If you need indoor air quality, personnel exposure and equipment safety assistance discussed in this information page call us at 1-800-344-4414 or email us at firstname.lastname@example.org for details and a free estimate.
November 14, 2018
Operating Rooms / Surgical Suites
Indoor air quality requirements in operating rooms are a complicated and delicate matter, to say the very least. The objective is to provide a safe and sterile environment for the patient while protecting the health and well-being of the surgery staff.
Maintaining safe hospital air quality in an operating room involves supplying anesthetic gases to the patient while scavenging the waste anesthetic gas so as not to anesthetize the surgeons and OR staff. Oxygen, a fire and explosion hazard, must be supplied as well. Further, infection control must involve air filtration of particulate matter. Temperature must be controlled for the comfort of the surgical staff but not warm enough to encourage bacterial growth. Relative humidity must be controlled too; if humidity is too low, electric shock or even explosion are possible—too high and condensate can encourage mold growth.
Monitoring particulates in the air is also vital. The acceptable amount of particulates in operating rooms and other critical environments is designated in the standard ISO 14644 (formerly Federal Standard 290E). An OR under ISO 14644-1 is considered an ISO Class 4 Clean Room with a limit of 10,000 particles /M3 of 0.1 um or larger.
Where anesthesia is used, regular monitoring of gas delivery systems for proper operation and leak detection is required. This also applies to waste anesthetic gas scavenging systems that must prevent the exhaled gases from escaping into the OR environment. We conduct leak detection as part of quality, semi-annual or annual audits to comply with JCAHO, OSHA, or NFPA requirements.
Waste Anesthesia Gas Surveys
There are very specific limits set by OSHA for exposure to anesthetic gases—not just nitrous oxide but also halogenated gases (halothane, enflurane, isoflurane, desflurane). In fact, halogenated gases may be more hazardous to medical staff than nitrous oxide since some have been implicated in miscarriages, birth defects, cancer, liver and kidney diseases and sterility.
These exposures can occur in hospitals, out-patient surgery clinics, emergency centers, medical clinics dental offices and veterinary hospitals. OSHA requires that operating room personnel be monitored for anesthetic gases and they have set permissable exposure limits (PELs).
Exposure to waste anesthetic gases can be the result of leaks due to ill-fitting connections and weak or faulty tubing and hoses. Bad habits and lack of procedures and training are also potential culprits.
Atlantic Environmental provides waste anesthesia gas testing/sampling by monitoring individuals during their work hours. We use passive samplers/dosimeters, small devices that clip to the individual’s clothes and measure the rate of exposure to each type of gas/chemical. We interpret the results to determine if and why any exposure problems are occurring, then correct and prevent them. Where problems are identified we can provide recommendations to correct such problems.
Ventilation Surveys for Hospital Air Quality
The Guidelines for the Construction of Hospital and Healthcare Facilities promulgates standards for ventilation requirements in hospitals and healthcare facilities, which are adopted and enforced by many states. To determine if your facility meets the specifications for hospital air quality, we conduct ventilation surveys to calculate the number of air exchanges per hour (ACH).
Personnel Exposure Monitoring
All employers are required by OSHA to monitor their workplaces for potential hazards. Medical facilities are at particular risk of subjecting employees to hazards that can cause health problems. Noteworthy chemicals specific to this industry include:
- Formaldehyde and Glutaraldehyde
A known human carcinogen classified by The National Toxicological Program’s 12th Report on Carcinogens, formaldehyde is a common chemical used in medical facilities as a laboratory preservative, an embalming fluid, and as a sterilizer. The use and treatment of formaldehyde is regulated by OSHA. Glutaraldehyde, used to disinfect medical and dental equipment, is also known to be toxic.We monitor formaldehyde and glutaraldehyde in tissue preservation areas, morgues, medical schools and labs. Formalin is the most common tissue preservative and is a combination of alcohols and formaldehyde.
- Ethylene Oxide
Used as a sterilizer for medical supplies and equipment and supplies, Ethylene Oxide (EtO) poses several hazards prompting OSHA to regulate its use and handling. According to OSHA, “EtO is both flammable and highly reactive. Acute exposures to EtO gas may result in respiratory irritation and lung injury, headache, nausea, vomiting, diarrhea, shortness of breath, and cyanosis. Chronic exposure has been associated with the occurrence of cancer, reproductive effects, mutagenic changes, neurotoxicity, and sensitization.”We provide testing/sampling for Ethylene Oxide in autoclaves and sterilizers, ensuring personnel and materials (such as cloth, plastics and synthetics) have not absorbed the dangerous chemical.
Xylene is often used in histology labs and pose serious health and physical hazards. Inhaling the vapors or having the substances touch the skin can cause poisoning including respiratory irritation and nervous system damage. The chemicals are also highly flammable.We monitor for xylene, acetone and alcohols and conduct auditing and training for safe handling practices.
Hospital Air Quality Sampling/Testing
Healthy indoor air quality is paramount in medical care facilities including hospitals, healthcare, nursing homes, assisted living and hospice care. Our services include indoor air quality surveys for mold, bacteria, dusts, noise, asbestos, carbon monoxide, carbon dioxide and general air quality in operating rooms, emergency rooms, patient rooms, clinics, offices and maintenance facilities. We also provide sampling/testing in pharmacies and medical dispensing areas for oncology chemical exposure to staff. Oncology chemical exposure is of increasing concern in packaging and disposing locations within the medical complex.
- Infectious Diseases
Methicillin-resistant Staphylococcus aureus (MRSA) is an often encountered infection problem. We can test for bacterial agents like MRSA using culture media or the more accurate PCR analysis.
Legionella pneumophila, the bacteria that causes Legionnaire’s Disease can be found in cooling towers, hot water heaters, showerheads, and anywhere warm water can stagnate. Testing/sampling water systems as a preventative measure or after an outbreak of Legionnaire’s Disease is an important part of any facility’s management plan as Legionella can have devastating effects on elderly tenants.
Mold may incubate and multiply in damp or wet areas in HVAC Systems or exterior walls. Some environmental mold spores, such as Aspergillus, can cause infections in the immuno-compromised. We test for mold, temperature, relative humidity and moisture.
We provide testing/sampling and project assistance in asbestos matters. This includes surveys to identify asbestos, air sampling for asbestos, project monitoring during abatement, specifications and regulatory assistance. We have a reputation for successfully dealing with asbestos matters in hospitals and other facilities that must remain functional 24 hours a day.
- Construction Projects
Noise and dust from construction projects is also a significant problem in medical complexes that may require testing/sampling to keep control of these problems during an expansion or renovation and make sure clean-up is thorough at completion. We also monitor for personnel exposure to roofing tars, silica and volatile organic compounds (VOCs) and offer appropriate respiratory protection plans. We can also provide part-time or full time safety or industrial hygiene personnel for hospital and medical facilities.
Safety Programs Development and Training
We offer safety program development to hospitals, healthcare and other patient care facilities. Our process includes a gap analysis to determine the effectiveness of current programs and writing OSHA complaint and facility specific procedures and programs if needed. We have extensive experience developing programs such as Respiratory Protection, Hazard Communication, Emergency Response, Confined Space, Fire and Electrical Safety, and Bloodborne Pathogens. Also available are Chemical Hygiene Plans.
To ensure correct fit and use of respirators, we perform respirator fit testing and training. this includes both qualitative and quantitative fit testing including for N-95 and P-100 respirators (dust masks). Safety training is available for hospital, healthcare and hospice personnel, home healthcare staff and visiting nurses.
Air Emissions Permitting
Air emissions permit requirements can vary substantially from state to state and facility to facility. They can include Title V Permits and permits to install (PTI), boilers, air conditioning, emergency diesel generators, and exhaust units. We can determine your facility’s specific requirements and assist in achieving and maintaining compliance.
Each of these aspects of monitoring and servicing hospital air quality requires a skilled and experienced team of industrial hygienists and air quality specialists. Over 40 years of experience in dealing with the myriad requirements of every aspect of hospital indoor air quality make us uniquely qualified to address these complex issues. Call us at 800-344-4414 to discuss your specific needs.
Our primary service areas for Air Quality in Hospitals and Healthcare Facilities Services are: NJ, NY, NYC, PA, CT, DE, (Boston) MA, RI, Wash DC, WI, MD, MI, (Chicago) IL, VA, IN, (Atlanta) GA, AL, NC, SC, TN, (Dallas, Ft Worth) TX, OK, DC, AR, we can service most other areas of the U.S. but with some added travel charges.