Air Monitoring

Anesthetic Gases in Healthcare

Healthcare Industry
Anesthetic GasesAccording to the U.S. Bureau of Labor Statistics, Healthcare was the largest industry in 2006 employing 14 million people of whom 13.6 million were wage/salary workers and 438,000 self-employed. In addition, 7 of the 10 fastest growing occupations were healthcare related, and were likely to generate 3 million new jobs in 10 years - more than any other U.S. Industry.

Healthcare workers face many workplace hazards; in addition to physical injuries such as needle stick injuries, back injuries and workplace stressors, they also run the risk of exposure to anesthetic waste gases, sterilant gases, solvents and disinfectants. Due to the growth of this industry, injury reporting has increased over the past decade.

Anesthetic Gases
The primary function of anesthetic gases is to block the sensation of pain allowing the patient to undergo surgical or other procedures without distress. There are several different types of anesthetics – general, inhaled, injected, and regional. Of particular concern in the healthcare workplace is exposure to anesthetic vapors from causes involving dosing technique, equipment leaks or failures, and waste anesthetic gases (WAG). Due to the high risk of workplace exposure, monitoring programs are required by several regulatory agencies such as OSHA, NIOSH, the American Hospital Association (AHA) and the Joint Commission on Accreditation of Health Care Organizations.

The most widely used anesthetic gases are halogenated ethers such as enflurane, halothane, isoflurane, and desflurane coupled with nitrous oxide.


Did you know? Our radiello® Anesthetic Gas and Vapor Sampling (Sterile) Kit – RAD125 was developed to sample nitrous oxide, isoflurane, ethrane, halothane, and sevorane in surgical theaters?
Components for one sampler are packed separately in one sealed and sterile bag; each sampler includes: 1 permeative body, 1 support plate, 1 vertical adapter, and 1 adsorbing cartridge.

Commonly Encountered Waste Gases, Chemicals, Vapors in Healthcare
Nitrous Oxide
Halogenated Ethers – Forane (isoflurane), Ethrane (Enflurane), Desflurane, Halothane, Sevorane
Sterilant Gases – Ethylene Oxide
Solvents, Disinfectants and Antiseptics – Aldehydes (Glutaraldehyde, Formaldehyde, Acetaldehyde); Phenols
Methyl Methacrylate (MMA)


Air Sampling Media by Regulatory Method
Method Contaminants of Interest Sampling Media
OSHA
OSHA 32 Phenols in Indoor Air Sorbent Tube – ORBO 615 (20053)
Passive Sampler– RAD147
OSHA 52 Formaldehyde Sorbent Tube – ORBO-24 (20231)
Passive Sampler– RAD165
OSHA 64 Glutaraldehyde Treated Filter – ORBO-827 (20069)
Passive Sampler– RAD165
OSHA 68 Acetaldehyde Sorbent Tube – ORBO-25 (20357)
Passive Sampler– RAD165
OSHA 94 Methyl Methacrylate Sorbent Tube – ORBO-356 (20047)
OSHA 103 Enflurane, Halothane, and Isoflurane Sorbent Tube – ORBO-91 (20360)
Passive Sampler– RAD125
OSHA 106 Desflurane Sorbent Tube – ORBO-91 (20360)
Passive Sampler – RAD125
OSHA 1007 Formaldehyde Passive Sampling – DSD-DNPH (28221-U)
Passive Sampler – RAD165
OSHA 1010 Ethylene Oxide Sorbent Tube – ORBO-100 (20255-U)
NIOSH
NIOSH 2018 Aliphatic Acetaldehyde Sorbent Tube – DNPH Tubes (505315)
Passive Sampler – RAD165
NIOSH 2531 Glutaraldehyde Sorbent Tube – ORBO-23 (20257-U)
Passive Sampler – RAD165
NIOSH 2532 Aliphatic Acetaldehyde Sorbent Tube – DNPH Tubes (505315)
Passive Sampler – RAD165
NIOSH 2538 Acetaldehyde by GC Sorbent Tube – ORBO-25 (20357)
Passive Sampler – RAD165
NIOSH 2541 Formaldehyde by GC Sorbent Tube – ORBO-23 (20257)
Passive Sampler – RAD165
NIOSH 2546 Cresol and Phenol Sorbent Tube – ORBO-615 (20253)
Passive Sampler – RAD147
NIOSH 3507 Acetaldehyde Sorbent Tube – ORBO-23 (20257)
Passive Sampler – RAD165
NIOSH 3702 Ethylene Oxide Sample Bag – 5L Tedlar Bag (24655)
NIOSH 6600 Nitrous Oxide Sample Bag – 5L Tedlar Bag (24655)

References
CDC/NIOSH - Healthcare
OSHA – Waste Anesthetic Gases Fact Sheet
US Bureau of Labor Statistics – Healthcare
Suruda A. Health effects of anesthetic gases. Occupational Medicine: State of the Art Reviews. 1997,12, 4, 627-634.
Application Guide for RAD125 – radiello® passive sampler for anesthetic gases and vapors


Nitrous Oxide (N2O) back to top

Nitrous Oxide is a commonly used anesthetic/analgesic in dentistry and surgical operations and is often referred to as “laughing gas”. Occupational exposure from inhalation can result in neurotoxic effects, also decrease in mental performance and audiovisual dexterity. It is often used with sevoflurane or desflurane in order to strengthen the anesthetic effect.


Exposure Limits
Agency Exposure Limit
ACGIH (TLV) 50 ppm, 90 mg/m³ TWA; Appendix A4 - Not Classifiable as a Human Carcinogen
NIOSH (REL) 25 ppm, 46 mg/m³ TWA over the time exposed. [Note: REL for exposure to waste anesthetic gas.]
(TWA=Time-weighted average; TLV=Threshold Limit Value; REL=Recommended Exposure Limit)

References
OSHA Health Guideline for Nitrous Oxide
NIOSH Safety and Health Topic: Nitrous Oxide

Related Products
5L Tedlar® Gas Sampling Bag, pk of 10 – (24655)


Halogenated Ethers back to top

Forane (Isoflurane)
Is used primarily in veterinary procedures and is often combined with other anesthetics such as nitrous oxide. It is widely used and has a stabilizing effect on the cardiovascular system. It’s less soluble in blood than halothane therefore results in more rapid recovery. Common signs of exposure are dizziness and headache and unconsciousness (in extreme cases). Pregnant women and operating personnel should minimize exposure.

Ethrane (Enflurane)
Is a vasodilator acting directly on smooth muscles. It is a non-flammable halogenated ether used as a general inhaled anesthetic primarily in veterinary procedures. It is a structural isomer of isoflurane. Extremely lipid (fat) soluble; may have prolonged action in obese individuals.

Desflurane
Is a highly fluorinated methyl ethyl ether used for maintenance of general anesthesia. It has lower blood and body tissue solubility therefore its uptake and elimination from the body is faster. It undergoes minimal metabolism and should have low potential for toxic effects.

Halothane (bronchiodialator)
Used since the 1960s, probably still the most widely used in the world though isoflurane is generally used in UK and USA. Halothane is in essence halogenated ethane (enflurane and isoflurane are halogenated methyl ethyl ethers). Chronic exposure said to lead to nervous system toxicity and behavioral changes. When used as a clinical anesthetic, halothane induces amnesia, analgesia, anesthesia, and respiratory depression [Hathaway et al. 1991]. Anesthetic doses range from 5000 to 30,000 ppm [ACGIH 1991]. During anesthesia, cardiac output may be reduced and arrhythmias may occur [Hathaway et al. 1991]. A syndrome called "halothane hepatitis" occurs in 1 in 10,000 halothane-induced anesthesia patients; this syndrome involves fever, anorexia, nausea, and vomiting and may progress to hepatic failure and death [Hathaway et al. 1991].
Is extremely sensitive to light and decomposes to toxic gases of bromine, chlorine and fluorine if not properly stabilized. It is incompatible with acids, light, heat and flames.

Sevorane (Sevoflurane)
Sevoflurane is the preferred agent for mask induction due to its lesser irritation to mucous membranes, along with desflurane, it is replacing halothane and forane. Like the other halogenated ethers, it is administered in a mixture of nitrous oxide and oxygen.
The U.S. Environmental Protection Agency (EPA) has classified sevoflurane as a greenhouse gas.


Exposure Limits
Contaminant/
Agency
Exposure Limit
Forane, Ethrane, Desflurane
ACGIH (TLV) 75 ppm, 566 mg/m3 TWA; Appendix A4 (Not Classifiable as a Human Carcinogen)
NIOSH (REL) 2 ppm Ceiling (60 min)*
(TWA=Time-weighted average; TLV=Threshold Limit Value; REL=Recommended Exposure Limit)
Haloethane
ACGIH (TLV) 50 ppm; 404 mg/m3 TWA
NIOSH (REL) 2 ppm of air; 16.2 mg/m³ (as a waste anesthetic gas) at a 60-minute ceiling limit that should not be exceeded during any part of the workday* [NIOSH 1992]
(TWA=Time-weighted average; TLV=Threshold Limit Value; REL=Recommended Exposure Limit)
*There are no established exposure limits but NIOSH recommends that no worker should be exposed at ceiling concentrations greater than 2 ppm of any halogenated anesthetic agent not to exceed 1 hour.

References
OSHA Health Guideline for Haloethane
Hathaway GJ, Proctor NH, Hughes JP, and Fischman ML [1991]. Proctor and Hughes' chemical hazards of the workplace. 3rd ed. New York, NY: Van Nostrand Reinhold.
ACGIH [1991]. Documentation of the threshold limit values and biological exposure indices. 6th ed. Cincinnati, OH: American Conference of Governmental Industrial Hygienists.
US EPA: Mandatory Part 98 - Mandatory Greenhouse Gas Reporting (PDF)
Application Guide for RAD125 - radiello® passive sampler for anesthetic gases and vapors

Related Products
ORBO-91 Sorbent Tube, pk of 25 - (20360)
radiello Anesthetic Gases and Vapors Diffusive Sampler - (RAD125)
SupelQ PLOT GC column, 30 m x 0.32 mm - (24242)
Headspace Vials 20 mL, with open top aluminum crimp caps and rubber PTFE septa.


Sterilant Gases back to top

Ethylene Oxide (EtO)
Ethylene oxide is commonly used a sterilant for medical equipment and supplies. It is both flammable and highly reactive. Acute exposures to the 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. Acute overexposure to ethylene oxide causes conjunctival skin, and respiratory tract irritation, including rhinitis, cough, and shortness of breathe.


Exposure Limits
Agency Exposure Limit
OSHA (PEL) for General Industry: Cancer & Reproductive Hazard 29 CFR 1910.1047 -- 1 ppm TWA; 5 ppm (15 Minutes) Excursion Limit; 0.5 ppm Action Level
for Construction Industry: 29 CFR 1926.1147 requirements identical to 1910.1047
for Maritime: 29 CFR 1926.1147 requirements identical to 1910.1047
ACGIH (TLV) 1 ppm, 1.8 mg/m³ TWA; Appendix A2 - Suspected Human Carcinogen
NIOSH (REL) <0.1 ppm, <0.18 mg/m3 TWA; 5 ppm, 9 mg/m3 (10 Minutes) Ceiling; Appendix A - NIOSH Potential Occupational Carcinogens
NIOSH (IDHL) 800 ppm
(TWA=Time-weighted average; TLV=Threshold Limit Value; PEL=Personal Exposure Limit, REL=Recommended Exposure Limit; IDHL=Immediately Dangerous to Life and Health concentration)

References
OSHA Safety and Health Topics - Ethylene Oxide

Related Products
ORBO-100 Carbotrap™ Sorbent Tube, pk of 25 - (20255-U)
5L Tedlar® Gas Sampling Bag, pk of 10 - (24655)
Equity-5 GC Column, 60-m × 0.32 mm i.d. capillary (df = 1.0 µm) - (28251-U)


Common Solvents, Disinfectants and Antiseptics back to top

Aldehydes

Glutaraldehyde
Glutaraldehyde is a toxic chemical that is used as a cold sterilant to disinfect and clean heat-sensitive medical, surgical and dental equipment. It is used in a limited number of applications, rather than as a general disinfectant. Specific applications include use as a disinfecting agent for respiratory therapy equipment, bronchoscopes, physical therapy whirlpool tubs, surgical instruments, anesthesia equipment parts, X-ray tabletops, dialyzers, and dialysis treatment equipment.

Short-term exposure has been known to burn irritate the mucous membranes and the skin. Inhaling it can irritate the nose, throat and respiratory system resulting in coughing and wheezing. It may also cause nausea, drowsiness, dizziness and nosebleeds. Long-term effects result from Glutaraldehyde as a desensitizer. Those who are desensitized have strong reactions even with little exposure to the compound. Common responses are asthma attacks and trouble breathing, but also skin allergies and eczema, itching and rashes. It is one of the leading causes of workplace asthma.

Formaldehyde
Formaldehyde is a common indoor air pollutant that is colorless with a strong and unique odor. It is present in medical preservatives, as a component of surgical smoke, adhesives, particleboard, paints and coatings, paper, foam, etc. Workers can inhale formaldehyde in the gas form and adsorb it in the liquid form through the skin. Exposure may result in irritated or burning eyes, stuffy nose and skin rashes. It is also known to cause headaches and flu-like symptoms. Chronic exposure may also result in bronchitis. It can also trigger other ailments like asthma, and behave as an allergen.

It is one of the only VOC’s regulated by the EPA. However, OSHA regulates it as a known carcinogen. Formaldehyde is also a concern in other industries such as healthcare-human and animal, teachers and students in a laboratory environment, construction workers, pulp and paper, automotive, maritime, and so on. It is also a common contaminant investigated in Vapor Intrusion, Sick Building, and Building related illness cases.

Acetaldehyde
Acetaldehyde is a volatile, flammable and colorless liquid with a pungent, fruity odor commonly used in disinfectants. It is widely used as a chemical intermediate, principally for the production of acetic acid, pyridine and pyridine bases, peracetic acid, pentaerythritol, butylene glycol, and chloral. It is used in the production of esters, particularly ethyl acetate and isobutyl acetate. It is also used to manufacture dyes and aniline rubber, as a flavorant, component of paints, adhesives, coatings, etc. It is dangerous when exposed to heat or flame; it can react vigorously with oxidizing material, acid anhydrides, alcohols, ketones, phenols, halogens, isocyanates, and strong alkalides and amines. It is also incompatible with acids, bases, alcohol, ammonia, amines, phenols, ketones, and hydrogen cyanide. It will polymerize readily in the presence of trace metals (iron). Acetaldehyde can form unstable or explosive peroxides with exposure to air. It may polymerize under influence of air and heat, acids, or bases with potential of fire or explosion. It is polymerized violently by concentrated sulfuric acid. Rubber products decompose on contact with acetaldehyde, but it is not corrosive to most metals.

Workers in a wide range of industries from Healthcare to Paints and Coatings can be exposed by inhaling the fumes. When ingested or inhaled, acetaldehyde can irritate the eye, nose, and throat; cause conjunctivitis, coughing, central nervous system depression, eye and skin burns, dermatitis, and delayed pulmonary edema.

Acetaldehyde is a by-product of yeast production and is a naturally occurring compound in wine, bread, soy sauce and other yeast fermented products. It is approved for use in phenolic resins in molded containers for contact with nonacidic foods. Acetaldehyde is exempted from a residue tolerance when it is used as a fumigant for storage of apples and strawberries.


Exposure Limits
Contaminant/
Agency
Exposure Limit
Glutaraldehyde
ACGIH (TLV) 0.05 ppm Ceiling
NIOSH (REL) 0.2 ppm TWA
Formaldehyde
OSHA (PEL) for General Industry: 0.75 ppm; 2 ppm STEL
for Construction Industry: 0.75 ppm; 2 ppm STEL
for Maritime: 0.75 ppm; 2 ppm STEL
ACGIH (TLV) 0.30 ppm, 37 mg/m³ TWA
NIOSH (REL) 0.016 TWA; 0.1 ppm Ceiling (15 minutes)
NIOSH (IDHL) 20 ppm
Acetaldehyde
OSHA (PEL) for General Industry: 200 ppm; 360 mg/m³ TWA
for Construction Industry: 200 ppm; 360 mg/m³ TWA
for Maritime: 200 ppm; 360 mg/m³ TWA
ACGIH (TLV) 25 ppm, 45 mg/m3 Ceiling; Appendix A3 - Confirmed Animal Carcinogen with Unknown Relevance to Humans
NIOSH (REL) none established, Appendix A - NIOSH Potential Occupational Carcinogens; Appendix C - Supplementary Exposure Limits (Aldehydes)
NIOSH (IDHL) 2,000 ppm
(TWA=Time-weighted average; TLV=Threshold Limit Value; PEL=Personal Exposure Limit, REL=Recommended Exposure Limit; IDHL=Immediately Dangerous to Life and Health concentration)

References - all Aldehydes
OSHA Hospital eTool-Glutaraldehyde: Best Practices for the Safe Use of Glutaraldehyde in Health Care. OSHA Publication 3258, (2006), 261 KB PDF, 48 pages.
OSHA Safety and Health Topics - Formaldehyde
OSHA Formaldehyde Standard
OSHA Chemical Sampling Information - Formaldehyde
NIOSH Safety and Health Topic - Formaldehyde
EPA Air Toxics - Formaldehyde
OSHA Chemical Sampling Information - Acetaldehyde
NIOSH Pocket Guide - Acetaldehyde
Application Guide for RAD165 - radiello Passive Sampler for Aldehydes

Related Products
radiello Cartridge Adsorbent for Sampling Aldedydes - (RAD165)
radiello Filtration Kit, pk of 20 - (RAD174)
radiello Aldehyde Calibration Standard - (RAD302)
DSD-DNPH Passive Sampling Device for Aldehydes, pk of 10 - (28221-U)
ORBO-25 Sorbent Tube for Acetaldehyde, pk of 25 - (20357)
ORBO-827 Filter, 37 mm, pk of 25 - (20069)
Aldehyde Standards Aldehyde/DNPH Standards
Ascentis® HPLC Columns C18 and RP-Amide columns 25 or 15 cm x 4.6, 5 µm
Acetonitrile, Spectranal® grade - (34921)

Phenolic Compounds (Phenols)

Phenol is commonly used as an antiseptic and analgesic in the Healthcare Industry. It also has other uses such as the primary chemical in embalming fluid for its preservation characteristics. It is more widely used for this purpose in medical embalming versus for public where formaldehyde is most often used. It has other uses such as in the manufacture of drugs, herbicides, synthetic resins, and cosmetics.

Common symptoms of exposure: Eye, nose, throat irritation; anorexia, nausea, vomiting, weight loss, lassitude (weakness, exhaustion), headache, dizziness, muscle ache, pain; cardiac arrhythmia; labored breathing, shortness of breath, pulmonary edema, cyanosis; liver, kidney damage; skin burns, dermatitis; ochronosis; tremor, convulsions, twitching; metabolic acidosis.
Skin Absorption: Numbness, collapse, coma.
Ingestion: acute abdominal pain, sore throat, diarrhea; smoky, greenish-dark urine; shock or collapse.


Exposure Limits
Agency Exposure Limit
OSHA (PEL) for General Industry: 5 ppm, 19 mg/m³ TWA; Skin
for Construction Industry: 5 ppm, 19 mg/m³ TWA; Skin
for Maritime: 5 ppm, 19 mg/m³ TWA; Skin
ACGIH (TLV) 5 ppm, 19 mg/m³ TWA; Skin; Appendix A4 - Not Classifiable as a Human Carcinogen
NIOSH (REL) 5 ppm, 19 mg/m³ TWA Skin; 15.6 ppm, 60 mg/m³ Ceiling (15 Minutes); Skin
NIOSH (IDHL) 250 ppm
(TWA=Time-weighted average; TLV=Threshold Limit Value; PEL=Personal Exposure Limit, REL=Recommended Exposure Limit; IDHL=Immediately Dangerous to Life and Health concentration)

References
OSHA Chemical Fact File - Phenols
NIOSH Pocket Guide - Phenols
EPA Air Toxics - Phenols
Application Guide for RAD147 – radiello Passive Sampler for Phenols

Related Products
radiello Cartridge Adsorbents for Sampling Phenolic Compounds - (RAD147)
ORBO 615 - (20053)
Phenol Standards
SPB1000 Capillary GC Column, 30 m x 0.32 mm - (24315)
Petrocol™ DH50.2 Capillary GC Column, 50 m x 0.2 mm - (24133-U)
Nukol™ Bonded free fatty Acid Phase Capillary GC Column, 30 m x 0.32mm - (24131)


Other Contaminants back to top

Methyl Methacrylate (MMA)
Methyl Methacrylate is used in the healthcare and dentistry industries as bone cement. It is a monomer of acrylic resin that is both moldable and pliable. When exposed to MMA in the dental office, dentists and other dental staff may experience hypersensitivity, asthmatic reactions, local neurological symptoms, irritant and local dermatological reactions. It is irritating to the skin, eyes, and mucous membranes and may also result in allergic reaction.

In addition to its use in the healthcare field, MMA is widely used in the manufacture of resin and plastics and is impregnated in concrete to make it water repellant.


Exposure Limits
Agency Exposure Limit
OSHA (PEL) for General Industry:100 ppm, 410 mg/m³ TWA
for Construction Industry: 100 ppm, 410 mg/m³ TWA
for Maritime: 100 ppm, 410 mg/m³ TWA
ACGIH (TLV) 50 ppm, 205 mg/m³ TWA; 100 ppm, 410 mg/m³ STEL; SEN; Appendix A4 - Not Classifiable as a Human Carcinogen
NIOSH (REL) 100 ppm, 410 mg/m³ TWA
NIOSH (IDHL) 1,000 ppm
(TWA=Time-weighted average; TLV=Threshold Limit Value; STEL=Short-term Exposure Limit; PEL=Personal Exposure Limit, REL=Recommended Exposure Limit)

References
EPA Air Toxics - Methyl Methacrylate
OSHA Chemical Sampling Information - Methyl Methacrylate
NIOSH Pocket Guide - Methyl Methacrylate

Related Products
ORBO-356 TBC on Charcoal Tube, pk of 50 - (20047)
Polymer Standards - includes MMA Standards and other polymers
SPB™-1 Capillary GC Column, 60 m x 0.32 mm - (24297)