Ethylene Oxide (EtO)

Questions: 1. Define the characteristics of ethylene oxide2. Define the characteristics of ethylene oxide covering toxicological effects and physiologic effects3. Discuss the OSHA exposure standards, personal protection equipments and correct sampling process for ethylene oxide. Answers: Introduction Ethylene Oxide (EtO) is a colorless, flammable gas that smells like ether at toxic levels. EtO is workable gas for many industrial and commercial purposes as intermediate, fumigant and sterilant of medical equipments. However, with potential utility characteristics, this gas also persist potential hazardous characteristics. As employees working in medical premises it is important to get knowledge on these characteristics of EtO as well as the process to minimise its hazardous outcomes of EtO sterilisation machine (Reichert Young, 1997, p.34). As a safety officer, Mr. Roy Whittaker has constructed this short description of essential data or information that employees at Blackheath Community Hospital need to know regarding new Ethylene Oxide Sterilization Machine to be installed in the organization. 1. Defining the characteristics of ethylene oxide The following are some of the most important characteristics of EtO sterilisation machine that every employee should know: - The EtO exposure rate is limited to a part of the million air parts and is measured as TWA that is 8-hour time-weighted average. The short-term exposure limit for EtO is 5 ppm for average sampling time of 15 minutes that is known as permissible exposure limits (PELs) The action level is calculated as per 8-hour TWA for employee exposure as threshold limit as per these standards. The OSHA standards provide knowledge on EtO occupational exposure, handling of materials containing EtO and processing protocol (Ackert-Burr, 2010, p. 285). 2. Defining the characteristics of ethylene oxide covering toxicological effects and physiologic effects Physiological effects The mild effects of EtO include irritation in eyes, skin, dermal and respiratory tract. Anaphylaxis Type-1 and Contact dermatitis Type -4 along with occupational asthma is commonly observed in people with EtO exposure. The common disease resulting due to the toxicology of EtO includes blurred eye, blisters, dizziness, nausea, vomiting, headache, and convulsions. The reproductive effects of EtO involve risk conditions in pregnancy as well as chances of abortion in women (Arnold et al. 2011). The neurological effects of ethylene oxide involve a major effect on the central nervous system. These are reports indicating the development of axonal degeneration as well as defects in the myelin sheath of the brain due to EtO exposure 1300mg. Genetic effects of gas involve an increase in chromosomal materials like chromatin material, lymphocytes and micronuclei. Breakage in genetic material DNA can also occur due to EtO exposure. EtO is also capable of generating carcinogenic effect giving birth to different cancers like leukaemia, Stomach, pancreases, haematopoietic, brain cancer etc. (Lewis et al. 2003). Toxicological effects Ethylene oxide causes toxicity by inhalation above the TWA limits leading to irritation in mucous membranes of throat and nose. EtO toxicology is known as acute poisoning. A bit higher toxicity of EtO can lead to trachea and bronchi damages as well as partial lung collapse. The occurrence of pulmonary oedema and cardiovascular damages are observed in the case of long-term ethylene oxide exposure of minimum 72 hours (Toxicological profile for ethylene oxide, 2016). 3. Discussing the OSHA exposure standards, personal protection equipments and correct sampling process for ethylene oxide OSHA exposure standards The following are OSHA exposure standards for employee collected from (OSHA factsheet, 2016). As discussed above the TWA level of ethylene oxide exposure the activities like air monitoring, medical examinations, training and labelling should be completed within this threshold time limit. The employees cannot release airborne EtO concentrations at of above the mentioned action level under normal circumstances If the employee exceeds the PEL level to ethylene oxide exposure than they should follow the required actions to avoid risk. Use of work practice and engineering controls mentioned in OSHA standards are recommended to control the exposure of ethylene oxide. The personal, area and leak monitoring are keen requirements to be performed for EtO exposure Employees should follow the written compliance program developed to reduce exposure risk of EtO Establish a specific area that allows Eto exposure above the threshold limit time that is named as leak area restricted for specific use Employee should strictly follow personal monitoring protocol as per OSHA standards to tackle this exposure The medical surveillance program is mentioned as keen requirement to be established in the organization to monitor employee exposure and risk Try to maintain employee rotation as per 8-hour TWA exposure limit time Provide warning labels on equipments or containers that cause high EtO exposure Select, maintain and provide personal protection equipments for the personal safety of the employee. Maintain initial and periodic monitoring of employee on regular basis to detect exposure rate Additional monitoring should be processed for any change in workplace conditions Medical surveillance compulsory for employee assigned in high exposure area and emergency EtO exposure above TWA level Maintain material safety data sheet as per OSHA hazard communication standards Maintain employee medical record and EtO exposure record for 30 days Provide medical aid and doctor facility for emergency conditions Do not allow drink, smoke or feeding in EtO zone (Small business guide for Ethylene oxide, 2016). Personal protection equipments The personal protective equipments (PPE) as per OSHA standards for getting protection from EtO are described below: - For eye and face protection the use of safety spectacles, goggles, laser safety goggles and face shields while handling EtO exposures. For body protection from EtO, the clotting material made from rubber, neoprene, plastics and rubberized fabrics provides protection from ethylene oxide. For the protection of respiratory system, the use of positive-pressure supplied air OSHA recommends equipment for employees dealing with EtO exposure. The use of full-face respirator is highly recommended by OSHA Keep first aid for personal protection during long-term EtO exposure (OSHA factsheet, 2016) Sampling process as per OSHA standards The sampling process as per OSHA standards for collecting EtO involves the use of charcoal tubes and sampling pumps that are followed by gas chromatography analysis. The process starts by desorbing charcoal tubes in 1% CS(2) benzene. Further, the sample is derivatized with hydrogen bromide or carbon disulphide followed by sodium carbonate treatment. The below provided are specific requirements of the sampling process. Air volume- 1 litre Sampling rate 0.05Lpm Detection limit based on mentioned air volume 13.3 ppb Estimate of Standard error 6.59 % Reliable quantitation limit 52.2 ppb Special requirements The provided sample should be analysed within 15 days of sampling date. This sampling process is convenient, sensitive and reproducible to allow proper analysis of Ethylene oxide. The reanalysis of this sample is also recommended and possible as per OSHA standards. The longer GC retention time reduces interferences in this sampling process of Ethylene oxide (Sampling and analytical methods for ethylene oxide (Non-mandatory) - 1910.1047 App D, 2016) Brief training program This training program for the employees will include a training session to demonstrate the process and techniques that employee need to follow regarding the handling of ethylene oxide machinery followed by a demonstration on OSHA standards and guidelines. After this employee will be provided with a training session regarding the management and protection techniques for using sterilisation machinery. The medical record of all the employees will be recorded for further processes after the training session. References Books Reichert, M., Young, J. H. (1997).Sterilization technology for the health care facility. Jones Bartlett Learning. Journals Ackert-Burr, C. (2010). Low-Temperature Sterilization: Are You In the Know?.Perioperative Nursing Clinics,5(3), 281-290. Arnold, E. V., Doletski, B. G., Dunn, T. M., Raulli, R. E., Mueller, E. P., Benedek, K. R., Murville, M. L. (2011).U.S. Patent No. 8,017,074. Washington, DC: U.S. Patent and Trademark Office. Lewis, M., Meek, M. E., Liteplo, R. G., World Health Organization. (2003). Ethylene oxide. OSHA factsheet. (2016). Retrieved 13 July 2016, from https://www.osha.gov/OshDoc/data_General_Facts/ethylene-oxide-factsheet.pdf Sampling and analytical methods for ethylene oxide (Non-mandatory) - 1910.1047 App D. (2016). Osha.gov. Retrieved 13 July 2016, from https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDSp_id=10074 Small business guide for Ethylene oxide. (2016). Retrieved 13 July 2016, from https://www.osha.gov/Publications/ethylene-oxide.pdf Toxicological profile for ethylene oxide. (2016). Retrieved 13 July 2016, from https://www.atsdr.cdc.gov/TOXPROFILES/TP137.PDF