OPERATIONAL STANDARDS
requirements from the UK government, unlike the USA, the HSE states the Control of Substances Hazardous to Health Regulations 2002 (COSHH) ‘requires employers to prevent or control exposure to hazardous substances. Where exposure cannot be prevented, employers are required to assess the risk to health, and provide adequate control measures when using hazardous chemicals’. Unfortunately, the growing pressure on hospitals for the ‘quick turnaround’ of decontamination processes has led to cases where the health and safety of staff and patients has been compromised due to poor PAA monitoring, resulting in serious consequences. HSE investigations found that the decontamination processes failed to protect staff sufficiently. Hospital trusts using equipment that
failed to monitor toxic gas levels were subjected to successful claims by staff for compensation. It is now widely believed in the industry that under COSHH legislation, where toxic gas vapour can be present, there now needs to be protection for staff who work in and around such areas. Following on from this, NFH contacted
ATi UK, specialists in analytical sensor monitoring solutions for gas and water applications, as part of its investigation into the value of continuous monitoring of background levels of PAA, used within their perfusion department for disinfecting their ‘heater cooler’ systems. This procedure has become common practice due to the potential of bacteria spread in this type of environment. The PAA used is of a high strength and is required to be contained in chemical cupboard storage. Due to their keen interest and
knowledge within this field, ATi UK were eager to assist the hospital and donated a portable, continuous test system that measures constant levels of PAA while logging the data. The D16 PortaSens lll was used by NFH to carry out investigations into the background levels within the working areas, while also being used to detect any leaks of seals within the chemical storage cabinet. The data from the portable gas detector during a series of sterilisation processes, revealed that levels exceeded > 1ppm even after the process had been complete. This demonstrated that potentially lethal levels of PAA could be inhaled by staff and stakeholders nearby, establishing that continuous monitoring is needed throughout decontamination processes. By implementing continuous monitoring
to check the background levels of PAA, the data could be used to prove when staff were safe to re-enter with the extraction in place. However, for the hospitals operating without this knowledge, staff are at high risk by continuing to work in potentially hazardous environments as the dangers are unknown. The hospital and hospital trust are also at risk of mitigation from the
IFHE DIGEST 2021
0.18 0.16 0.14 0.12 0.10 0.08 0.06 0.04 0.02 0
0 50 100 150 200 Time (seconds)
Figure 1. Extraction of PAA vapours during routine disinfection, that peaked at a maximum of 0.16 ppm during decanting and measuring concentrated of PAA, after which the system extracted the remaining vapours over a period of five minutes.
effects of toxic gas poisoning, due to there being no continuous monitoring in place. NFH prides themselves on prioritising the health and safety of their staff and patients and feel strongly that all hospitals need to investigate the background levels in their hospitals to allow for the correct PPE and on this basis, a white paper was produced.
Results A total of 42 disinfection cycles were recorded during the study, with an example of PAA exposure and extraction (Fig 1). PAA concentrations peaked at 0.16 ppm during a routine disinfection; this peak occurred during decanting of the concentrated Puristeril 340 and slowly declined as the ventilation system extracted it. Paul Hill, Newcastle Upon Tyne Hospitals
NHS Foundation Trust, said: “In my personal opinion a portable monitor should be considered an essential part of everybody`s cleaning protocol when using PAA to clean equipment. “It would seem our exposure levels are
well below recommended standards, with peaks at expected times, however we have always been very proactive here at Freeman. Without an across the board standard procedure for those units using PAA to clean heater-coolers, some units may be unknowingly unsafe in their practice. Therefore, we strongly recommend that every unit performs an audit of their practice like we have done.”
Monitoring PAA levels Peracetic, or peroxyacetic, acid is an organic compound that is characterised by a very rapid action against all micro- organisms. Areas within medical facilities use equipment that requires continuous sterilisation, such as perfusion and endoscopy re-processing, due to its effectiveness in killing bacteria and microbes. Used in these environments, it will destabilise any molecule it can react with, such as those that make up micro- organisms. Any spillage of PAA is a serious incident
and hospital procedures require staff to immediately leave the room and call the fire brigade, but the cost of this is several thousands of pounds. Staff who work in these areas should
have the appropriate protection, along with the correct equipment to measure background levels of the toxic vapour that comes off chemicals such as PAA, hydrogen peroxide, chlorine dioxide and even strong bleach, as the high levels used in confined spaces can be dangerous if not extracted properly. The only way to ensure the safety of
staff working within these departments against this high strength oxidant is to monitor and alarm where levels exceed that of the exposure guidelines and must be monitored as part of quality controls programmes. This can be done with fixed or portable
toxic gas detectors with specialist, reliable and accurate PAA sensors. However, only two companies in the world make accurate sensors that can be used to protect staff, one of which is ATi UK. Monitoring chemicals such as PAA
enables you to effectively manage the breathing environment. This continuous monitoring allows you to validate that the vapour in the air is safe and can also be used to demonstrate and prove that staff and patients are at no risk in these potentially hazardous areas. Medical instruments, including
endoscopes, can be sterilised multiple times a day at higher levels of PAA than ever before. The increase in usage of re- processing cabinets can lead to issues created from wear and tear on sterilisers and re-processors, increasing the risk to those working closely to them. It is therefore essential to understand and monitor PAA vapour levels.
Protecting lives and preventing legal action The high reactivity of PAA that underlies its benefits also means that excessive exposure to the vapour can be harmful and can cause serious health issues, including:
101 250 300 350
PPA concentration (ppm)
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