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?????Occupational health and safety in health
care

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• A. Nayebzadeh PhD., CIH

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• Anticipation
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Factors Affecting The Level of Exposure of
Operating Personnel to Nitrous Oxide

• A. Nayebzadeh PhD (McGill University)
• Certified Industrial Hygienist (USA)

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Reproductive toxic effects of N2O

• Since 70s epidemiological studies indicated
  positive association between N2O exposure and
  spontaneous abortion and birth defects
• Studies showed increased risk as much as
  threefold
• In 1994 NIOSH published a warning

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Introduction

• Preventive leave in Québec as soon as pregnancy
  is confirmed
• 90 salary until the end of pregnancy
• Zero exposure policy for N2O

• TLV-TWA 50 ppm
• Quebec program unique in North America
• Lack of previous environmental survey
• Huge cost for an ambiguous risk

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Objectives

• To evaluate the level of exposure to N2O among
  female OR personnel
• To determine factors affecting the level of
  exposure
• To assess needs to review the Québec preventive
  leave program

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Method and Material (1)

• McGill University Health Centre
• Five university hospitals
• 11500 employees
• 36 active operating rooms
• 130 nurses (f), 44 techs (f), other 24 (f)
• Team of HSE including IH and IH techs

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Method and Material (2)

• Use of MIRAN 1B2 (IR spectrophotometer) for
  direct reading and leak testing
• High P and low P testing and general monitoring
  in the OR blocks
• Use of Nitrous Oxide passive samplers followed by
  thermal desorption and IR analyzer
• 80 badges for shift-long monitoring of female
  employees
• Three hospitals within 3 months

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Method and Material (3)

• Employees were given a complete instruction
• Time spent in the OR type of surgery were
  recorded
• HP and LP leak number and concentrations were
  recorded
• Randomly selected days, employees
• Multiple-day sampling

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Results (Direct reading)

• One hospital did not have any HP leak
• Two other hospitals has one and three HP leaks
  each (100-600 ppm)
• HP leak created an ambient baseline
  concentrations of 0.5 to 10 ppm in the OR
• Majority of ORs had several LP leaks (25-250 ppm)
• Ambient level N2O after simulation in the OR
  0.5-14 ppm

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Results (Passive sampling)

• TWA- GM concentration lt2 ppm for hospital with no
  HP leak
• 15/18 not detectable
• TWA-GM lt2 ppm for hospital with one HP leak
• 17/21 not detectable
• TWA-GM 4.5 ppm for hospital with three HP leak
• 7/50 not detectable
• Max TWA observed 11.5 ppm

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Results

• HP leaks the most important determinant of N2O
  exposure
• Type of surgery the second most important
  determinant
• No obvious trend among job categories
• Overall TWA lt2 ppm

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Conclusion

• A simple management program can lead to a leak
  free environment
• Regular leak testing
• Training of Techs
• Quebec preventive program requires a complete
  revision
• The saving would be 40-50 million/y
• Epidemiological study can better detect the
  effectiveness of the Quebec program