• Substitute other cold sterilants for EtO. However, use extreme care when selecting possible substitutes. It is necessary to fully evaluate possible health effects and exposure potentials of alternatives to EtO before making a selection.

• Use proper ventilation with EtO gas.
  
  
  • Typical operations that could cause worker exposure to EtO are removing sterilized items from the EtO sterilizer, moving items from the EtO sterilizer to the aerator unit, and changing bottles of EtO gas. You can control airborne concentrations of EtO most effectively at the source of contamination by enclosing the operation and/or using local exhaust ventilation.

• Reduce exposure to EtO during the sterilization process.
  
  
  • Do not occupy the sterilizer loading and mechanical rooms while operating the sterilizer unit.
    
    
  • Operators should crack the door no more than two inches and allow the load to "off gas" before moving to transfer carts. A ventilated exhaust hood should be installed above the sterilizer door.
    
    
  • Operators should avoid close contact with newly sterilized unaerated loads.

• Vent ethylene oxide through a non-recycled or dedicated ventilation system. For a discussion of ventilation of aeration units, sterilizer door areas, sterilizer relief valves, and ventilation during cylinder changes, see the appendix of 29 CFR 1910.1047 (Ethylene Oxide).

• To detect inadequate ventilation and cause automatic shutdown have machine alarms in place. Air pressure in laboratories and isolation rooms should be negative so that contaminated air is drawn through the exhaust vents rather than circulating throughout the rest of the building.

• Use appropriate PPE when changing cylinders including butyl apron, gloves, and a canister respirator.

• Use EtO detector systems and room monitors to signal any leakage of gas, and passive dosimeters for personal exposure monitoring.

• Use specialized gas-line connections to minimize EtO leakage during use and during change out of EtO cylinders.

• Conduct periodic personal monitoring, as well as, monitoring for leaks at gas-line connectors.

• Keep a written log for any detected leak and any service done on an ethylene oxide chamber. Replace sterilizer/aerator door gaskets, valves, and fittings when necessary. OSHA Tech Manual Section VI, Chapter 1-Health Hazards.

• Ethylene Oxide, Safety and Health Topics Page.
• Ethylene Oxide Sterilizers in Health Care Facilities. NIOSH, (1989, July 13).
• Ethylene Oxide Sterilizers in Health Care Facilities. NIOSH Current Intelligence Bulletin-52 (1997, October 22), 15 pages. Describes exposure control methods for sterilizers, including Work Practice Guidelines, available to post copies by sterilizers, supply cylinders, and mechanical access rooms.

• Store glutaraldehyde products in closed containers, in well ventilated areas. Post signs to remind staff to replace lids after using product.

• Use glutaraldehyde products in rooms that are well ventilated and large enough to ensure adequate dilution of vapor, with a minimum air exchange rate of 10 air changes per hour. Ideally, install local exhaust ventilation such as a properly functioning laboratory fume hood to control vapor.

• Use appropriate PPE to minimize exposure including:

• Gloves which are impervious to glutaraldehyde such as those made of Butyl Rubber, Nitrile, and Viton^® which have been shown to provide full shift protection from glutaraldehyde.

• Splash proof goggles and/or full-face shields when working with glutaraldehyde to protect eyes.

• Wear appropriate PPE as required by the Bloodborne Pathogens Standard 1910.1030(d)(3)(i) if blood or Other Potentially Infectious Materials (OPIM) exposure is anticipated. The type and amount of PPE depends on the anticipated exposure including:
  
  
  • Gloves must be worn when hand contact with blood, mucous membranes, OPIM, or non-intact skin is anticipated, or when handling contaminated items or surfaces [1910.1030(d)(3)(ix)].
    
    
  • Wearing thick utility gloves and gowns can offer additional protection to the employee sorting contaminated items.
    
    
    • Utility gloves may be decontaminated for re-use if the integrity of the glove is not compromised. However, they must be discarded if they are cracked, peeling, torn, punctured, or exhibit other signs of deterioration or when their ability to function as a barrier is compromised. [1910.1030(d)(3)(ix)(C)].

• Promote using engineering controls such as safer needle devices to help remove or isolate exposures to blood and bloodborne pathogens (e.g., self-sheathing needles, needle less connectors, retractable needles) [1910.1030(c)(1)(iv), 1910.1030(d)(2)(i) and OSHA Directive, CPL 2-2.69 (2001, November 27).

• Discarding contaminated needles and other sharp instruments immediately or as soon as feasible after use into appropriate containers [1910.1030(d)(4)(iii)(A)(1)].

• Sharps containers need to be available, and in close proximity to areas where sharps may be used [1910.1030(d)(4)(iii)(A)(2)].

• Contaminated needles and other contaminated sharps shall not be bent, recapped, or removed except as noted in paragraphs (d)(2)(vii)(A) and (d)(2)(vii)(B).

• Employers must provide readily accessible hand washing facilities, [1910.1030(d)(2)(iii)] and ensure that employees wash their hands immediately or as soon as feasible after removing gloves [1910.1030(d)(2)(v)].

• Redesign workstations so packaging and equipment can be reached while maintaining the elbows in close to the body.
  
  
• Use carts with large, low rolling, low resistance wheels, that can easily roll over mixed flooring as well as gaps between elevators and hallways.
  
  
• Minimize prolonged overhead activity (e.g., lower stacking shelves to shoulder height).
  
  
• Use height-adjustable work surfaces or lift tables to minimize head tilt.
  
  
• Rotate workers through repetitive tasks.
  
  
• Pad the edge of work surfaces which come into contact with the elbow or forearm which could cause contact trauma.
  
  
• Provide sit/stand stools at work stations.

• Use anti-fatigue mats.
  
  
• Use shoes with well-cushioned insteps and soles where floor mats cannot be used.
  
  
• Provide a foot rest bar so employees can continually alter their posture by raising one foot.
  
  

For additional information, see HealthCare Wide Hazards - Ergonomics.

• Ergonomics Safety and Health Topics Page.

• Implement a written program that meets the requirements of the Hazard Communication Standard to provide for worker training, warning labels, and access to Material Safety Data Sheets (MSDS).

• Provide appropriate PPE: (e.g.,  gloves, goggles, splash aprons) when handling hazardous dishwashing detergents and chemicals [1910.132]. For additional information, see HealthCare Wide Hazards - PPE.

• Medical Services and First Aid: Where the eyes or body of any person may be exposed to injurious corrosive materials, provide suitable facilities for quick drenching or flushing the eyes and body within the work area for immediate emergency use [1910.151(c)].

• Use dishwashing machines that automate the dispensing of washing chemicals to minimize employee exposure to chemicals. Workers must still be cautious and use appropriate PPE (e.g., goggles, and/or gloves) when changing out the containers of detergent.

• Employers must provide appropriate gloves when exposure to blood or other potentially infectious materials (OPIM) exists [1910.1030 Bloodborne Pathogens Standard].

• Make alternatives readily accessible to those employees who are allergic to the gloves normally provided [1910.1030(d)(3)(iii)].