Hospital eTool: Central Supply Module

Hospital eTool
Central Supply Module


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Click on the area for more specific information. Central Supply Room Module

Common safety and health topics:

Bloodborne Pathogens
Ergonomics
Hazardous Chemicals
Slips/Trips/Falls
Latex Allergy

Exposure to Ethylene Oxide Gas (EtO)

Ethylene Oxide (EtO) possesses several physical and health hazards that merit special attention. EtO is a colorless liquid below 51.7°F, or a gas that has an ether-like odor at concentrations above 700 parts per million (ppm) and is both flammable and highly reactive. The current OSHA Permissible Exposure Limit (PEL) for EtO is 1 ppm for an 8hr time weighted average with a 5ppm excursion level.

Potential Hazard

Staff exposure to EtO. EtO is used within central supply as a sterilant for items that can not be exposed to steam sterilization. Exposure usually results from improper aeration of the ethylene oxide chamber after the sterilizing process or during off-gassing of sterilized items or poor gas-line connections. It can also occur in outpatient surgery clinics, cardiac catheterization laboratories, operating rooms, dental labs, autopsy labs and other areas.

Health Effects:

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.

Possible Solutions

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.
EtO Room Monitor	Passive Dosimeter for personal exposure monitoring	EtO Monitoring Station

Additional Information

Ethylene Oxide, Technical Links.
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.
Reproductive Hazards. OSHA Summary Sheet (1994, December 30), 3 pages. Overview of the OSHA identified possible priority of workplace reproductive hazards.

Mercury Exposure

Potential Hazard

Employees can be exposed to mercury from accidental spills that occur during sterilization and centrifugation of thermometers in central supply areas. Exposure to mercury occurs through inhalation or through skin contact. If spills are not promptly cleaned up, mercury may accumulate on surfaces and then vaporize and be inhaled by unaware workers.

Possible Solutions

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.

Glutaraldehyde

Potential Hazard

Employee exposure to glutaraldehyde, found in products such as Cidex, Aldesen, Hospex and others, when instruments or other items are cold sterilized in central supply.

Possible Solutions

	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.

For additional information, see HealthCare Wide Hazards - Glutaraldehyde, PPE, Hazardous Chemicals.

Burns/Cuts

Potential Hazard Autoclave

Employee exposure to burns or cuts that can occur from handling or sorting hot sterilized items or sharp instruments when removing them from autoclaves/sterilizers or from steam lines that service the autoclaves.

Possible Solutions

Establish work practices to prevent hazards such as:
- Do not remove items from sterilizers until cooled.
- Avoid handling sharp ends of instruments.
- Use forceps or other devices to remove sharp instruments from baskets and autoclaves.
Provide appropriate Personal Protective Equipment (PPE).
- Employers must assess tasks to identify potential worksite hazards and provide and ensure that employees use appropriate personal protective equipment [1910.132].
  
  Employers shall require employees to use appropriate hand protection when hands are exposed to hazards such as cuts or lacerations and thermal burns. Examples of PPE which may be selected include using oven mitts when handling hot items, and steel mesh or kevlar gloves when handling or sorting sharp instruments [1910.138(a)].

For additional information, see HealthCare Wide Hazards - PPE.

Bloodborne Pathogens (BBP)

OSHA has revised its Bloodborne Pathogens Standard 1910.1030, because of the Needlestick Safety and Prevention Act, effective date April 18, 2001.

Potential Hazard

Employee exposure to BBP and other potentially infectious materials as bloody, contaminated surgical instruments and sharps (e.g., needles, scalpels) are sorted. Employee must discard any disposable sharps and recycle reusable instruments/equipment that need to be washed and sterilized before their next use.

Possible Solutions

	Wear appropriate PPE as required by the Bloodborne Pathogens Standard 1910.1030Gloves 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, needleless connectors, retractable needles) [1910.1030(c)(1)(iv), 1910.1030(d)(2)(i) and OSHA Directive, CPL 2-2.69 (2001, November 27).
	The Bloodborne Pathogens Standard also requires:
	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 handwashing 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)].

For additional information, see HealthCare Wide Hazards - Bloodborne Pathogens.

Ergonomics

Ergonomics is the science of fitting the job to the worker. When there is a mismatch between the physical requirements of the job and the physical capacity of the worker, work-related Musculoskeletal Disorders (MSD) can result.

Potential Hazard

Employee exposure to MSD from repetitive, prolonged, reaching, when sorting sterilized packages or lifting above shoulder height to reach high shelves of equipment or when pushing and pulling heavy carts full of dirty or clean items. Static postures may occur from continuously standing in one position while sorting instruments. Contact trauma to forearm area can occur if employee rests wrists on hard sharp counter surfaces when sorting.

Reaching/Lifting

Possible Solutions

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.

Well Maintained Cart

Padded Work Surfaces

Sit/Stand Stool

Additional Information

HealthCare Wide Hazards - Ergonomics.
Ergonomics, Technical Links Page.
Operating Room Set Up And Clean Up. OSHA Ergonomic Report.
OSHA's Ergonomic Generic Solutions eCAT.

Hazardous Chemicals

Potential Hazard

Employee exposure to hazardous chemicals that may be used in the initial washing process of dirty instruments.

Unlabeled chemicals and untrained employees.

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

Possible Solutions

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 more 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.

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

Slips/Trips/Falls

Potential Hazard

Employee exposure to slippery floors from steam and washing processes.

Possible Solutions

Keep floors clean and dry [1910.22(a)(2)]. In addition to being a slip hazard, continually wet surfaces promote the growth of mold, fungi, and bacteria which can cause infections.
Keep aisles and passageways clear and in good repair, with no obstruction across or in aisles that could create a hazard [1910.22(b)(1)]. Provide floor plugs or ceiling plugs for equipment, so power cords need not run across pathways.

For additional information, see HealthCare Wide Hazards - Slips/Trips/Falls.

Latex Allergy

Potential Hazard

Employee exposure to latex and latex allergy from wearing gloves when handling and sorting contaminated, bloody equipment, or when handing sterile equipment.

Possible Solutions

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)(iii)].

For additional information, see HealthCare Wide Hazards - Latex Allergy.