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WCB – FUNDED PROJECT
CHEMICAL EXPOSURE
ASSESSMENT AT LANGLEY
MEMORIAL HOSPITAL
Nurses’ Exposure: Formaldehyde in the
Dirty Core and Nitrous Oxide in Labour and
Delivery
Langley, British Columbia
Summer 2001
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Résumé du contenu

Page 1 - MEMORIAL HOSPITAL

WCB – FUNDED PROJECTCHEMICAL EXPOSUREASSESSMENT AT LANGLEYMEMORIAL HOSPITALNurses’ Exposure: Formaldehyde in theDirty Core and Nitrous Oxide in Labour

Page 2 - Conclusions:

52.2.3 Potential Health EffectsA wide variety of health effects have been potentially linked with occupational nitrous oxideexposure including: reduc

Page 3 - Recommendations

World Headquarters625 Alpha Drive, Pittsburgh, PA 15238-2878Ph: 412-963-2000 • Fax: 412-963-2091 • Toll Free: 800-736-4666Website: www.bacharach-inc.c

Page 4

6frequency of nitrous oxide exposure occurred was associated with reduced fecundability (timerequired to get pregnant). They found no association bet

Page 5 - APPENDICES

7Studies have shown that intermittent flow apparatus produce far less pollution than continuousflow methods used by anaesthetic machines (Heath et al.

Page 6 - 2.1 Formaldehyde

8was dispensed for approximately 5-10 seconds and the remainder of the time was spent fillingout the biopsy record sheet.Nurses wore rubber latex glov

Page 7

9The ventilation control measures for nitrous oxide in the delivery room were the scavengingsystem (local exhaust ventilation) and the general dilutio

Page 8 - 2.2 Nitrous Oxide

104.1.3 Silica Gel TubesEnvironmental (area) sampling was conducted using two personal pumps and treated silica geltubes. The pumps were calibrated

Page 9

114.1.5 Smoke TubesSmoke tube testing was conducted to visualize the effectiveness of the general exhaustventilation in the dispensing area. The sm

Page 10

12instruments developer at Geotechnical Instruments in England. Product information can befound in Appendix 11 of this report.Several WCB of BC lab t

Page 11

13The sampling procedure for this study consisted of using passive dosimeters, a Miran infra-redspectrophotometer and the Medigas 3010, personal infra

Page 12 - 3.1 Dirty Core Area

14The Medigas 3010 was kept plugged in and on (with the pump off) during the down time. TheMedigas 3010 had to be kept on due to the 15 minute warm u

Page 13 - 3.2 Maternity Ward

iSUMMARYNurses’ exposure to formaldehyde in the dirty core and nitrous oxide in labour and deliveryrooms was measured on July 10 and July 26 to August

Page 14 - 4.1 Formaldehyde

154.2.7 StrategyThe sampling strategy using passive dosimeter, Miran and Medigas 3010 was chosen since therewould be at least one personal and one en

Page 15

165.1.3 Smoke TubesThe effectiveness of the general exhaust ventilation at removing the formalin vapours from thedirty core area was tested using a s

Page 16 - 4.2 Nitrous Oxide

175.2.2 Medigas 3010Personal exposure data for nurses was collected by the Medigas 3010 during 9 deliveries. Ofthese deliveries, data from Deliverie

Page 17

185.2.3 Passive Dosimeter BadgesPassive dosimeters were given to 2 to 4 nurses at the beginning of their shift. In total 31 badgeswere used in this

Page 18

19is 10 cfm. The balance report also contained the flow rates for the two exhausts in the mainroom, which were 203 cfm each and the bathroom exhaust

Page 19

20The average exposure data collected for the Miran were higher than the average exposure datacollected by the Medigas 3010. This would be expected s

Page 20 - 5.1 Formaldehyde

21Delivery 4 and Delivery 5 labour and deliveries occurred simultaneously. Delivery 4 wasmonitored for the entire labour and delivery and after the ba

Page 21 - 5.2 Nitrous Oxide

22screaming causing the nurse to be exposed to high levels of nitrous oxide. In other cases nitrousoxide was used for a short period of time and then

Page 22

237.0 CONCLUSIONSFormaldehyde:• Although worker exposure to formaldehyde in the dirty core area did not exceed WCB of BCexposure limits, exposures m

Page 23

248.0 RECOMMENDATIONSFormaldehyde:• Implement an exposure control plan as per OHS Reg 5.57 (2) – Designated Substances. Thisregulation states that

Page 24 - 6.2 Nitrous Oxide

iiRecommendationsFormaldehyde:• Implement an exposure control plan as per OHS Reg 5.57 (2) – Designated Substances. Thisregulation states that subst

Page 25

25APPENDIX 1SAMPLING LOCATION PLANS

Page 26

1Ox, CO2 and N2OcylindersShelf with IV solution andempty bucketsDoorwaySink Counter Double sinkLarge deep sinkExhaust inceilingSampleFridgeFormalindis

Page 27

2BathroomDoorBedFetal incubatorstored in cupboardSofaSinkWindowN2O supply and scavenging systemExhaust 0.5 mfrom floorExhaust 0.5 mfrom floorFresh air

Page 28 - 7.0 CONCLUSIONS

1APPENDIX 2PHOTOGRAPHS

Page 29 - 8.0 RECOMMENDATIONS

2Plate 1: View of dirty core sample room on the 2nd Floor of Langley Memorial Hospitallocated in Langley, British Columbia.Plate 2: View of the cent

Page 30 - SAMPLING LOCATION PLANS

3Plate 3: View of the left portion of the dirty core room.Plate 4: View of the formaldehyde dispensing station.

Page 31

4Plate 1: View of typical labour and delivery room on the 3rd Floor of Langley MemorialHospital located in Langley, British Columbia.Plate 5: Close-

Page 32

5Plate 2: View of typical labour and delivery room.Plate 3: View of typical labour and delivery room.

Page 33 - PHOTOGRAPHS

6Plate 4: View of typical labour and delivery room.Plate 5: View of nitrous oxide delivery system and scavenging system.Plate 6: View of scavenging

Page 34

7Plate 7: View of fresh air supply located in the ceiling of the labour and delivery room.Plate 8: View of room exhaust located approximately 40 cm

Page 35

iiiTABLE OF CONTENTS1.0 Introduction ...12.0 Liter

Page 36

8APPENDIX 3REFERENCES

Page 37

1ACGIH. 1992. Nitrous Oxide Criteria Document. 1134-1138.Ahlborg Jr. G, Hemminki K. 1995. Reproductive Effects of Chemical Exposures inHealth Pro

Page 38 - 0 delivery

2Heath BJ, Done M, Balog O, Ziccone S, Rosewarne F. 1994. The Effect of Scavengingon Nitrous Oxide Pollution in the Delivery Suite. Aust NZ J Obste

Page 39 - Room exhaust

3Schumann D. 1990. Nitrous Oxide Anaesthesia: Risks to Health Personnel. Int NursRev 37: 1: 214-7.Schuyt HC, Verberk MM. 1996. Measurement and R

Page 40 - REFERENCES

1APPENDIX 4FORMALDEHYDE GASTEC TUBERESULTS

Page 41

1Langley Memorial Hospital, Formaldehyde Dispensing Station located in Dirty Core, July 12, 2001SampleNumberTime (Amountof TimeDispensing)Tissue Type

Page 42

1APPENDIX 5NITROUS OXIDEPASSIVE DOSIMETER RESULTS

Page 43

1Nurses' Exposure to Entonox in Labour and Delivery *Langley Memorial Hospital, Langley, British ColumbiaNurse Identifier Date FieldSampleNumber

Page 44 - FORMALDEHYDE GASTEC TUBE

2Nurse's Name Date FieldSampleNumberStartTimeStop Time Length of shift (showlength of breaks)# deliveriesin shift# N2Odeliveries inshiftBadgepro

Page 45

3Nurse's Name Date FieldSampleNumberStartTimeStop Time Length of shift (showlength of breaks)# deliveriesin shift# N2Odeliveries inshiftBadgepro

Page 46 - PASSIVE DOSIMETER RESULTS

ivAPPENDICESAppendix 1 – Sampling Location PlansAppendix 2 – PhotographsAppendix 3 – ReferencesAppendix 4 – Formaldehyde Gastec Tube ResultsAppendix 5

Page 47 - < 0.7

1APPENDIX 6NITROUS OXIDEMIRAN GRAPHS

Page 48

1Miran Delivery 105010015020025030035021:10:4821:16:2821:22:0821:27:4821:33:2821:39:0821:44:4821:50:2821:56:0822:01:4822:07:2822:13:0822:18:4822:24:28

Page 49

2Miran Delivery 20501001502002503003502:21:082:33:282:45:482:58:083:10:283:22:483:35:083:47:283:59:484:12:084:24:284:36:484:49:085:01:285:13:485:26:08

Page 50 - MIRAN GRAPHS

3Miran Delivery 305010015020025030035018:36:2818:38:0818:39:4818:41:2818:43:0818:44:4818:46:2818:48:0818:49:4818:51:2818:53:0818:54:4818:56:2818:58:08

Page 51 - Miran Delivery 1

4Miran Del ivery 405010015020025030035013:29:2813:32:4813:36:0813:39:2813:42:4813:46:0813:49:2813:52:4813:56:0813:59:2814:02:4814:06:0814:09:2814:12:4

Page 52 - Miran Delivery 2

5Miran Delivery 605010015020025030035019:44:0819:47:2819:50:4819:54:0819:57:2820:00:4820:04:0820:07:2820:10:4820:14:0820:17:2820:20:4820:24:0820:27:28

Page 53 - Miran Delivery 3

6Miran Delivery 70501001502002503003505:57:286:04:086:10:486:17:286:24:086:30:486:37:286:44:086:50:486:57:287:04:087:10:487:17:287:24:087:30:487:37:28

Page 54 - Miran Del ivery 4

7Miran Delivery 80501001502002503003501:33:481:37:081:40:281:43:481:47:081:50:281:53:481:57:082:00:282:03:482:07:082:10:282:13:482:17:082:20:282:23:48

Page 55 - Miran Delivery 6

8Miran Delivery 905010015020025030035010:51:0810:54:2810:57:4811:01:0811:04:2811:07:4811:11:0811:14:2811:17:4811:21:0811:24:2811:27:4811:31:0811:34:28

Page 56 - Miran Delivery 7

1APPENDIX 7NITROUS OXIDEMEDIGAS 3010 GRAPHS

Page 57 - Miran Delivery 8

11.0 INTRODUCTIONBetween July 10, 2001 and August 2, 2001, Charlotte Ferguson, Masters student in OccupationalHygiene from McGill University, conduct

Page 58 - Miran Delivery 9

1Delivery 2 July 27, 20010501001502002503003502:12:012:14:012:16:012:18:012:20:012:22:012:24:012:26:012:28:012:30:012:32:012:34:012:36:012:38:012:40:0

Page 59 - MEDIGAS 3010 GRAPHS

2Delivery 3 July 27, 200105010015020025030035017:17:3017:21:3017:25:3017:29:3017:33:3017:37:3017:41:3017:45:3017:49:3017:53:3017:57:3018:01:3018:05:30

Page 60 - Delivery 2 July 27, 2001

3Delivery 4 July 30, 200105010015020025030035013:35:0013:39:0013:43:0013:47:0013:51:0013:55:0013:59:0014:03:0014:07:0014:11:0014:15:0014:19:0014:23:00

Page 61 - Delivery 3 July 27, 2001

4Delivery 5 July 30, 200105010015020025030035015:57:0015:58:0015:59:0016:00:0016:01:0016:02:0016:03:0016:04:0016:05:0016:06:0016:07:0016:08:0016:09:00

Page 62 - Delivery 4 July 30, 2001

5Delivery 6 July 31, 200105010015020025030035019:44:3019:48:3019:52:3019:56:3020:00:3020:04:3020:08:3020:12:3020:16:3020:20:3020:24:3020:28:3020:32:30

Page 63 - Delivery 5 July 30, 2001

6Delivery 7, August 1, 20010501001502002503003505:57:016:00:016:03:016:06:016:09:016:12:016:15:016:18:016:21:016:24:016:27:016:30:016:33:016:36:016:39

Page 64 - Delivery 6 July 31, 2001

1APPENDIX 8PATIENT CONSENT FORM

Page 65 - Delivery 7, August 1, 2001

2Patient Consent Form for study: Nurses’ Exposure to Nitrous OxideLangley Memorial Hospital, the Workers’ Compensation Board of BCand McGill Universi

Page 66 - PATIENT CONSENT FORM

3APPENDIX 9PASSIVE DOSIMETER PRODUCT INFORMATION

Page 68 - APPENDIX 9

2 Formaldehyde is used as a tissue preservative in hospitals as a 10% Formalin solution. Thissolution contains formaldehyde (3-4%), methanol (0.5-1.5

Page 70

6APPENDIX 10FORMALDEHYDE AND NITROUS OXIDEMSDS

Page 71 - APPENDIX 10

CAS# 50-00-0Code R-240010Formula weightSupersedesNot applicable.FORMALIN SOLUTION 10%Not applicable.Formaldehyde buffered 10%, R-240010, 41915For labo

Page 72 - Material Safety Data Sheet

Section V. Toxicological PropertiesMay be fatal by ingestion, inhalation, or by skin absorption. Lachrymator. Target organs: central nervous system,

Page 73 - Auto-ignition temperature

Section VI. First Aid MeasuresSection V. Toxicological PropertiesReaction with hydrochloric acid may form bis-chloromethyl ether which is a confirmed

Page 74 - Section VII. Reactivity Data

While the company believes the data set forth herein are accurate as of the date hereof, the company makes no warranty with respect theretoand express

Page 75 - Section X. Other Information

7APPENDIX 11MEDIGAS 3010 PRODUCT INFORMATION

Page 76 - APPENDIX 11

Instruction 19-9208N2O MonitorModel 3010P/N 19-7109Operation & MaintenanceRev. 5 – December 2001Product Leadership • Training • Service • Reliabil

Page 77 - Model 3010

WARRANTYBacharach, Inc. warrants to Buyer that at the time of delivery this Product will be freefrom defects in material and manufacture and will conf

Page 78 - WARRANTY

iInstruction 19-9210N2O Monitor 3010ContentsSPECIFICATIONS ... ii1.0

Page 79 - Contents

3In 1990 Blair et al., reviewed epidemiological evidence of the relationship between occupationalformaldehyde exposure and cancer. They reviewed 32 e

Page 80 - SPECIFICATIONS

SPECIFICATIONSRange & Resolution ... 0 to 1,000 ppm N2O; 5 ppm resolutionBattery Life ... Up to 9 hours on one chargeBa

Page 81 - 1.0 INTRODUCTION

Instruction 19-9208 1N2O Monitor 30101.0 INTRODUCTION1.1 GeneralThe Bacharach N2O Monitor 3010 is easy to use, but it is essential thatthis instructio

Page 82 - 1.3 Units of Measurement

N2O Monitor 30102 Instruction 19-92081.3 Units of MeasurementThe monitor’s LCD shows N2O concentrations expressed as either acurrent (real time) ppm r

Page 83 - 2.0 OPERATION

Instruction 19-9208 3N2O Monitor 30102.0 OPERATION2.1 Important NoteAlways ensure that the monitor’s gas inlet connector (Figure 1, Item B)and outlet

Page 84 - 2.4 Normal ppm Mode

N2O Monitor 30104 Instruction 19-92082.3 Start-Up DisplayThe display that appears when the monitor is first turned ON depends onwhat TWA format the mo

Page 85 - O Monitor 3010

Instruction 19-9208 5N2O Monitor 30102.5 Time Weighted Average (TWA) ModeThe monitor’s display is toggled between its normal and TWA displaymodes by p

Page 86 - 2.7 Auto-Stablization Mode

N2O Monitor 30106 Instruction 19-9208To start a new TWA reading after the monitor has been turned ON, pressand hold down the f1 button for 3 seconds o

Page 87 - 2.8 Leak Detection Mode

Instruction 19-9208 7N2O Monitor 3010Note: Only TWA values are displayed while in the auto-stablization mode—normal ppm readings are not available.Whi

Page 88 - 2.10 Datalogging

N2O Monitor 30108 Instruction 19-92082.9 Pump Operation (ppm Mode only)Important! The restrictor (Figure 1, Item C) must be removedfor the pump to ope

Page 89 - 2.13 Fault Condition Warning

Instruction 19-9208 9N2O Monitor 30102.11 Battery Low DisplayWhen the battery voltage falls below a pre-determined level, the displaywill alternate be

Page 90 - 2.16 Cross Sensitivity

4An article written by Munley et al., in 1986 looked at midwives’ exposure to nitrous oxide. Theyfound mean exposures that were not significantly les

Page 91 - 3.0 MAINTENANCE

N2O Monitor 301010 Instruction 19-92082.14 Flow Fail WarningWhen the pump is ON, a flow detector within the monitor will indicatewhen there is insuffi

Page 92 - 3.6 Factory Settings

Instruction 19-9208 11N2O Monitor 30103.0 MAINTENANCE3.1 Battery ChargingWhen the “BattLow” message is displayed (refer to Section 2.11), themonitor m

Page 93 - 3.7 Response Check

N2O Monitor 301012 Instruction 19-92083.2 CleaningKeep the monitor clean by wiping it with a soft cloth dampened with amild detergent solution. The mo

Page 94 - 3.8 Zero Calibration

Instruction 19-9208 13N2O Monitor 3010WARNING! After resetting the monitor to its factory settings,a zero calibration must now be performed per Secti

Page 95 - 3.8.2 Nitrogen Calibration

N2O Monitor 301014 Instruction 19-92083.8 Zero CalibrationThere are two methods available to perform a zero calibration:• Fresh Air• NitrogenNote that

Page 96

Instruction 19-9208 15N2O Monitor 30103.8.1 Air Calibration1. If not already done, switch ON the monitor per Section 2.2.2. Press the f3 button to tur

Page 97 - 4.0 PARTS & SERVICE

N2O Monitor 301016 Instruction 19-92082. Using the Bacharach Calibration Kit with an N2 cylinder attached asshown in Figure 2, adjust the regulator fo

Page 98

Instruction 19-9208 17N2O Monitor 30104.0 PARTS & SERVICE4.1 Replacement Parts and AccessoriesReplacement Parts110/240 VAC USA & European Plug

Page 99 - Instruction 19-9208 19

N2O Monitor 301018 Instruction 19-92084.2 Bacharach Sales/Service CentersCalifornia7281 Garden Grove Blvd.,Suite HGarden Grove, CA 92841Phone: (714) 8

Page 100 - World Headquarters

Instruction 19-9208 19N2O Monitor 3010

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