What’s that smell?

By Steve MacArthur, Hospital Safety Consultant

First off, please accept my wishes to each of you and your families for a most joyous and restful Thanksgiving holiday—I am thankful for the presence of each of you in this conversation and hope that I provide some level of support to your professional lives.

The other day, I fielded a question regarding the use of plug-in air fresheners and what regulatory-based prohibitions/allowances might be entertained in determining how best to manage these devices at the facility level.

This is one of those funky subjects that kind of folds back on itself in a couple of different ways. Part of the issue is that there are a variety of air freshener products on the market, some of which contain scented oils or paraffins that (in some cases) can be flammable or combustible.

I think from a practical standpoint, anything that increases the flammable or combustible load in our facility is probably not the best idea. I suppose you could apply the same logic to a basket of potpourri setting on someone’s desk (at least in terms of combustibility), but feel free to consider what you’ve found during rounds, etc., to determine how much of an issue you’d want to make this.

Much in the way that there is no strict regulatory guidance on the use of certain appliances (toasters, toaster ovens, microwave ovens, George Foreman grills) that can show up in healthcare facilities (usually in staff lounge areas), the only authority having jurisdiction (AHJ) from which I’ve received any direction was a representative of the property insurer for the hospital where I first started my healthcare career (that’s an awkward sequence right there, you betcha).

The insurer’s “take” was that while there was no regulation that prohibited the use of such appliances, if there was a conflagration event, they would likely not cover it. So, depending on who folks have for property insurance, it might be worth seeing if there’s an official position (or unofficial guidance) in this regard.

Ultimately, what I keep coming back to is this: A lot of these “appliances” are not necessarily designed for commercial use (if you look at the fine print on the bottom or packaging for the device, it usually indicates that it is “for household use only”), so my general pushback to folks who tried to introduce “cheap” appliances into the environment was that they could have something, but that something had to be commercial grade.

This strategy had two benefits—commercial grade stuff is generally more sturdily manufactured, but also it tends to be more expensive, so the “casual” desire for something tended to go by the wayside when it was clear that the expense was going to be more than $20 to get what they wanted.

From a regulatory perspective, while I don’t know that air fresheners have ever been cited in a survey, there is that whole notion of equipment and supplies being used in accordance with the manufacturer's instructions for use (IFUs), which could be a pivot point if someone wanted to go that route.

The other piece of this (and I’m putting on my EVS hat) is that there needs to be some analysis of what the aim is in using the devices. Are we looking to make our office smell more “home-y” or are we covering up another scent/odor that might better be neutralized than covered up?

Again, as an old environmental services (EVS) hand, I’m always mindful of scents/odors that might be indicating some other issue. Plus, given the proliferation of personal allergies to scents, etc., you may even want to consider the involvement of the folks in Human Resources when figuring out what can and/or cannot be permitted for use.

I guess my overarching thought is that you probably want to have some sort of vetting process for these types of products—one that includes the involvement of EVS—so you have control of where these devices are used or have a shot at the identification of alternative methods of “scientology.” I am no big fan of some of the sprays, etc., that can be introduced (though if someone has a fresh-baked bread spray, I would be all over that), so I recognize that not every scent is to everyone’s liking (it’s tough enough to reach consensus on important issues, never mind what smells “good”), so there has to be some method or process for managing the olfactory environment in its entirety.

As I look back at what I’ve just written, I do ponder the thought of whether I am over-complicating my response; in a perfect world, this would be a pretty straightforward conversation, but since that perfect world doesn’t seem to be manifesting itself, I guess we have to “fall back” on process.

About the Author: Steve MacArthur is a safety consultant with Chartis Clinical Quality Solutions (formerly known as The Greeley Company) in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Healthcare Safety Leader. Contact Steve at stevemacsafetyspace@gmail.com.