n

hazards faced by many workers in health care facilities, especially
those who work in laboratories, operating theatres, radiology
suites, pharmac ies, dialysis units, Central Supply Sterile
Depart me nts and mortuaries. Proper management of chemicals is
essential as improper handling and uncontrolle d exposure to
chemicals can cause safety incidents such as spills, splashes and
explosions as well as occupational diseases ranging from contact
dermati tis , systemic and end-organ damage to teratogenicity and
canc ers . Workers dealing with chemicals must know how to handle
and manage chemicals appropri a tely, in line with the prevailing
regulations , to protect themselves as well as others.
Medical Staff Safety and Health Unit, Quality in Medical Care Section
4 M edical Developm ent Division, M inistry of Health M alaysia
1 1: 5 4 AM P ag e 5
GUIDELINES ON CHEMICAL MANAGEMENT IN HE AL T H CARE FACILITI E S
MINIST RY OF HEALTH
Recognising the importance and comple xity of chem ic al

manageme nt, the Ministry of Health has taken the initiativ e to produc e
the "Guidelines on Chemical Management for the Health Care
Facilities". It serves as a quick and practical guide, as well as a
reference on chemical safety, its health effects, control measure s,
relev ant laws and safe work practices in a conci s e and user-frie n dl y
manner for all health care workers throughout the country. I am
confident that the guidelines will be a valuable resource for our
Hospital Directors , District Health Officers, doctors, dentis ts, all ied
health profess ionals and other stakeholders.
I would like to congratulate the Technic al Committee respons i b l e

for the guidelines and the Quality in Medical Care Section of the
Medical Developm ent Division of MOH for their commend a bl e
efforts in developing this guideline. It is the product of a collabora ti v e
effort of a number of expert s from various disciplines in the Ministry
of Health, Depart me nt of Occupatio nal Safety and Health, Academy
of Occupational and Environme ntal Medicine Malaysia and the pri vate
sector. I hope the guidelines will be utilised by all our health care
providers to ensure their own safety and health and those of other s
in the health care profes sion.
TAN SRI DATO' SERI DR. HJ. MOHD ISMAIL MERICAN

Director-G eneral of Health, Malaysia
6 September 2010
M edical Developm ent Division, M inistry of Health M alaysia 5
1 1: 5 4 AM P ag e 6
MINISTRY 0 F HEALTH
Tan Sri Dato' Seri Dr. Hj. Mohd Ismail Merican

Director-General of Health Malaysia
Datuk Dr. Noor Hisham bin Abdullah

Deputy Director-G eneral of Health (Medical)
Dato' Dr. Azmi bin Shapie

Director Medic al Development Division
Dr. Hjh. Kalsom binti Maskon

Deputy Director
A Ministry of Health Malaysia
TECHNICAL CHAIRPERSON
Dr. Nor' Aishah binti Abu Bakar

Public Health Physician (Occ upational Health)
Senior Principal Assistant Director
Dr. Ganesh Balasingam

1 1: 5 4 AM P ag e 7
MINIST RY OF HEALTH
MEMBE RS OF THE TECHNICAL COMMITTEE
Ir. Hj. Anuar Mohd Mokhtar

Deputy Director
Department of Occupational Safety and Health, Selangor
Dr. Abu Hasan bin Samad

President
Academy of Occupational and Environme ntal Medicine Malaysia
Medical Advisor/ Country Occupational Health Manager
Exxon Mobil Exploration and Produc tion Malay sia
Dr. Abed Onn

Honorary Secretary
Academy of Occupational and Environme ntal Medicine Malaysia
Occupational Health Consultant
G.E. Internatio nal
Ir. Nimi Ahmad

Senior Industrial Hygienist
Dr. Anza binti Elias

Public Health Physician (Occ upation al Health)
Institute for Medic al Researc h
Dr. Sirajuddi n Hashim

Occupational Health Unit
Disea s e Control Division
Ministry of Health Malays ia
Dr. Priya Ragunath

Occupational Health Unit
Disea s e Control Division
Ministry of Health Malays ia
1 1: 5 4 AM P ag e 8
MINISTRY 0 F HEALTH
MEMBE RS OF THE TECHNICAL COMMITTEE II
Dr. Ahmad Riadz bin Mazeli

Environmental Health Unit
Disease Control Division
Dr. Zahara h binti Zainuddin

State Occupational and Environmental Health Officer
Selangor Health Department
Dr. Zuraida binti Mohamed

Negeri Sembilan Health Department
Dr. Maznie da Mahjom

Wilayah Persekutuan Health Department
Dr. Suriati Mohd

Pathologist
Histopatology Unit
Hospital Kual a Lumpur
Dr. Mohd Rashid bin Baharon

Dental Division
Dr. Mohd. Azman Yacob

Principal Assistant Director
Ir. Voon Kok How

Senior Assistant Director
Engineering Division
1 1: 5 4 AM P ag e 9
MINIST RY OF HEALTH
MEMBERS OF THE TECHNICAL COMMITTEE
Ir. Khew Swee Lian

Assistant Director
Engineering Division
Puan Vuctoria Ponnusa my

Medical Laboratory Technologist
Family Health Development Division (Primer)
Encik Sayed Mohd Fadzil Science

Officer (Biochemis try ) Family Health
Development Division Ministry of
Health Malaysia
Haji Ishak bin Mat Dahalan

Chief Medical Laboratory Technolo gis t
Hospital Kual a Lumpur
Puan Norazree n binti Ibrahim

Medical Laboratory Technologist
Putrajay a Health Clinic
SECRETARIAT
Quality in Medical Care Section, Medical Developme nt Division

Puan Norhizan binti Othman

Encik Suffian bin Mohamad Nor
11/4/10 1 1 : 5 4 AM Pa ge 1 0
GUID E L IN E S ON CHEMI C A L MANAGEMENT IN HEALTH CARE FACILI T I E S
MINIST RY 0 F HEALTH
SCOPE OF THE GUIDELINES I

These guidelines were produced to meet the needs of health care facilities under the Ministry
of Health which include hospitals , health clinics and dental clinics.
OBJECTIVES OF THE GUIDELINES I

General Objective
To improv e the management of chemicals in health care facilities under the Ministry of Health,
Malaysia.
Specific Objectiv es
To increas e the knowledge and awareness of personnel on chemical management.

To educate the personnel on the potential adverse health effects of chemical exposure.
To educate the personnel on the existing laws pertaining to handling of hazardous
chemic als .
To promote safe and healthy work practic es among personnel during chemic al handling.
To guide the personnel on trans port ation, storage and disposal of hazardous chemicals.
1 1: 5 4 AM P ag e 11
MINIST RY OF HEALTH
1.0 INTRODUCTION
The use of chemicals is seen in many occupations including health care. Poor manage m e n t
of chemicals can cause safety incidents such as spills , splashes and explosions; and
also lead to occupational diseas es , poisoning and cancers.
A study on "Self Assessmen t of Safety and Health Aspects in the Ministry of Heal th
Hospitals" in 2007 by the Quality in Medic al Care Section, Medical Develop m e n t
Division, MOH which involved 134 hospitals showed that only a small percen tage of
hospitals fulfilled all the safety and health criteria related to safe manageme nt of
chemic als . The results are as follows :
• Provision for Personal Protective Equipment (PPE ) (37.1% )

• Proper dispos al of chemical waste (25.2%)
• Complianc e to PPE usage (17.6%)
• Correct signage (17.6% )
• Proper storage of chemical (9.7%)
Personnel working in the Pathology, Pharmacology and Radiology Depart men ts are at
a higher risk of exposure to chemicals .
2.0 HAZARDOUS CHEMICALS
2.1 Definition of Hazardous Chemicals
Hazar dou s chemi c al s are substanc e s or preparations that are capabl e of

causing harm either through its physical and chemical properties or its toxicity.
It can be in the form of dust, gas, liquid, compound or mixtures; natural or
synthetic .
2.2 Common Chemicals Used In Health Care Facilities and the Health Effects
(Refer Appe ndix I)
11/4/10 1 1 : 5 4 AM Pa ge 1 2
MINISTRY 0 F HEALTH
3.0 PRINCIPLES OF TOXICOLOGY
3.1 Mode of Entry
Chemicals can enter the body via various routes which are the skin, nose,
mouth, mucous membrane and placenta.
3.1.1 Inhalatio n
Chemicals in the workplace have the potential to be dispersed into the

air in the form of droplets , gas, vapour or mist; that when inhaled, reach the
alveoli of the lungs and have the capaci ty to enter the blood and be
distribu ted throughout the body.
Inhalatio n
3.1.2 Skin and Mucous Membrane Absorptio n
Workers handling chemi c al s are at risk of chemical absorption via skin

and/or eyes.
Organic and caustic (alkaline) chemicals penetrate the skin by soften i n g

the keratin cells, then pass into the dermis and may even enter the
blood stream.
Other causes of chemic al entry through the skin:
• Dryness and cracking of the skin caused by frequent contact

with detergen ts or organic solvents.
• Cuts, punctures and scrapes through which the chemical may
pass into the body.
11/4/10 1 1 : 5 4 AM Pa ge 1 3
3.1.3 Eye Absorption
Chemicals in the form of liquid, vapour, gas, aeros ol and mist can enter
the eyes. Chemic al solvents like toluene can penetrate through the
outer layer of the eye and may pass into the blood via the blood vessels
of the eye.
Depen di n g on the corros iv e nature of the chemical, the eye maybe

damaged leading to conditions like kerati tis.
Eye Absorption Skin Absorptio n
3.1.4 Ingestio n
Chemicals can enter the body via:
• The gut when food and/or drinks conta mi nated with chemicals
are cons ume d.
• The mouth when smoking cigarettes contaminate d with
chemic als .
Ingestio n
11/4/10 1 1 : 5 4 AM Pa ge 1 4
3.1.5 Transplac ental
A fetus maybe exposed to chemicals through transplac enta l transfer via

the bloodstream of a pregnant mother.
Transplac en tal
3.2 Dose-R e s pons e Relations hip
The toxicity (harmful action) of a substance will manifest only when it comes in
contac t with a living biologic al system. The toxic potency of a chemical is the
relationship betwee n the dose (the amount) of the chemical and the respon se
that it produces in the biologic al system.
3.3 Toxic Effects of Chemicals
• Generally, higher doses of chemicals and longer exposure will cause

more harm.
• Acute poisoning is commonly caused by a single large exposure with
rapid absorption of the substance, e.g. carbon monoxide or cyani d e
poisoning .
• Chronic poisoning is commonly caused by prolonged or repe a t e d
exposure to chemicals and the symptoms may not be immedi at e ly
apparent, e.g. lead or mercury poisoning and pesticide exposure.
• Local effect refers to the effect of the chemical at the site of cont a c t
which may be the skin, mucous membran es, respirat ory tract,
gastrointestinal system and/or the eyes.
• Systemic effect refers to the effect of the chemical followin g
distribu tion of the chemic al throughout the body. For example, an
11/4/10 1 1 : 5 4 AM Pa ge 1 5
inhaled materi al may act on the liver or even on the bone marro w as in
inhaled benz ene.
• Cumulative effect means the chemic al has accumulated in the body as
a result of numerous chronic exposure. The effects are not seen until a
critical body burden is reache d.
• Synergistic effect means the effect of two or more chemicals is greater
than the effect of the individu al chemical, e.g. exposure to both alcohol and
chlorinated solvent is greater than the effect of alcohol or solv e n t
individu ally .
3.4 Factors Affecting Toxicity
The rate of entry (how fast the toxic dose is delivered) and route of
exposure (by what means) affects the amount of the substan ce
entering the workers body.
Age can affect the capacity to repair tissue damage.
State of health, physical condition, and life style, can affect the toxic
respons e. Pre-existing diseases can result in increased sensitivi ty t o
the chemicals .
Environme ntal factors such as temperature and pressure may also
affect the chemical exposure to the individual.
Genetic predispos ition.
Gender of the exposed individual .
1 1: 5 4 AM P ag e 16
4.0 LAWS AND REGULATIONS RELATED TO HAZARDOUS CHEMICALS

Ill
4.1 Occupationa l Safety and Health Act 1994
The Act states that it is the duty of every employer and self-em ployed person
to ensure as far as practicable, to provide a safe and healthy work environ m e n t
for all workers.
The Act applies throughout Malaysia to the industries specifi ed in the First
Schedule (Refer Appendix II).
The Act does not apply to:
• Work on board ships governed by the Merchant Shipping Ordinance

1952, the Merchant Shipping Ordinance 1960 of Sabah (Saba h Ord.
11/60) or Sarawak (Sarawak Ord. 2/60).
• The armed forces.
The list of Regulations pertaining to chemicals under this Act are:
1. Occupation al Safety and Health (Classific atio n, Packaging and Labeli n g

of Hazardous Chemicals ) Regulatio ns 1997.
2. Occupatio nal Safety and Health (Prohi bition of Use of Substanc e) Order
1999.
3. Occupatio nal Safety and Health (Use and Standards of Exposure of
Chemicals Hazardous to Health) Regula tions 2000.
4. Occupatio nal Safety and Health (Notific atio n of Accident, Danger o us
Occurrenc e, Occupational Poisoni ng and Occupational Diseas e )
Regulatio ns 2004.
4.2 Occupational Safety and Health (Classifica tion, Packaging and Labelling of
Hazardous Chemical) Regulat ions 1997
4.2.1 Scope
Thes e Regulations apply to suppliers of hazardous chemicals except

hazardous chemicals which are•
(a) Radioactiv e material

(b) Pesticide s
1 1: 5 4 AM P ag e 17
MINIST RY OF HEALTH
(c) Listed as poisons in the Poisons List Order 1993, except for
chemic al which are classified therei n as industrial and laboratory
poisons ;
(d) Drugs under the Sales of Drugs Act 1952;
(e) Sche dul ed wastes in the First Schedule of the Environmen tal
Quality (Schedule Wastes) Regulations 1989;
(f) Foodstuff.
Thes e Regula tions shall not apply to•
(a) The transport ation of hazardous chemicals by rail, road, in lan d

waterway , sea or air.
(b) Hazardous chemicals in transit which are stored at a bonded
warehous e .
4.2.2 Duty of Supplier
It is the duty of supplier to:

• Classify hazardous chemicals based on physicoc he m i c al
properties (explosive etc), health effects (very toxic, corros iv e
etc).
• Pack haza rdo us chemical according to the requirement of
Classific ation, Packaging and Labelli ng of Hazardous Chemical
Regulations 1997.
• Label the chemical container according to the requirement of
Classific ation, Packaging and Labelli ng of Hazardous Chemical
Regulations 1997.
• The label should both be in Bahasa Malaysi a and Englis h.
Example of a chemical container with labeli ng
1 1: 5 4 AM P ag e 18
MINISTRY 0 F HEALTH
• The label should contain:

the name of hazardous material.
the name, address and telephone number of the
supplier.
danger symbol (schedule 2).
nature of special risk (schedule 3)- eg: R45 may cause
canc er.
safety measures (schedule 4)- S25 avoi d contact with
eyes.
• Supply Chemical Safety Data Sheet (CSDS):
Chemic al product, ingredien ts, first aid, toxicological
info, handling, storage.
• According to the Occupation al Safety and Health
(Clas sific atio n, Packaging and Labeling of Hazardo us Chemi ca l )
Regulations 1997, the CSDS shall contain the followin g
information:
i) The chemic al product itself including the trade or
common name of the chemical and company
identifi c ation with the detail of the supplier.
cf ii) Composition of ingredie nts that clearly identifies the

hazardous chemical for the purpose of conducting a
hazard evaluation.
iii) The hazard identification.
iv) The first aid measures.
v) The fire fighting measures.
vi) The accidental releas e measures .
vii) The handling and storage.
viii) The expos ure control and personal protecti o n
(including the possible methods of monit or i ng
workplac e exposure).
ix ) The physic al and chemic al propertie s.
x) The stability and reactivity.
xi) The toxicology information (includi ng the potential routes
of entry into the body and the possibility of synerg is m
with other chemicals or hazards encountered at work).
xii) The ecologic al information.
xiii) The disposal information.
xiv) The transport information.
xv) The date of preparation of the CSDS.
1 1: 5 4 AM P ag e 19
MINIST RY OF HEALTH
The CSDS shoul d contain all fifteen elements described above althou g h
there may be a variation in the order. Do not assume that if a section is
left blank, there is no risk.
4.2.3 Procurement of Chemic als
The procurement officer must ensure that the chemicals are proper ly
labelle d and the CSDS is supplied along with the chemicals. This should be
stated in the contrac t with the supplier. Chemicals that are supplied without
a CSDS or label should not be accepted.
4.3 Occupational Safety and Health (Use and Standards of Exposure of Chemical
Hazardous to Health) Regula tion s 2000
4.3.1 Definitio n
Hazar dou s chemi cal s are substances or preparations that are capa bl e
of causing harm either through its physical and chemical properties or
its toxicity. It can be in the form of dust, gas, liquid, compound or
mixtures; natural or synthe tic.
Howev er, according to the USECHH Regulations 2000, "chemic a ls

hazardous to health" is defined as any chemical or preparation which:
• Is listed in Schedule I and II.

• Possesses any of the properties categorised in Part B of
Schedule I of the CPL Regulatio ns 1997.
• Comes within the definition of 'pesticide' under the Pesticides
Act 1974.
• Is listed in the First Schedule of the Environme ntal Quality
(Schedule Wastes) Regulations 1989.
Thes e regulations apply to all places of work which use (producti o n,
processi ng, handling, storage, transport, disposal or treatment) chemic a l
hazardous to health except:
• Substances defined as radioacti ve materials under Atomic

Energy Licensing Act 1984.
• Foodstuffs
• Substanc e hazardous to health solely by explos ive or
flammable properties or solely because they are at high or lo w
temperature or a high pressure.
• Pharmac e utic al products.
11/4/10 1 1 : 5 4 AM Pa ge 20
MINISTRY 0 F HEALTH
4.3.2 Chemical Register (Refer Appe ndix Ill)
An employer is required to identify and register all chemi c als

hazardous to health used at the workplace in a register known as the
Chemical Register.
The conten t of the Chemic al Register:
• List of all the chemicals used in the workplace.

• Current Chemic al Safety Data Sheet (CSDS ) for all chem ic al
hazardous to health.
• The averag e monthly or yearly amount of chemicals hazar d o us
to health handle d, stored, transport e d, disposed or treated at
the work area.
• The name, address and contact number of the supplier (local or
foreign) of each of the hazardo us chemic al.
• The chemical register must be updated when a new chemical is
added to the work place.
Chemical Register:
• Must be acces si bl e to all empl oy ees who are exposed or likely

to be expos ed to chemical hazardous to health at the workplac e .
• Useful to the safety and health officers, chemical health risk
assessors , firemen and rescuers and doctors who man a g e
patients with chemical poisonin g.
• Must be properly maintaine d and updated from time to time.
4.3.3 Chemical Health Risk Assessment (CHRA)
• It is mandatory for the employe r to perform an assessment of

health risks arising from the use of chemical hazardous to
health at the workplace .
• Employ ers are not permitte d to use any chemical hazardous to
health unless the assessment (CHRA) has been conducted.
The CHRA must contain the potential risk to employees resulting from
exposure to chemic al hazardous to health, method and procedure adopte d
in chemical use, nature of hazard, degree of exposure, measures of control
of exposure, exposure monitoring programme, necessity for heal th
surveillance programme and requireme nt for the training.
11/4/10 1 1 : 5 4 AM Pa ge 2 1
4.3.4 Workplace Exposure Monitorin g
Workplace exposure monitoring is divided into environme ntal and pers ona l
monitoring.
a) Environme nta l Monitoring
Environmental Monitoring is a validated method used t o

monitor a wide variety of airborne chemical substances in the
workplace environment.
b) Personal Monitoring
Personal monitoring is a technique that is used to measure the

level of exposure experienced by the individual worker throug h
sampling of the air from the worker's breathing zone.
4.4 Occupa tiona l Safety and Health (Notif ica t ion of Accide nt , Dangerous
Occurre nc e, Occupa tional Poisoning and Occupationa l Disease) Regulations
2004
4.4.1 Scope
According to this Regulation any acciden ts, dangerous occurre nc e ,

occupation al poisoning or occupational disease that has occurred in
the place of work should be notified by the employer to the Depart m e n t
of Occupational Safety and Health (DOSH).
The import a nce of incidence notificatio n by the medic al practitioners t o

DOS H on suspec te d or diagnosed occupatio nal diseases and
occupation al poisoning is to:
• Determine the underlying cause so that remedial actions can be

taken in order to prevent similar incidenc es.
• Monitor trend of occupatio nal accidents, poisoning and
disease s as a basi s for planning and new policy/prog r am
establishment; and law enforcem ent.
The reporting is done using the DOSH gazetted JKKP 6 and JKKP 7
forms.
1 1: 5 4 AM P ag e 2 2
MINISTRY 0 F HEALTH
The Ministry of Health has been using the WEHU forms for the
notification of accidents, dangero us occurrences, occupatio n al
poisoning or occupational diseases that occur in the health facilities
under the MOH. DOS H has agreed that the MOH should continue to use
these form for this purpose with the adaptation of JKKP forms.
4.4.2 Notification Forms for MOH Facilities
WEHU L1 & L2 (JKKP 7)- for occupational lung diseases

WEHU S1 & S2 (JKKP 7)- for occupational skin diseases
WEHU E1 & E2 (JKKP 7)- for occupational noise induced hearing
loss (NIHL)
WEHU D1 & D2 (JKKP 7)- for occupational poisoning and other
occupational diseases
WEHU A1 & A2 (JKKP 6) - for occupational accidents
4.5 Environmental Qualit y (Schedule d Wastes) Regulat ions 2005
Any waste that falls within the categories of waste listed in the First Schedule
(Refer Appe ndix IV) of the Regulations is known as Scheduled Waste.
According to the Regulations , the Scheduled Waste can only be disposed in

predetermined premises only. The waste must be rendered innocuous before
disposal.
Examples of waste generated in the health care facilities
• Used developer and fixer from the Radiology Depart ment.

• Waste containing formaldehyde.
1 1: 5 4 AM P ag e 2 3
MINIST RY OF HEALTH
5.0 CONTROL OF HAZARDOUS CHEMICALS
5.1 Elimina tion
Eliminatio n is the process of removing the chemical hazard from the workplac e .
It is the most effective way to control a risk becaus e the hazard is no lo nge r
present and shoul d be used whene v er possible.
e.g. Replacing X-rays machines that use chemicals to develop the X-ray film
with X-ray machines that produce digital images.
5.2 Substitution
Substitution occurs when a new chemical or substance is used instead of the

original chemical. The aim is to choose a new chemical that is less hazar d ous
than the original.
e.g. Replacing Cidex with Hemoclean (Perac etic Acid).
5.3 Enclos ure & Isolation
Thes e methods aim to keep the chemical isolated from the worker. An
encl osu re keeps a selec ted hazar d "physically " away from the worker. For exampl e ,
an encl os ed equipmen t is seal ed away and is typically 'opened' only for cleaning
or maintenan c e. Isolatio n places the hazardous proc ess "geographically" away
from the majority of the workers and hence minimizing the exposure of the
chemic al to the workers.
e.g. Preparation of cytotox ic drugs in an isolated room.
5.4 Adminis t ra t ive Control
5.4.1 Commitment and Responsibility
a) Manage me nt Commit me nt (Refer Appendix VJ
The initiation of a chemical protection program can only be

carried out successfully with commitmen t from the top
management such as the Ministry of Health, hospital directo rs ,
heads of depart me nt and medical officers of health.
11/4/10 1 1 : 5 4 AM Pa ge 24
MINISTRY 0 F HEALTH
b) Manageme nt Responsibili ty
• Establis h a Chemic al Management Program in the

organiz ation.
• Assi g n an individual to be in charge of the che mi ca l
managem ent.
• Notify occupational accidents, disea s es and poisoni n gs
related to chemicals to the Depart ment of Occupati o n al
Safety and Health (DOSH) and the State Health
Depart me nt.
• Take the necessary correcti ve action.
• Monitor and evaluate the program.
Management must ensure:
Workers:
understand and follow the safe operating
procedures.
wear/use the appropri ate personal protec tive
equipment (PPE).
have undergone the necessary training
required to ensure the safe use of chemicals.
Adequate supply and maintenance of PPE.
All equipmen t and machi nes are in good working order
and properly maintaine d.
A chemical registry is established for all chemicals.
c) Workers Responsibility (Refer Appendix VI)
Workers who are exposed to chemicals must ensure that:
• All work processes are planned and conduc t e d

according to the standard operating procedures.
• Appropriate PPE are worn when handling hazard o us
chemi cal s in the laboratory.
• Daily compliance with proper safe practices.
• Unsafe act or practices are reporte d to the
supervis or/H ead of Department.
1 1: 5 4 AM P ag e 2 5
MINIST RY OF HEALTH
d) Care for High Risk Workers
Thes e are workers who are more susceptible to develop sympt o ms

and/or illnesses due to exposure to chemic als, e.g. pregnant
women should not be exposed to lead. The Occupatio nal Heal th
Physicians are responsible for providing recommendations that
will protect these high risk workers including workers wi th
hypers ensitivi ty to chemicals, chronic diseases and those with
certain disabilities .
This may include selection of a job that minimizes adver s e

chemic al effects, provision of special equipment or protec ti v e
devices or medical removal.
5.4.2 Safety and Health Policy
All health care facilities must have a Safety and Health Policy which all
staff must adhere to.
5.4.3 Safety and Health Committee
According to the Occupational Safety and Health Act 1994, a Safety and
Health Committee should be established where there are forty or more
workers employed at the workplace.
This committee must cons ists of employer and emplo y e e s

repres en tativ es . The main function is to discuss issues pertaining t o
safety , health and welfare of workers and take appropri ate reme d ia l
meas ures .
5.4.4 Safe Operating Procedures (SOP)
• Safe operating procedures are a set of written proced u r e s

explaining how to work safely with hazardous chemicals.
• When writing a SOP for a work procedure, the steps for safety
precautions /prev e ntive methods shoul d be included, e.g.
appropriate PPE required for the work procedure.
• There shoul d be a SOP for a particular work procedure /proc e s s
which should be adopted by all hospitals.
• The SOP shoul d be easilly accessible to all staffs invol v ed in the
work proces s .
11/4/10 1 1 : 5 4 AM Pa ge 26
5.4.5 Modific ation of the Work Process.
Making changes in the work process to make it safer and less

hazardous to health and safety.
5.4.6 Training
a) Law and Training
According to the Occupatio nal Safety and Health (Use and

Standards of Exposure of Chemic al Hazardous to Heal th)
Regulations 2000, it is the duty of the employ er to ensure that
empl oy e es who may be exposed or likely to be exposed t o
chemicals hazardous to health is provided with relev a nt
informatio n, instruc tions and training to create awareness and
enabl e the workers to take the necessary precautions.
The employ er must review and conduct the training program

every 2 years; when there is a change in the hazard informat i o n
on the chemicals hazardous to health, standard opera ti n g
procedure or control measures; and each time employees are
assigned to a new task or new work area.
Information and training may be done either by:
• Individual chemical or
• Categories of hazards
If there are only a few chemicals in the workplac e, discus s i o n

can be based on each individual chemical. Where there are a
large number of chemicals or the chemicals change frequentl y ,
discussion can be based on the hazard categories (e.g flammable
liquids , corrosiv e materials, carcinoge ns).
b) Content of the Training
The training programs should include the following:
• Relev ant laws and regulations

• Health effects of the chemical
• Personal protec tive equipment
• Interpreting labels and CSDS
1 1: 5 4 AM P ag e 2 7
M I N I s T R y 0 F H E A L T H
• Chemical registry
• Storage of hazardous chemicals
• Safe handling and disposal procedures
• Monitoring of chemical exposure
• Spillage & clean up procedures
• First aid measures
• Proper/safe use of equipment (e.g fume hood)
• Notification of occupational accident, diseases and
poisoning related to chemicals
• Medical surveillance and medical removal
5.4.7 Hazard Communic atio n
Employees have the right and the need to know the chemicals they are
exposed to when working, its potential adverse effects; and protec ti v e
measures available to prevent these potential adverse effects from
occurring.
Knowledge acquired under the hazar d communication will help:
• Employers to provide safer workplaces for their employees.

• Employees to take steps in reducing exposure to potentia ll y
hazardous chemicals, substitute with less hazardous materials ,
and establish proper work practices.
5.4.8 Medical Surveillance Program
Appropriate Medical Surveillanc e program is necessary for workers

exposed to 35 chemicals (Refer Appendix VII) mentioned in the
Occupational Safety and Health (Use and Standards of Exposure of
Chemical Hazardous to Health) Regulations 2000. Medical Surveilla n ce
can only be conducted by registere d occupational health doctors.
Medical Surveillanc e involves complete history taking (medical and

occupational history), clinical examination, workplace and biologic al
monitoring. The purpose of Medical Surveillance is to identify changes
in health status of workers due to occupational exposure to chemicals and
for early diagnosis , treatment and intervention.
Examples of chemicals used in Ministry of Health facilities which

require Medical Surveillanc e are:
11/4/10 1 1 : 5 4 AM Pa ge 28
MINISTRY 0 F HEALTH
• Mercury
• Phenol
• Xylene
• Organophos phates
5.4.9 Medical Remov al
According to the Occupational Safety and Health (Use and Standards of

Expos ure of Chemic al Hazardous to Health) Regulations 2000, a worker
needs to be removed from a workplace if the Medical Surveill a n ce
shows evidenc e of significant exposure to chemicals . More strin g e n t
rules are applicable to female workers of reproductive age,
pregnant/l ac tating mothers and workers with certain health conditions.
5.4.10 Adequate Staffing
Employ er shall provide adequate staff per shift. Lack of staff can cause
overwork , exhaustion and errors; leading to accidents and mishaps.
5.4.11 Work Rotation
Work rotation is one method of minimizing the duratio n and frequency

of exposure of workers to chemicals .
5.5 Engineeri ng Control - Ventilation
Ventilatio n is a method of control that strategic ally "adds" and "remov es" air in
the work environment. Ventilation can remove or dilute an air contaminant if
designed properl y.
5.5.1 Types of Ventila tion
• General Ventilation - This is a system of ventilation consisting

of either natural or mechanically induced fresh air movements
to mix with and dilute contaminants in the workroom air. This
is not the recommended type of ventilation to control
contami nants that are highly toxic, when there may be
corrosion problems from the contaminant, when the worker is
close to where the conta minant is being generated, and where
11/4/10 1 1 : 5 4 AM Pa ge 29
fire or explosion hazard s are generated close to sources of

ignition.
• Local Exhaust Ventilation - A ventilation system that capt ures

and removes the contaminants at the point where they are
being produced before they escape into the workroom air. The
system consists of hoods, ducts, a fan and possi bl y an air•
cleaning devic e. Advantage s of local exhaust ventilation over
general ventilation include: it removes the contami nant rather than
diluting it; it requires less air flow and thus is more economi c al
over the long term; and the system can be used to conserve or
reclaim valuable materials . However, the system must be
properly designed with the correctly shaped and placed hoods ,
and correc tly sized fans and ductwork.
5.5.2 Maintenanc e of Local Exhaust Ventilation (LEV)
Local Exhaus t Ventilatio n should undergo regular inspection and

maintenanc e during which the LEV is checked for leaks in the extrac ti o n
system and blockages in the filters. Blocked filters will affect the
efficiency of the extraction system. LEV must be thoroughly examined and
tested at intervals according to the manufacturer's instruc tions.
5.5.3 Laboratory Fume Hoods
Fume hoods are desi gned to remov e chemical fumes and aeros o ls
away from the work area.
a) Principle
The Laboratory Fume Hood uses local exhaust ventilation t o

prevent hazardous , offensive, or flammable gases and vapour s
from mixing with the general room air. Fume hoods are
designed to remove chemic al fumes and aerosols away from
the work area.
The air is drawn from the front/f ace of the cabi net using a fan;
which then either expels the air outside the building or made
safe through filtration, and recirculated back into the room. The
ventilatio n require ments for a specific chemical can be
obtained from the CSDS, appropriate SOP or chemical label.
11/4/10 1 1 : 5 4 AM Pa ge 3 0
MINISTRY 0 F HEALTH
Examples of Fume Hood
b) Guide to Fume Hood Usage
Ideally, the hood shoul d be evaluated before the beginning

of a work process to ensure adequate face veloc i ti e s
(typically 60-100 fpm) and the absen ce of exces s i ve
turbulenc e.
During fume hood usage, keeping the face openi n g
small (keeping the sash low) improves the hoods
overall performance.
Place the chemi c al s and apparatus 5-10 cm behind the
front edge of the hood. Thi s can reduc e the v apor
conc entration at the user's face by 90%.
Do not use the hood to store chemicals.
Factors such as placement of equipme nt in the hood, room
drafts from open doors or windows, persons walking
by can disrupt the airflow pattern; and thus the
performanc e of a hood.
Do not allow solid objects or materials (such as
paper/tis s ue) to enter the exhaust system as it can get
lodged in the ducts or fans and affect operations.
Be prepared for emergencies such as ventilation failure
(power failure) or fire/explosion in the hood.
A fume hood must be used when handling toxic
chemicals .
5.6 Control of Chemical Hazards in Dental Facilities
5.6.1 Engineering Control
Devices to capture amalgam which include chair side trap, vac uum
pump filter or amalgam separator. Amalgam sludge is a mixture of solid
and liquid amalgam captured by these devices and is sent for recycling.
11/4/10 1 1 : 5 4 AM Pa ge 3 1
5.6.2 Administrative Control
Dental best practice management - it is a series of amalgam waste

handling and dispos al practices .
This includes :
• Proper collection of amalgam sludge, contac t amal g a m

(amalgam that was in contact with a patient, extracted tooth
containing amalgam). empty amalgam capsules, non-con t act
dental amalgam (leftover amalgam from procedures).
• Storage of amalgam.
• Recycling of the disposed amalgam.
5.7 Signages
Each laboratory has to have signage's that provide the appropriate hazard
warnings and safety information to visitors and housekeeping personnel.
Examples of signage's
11/4/10 1 1 : 5 4 AM Pa ge 3 2
MINISTRY 0 F HEALTH
5.8 Personal Protect iv e Equipment
Personal Protective Equipment are equipment used or worn to protect

individual workers from safety and health hazards at the workplac e. Exampl es
of PPE for chemical exposure are respirators , gloves, eye protection, apron, body
suit and safety foot wear. According to the law, PPE must be made available
to employees by the employ er at no cost to them (employe es). It is the
respons ibility of the employees to use the PPE.
5.8.1 Conditions where PPE may be necessary :
• When adequate control cannot be instituted using engineer i n g

and administrative controls alone.
• When temporary control is needed to safeguard health until
adequate control by other methods is instituted (e.g. when urgen t
control is needed during a chemical spillage.
5.8.2 Personal Protecti ve Equipment Requirement
The PPE chos en must be from a list approved by the Department of

Occupatio nal Safety and Health (DOSH ) which are categorized as
below:
• Respiratory protec tion using certain apparatus such as air•

purifying respirators.
• Eye protection using face shields, goggles and safety glas ses
which is of internatio nal standards.
• Skin protection using apron and gloves which is of
international standard s .
The employ er must ensure that the PPE chosen is:
• Appropriately chosen for the individu al and task.

• Used appropriately.
• Well maintained, clean and can function well.
Employ ees should undergo training on the proper use, storage and
maintenanc e of the PPE.
Examples of PPE according to chemical exposure in Ministry of Health

Facilities is shown in Appe ndix VIII.
11/4/10 1 1 : 5 4 AM Pa ge 3 3
5.8.3 Types of Personal Protective Equipment Used In Chemical Handling
a) PPE for Skin Protection - Gloves
• Workers should familiariz e thems elves with the

permeatio n rate and breakthro ugh time for the
chemical resistant gloves provided by the
manufac turer's test data.
• Disposable nitrile gloves provide adequate protec ti o n
against small quantities of accidental hand contact with
most laboratory chemicals.
• In cases of chemical spillage on their gloves, la b
workers should immediately remove them, wash their
hands and use new gloves.
• Used gloves shall not be used outside the lab.
b) PPE for Eye Protection
The use of safety glasses with side shield provides eye

protec tion but does not provide face protec tion during a chem ic al
splash. It is recommended to use the face shield for face and
neck protec tio n against the hazard of chemical splashes.
11/4/10 1 1 : 5 4 AM Pa ge 3 4
MINISTRY 0 F HEALTH
Gloves (Refer to Appe ndix VIII
Laminate Film Nitrile
Supported Polyviny l Alcohol Polyviny l Chloride (PVC)
Natural Rubber Unsupported Neoprene
Neoprene
11/4/10 1 1 : 5 4 AM Pa ge 3 5
Safety Goggles/Gla sses
Safety glasses Safety glasses with side shield
I~
Face shield
c) PPE for Lung Protection - Respirators
The design of respirators is such that it protects the user

against specific types of substance s and within spec i fic
conc entration ranges only. The user should not use a respira t o r
unless assigned one, and before use, the user must be fit tested
and trained on how to use the respirator.
The selec tion of respirator is based on:
• The hazard (chemical)

• The protec tion factor required
The types of respiratory protective equipment:
• Particle-removing air purifying respirators (N95, N100)

• Gas and vapor-removing air purifying respirators
The user should be familiar with the limitations of each type of

respirator and also the signs for respirator failure such as odor
11/4/10 1 1 : 5 4 AM Pa ge 3 6
MINISTRY 0 F HEALTH
Particle-remov ing air purifying respirators
Respirators
N95 Facemas k Dual Cartridge Respirator
breakthrough and filter clogging . Ideally, respirators must be

used in conjunction with a written respiratory protection program.
d) PPE for Body Protection
During routine lab work, the skin and body shoul d be protec t e d
against contac t with laboratory chemicals. Lab coats must be
worn when handling hazardous chemicals to avoid body
contac t which may result from splashes and accidenta l spi lls .
Other forms of body protection may also be used, such as
11/4/10 1 1 : 5 4 AM Pa ge 3 7
disposable work suits. Thes e suits are used agai nst toxic
chemic als . Lab coats whi ch have been exposed to chemic als
shall not be used outside the lab.
e) PPE for Foot Protection
During chemic al handling, workers should wear boots or

closed shoes that are made of rubber, PVC or neoprene (depending
on the chemical).
6.0 CHEMICAL STORAGE
6.1 Principles of Chemic al Storage
Depart ments using chemicals should store the chemicals according t o

compatibility and not in alphabetic al order. The space betwee n chemic al classes will
depend on the storage area available. All the chemicals used in a one room should
be arranged into classes .
The segregatio n of chemi c al s used in a single work process into separ a te

rooms should be avoided as frequent transport of chemicals between rooms/l a bs
increases the probability of a chemical spill.
Strong corrosiv e reagents shoul d be kept in spill trays. Liquid chemicals should
never be stored above eye level as chemical spillage may occur during
handling.
Store flammable solven ts away from strong oxidising agents such as chro m ic
acid and hydrogen peroxide.
All storage cabinets located in hallways (outside the lab) must
• Contain the name of the owner.

• List the name of the chemicals in the cabinets.
This information is critical during emergencies such as fires, chemical spill a g e

or poisoning that take place after office hours where emergency personnel have
to respond.
11/4/10 1 1 : 5 4 AM Pa ge 3 8
MINISTRY 0 F HEALTH
6.2 Storage of Flamma ble Liquids
All flammable and combus tible liquids must be stored in a flammable-liquid

storage cabinet.
Flammable-liquids storage cabinets are not intended for the storage of:
i. Materials that are highly toxic

ii . Acids or bases
iii. Compres s ed gases
iv. Pyrolytic chemic al
FLA
KEEP
Flammable-liquid Storage Cabinet
6.3 Chemica l Stability
The stability of a chemical will depend on its susceptibility to dange r o us

decomposition. Chemic als such as ethers and olefins can form peroxides when
exposed to air and light which occurs during packaging; which allows the
chemic al to undergo dangerous decomposition even when the containers are
not opened.
1 1: 5 4 AM P ag e 39
MINIST RY OF HEALTH
7 .0 HANDLING AND TRANSFERRING OF HAZARDOUS CHEMICALS
The greatest potenti al for exposure to hazardous chemicals is during transferring of

chemic als . Chemical spillage occurring outside the store rooms and labs can lead to the
release of hazardous conc entrations of vapour and gases into the atmosphere affec tin g
the building occupants.
The following is a guide during the transfer of chemicals outside the laboratory :
Flammable liquids in glass containers should not be more than 20 Litres when
transporte d on the freight elevator unless the original shipping carton (box) is
used and the substanc e is on an appropriate cart.
Chemicals that are incompatible, for example chromic acid (oxidizing acid) and
ethyl acetate (flammable liquid), should not be transferred on the same cart.
During transfer, the chemical substances must be clearl y labeled with the
correct chemic al name. The labels maybe hand-w ritten provided it contains the
chemic al name and not the chemic al formula or structural formula.
The transfer carts used must have sides for each shelf which are high enough
to retain the chemic al containers . The wheels of the cart must be large enough
to prevent it from being caught in floor cracks, door and elevator thresholds.
During the transfer of chemic als, personnel must wear the appropri ate PPE
(disposable gloves and safety glass es).
Hazardous chemicals should be transferred in freight elevators . Passeng e r
elevators should not be used to transfer hazardous materials if freight elevat or s
are available.
The CSDS provi des information required for the trans port atio n of chemicals .
8.0 DISPOSAL OF HAZARDOUS CHEMICALS 111
All hazardous chemicals must be disposed of in accordance with the Environm e n t a l

Quality (Scheduled Waste) Regulation 2005 and by the authorized waste manage m e n t
companies .
Guide on Waste Collec tion
• Unless you have written approv al from the Depart me nt of Environme nt,
disposal of chemicals by way of the sanitary sewer system is prohibited.
• All lab personnel must be familiar with the location and composition of all
wastes produced in the lab.
11/4/10 1 1 : 5 4 AM Pa ge 40
MINISTRY 0 F HEALTH
Waste contain ers must remain closed except when adding more waste into
them. Open containers can lead to the release of toxic chemical into the
atmosphere in the form of vapour, aerosol or gases. It also increases the
chances of spillage.
Waste chemicals must not be placed or left for removal in hallway s .
Only specific non-haz ardous chemicals can be disposed through the sink.
Chemical affluent shoul d be treated before being disposed off into the sink.
Biological specimens should be separate d from the chemical before being
disposed off separately . Formalin shoul d be dispos ed as sche dul ed waste
whereas biologic al specimens as clinical waste.
9.0 CHEMICAL SPLASH
9.1 Chemic al Splash Into The Eye(s)
Toxic chemical splash into the eye(s) can cause serious injury that may lead to
blindness .
Treatme nt
• Forcibly keep eye lids open.

• Wash eyes gently using clean cold water or normal saline from an
Eyewash Station/water sourc e.
• Keep washing steadily for at least 20 minutes .
• Rinse/was h hands/body thoroug hly using a Shower to remove
chemic al.
• Remove contact lens if you are weari ng one.
• Do not rub eyes.
• Do not use eye drops until seen by a doctor.
• Seek medic al help immediately.
• Remember the name of the chemical and take its CSDS (Refer
Appe ndix IX) along with the worker to the treating doctor.
9.2 Chemical splash on skin
i. Remain calm.
ii . Quickly remove all conta minated clothing .
iii. Immedia tely wash away contaminant using the safety shower or other
available source of water.
iv. Allow water to run over the affected body area for at least 15 minutes.
Do not use neutraliz ing chemicals, creams or lotions.
11/4/10 1 1 : 5 4 AM Pa ge 4 1
v. Do not move an injured person unless they are in further danger.

vi. Remember the name of the chemical and take its CSDS (Refer
Appe ndix IX) along with the worker to the treating doctor.
Shower and Eyewash
10.0 CHEMICAL SPILLAGE
10.1 Definit ion of Chemical Spillage
Chemical spillage is defined as the uncontrolled release of hazardous chemic als

which maybe solid, liquid or gas. Worksite measures to reduce the potential for
spills and plans for responding to chemical spillage is necessary; regardless of
the type or quantity of hazardous chemical. Preparatio ns for chemical spill a g e
include safety equipment for spills and emergency procedures .
11/4/10 1 1 : 5 4 AM Pa ge 42
Steps in Handling Chemica l Spillage (Refer to 10.2 and 10.3)
Alert others of the spill
Isolate the area: use barrier tape
Review the spill clean-up procedures recommended in the

CSDS
Open the chemic al spill kit
Wear protec ti ve equipme nt as needed
Confine spill to small area with chemic al absorbent materials
Acid and base spill s shoul d be neutraliz ed prior to clean-up
Collect residue, place in disposal container, and label waste

container
Place all conta minated PPE into a chemical resistant bag for
disposal
Wash hands
1 1: 5 4 AM P ag e 4 3
MINIST RY OF HEALTH
10.2 Immediate Action After Spillage of Hazardous Chemica ls While Awaiting

Trained Personnel
i) Alert the workers around the area immediately.

ii) Workers should be highly cautious if the spillage involves corrosiv es,
highly toxic or reactive chemicals.
iii) Call for assistance as it could threaten the health of the health care
workers, patients and others in the vicinity.
iv) Put up a warning sign to indicate the area where the spillage has
occurred. This is to limit access to the area.
v) Cleaning of chemical spillage must be undertaken by trained personnel.
10.3 Handling of Chemical Spillage
All chemicals should be deemed as dangerous during handling.

i) Read the chemical label carefully before proceeding.
ii) Do not inhale or taste chemical.
iii) Use PPE such as goggles , gloves, lab coat, apron when handling
chemical.
iv) Skin that comes in contact with chemical should be washed
immediately with soap and water.
Chemical spillage should be cleaned up according to the CSDS. Example:

during the spillage of concentrated acids, pour sufficient amounts of sodium
bicarbonate on top of the spillage and leave the room till the carbon dioxide
released from the reaction has dispersed. The spillage can then be cleaned and
put into a strong chemical resistant container.
10.4 Chemica l Spilla ge Kit
Laboratories should be equipped to handle small amounts of low hazard

chemical spills. The Chemical Spillage Kit is required for handling chemical
spills. These kits may sometimes vary according to the chemical.
Chemical Spillage Kit should consists of absorbents, PPE, clean-up material.
1 1: 5 4 AM P ag e 4 4
MINISTRY 0 F HEALTH
Personal Protectiv e Equipment (PPE)
• Goggle s and Face Shield

• Heavy Neoprene Gloves
• Dispos abl e Lab Coat and Corrosive Apron
• Plastic Vinyl Booties
• Respirators (All lab personnel must be properly fit tested
before using a respirator.)
11.0 CHEMICAL FIRES I
Flammable chemicals can cause accidental fires which is a major hazard. Special
precautions shoul d be taken during chemical handling such as adhering to the safe
operating procedure to prevent such incident.
Keep flammable chemicals away from heat or direct sunlight.
The health care facilities must also supply adequate portable fire extinguishers which
are easily identified, located and readily accessible to the health care workers. The fire
extinguis hers must be properl y maintained and kept in their designate d places at all
times except during use. Fire extinguishers shoul d be chec k ed for its validity by lookin g
at the expiry date. Fire extinguis h ers which have expired shoul d be replac ed with a new
one.
Fire drill should be conducted at least once a year.
12.0 EMERGENCY RESPONSE PLAN I
All health care facilities must have their own Emergency Response Plan which outlin e
the steps needed to handle any emergencies and provide appropri ate guidan c e on what
to do during emergency situations . Example of an emergency is explosion and fire due
to explosiv e chemic als . Emergency exits must be clear at all times. Thes e exits should
not be blocked, locked or hidden. The Emergency Resp ons e Team shoul d be updat e d
regularly (e.g every six month) and properly trained to handle emergency situatio ns .
Evacuation exercis es shoul d be conduc ted regularly , if possi bl e once a year.
11/4/10 1 1 : 5 4 AM Pa ge 45
13.0 HAZARDOUS DRUGS
Hazardous drugs were included in this guideline even though it is classifie d as a drug
and not as chemic al due to its frequent use in tertiary hospitals and its toxic nature.
Examples of hazardous drugs are cytoto xic drugs used for cancer chemother a p y,
antiviral drugs , hormones , certain bioengineered drugs and other miscellaneous drugs.
The health effects of hazardous drugs on health care workers depend s on the expos ure
and its toxicity; and may manifest in the form of skin diseas es, infert ility, miscarri ag e ,
birth defects , leukaemia or other cancers .
13.1 Conditions for Exposure
Expos ure to these drugs can occur during manufacture, transport , distribution
and disposal. Health care workers that may be at risk of exposure are:
Pharmacists and pharmacy technicians

Nurses
Doctors handling cytoto xic drugs
Operating room staff
Workers can be exposed to hazardous drugs through its presence in the air,
work surfac es, clothing , medical equipment, patient urine or faeces.
During handling (preparation, administration or disposal of hazardous drugs ),

health care workers may be exposed when the drugs create aerosols or
generate dust. Exposure can also happen during cleani n g up of spills or when
touching surfaces contaminated with these drugs.
The activities that may result in exposure through inhalation, skin contact,
ingestion, or injection are:
• During reconstitution of powdered or lyophiliz ed drugs and dilution.

• Expelling the air from syringes containing hazardous drugs .
• During the adminis tratio n of hazardous drugs to patients through the
intramusc ular, subcutan eous, or intravenous (IV) routes.
• When counting out individual, oral doses and tablets that are uncoated
from multidos e bottles .
• Using a unit-dos e machi n e on uncoated tablets.
• Crushing tablets to make oral liquid doses.
11/4/10 1 1 : 5 4 AM Pa ge 46
MINISTRY 0 F HEALTH
• Making custom-dos age capsules by compounding potent powders.

• Skin contac t with measurable amount of drugs present on exterior of
drug vial, work surfac es, floors, and final drug products (bottles, bags,
cassettes, and syringes ).
• The production of aerosols either by direct IV push or by IV infusio n
when adminis trating hazardous drugs.
• Bed side procedures like priming the IV set containing hazard o us
drugs . Handling body fluids or body-fluid-conta minated clothi n g,
dressings , linens , and other materials.
• Handling contaminated wastes generated at any step of the prepara ti o n
or administratio n process .
• During specialized procedures such as intraoperati ve or intraperi to n e a l
chemotherapy in the operating room.
• When handling unused hazardous drugs or hazardous drug
contaminated waste.
• Deconta minating and cleaning areas contaminate d with hazard o us
drugs .
• Transporting waste containers conta min ated with hazardous drug.
• During the removal and disposal of personal protective equipmen t
(PPE ) used for handling hazardous drugs or waste.
13.2 Factors Affecting Exposure
The factors affecting exposure of workers are:
• Drug handling circumstances (preparation, administration, or disposal)

• Amount of drug prepared
• Frequency and duration of drug handli ng
• Potential for absorption
• Use of ventilated cabinets
• Use of personal protecti ve equipment
• Work practices
The chance of experienc ing adverse effects of the hazardous drug increas e s
with the amount and frequency of exposure. The other contributing factors are
the lack of proper work practic es or non-com pliance to the SOP.
11/4/10 1 1 : 5 4 AM Pa ge 47
13.3 Control Measures in Handling Hazardous Drugs
13.3.1 Engineering Control
a) Use ventilated cabinets -example : cytotoxic drug safety

cabinet
b) General Ventilation
The storage area must have sufficient general exha u st

ventilation to dilute and remove any airborne conta minant.
A dedic ated emergency exhaus t fan large enough to quic kly

purge airborne contaminants from the storage room in an
event of a spill.
Cytotoxic Drug Safety Gabi net
13.3.2 Personal Protec tiv e Equipment
a) Respirators
Surgical masks do not provide adequate protection. Use

NIOSH-c ert ified respirators.
11/4/10 1 1 : 5 4 AM Pa ge 48
MINISTRY 0 F HEALTH
b) Gloves - example for cytotoxic drugs

• Wear chemotherapy gloves
• Make sure that gloves are labeled as chemotherapy
gloves and make sure such information is available.
• Wear double gloves
• Consider using chemotherapy gloves for haza r d ous
drugs that are not chemotherapy drugs or for which no
information is available.
• Change gloves every 30 minutes or when torn,
punctured, or conta minate d.
c) Aprons
• Use disposa bl e apron s made of polyeth ylene-co a t e d

polypropylene (which is non-linting and non•
absorbent).
• Make sure gowns have closed fronts, long sleev es , and
elastic or knit closed cuffs.
• Dispos e of protecti ve gowns after each use.
cf
1 1: 5 4 AM P ag e 4 9
MINIST RY OF HEALTH
APPENDIX I
Common Chemicals Used In Health Care Facilities and the Health Effects
a) Common Chemicals Used In Hospitals
i) Ethylene oxide
Ethylene oxide is used as a sterilant and a disinfecta nt in the cardiac catheteriz a ti o n

laboratory and outpatient surgical clinics. Exposure to this chemical can occur
when improper control (ventilatio n) measures are used during/after the
sterilizing process .
Acute effects
Irritation to the eyes and respiratory system. There maybe vomiting and diarrh o e a .
Chroni c effects
Secondary respiratory infections , skin sensitization, altered behaviour, ane mi a ,
miscarriages , and reproduc ti v e problems. Ethylene oxide also has carcinoge n ic
effect.
ii) Nitrous oxide, Halot ha ne , Enfluora ne
Expos ure to these gases can occur from poor work practices where waste
gases are released into the environment during the administratio n of anesth e si a .
It can also occur post operati v ely where patients exhale anesth etic gases during
recovery and from poor maintenance of anesthetic machines which may cause
waste gases to escape.
Acute effects
Thes e gases effect the central nervous system which may lead to drowsin es s ,
irritabil ity, depres sion, headac hes, nausea, poor coordina tion and judgement.
Chroni c effects
Embryoto xici ty, liver and kidney disease , and cancer.
11/4/10 1 1 : 5 4 AM Pa ge 5 0
MINISTRY 0 F HEALTH
iii) Methyl methac rylat e (MMA)
It is used in orthopedic surgery to secure the prostheses to the bone. HCW are
expos ed to this acrylic cement-lik e substanc e during the mixing and preparat i o n
of this chemical in the operating room.
Acute effects
Irritation to the eyes, skin and mucous membrane.
Chroni c effects
Liver degeneration, mutagene sis and teratogene sis.
iv) Formaldehy de
Formalde hy de is used as a fixative in histopa thology speci m e ns in most

laboratories . It is also used in morgues to preserve dead bodies.
Acute effects
Irritation to the eyes and respiratory system when exposed to the liquid and
vapour forms. Ingestion of large amounts can lead to severe abdominal pains,
nausea, vomiting and possible loss of conscious ness .
Chroni c effects
Laryngitis , bronc hitis or bronc hial pneumonia from inhalation of high
conc entration vapor for long periods of time. Prolonged exposure may also le ad
to conjuncti vi tis .
Formaldehyde is a human carcinogen (Group 1, IARC Classification of

Carcinogen) with the ability to cause nasopharyng eal carcinoma.
Formalin - chemi cal carci n oge n Use of Incorrect PPE (face mask) - the
correct PPE is a F(form) respirator
11/4/10 1 1 : 5 4 AM Pa ge 5 1
v) Toluene or Xylene
Toluene or Xylene is a solvent used to fix tissue specimens and rinse stains . It
is found primarily in the histology, hematolog y, microbiology, and cytolog y
laboratories .
Acute effects
Irritation to the eyes and respiratory system when exposed to the liquid and
vapour forms. Central Nervous System symptoms such as dizzines s, headac h e,
and mental confus ion from inhalation of the vapour. Ingestion and skin contact can
lead to poisoning by absorption through the skin and gut. The chemical is
extremely flammable and can cause thermal burns.
Chroni c effects
Chronic or prolonged skin contact can lead to dermatitis . Repeate d prolo ng e d
inhalation of xylene conta ini ng benzen e impurities may cause leukae mi a .
Toluene has also been suspected to cause reproducti ve disorders.
vi) Acrylamide
A resin used in research labs to produce gels for biochemical separations.
Acute effects
Irritation of the eyes and the skin.
Chroni c effects
Central nervous system disorders such as polyneuropath y. The resi n is also a
mutagen and a suspected carcinoge n.
Chemicals Used in the Radiology Department
The sign and symptoms of exposure to fixer and developer may defer betw e e n
different fixers and developers .
vii) Fixer
Irritatio n of the respiratory tract in asthmatics or persons with know n

respiratory problems.
11/4/10 1 1 : 5 4 AM Pa ge 5 2
MINISTRY 0 F HEALTH
viii) Developer
Irritant to the skin. Can cause corrosion to the mucous membrane and the eyes.
Repeated or prolonged skin contact can cause irritation and sensitiz a ti o n .
Respiratory irritation can be cause d by inhalatio n of the vapour.
b) Common Chemicals Used in Vector Control
i) Resigen
It is a pyrethroid which is used in insect control such as mosquitoes. The

decline in use of organophosphate pesticides in the past decade due to its side
effects has caused an increase in the use of pyrethrins and pyrethroids .
Local effects
Parasthesia to the skin and eyes which maybe severe. Usually resolves within
24 hours.
Systemi c effects
Dizzines s, headache, naus ea, anorexia, fatigue, listles snes s, vomiting, epigas t ric
pain, muscular fasciculation and convulsions.
ii) Sumithion
It is a organophosphate and synthetic pyrethrum derivative used in insect

control such as mosquitoes . Harmful if swallowed or by inhalation and skin
contact. Cause s irritation to eyes, respiratory system and skin.
iii) Malathion
It is an organophos ph ate insecticide. Entry into the body is commonly by skin

contac t and the eyes. Other modes of entry are through the lungs and
gastrointestinal tract. It is non irritating to the eyes but causes slight skin
irritation.
Malathion is a cholinesterase inhibitor which gives rise to the health effects.
Acute effects
Central Nervous System Anxiety, dizzines s, headac he, sleeples s ness,
confusion, coma, convuls ions.
11/4/10 1 1 : 5 4 AM Pa ge 5 3
Respiratory Dyspnoea, chest tightnes s, bronchospasm,
bronchial hypersecretion, pulmonary oedema.
Gastrointes tinal Salivation, nausea, vomiting, abdomi nal colic,
diarrhoea, pancreati tis.
Occular Lacryimation, miosis, blurring of vision
Muscular Fasciculation, cramps
Chroni c effects
Non-speci fic : Headac he, quick onset of fatigue, disturbe d sleep, anorexia
Central and Autono mic Nervous System : Nystagmus, tremors, failing memory,
disorien tation.
Peripheral Nervous System : Paresis, neuritis, paralys is
c) Common Chemicals Used in Dental Facilities
Mercury is a Metallic Silvery liquid that evaporates at room temperature.
i) Inorganic Mercury
Dental amalgam is used for tooth filling due to its strength, durability and lo w
cost. Amalgam is an alloy that is made up of mercury, silver, tin, copper and
zinc. A person maybe exposed to mercury through ingestion and inhala ti o n
when small amounts of mercury vapour are releas ed over time.
Expos ure to mercury may also occur when mercury reaches the water throu g h
human activity, eg combus tion of fuel for energy produc tio n (53%) and
combus tion of waste (34%). Dental amalgam is a stable form but when inciner a t e d
it releases mercury vapour into the atmosphere. The vapour eventually collects in
the waterways.
Acute effects of Inorgani c and Elemental Mercury

Chemical pneumonitis -chest pain,dyspnea, cough.
Gastrointes tinal tract irritation, circulatory collapse, acute renal failure
Chroni c effects of Inorgani c and Elemental Mercury

Weight loss, insomnia, erythrism, tremor, dysarthria, gingivi tis, stomati t is ,
excessive salivation and metallic taste. Dental amalgam should not be dispose d
into the infectious waste bags, sharps container or ordinary garbage bags.
Neither should it be flushed down the drain. Some communities incinerate their
medical waste, ordinary garbage bags and/or sludge from waste water
treatment plants.
The best method for amalgam control is to recycle it.
11/4/10 1 1 : 5 4 AM Pa ge 5 4
ii) Plaster of Paris in Dental Facilities.
Plaster of Paris is a nuisance particulate which causes irritation of the eyes,

skin, mucous membranes and respiratory system.
Ingestio n: Acute: Gastrointestinal blockage if material hardens .
d) Common Chemicals used in Research Labs
Chloroform
Acute effects
Inhalation of chloroform causes depression of the central nervous system. Initially the
body and face may have a warm feeling, irritation of the skin, eyes and mucous
membrane. This may be followed by excitation, loss of reflexes, sensation and
conscious ness . Prolonged inhalation can lead to paralysis, cardiac and respirat o ry
failure, and death. Other symptoms include diges tive upset, mental dullness, dizzines s; eye
and skin irritation. Liquid chloroform splash can cause burning of the eyes and corne a l
injury, burning and redness of the skin. Pregnant wome n who are exposed to chlorof orm
may result in fetal malformation or death. (base d on animal studies).
Chroni c effects
Chronic chloroform exposure leads to neurologic al and gastrointestinal sign and
symptoms resembling chronic alcoholis m. The skin maybe red, dry and cracked.
11/4/10 1 1 : 5 4 AM Pa ge 5 5
APPENDIX II
Occupational Safety and Health Act 1994
First Schedule
1. Manufac turing
2. Mining and Quarry ing
3. Construction
4. Agriculture, Forestry and Fishing
5. Utilities :
a. Electricity ;
b. Gas;
C. Water; and
d. Sanitary Services
6. Transport, Storage and Communic ation
7. Wholesale and Retail Trades
8. Hotel and Restaurants
9. Finance, Insurance, Real Estate and Business Services
10. Public Services and Statutory Authorities
11/4/10 1 1 : 5 4 AM Pa ge 5 6

MINISTRY 0 F HEALTH
IL'LIT
Template of a Chemical Register
Section A: Company Information

Nam e of com pany: DO SH Registration No: Location:
S Y A R I K A T X Y Z
I I I I I I I I I I I I I I I I I I I I
(Refer to G uidelines for the Preparation of a
Chem ical Register sector code and class of
P rocess O peration:
industry)
I I I I I I I I I I
Code of Sector:
I I I I I I I I I
Class of Industry:
I I I I I I I I I
Physical
Product Nam e of Form
Nam e Chem ical of
A ddress: Com pany A ctivity (P lease enter (V) in the Chem ical
p appropriate box below)
1 1 3 J A L A N J
u 2 0 D M anufacturer
□
Distributor
□
□
Form ula tor
Im porter End- Unleaded Not
L
□
G asoline applicable
user
City:
I I I I I I I I
S A P 9436
Not
applicable L
Postcode:
I I I I I I I I
State:
Prepared By:
I I I I I I I I
Location:
Telephone No: I I
I I I I I I I I Title:
Em ail:
I I
Date:
I I I I I I I I I
I I
11/4/10 1 1 : 5 4 AM Pa ge 5 7
Section B: List of Chemicals Hazardous to Health
No. of Hazardous Chem icals; No. of Workers:
I I I I I I I I I I I I I I I I I I I I I M ales:
□
Fem ales:
□
I I I I I I I I I I
Com ply with Nam e,

Classification, a ddress of supplier
Type of Control M easures Usage o f Chem ical P ackaging and and Contact
No. of Name of Labelling Regulation number
Workers G AS No. active 1 977 (Tel No/em ail)
Exposed Ingredient
Engineering CS DS Label
Controls PPE Type Q uantity (Y/N) Class (Y/N)
PVC 200m ° G asoline y y y X Y Z M alaysian S dn.

3 p
Gloves /m onth Benzene y y y Bhd, 27 Jin lpoh
K .Lum pur
Tel No. 03-309876
320m °
2 Respirator p X ylene y y y
/m onth
Section C: Name of Person Who Prepared the Review
Reviewed By:
Location:
I I
Title:
I I
Date:
I I
11/4/10 1 1 : 5 4 AM Pa ge 5 8
MINISTRY 0 F HEALTH
APPENDIX IV
Environmental Quality (Scheduled Waste) Regulations 2005

First Schedule
i) Metal and metal-bearing wastes

Example: arsenic from arsenic containing compounds, lead from lead acid batteries,
cadmium and nickel or mercury and lithium from batteries, waste containing mercury.
ii) Wastes containing principally inorganic constituents which may contain metals and
organic materials.
Example: sludge containing asbestos, sludge containing metals such as chromium,
copper, nickel, zinc, used inorganic acids.
iii) Wastes containing principally organic constituents which may contain metals and
inorganic materials.
Example: waste containing formaldehyde, waste of phenol or phenol compou n d s ,
rubber or latex wastes or sludge containing organic solvents or heavy metals.
iv) Wastes which may contain either inorganic or organic constituents.

Example: discarded drugs containing psychotropic or harmful substances such as
carcinogens, mutagens or teratogens, pathogenic wastes, clinical wastes or
quarantined material, waste arising from the preparation and productio n of
pharmac eutical produc ts .
v) Other wastes
Any residues from treatment or recovery of scheduled wastes.
11/4/10 1 1 : 5 4 AM Pa ge 5 9
APPENDIX V
Steps in the Manageme nt of Hazardous Chemica ls in Health Care Facilities
Identify the chemical and formulate a chemical registry
Prepare a data bank containing the Chemical Safety Data Sheet

for all the identified chemicals
Identify chemicals hazardous to Health and Safety
Ensure all chemicals are labelled Stop

properly according to CPL Regulations
Conduct a Chemical Health

Risk Assessment (CHRA)
Identify work, worker or/and workplace that require

improvement, training, exposure monitoring and health
surveillance
~- - ---M_a_
ke_t_h_e_im_p_r_ov_e_m_e_n_
y
t ----~1◄
Review the changes I
Improvement adequate for chemical health protection

v
Yes No
Review if there is any change in work process or

introduction of new chemical
11/4/10 1 1 : 5 4 AM Pa ge 6 0
APPENDIX VI II
Workflow for Workers Working with Chemicals
Identify the chemical in the work process
Read the relevant CSDS & SOP's and know the Emergency
Procedures
Follow the Standard Operating Procedures
l
Use the appropriate Personal Protective Equipment
Ensure fume hood is working

(where fumehood is required /av aila ble )
Dispose chemical according to Schedule Waste Regulations
Keep the work surface clean on completion of work
1 1: 5 4 AM P ag e 61
MINIST RY OF HEALTH
APPENDIX VII
Hazardous Chemicals That Require Medical Surveillanc e
1. 4- Aminodipheny l
2. Arsenic and any of Its compounds
3. Asbestos
4. Auramine
5. Benzidine
6. Beryllium
7. Cadmium and any of Its compound
8. Carbon Disulphide
9. Disulphur Dichloride
10. Benzene Including Benzol
11. Carbon Tetrachloride
12. Trichloroethylene (Tee)
13. N-hexane
14. Bis (Chloromethyl) Ether (Berne)
15. Chromic Acid
16. Chromium Metal and Its Compounds
17. Free Crystalline Silica
18. lsocyanates
19. Lead (Including Organic Lead Compounds )
20. Manganes e
21. Mercury
22. Mineral Oil Including Paraffin
23. B-naphthyl amine
24. 1- Naphthylamine & Its Salts
25. Orthotolidine and Its Salts
26. Dianisidi ne and Its Salts
11/4/10 1 1 : 5 4 AM Pa ge 6 2
27. Dichlorobenz idine & Its Salts

28. Nitrodiphenyl
29. Nitro or Amino Derivatives of Phenol and of Benzene or Its Homologues
29.1 Nitrobenz ene
29.2 Aniline
29.3 Toluene
29.4 Xylene
30. Nitrous Fumes, Chromate or dichromate of potassium, sodium, ammonium or zinc
31. Pesticides (Organophosphates Only)
32. Pitch
33. Tar, Bitumen & Creosote
34. Vinyl Chloride Monomer (VCM)
35. Nickel Sulfide Roasting, Fume and Dust as Nickel
11/4/10 1 1 : 5 4 AM Pa ge 6 3
APPENDIX VIII
Choice of PPE Accordi ng To Chemi c al s used In The MOH Health Care Facilities
Chemical Name
Aluminium - soluble
HHHIEE
Aluminium Radiology N95
Glove
salts Sulphate
Mercury - inorganic Mercurous Radiology Hg/N95 Nitrile

compound Chloride PVC (Polyvinyl chloride)
Natural rubber
Ethylene glycol Ethylene glycol Radiology 0V/N95 Laminate film

(aerosol) Synonyms: Unsupported neoprene
- Gly col Nitrile
- Ethylene alcohol PVC Natural
rubber
Hydroquinone Hydroquinone Radiology (F)0V/N9 5 Nitrile

(saturated) PVC
Syn: Neoprene
- Quinol Natural rubber
cf - Dihydroxy benzene
Formaldehyde Formaldehyde Radiology F(Form) Laminate film

Syn: Pathology Nitrile
- Formalin
- Methylene oxide
Hydrochloric Acid Hydrochloric Radiology AG Laminate film

Syn: Acid Pathology Unsupported neoprene
- Hydrogen chloride Nitrile
- Muriatic Acid Neoprene
PVC Natural
rubber
Chlorine (gas) Efferversent Endoscopy F(AG) Nitrile

chlorinated
tablet (Presept)
Gluteraldehy de Gluteralde hy de Endoscopy F(0V) Unsupported neoprene

PVC Natural
rubber
Phenol Liquid phenol Dermatology 0V/N95 Nitrile
M edical Staff Safety and Health Unit, Q uality in M edical Care Section
(d
11/4/10 1 1 : 5 4 AM Pa ge 6 4
MINISTRY 0 F HEALTH
Chemical Name
Trichloroacetic acid
HHHI E H
Trichloroacetic Dermatology OV/AG
Glove
acid 30%
Ethyl ether Ether Dermatology ov Laminate film

Syn: Nitrile
- Diethyl ether
- Ethyl oxide
- Ether
Sodium hydroxide Sodium Pathology N95 Laminate film

Syn: hydroxide Unsupported neoprene
- Caustic soda solution Nitrile
Natural rubber
Neoprene
PVC
Chloroform Chloroform Pathology ov Supported polyvinyl

Syn: alcohol
- Trichlorometha n e
cf Methyl alcohol
Syn:
- Methanol
Methyl alcohol Pathology SA Laminate film
Nitrile
- Carbinol
Xylene Xylene Pathology ov Laminate film

Syn: Supported polyvinyl
- Xylol alcohol
- Dimethylbenz e ne
Potassium hydroxide Potassium Pathology N95 Unsupported neoprene

Syn: Hydroxide Nitrile
- Potassium Hydrate PVC
Natural rubber
Neoprene
Ethyl alcohol Ethyl alcohol Pathology ov Laminate film

Syn: Nitrile
- Ethanol Unsupported neoprene
Hydrogen peroxide Hydrogen Pathology SA(F) Unsupported neoprene

Syn: Peroxide Nitrile
- Hydrogen dioxide PVC
- Peroxide Natural rubber
Neoprene
(d
11/4/10 1 1 : 5 4 AM Pa ge 6 5
Chem i ca l Nam e
Methyl metacrylate
HHHIEH
Methyl Oral Surgery ov
Glove
Laminate film
Syn: metacrylate Supported polyvinyl
- Metacrylic acid alcohol
- Methyl ester
lsopropyl alcohol ls opropanol Pharmacy (F)OV Laminate film

Syn: Nitrile
- Is opropanol PVC
- 2-pr0pan0l Neoprene
Titanium dioxide Titanium harmacy N95

Syn: dioxide powder
- Anatase
- Brookite
Acetone Acetone Pathology ov Laminate film

Syn:
- 2-pr0panone
- Dimethyl ketone
- Ketone propane
cf Paraffin wax fumes White soft
paraffin Yellow
Pharmacy N95
soft paraffin
Liquid paraffin
N-propanol Desmanol Endoscopy F(OV) Laminate film

Syn: Nitrile
- N-propyl alcohol Unsupported neoprene
- 1-pr0panol
- Ethyl carbinol
Formic acid Formic acid Pathology ov Laminate film

Syn: Unsupported neoprene
- Hydrogencarboxylic PVC
acid Neoprene
- Methanoic acid
Ammonia Ammonia Pathology (F)AM Nitrile

Syn: solution Unsupported neoprene
- Anhydrous ammonia
Cyclohexane Cyclohexane Pathology F(OV) Laminate film

Syn:
- Hexahydrobenz en e
- Hexamethylene
(d
11/4/10 1 1 : 5 4 AM Pa ge 6 6
MINISTRY 0 F HEALTH
Chem i ca l Nam e
Ethyl acetate
HHHIEH Ethyl acetate Pathology F(OV)
Glove
Laminate film
Syn:
- Acetic ester
- Acetic ether
- Ethyl enthanoate
Ammonium chloride Ammonium ENT N95 Unsupported neoprene

chloride AM/N95 Nitrile
Sulphuric acid Sulphuric ENT N95 SA 95% - Laminate film

Syn: acid (SA) SA 120% - Laminate film
- Hydrogen sulphate SA 47% - Unsupported
neoprene
Oxalic acid Oxalic acid Pathology OV/N95 Unsupported neoprene

Syn: Nitrile
- Oxalic acid dihydrate PVC
- Ethane dioic acid Natural rubber
Neoprene
cf Ferric chloride
Heptane
Ferric chloride
Heptane
Pathology
Pathology
N95
ov
Syn:
- N-heptane
- Normal heptane
Ethyl chloride Ethyl chloride Pharmacy SA

- Chloroethane
- Hydrochloric ether
Picric acid Picric acid Pathology N95

Syn:
- 2,4,6 trinitrophenol
Boric acid Boric acid Pathology N95

Syn:
- Orthoboric acid
- Hydrogen orthoborate
Phosphoric acid Phosphoric cssu N95 Laminate film

Syn: acid Unsupported neoprene
- 0-phosphoric acid Nitrile
- m-phosphoric acid PVC
11/4/10 1 1 : 5 4 AM Pa ge 6 7
GUIDELI NE S ON CHEM I C AL MANAGE M ENT IN HEALTH CARE FACI LITI ES

M I N ISTR Y 0 F HEALTH
APPENDIX IX
Example of Chemical Safety Data Sheet
BAHAGIAN 1: PENGENALP AS TIAN PAODUK KIMIA DAN SYARIKAT

SECTION 1 : CHEMICAL PRODUCT AND COMPANY IDENTIFICATION
1.1 Maklumat Produk / Product Details
Nam a Produk r Product Nam e
Nam a Dagangan / Trade Name
Nama Kimi : Adunan pasir, simen, "super plasti ci zer" & bahan tamb ahar
Cho m ical Na me : Powdorod blond of sands, camont, suporplasticizor & addi tivo s
Hurai an Prod uk I Product Dascription : "Grout" berasas kan sime n

: Cement based grout
Berat Molekul / Molecula r Weight :Tlada/ NIA
Kumpul an Bahan Kimia : Tiada kaitan

Cho m ical Family : Not applicable
Kegunaan : Rujuk kepad a risalah data produ k

Use • o for to product data sheet
1.2 Penge nalpa stian S yarikat/ Company Identification
Nama dan alama t pengilang I

Manufacturor's Namo and Address
Nombor telefon / Tolophono No.

Nombor telefon kecemasa n/
Emorgoncy Tolophono No.
Nama dan alama t pengimpot / pengeluar tempatan

Importer's / Distributor's Name and A ddress
Nombo r telefon / Telephone No.
Nombo r telefon kecemasa n/
Emergency Telephone No.
1.3 Titik Hubung a n / Contact Point

: Peng uru s Perse kitaran, Keselam a tan & Kesihat an /
Gelaran Jaw atan / Designation
Environmental, Health & Safety M anager.
Nombo r telefon / T lophone No.
Nota / Note; Titik hubungan yang diberikan hendaklah terus kepad a seseorang yang boleh
me mperj el a s maklumat lanjut dan/ atau bibliog rafi sesu atu produk i bah an kim ia.
The contact point given should direct a callor to someone who can clarity inform ation or
provide turthor inform atio n and / or a bibliography of the product. The titlos of a position or
section should be inserted.
11/4/10 1 1 : 5 4 AM Pa ge 6 8
GUIDELINES ON CHEMI CAL MANAGEMENT IN HEALTH CARE FACILITI E S
M N S T R Y 0 F HEALTH
BAHAGIAN 2 : KOMPOSISI/ MAKLUMAT BAHAN

SECTION 2: COMPOSITION/ IN FORMATION ON IN GREDIENT
No. CASI Had P ondodahan/ K adaran/ Data K otoksikan/ Toxicity
Nama K i m ia / Chom ical Name CAS No. E xposure Limit Proportion Data
Simon P ortland Biasa / Ordinary P ortland TWA 10mg/m (total)
65997-15-1 < 50% NIA
Comont TWA 5mg/m (resp)
SAHAGIAN 3: SIFAT- SIFAT FIZIKAL DAN KIMIA

SECTION 3: PHYSICAL AND CHEMICAL PROPERTIES
Rupa /Aspect : S orbuk borwarna kolabu / Grey coloured powder
Bau / Odour : Tlada bau / Odourless
K obolohlarutan dalam air / Solubility in wator : S opara larut Partially solublo
Takat Didih / B oling Point : Tiada data/ N'A Takat lobur / Molting Point : Tiada data/ N'A
Tokanan wap / Vapour pressure : Tiada data N'A Ni lai pH/ pH value : Tiada data NA
Peratusan bahan mudah m eruap/ : Tiada/ N'A Kadar penyejatan/ : Tiada/ N'A
P ercentage volatiles E vaporation rate
K etumpatan pukal / Bulk density Ketumpatan wap/ Vapour .A

donsity da dat
; Ia0a ata A
:- 1000 kg/m' NV
Suhu pengautocucu ha n/ Takat ki lat / Flash point : Tlada / N'A

Autoignition temperature
Had kemudahbakaran (%)/ : Tiada/ N'A Sifat - sifat lain jika berkenaan/ : Tiada / N/A
Flammable limit (%) Other properties if appli cable
BAHAGIAN 4 : PENGENALPASTIAN BAHAYA

SECTION 4: HAZARD IDENTIFICATION
Bahaya - bahaya paling utama / Main Hazards
: Apabila dicampur dengan air, larutan alkali yang kuat dihasilkan. Sentuhan pada mata atau kulit m ungkin
menyobabkan kakisan dan locuran kul it yang serius / Whon m ixed with wator, strong alkaline solution is produod.
Contact with oyes or skin may cause serious burs and ulceration.
BA AGIAN5:LANG .A - NGKAH PERTOLONGAN CEMAS

SECTION 5: FIRST AID MEASURES
Sentuhan m ata : Jikalau torkona mata, basuh mata dongan air bersih yang banyak dengan segera
selama 15 m ini t. Dapatkan rawatan perubatan secepat mungkin.
Eye contact If oyos are contaminated, flush them im m ediately without delay with large amount of clean
wator tor at least 15 m inutes. Sook m edic al attention im m ediately.
Sentuhan kulit : Tanggal kan pakaian dan kasut yang tercemar basuh terlebih dahulu sebel um
memakainya semula. Bilaslah kulit yang terkena dengan air bersih selam a 15 minit.
Gunakan sabun untuk mencuci kulit yang terken a.
Skin contact ; Romovo contaminated dothes and shoos - launder bofore rouso. Wash all splashos
imm ediately with plenty of wa ter for 15 m i nutes. Use soap to clean the contaminated skin.
S edutan : Bawalah cepat-cepat pesakit terkena sedutan ke tempat berudara berslh. Dapatkan
rawatan perubatan jikolau terdapat simpton - simpton kelihatan.
Inhalation Romove the affected patient to fresh air place. Obtain m edic al assistance if symptoms persis t.
Tortolan :J angan masukkan apa jua bahan ke mulut m angsa yang pitam atau m enggelotar. Ji ka
tertelan, beri mangsa yang dalam keadaan sedar, minum 4-8 oz susu atau air. Hubung i
doktor donaan soqora.
Ingestion : Never giv e anything by mouth to an unconscious or convulsing person. It ingested, have the
conscious victim drink 4-8 oz ot m ilk or water, Contact a physician imm ediately.
Nota untuk pegawal perubatan / Note to physician : Tiada/ N'A
M edical Staff Safety and Health Uni t, Q uali ty in M edical Care Section
11/4/10 1 1 : 5 4 AM Pa ge 6 9
GUIDELI NE S ON CHEM I C AL MANAGE M ENT IN HEALTH CARE FACI LITI ES

M N S T R Y 0 F HEALTH
BAHAGIAN 6 : LANGKAH - LANGKAH PEMADAMAN KEBAKARAN

SECTION 6 : FIRE - FIGHTING MEASURES
Media pemadam an / E xtinguishing modia :Tiada/ N/A
Arahan pemadam an api / Firo - fighting instruction : Tiada / N/A
Bahaya- b ah aya utama / S pocial hazards :Tiada/ N/A
BAHAGIAN 7: LANGKAH- LANGKAH PENGAWALAN PELEPASAN TIDAK SENGAJA

SECTION 7: ACCIDENTAL RELEASE MEASURE
Kebocoran/ tumpahan : Sapu dan masukkan ke dalam bekas untuk pembuangan khusus menur ut
"Env ironmental Quality (Scheduled Waste) Regulation 2005" dan lain - lain panduan
vana diisu oleh pihak DOE dan / atau pihak tempat an.
Leak/ Spill S weep & pack into containers for special waste disposal in accordance to E nvironmental
Quality (Scheduled Waste) Regulation 2005 and other guidelines issued by DOE and/ or local
authoritie s.
BAHAGIAN : PENGENDALIAN DAN PENYIMPANAN

SECTION 8 : HANDLING AND STORAGE
P engendalian : E l akkan daripada kelembapan, terkena pada kulit dan mata. Praktikkan cara
pengurusan industri yang baik.
Handling • Avoid m oisture. Avoid contact with skin and eyes. Observe good industrial practice.
Penyimpanan : S i mpan di tempat kering dan mempunyai pengudaraan yang baik.

Storage Keep in dry and well ventilated area.
BAHAGIAN 9: KAWALAN PENDEDAHAN DAN PERLINDUNGAN DIRI

SECTION 9: EXPOSURE CONTROL AND PERSONAL PROTECTION
Had pendedahan / Exposure limit : Tiada/ N/A
Perlindungan diri / Personal Protection
Perlindun g an mata / kulit : Pakail ah pelindung mata dan muka. Pakai juga pakaian perlindung an
yang sesuai.
E ye/ skin protection : Wear eye l ace protection. Wear also suitable protectiv e dothing.
P erlindungan pernaf asan : Perlu. Pakailah topeng pelindung habuk di tempat yang mempunyai
pengudaraan yang baik. Di tempat tertutup yang kedap udara, topeng
pernafasan separu h atau lengkap diperlukan .
Respiratory protection : Required. Woar dust protection mask in well ventil ated area, half-face or full
face respirators in enclosed area.
Pengud araan : Pastikan tompat baker] a moempunyai pengaliran udara yang baik
V entilation Make sure aw ays work in a well ventilated area
BAHAGIAN 10: KESTABILAN DAN KEREAKTIFAN

SECTION 10 : STABILITY AND REACTIVITY
Keadaan yang perlu dielak / Conditions to avoid : Tiada / NA
Bahan tak serasi / lncompalibililies : Asid dan bahan pengoksid aan yang kuat / Acids
and strong oxidising ager ts
Produk pengurai an / Decomposition products : Dalam bentuk asid sahaj a / In the event of acid only.
empolimer an berbah aya / Hazardous poly merisation : Tiada/ N/A
M edical S taff S afety and Health Unit, Quality in M edical Care S ection
M edical Developm ent Division, Ministryof Health Malaysia 69
11/4/10 1 1 : 5 4 AM Pa ge 7 0
GUIDELINES ON CHEMI CAL MANAGEMENT IN HEALTH CARE FACILITI E S
MINISTRY 0 F HEALTH
BAHAGIAN 11 : MAKLUMAT TOKSIKOLOGI

SECTION 11: TOXICOLOGICAL INFORMATION
Data kotoksikan : Tiada data Organ sasar an ; Tiada data
/ Toxicity data NA Target organs • NA
Kokarsino go n ika n Tada data Kosan pem biakan : T ada data
Carcinogenicit y • NA Reproducti ve ef f ect .NA
Kesan kronik : Tada data Kesan pendeda ha n berlebihan : Tiada data

Chronic ottocts : NA E tfocts of ovoroxposu r :N A
Keadaan perubatan yang secara umum menjadi berta mb ah buruk akibat pendedaha n : Tiada data
Medical conditions generally aggravated by exposure NVA
BAHAGIAN 12 : MAKLUMAT EKOLOGI

SECTION 12 : ECOLOGICAL IN FORMATION
Kebolehgerakan : Tada data Pembiot u m puka n : Tlada data

Mobility : NA Bio.a ccu mula ti on : NA
Kobolohbiorosotan Tlada data Kotoksikan akuatik : Tiada data

Biodegradi b lit y : NA Aquatic toxicity NA
BAHAGIAN 13: MAKLUMAT PEMBUANGAN

SECTION 13 : DISPOSAL IN FORMATION
Perbuan ga n Produk : lanya haruslah dibuang menurut "Environ m ental Quality (Scheduled Waste) Regulation
2005" & lain-lain panduan yang diisu oleh DOE dan / atau pihak tempatan.
Product Disposal ; It must be disposed of f in accordance with the Environmental Quality (Schedule d Waste)
Regulation 2005 and other guidelines issued by DOE and / or local authorities
Pombuan ga n Bekas : Bokas - bekas yang tidak boleh dlbersihkan haruslah dlbuang sebagal slsa buangan
prod uk.
Container Disposal : Packaging that cannot be cleaned should be disposed off as product waste
BAHAGIAN 14 : MAKLUMAT PENGANGKUTAN

SECTION 14: TRANSPORT INFORMATION
IMDG UN No. CAO/ IATA
GGV E / GGVS RID/ ADR ADNR
BAHAGIAN 15: MAKLU M A T PENGAWALAN

SECTION 15: REGULATORY IN FORMATION
M a klu mat label Mere n gsa
Labelling inf ormation : Irritant
Un I Risk Phrases
R3I mpernaf asan dan kuit/
stom and skin.
Unokat in Kesel am at an / Saf e P hrases

$36/37/39 [Pakailah pakaian porlindungan, sarun g tangan dan polindu n g mata /muka yang sosuai/
Wear suitable protective clothing. gloves and eyes/lace protection.
1 1: 5 4 AM P ag e 71
MINIST RY OF HEALTH
REFERENCES
1. American Dental Waste. 2007. Best Management Practices for Amalgam Waste.
2. Centers for Disease Control and Prevention, USA. 2008. Dental Amalgam Use and
Benefits .
3. Department of Occupational Safety and Health, Malaysia. 2001. Guideli nes on the
Control of Chemical Hazardous to Health.
4. Department of Occupational Safety and Health, Malaysia. 2001. Guideli nes on Medical
Surveillance.
5. Environmental Protection Agency, USA. 2009. Pyrethroids and Pyrethrins.
6. Environmental Quality (Scheduled Wastes) Regulations 1989, 2005.

7. Health and Safety Executive, 1992. A Short Guide to the Personal Protecti v e
Equipment at Work Regulations .
cf 8. National Institute for Occupational Safety and Health, USA.Sept 2004. Preventing
Occupational Exposure to Antineoplas tic and other Hazardous Drugs in Health Care
Settings .
9. National Institute of Occupational Safety and Health, Malaysia, 2005. Chemical

Exposure Main Danger at Work.
10. Nor'Aishah Abu Bakar. Quality In Medical Care Section, Medical Development
Division, Ministry of Health. 2007. Self Assessment of Safety and Health Aspects in
Ministry of Health Hospitals .
11. Nor'Ais hah Abu Bakar & Ganesh Balasingam. Quality In Medical Care Section, Medical
Development Division, Ministry of Health. 2008. Chemic al Risk Assessment In Five
Hospitals.
12. Occupational Safety and Health Act 1994.
13. Occupational Safety and Health (Classifications , Packaging and Labelling of

Hazardous Chemical) Regulations 1997.
14. Occupational Safety and Health (Use and Standards of Exposure of Chemical
Hazardous to Health Regulations 2000.
11/4/10 1 1 : 5 4 AM Pa ge 7 2
15. Occupational Safety and Health (Notific ation of Accidents, Dangerous Occurrence,
Occupational Poisoning and Occupation al Diseas e ) Regulations 2004.
16. Occupational Safety and Health Adminis tration, United States Department of Labor.
2007. Medical Screening and Surveillanc e.
17. Occupational Safety and Health Adminis tration, United States Department of Labor.
2008. Hospital Investigations : Health Hazards. OSHA Technic al Manual.
18. World Health Organiz ation. 1996. Users Manual for the Interna tion al Programme on
Chemical Safety, Health and Safety Guides .

Chemical Management Guidelines for Healthcare Facilities

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Chemical Management Guidelines for Healthcare Facilities

Uploaded by

Copyright:

Available Formats

I I

Medical Staff Safety and Health Unit

Foreword by The Director-General of Health, Malaysi a 4

Members of The Technic al Committee 7

Scope of The Guidelines 10

Objectiv es of The Guideli nes 10

cf 1.0 Introduc tion 11

2.0 Hazardous Chemicals 11

3.0 Principles of Toxicology 12

4.0 Laws & Regulations Related to Chemicals 16

5.0 Control of Hazardous Chemic als 23

6.0 Chemic al Storage 37

7.0 Handling and Transferring of Hazardous Chemic als 39

8.0 Dispos al of Hazardous Chemic als 39

9.0 Chemic al Splash 40

10.0 Chemic al Spillage 41

11.0 Chemic al Fires 44

12.0 Emergency Respon se Plan 44

13.0 Hazardous Drugs 45

APPE N DIX VII 61

GUID E L IN E S ON CHEMI C A L MANAGEMENT IN HEALTH CARE FACILI TI E S

Chemic al hazards are some of the more dangerous and commo n

GUIDELINES ON CHEMICAL MANAGEMENT IN HE AL T H CARE FACILITI E S

Recognising the importance and comple xity of chem ic al

I would like to congratulate the Technic al Committee respons i b l e

TAN SRI DATO' SERI DR. HJ. MOHD ISMAIL MERICAN

GUID E L IN E S ON CHEMI C A L MANAGEMENT IN HEALTH CARE FACILI TI E S

Tan Sri Dato' Seri Dr. Hj. Mohd Ismail Merican

Datuk Dr. Noor Hisham bin Abdullah

Dato' Dr. Azmi bin Shapie

Dr. Hjh. Kalsom binti Maskon

Dr. Nor' Aishah binti Abu Bakar

Dr. Ganesh Balasingam

GUIDELINES ON CHEMICAL MANAGEMENT IN HE AL T H CARE FACILITI E S

MEMBE RS OF THE TECHNICAL COMMITTEE

Ir. Hj. Anuar Mohd Mokhtar

Dr. Abu Hasan bin Samad

Dr. Abed Onn

Ir. Nimi Ahmad

Dr. Anza binti Elias

Dr. Sirajuddi n Hashim

Dr. Priya Ragunath

GUID E L IN E S ON CHEMI C A L MANAGEMENT IN HEALTH CARE FACILI TI E S

MEMBE RS OF THE TECHNICAL COMMITTEE II

Dr. Ahmad Riadz bin Mazeli

Dr. Zahara h binti Zainuddin

Dr. Zuraida binti Mohamed

Dr. Maznie da Mahjom

Dr. Suriati Mohd

Dr. Mohd Rashid bin Baharon

Dr. Mohd. Azman Yacob

Ir. Voon Kok How

GUIDELINES ON CHEMICAL MANAGEMENT IN HE AL T H CARE FACILITI E S

MEMBERS OF THE TECHNICAL COMMITTEE

Ir. Khew Swee Lian

Puan Vuctoria Ponnusa my

Encik Sayed Mohd Fadzil Science

Haji Ishak bin Mat Dahalan

Puan Norazree n binti Ibrahim

Quality in Medical Care Section, Medical Developme nt Division

Puan Norhizan binti Othman

GUID E L IN E S ON CHEMI C A L MANAGEMENT IN HEALTH CARE FACILI T I E S

SCOPE OF THE GUIDELINES I