IH Monitoring What have we learned over the last 20 years? Vanda Puhalovich, MPH, CIH, CSP, HEM Lilly Kaneshige, MPH, CIH, HEM

Transcription

1

2 IH Monitoring What have we learned over the last 20 years? Vanda Puhalovich, MPH, CIH, CSP, HEM Lilly Kaneshige, MPH, CIH, HEM

3 Presentation Outline Part 1 Risk Assessment and Sampling Strategy Part 2 Lessons Learned by Agent Part 3 Putting it all together Part 4 Future Considerations 3

4 PART 1 RISK ASSESSMENT AND SAMPLING STRATEGY 4

5 Annual Periodic Strategic Scope Assessment Frequency Evolution Chemical Process Regulatory driven Risk driven Resource management Leverage data 5

6 Risk Assessment Monitoring Survey Follow Up Annual Questionnaire 6

7 Sampling Strategy Worst case Task based OSHA/NIOSH methodology Active vs. passive 7

8 Data Management 8

9 PART 2 LESSONS LEARNED BY AGENT 9

10 Ethylene Oxide (EtO) Phasing out Cal/OSHA standard (8 CCR 5220) Robust engineering controls Lessons Learned Non-detect exposures unless equipment failure or trapped in load 10

11 Glutaraldehyde Substituting out Regulated air contaminant (8 CCR 5155) Varying concentrations/formulas result in different exposures (e.g. 28 day vs 14 day) 11

12 Glutaraldehyde Issues/Challenges Work practice dependent Variety of engineering controls > 12 >12 Lessons Learned Consolidate process Improve work practices Snorkel control performance dependent on user Work with vendor to establish performance criteria Better Worse 12

13 ortho-pthalaldehyde (OPA) Alternative to glutaraldehyde Not a regulated air contaminant Low vapor pressure 13

14 ortho-pthalaldehyde Issues/Challenges No recommended occupational exposure level No approved monitoring method Lessons Learned Engineering controls similar to glutaraldehyde Neutralization external to reprocessor Contraindications for urology 14

15 Hydrogen Peroxide (H 2 O 2 ) Regulated air contaminant (8 CCR 5155) Increasing in usage Varying concentrations/formulas 15

16 Hydrogen Peroxide Issues/Challenges: Low PEL and high odor threshold Sampling challenges Potential exposure at manual handling points Lessons Learned Sampling methodology Closed system Eliminate rinsing emptied bottles Better Worse 16

17 Peracetic Acid (PAA) Used in combination with hydrogen peroxide Not a regulated air contaminant* * 2014 ACGIH TLV 17

18 Peracetic Acid Issues/Challenges Sampling challenges Exposure at manual handling points Lessons Learned Closed system Minimize manual handling Better Change-out solution at the lowest feasible percent display reading Dilute and pour residual disinfectant solution slowly 18

19 Formaldehyde (HCHO) Cal/OSHA standard (8 CCR 5217) Formalin (3.7% formaldehyde solution) 19

20 Formaldehyde Issues/Challenges Varied engineering controls and performance Inconsistent work practices Lessons Learned Prefab grossing stations and dedicated tissue dumping workstations Recap specimen and waste containers Use absorbent neutralizing pads Rinse large specimens OR delivery of fresh specimens Better Worse 20

21 Xylene Regulated air contaminant (8 CCR 5155) CAP driven Staining, coverslipping 21

22 Xylene Issues/Challenges Strong odor at low concentrations Lessons Learned Address nuisance odors Monitoring rationale letter for CAP Work with CAP to update checklist used by inspectors 22

23 Waste Anesthetic Gas (WAG) Nitrous oxide and Isoflurane are regulated air contaminants (8 CCR 5155) Sevoflurane and Desflurane are not regulated 23

24 Waste Anesthetic Gas Issues/Challenges Work practice dependent Risk perception Scheduling Lessons learned Pediatric mask induction, Head and Neck Engage anesthesia providers to develop work practice guidance Reach out to KP School of Anesthesia Scavenging capability 24

25 Noise Cal/OSHA standard (8 CCR ) Associated with industrial processes 25

26 Noise Issues/challenges Limited engineering controls Unanticipated exposures Limited exposure window Lessons Learned Dependent on administrative controls Monitoring rationale letter for CAP for lab exposures 26

27 PART 3 PUTTING IT ALL TOGETHER 27

28 Standardize Template Design Monitoring Rationale Fact Sheet 28

29 Collaborate Staff Vendors Peers 29

30 Share Present/Publish Consensus Groups Regulatory and Accreditation Bodies 30

31 PART 4 FUTURE CONSIDERATIONS 31

32 Indoor Air Quality Current State: Employee interviews Site walkthrough Ventilation system check Monitoring requests 32

33 Indoor Air Quality Future State: Standardized approach with EH&S, EHS, EVS, Facilities and HR involvement Improved communication processes with employees Monitoring criteria Identify end point for investigation 33

34 Hazardous Drugs Current State Few, if any, regulatory limits or OELs Limited sampling methodologies Future State Legislative activity Industry consensus guidelines 34

35 35

36