• In liquid form, Ethylene oxide can cause eye irritation and injury to the cornea, frostbite, and severe irritation and blistering of the skin upon prolonged or confined contact.
  
  
• Ingesting EtO can cause gastric irritation and liver injury. Acute effects from inhaling EtO vapors include respiratory irritation and lung injury, headache, nausea, vomiting, diarrhea, shortness of breath, and cyanosis.
  
  
• Exposure has also been associated with the occurrence of cancer, reproductive effects, mutagenic changes, neurotoxicity, and sensitization. Ethylene oxide has been shown to cause cancer in laboratory animals and has been associated with higher incidences of cancer in humans. Adverse reproductive effects and chromosome damage may also occur from EtO exposure.

• 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.
  
  
  • Registered Antimicrobial Products Registered with the EPA as Sterilizers [93 KB PDF, 10 pages]. Environmental Protection Agency (EPA), (2009).
    
    
• 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. See OSHA Technical Manual, Section VI: Chapter 1 - Hospital Investigations: Health Hazards.
  
  

EtO Room Monitor

Passive Dosimeter for personal exposure monitoring

EtO Monitoring Station

• Ethylene Oxide. Safety and Health Topics Page.
• Ethylene Oxide Sterilizers in Health Care Facilities. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH), (1989, July 13).

• Prevent the spill in the first place by replacing outdated glass thermometers and sphygmomanometers.
  
  
• Make sure that spills are cleaned up promptly and safely, by workers or a team trained in proper procedures.
  
  
• Periodically train employees to understand procedures and to correctly follow policies, (e.g., procedures in place that provide for isolation of the contaminated area).
  
  
• Have spill kits available to help clean up small spills of 25 ml or less.

For additional information, see Healthcare Wide Hazards - Mercury.

• 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 29 CFR 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 [29 CFR 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. [29 CFR 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) [29 CFR 1910.1030(c)(1)(iv), 29 CFR 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 [29 CFR 1910.1030(d)(4)(iii)(A)(1)].

• Sharps containers need to be available, and in close proximity to areas where sharps may be used [29 CFR 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 29 CFR 1910.1030(d)(2)(vii)(A) and 29 CFR 1910.1030(d)(2)(vii)(B).

• Employers must provide readily accessible hand washing facilities, [29 CFR 1910.1030(d)(2)(iii)] and ensure that employees wash their hands immediately or as soon as feasible after removing gloves [29 CFR 1910.1030(d)(2)(v)].

For additional information see Healthcare Wide Hazards - Bloodborne Pathogens.

Reaching/Lifting

• Well maintained cart

  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.
  
  

  Padded Work Surfaces

• 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.
  
  

  Sit/Stand Stool

For additional information see Healthcare Wide Hazards - Ergonomics.

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• Unlabeled chemicals and untrained employees.
  
  
• Not using appropriate personal protective equipment when handling hazardous chemicals which may be found in soaps, disinfectants, cleaners, etc.

• 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 [29 CFR 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 [29 CFR 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.

For additional information, see Healthcare Wide Hazards - Hazardous Chemicals.