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
SUMMARY Nurses’ exposure to formaldehyde in the dirty core and nitrous oxide in labour and delivery rooms was measured on July 10 and July 26 to August 2, 2001, using personal and environmental sampling methods, at Langley Memorial Hospital (LMH) in British Columbia. The project was funded by the Workers’ Compensation Board (WCB) of British Columbia (BC) as part of a Chemical Exposure Risk Assessment for the South Fraser Health Region.
Recommendations Formaldehyde: • Implement an exposure control plan as per OHS Reg 5.57 (2) – Designated Substances. This regulation states that substances designated as ALARA substances must be substituted, however, if it is not practicable then the employer must implement an exposure control plan to maintain workers’ exposure as low as reasonably achievable below the applicable exposure limit.
TABLE OF CONTENTS 1.0 Introduction .......................................................................................................1 2.0 Literature Review..............................................................................................1 2.1 Formaldehyde ..................................................................................................................... 1 2.2 Nitrous Oxide.....................................................................................................
APPENDICES Appendix 1 – Sampling Location Plans Appendix 2 – Photographs Appendix 3 – References Appendix 4 – Formaldehyde Gastec Tube Results Appendix 5 – Nitrous Oxide Passive Dosimeter Graph and Table Appendix 6 – Nitrous Oxide Miran Graphs Appendix 7 – Nitrous Oxide Medigas 3010 Graphs Appendix 8 - Patient Consent Form Appendix 9 – Passive Dosimeter Product Information Appendix 10 – Formaldehyde and Nitrous Oxide MSDS Sheets Appendix 11 – Medigas 3010 product information iv
1.0 INTRODUCTION Between July 10, 2001 and August 2, 2001, Charlotte Ferguson, Masters student in Occupational Hygiene from McGill University, conducted a chemical exposure assessment at Langley Memorial Hospital (LMH) located at 22051 Fraser Highway in Langley, British Columbia. The assessment included a walk-through survey and sampling for formaldehyde in the dirty core area (outside operating rooms) and nitrous oxide in the maternity wards.
Formaldehyde is used as a tissue preservative in hospitals as a 10% Formalin solution. This solution contains formaldehyde (3-4%), methanol (0.5-1.5%), sodium hydroxide (0.1-0.6%), phosphoric acid (0.1-0.6%) and water (balance). Formaldehyde is a known eye, skin, respiratory tract irritant and is considered by the American Conference of Governmental Industrial Hygienists (ACGIH) as a suspected human carcinogen (nasal cancer). It is also designated as a suspected human carcinogen by the WCB of BC.
In 1990 Blair et al., reviewed epidemiological evidence of the relationship between occupational formaldehyde exposure and cancer. They reviewed 32 epidemiological studies and found an excess of brain cancer, colon cancer and leukemia among embalmers, anatomist and funeral directors. They noted that these professions are exposed to a wide variety of chemicals and therefore there are many potential causes of these excess cancers.
An article written by Munley et al., in 1986 looked at midwives’ exposure to nitrous oxide. They found mean exposures that were not significantly less than the Swedish 8hr TWA of 100 ppm and one average exposure was 360 ppm. These values were based on an unscavenged nitrous oxide delivery system and they noted that with scavenging in place the exposure could be reduced by a factor of 2 to 5.
2.2.3 Potential Health Effects A wide variety of health effects have been potentially linked with occupational nitrous oxide exposure including: reduced fertility, increased incidence of spontaneous abortion, increased frequency of sister chromatid exchanges (SCE), interference with vitamin B12 metabolism and audiovisual disturbances. Hoerauf et al. found an increased number of SCE from exposure in the operating room to an 8 hr TWA of 12.5 ppm.
frequency of nitrous oxide exposure occurred was associated with reduced fecundability (time required to get pregnant). They found no association between nitrous oxide exposure and spontaneous abortion. The main critique of this study was the lack of measured nitrous oxide exposure. At this point in the research, no dose and effect relationship has been established concerning the health effects of nitrous oxide exposure in the work environment. 2.2.
Studies have shown that intermittent flow apparatus produce far less pollution than continuous flow methods used by anaesthetic machines (Heath et al., 1994). One of the main problems in labour and delivery is that the mother controls the administration of nitrous oxide and removes the mask between contractions. Since the nitrous oxide is off gassed for 17 to 35 minutes after stopping it means the mother is off-gassing directly into the room between contractions. Heath et al.
was dispensed for approximately 5-10 seconds and the remainder of the time was spent filling out the biopsy record sheet. Nurses wore rubber latex gloves while dispensing the formalin. A plexiglass splash shield was fixed above the formalin container. The only ventilation located in the room was the general dilution ventilation provided by the HVAC system of the building.
The ventilation control measures for nitrous oxide in the delivery room were the scavenging system (local exhaust ventilation) and the general dilution ventilation (three fresh air supply outlets located in the ceiling and two wall mounted exhaust grills located near floor level. 4.0 SURVEY EQUIPMENT AND PROCEDURE 4.1 Formaldehyde 4.1.1 • Equipment Gastec Pump No.
4.1.3 Silica Gel Tubes Environmental (area) sampling was conducted using two personal pumps and treated silica gel tubes. The pumps were calibrated using a mini buck calibrator, model number M-5, Serial Number 050621 last calibrated on March 21, 2001. The pumps were field calibrated upon arrival at the hospital and at the end of the sampling day, each time requiring three readings within 5% to show that the pump had stabilized.
4.1.5 Smoke Tubes Smoke tube testing was conducted to visualize the effectiveness of the general exhaust ventilation in the dispensing area. The smoke tube was activated at intervals of one foot up to approximately seven feet from the exhaust. The ceiling mounted exhaust duct opening was located approximately seven feet away from the dispensing station. 4.1.6 Strategy Direct reading colorimetric tubes with hand held pump and treated silica gel tubes with low flow pumps were used.
instruments developer at Geotechnical Instruments in England. Product information can be found in Appendix 11 of this report. Several WCB of BC lab tests were conducted prior to testing this new instrument in the field. A sampling bag with 122 ppm N2O was sampled for a three hour period. Testing was also conducted using a 25 ppm standard. The response time of the unit was verified by testing a 122 ppm standard for three 20 minute intervals.
The sampling procedure for this study consisted of using passive dosimeters, a Miran infra-red spectrophotometer and the Medigas 3010, personal infra-red active sampler. The nurse wearing the Medigas 3010 was followed for the duration of the nitrous oxide use and her activities were noted in an activity log. 4.2.
The Medigas 3010 was kept plugged in and on (with the pump off) during the down time. The Medigas 3010 had to be kept on due to the 15 minute warm up time required and only a few minutes warning was given prior to the use of nitrous oxide. 4.2.5 Passive Dosimeter Badges At the beginning of each shift the charge nurse assigned patients to each nurse. Nitrous oxide passive dosimeter badges and badges were given to two to four nurses following this assignment.
4.2.7 Strategy The sampling strategy using passive dosimeter, Miran and Medigas 3010 was chosen since there would be at least one personal and one environmental sample per delivery to a maximum of two personal samples and one environmental sample for each delivery. The Medigas and passive dosimeter badges are personal samples and their data can be compared to the WCB OF BC exposure limits.
5.1.3 Smoke Tubes The effectiveness of the general exhaust ventilation at removing the formalin vapours from the dirty core area was tested using a smoke tube. The formalin dispensing station spigot was located approximately seven feet from the ceiling-mounted exhaust grill in the dispensing room.
5.2.2 Medigas 3010 Personal exposure data for nurses was collected by the Medigas 3010 during 9 deliveries. Of these deliveries, data from Deliveries 1, 8 and 9 are suspect because air calibration of the unit failed meaning the unit could not be re-zeroed and therefore the data was excluded from the results. Data for Deliveries 2 to 7 ranged from 0 to 566 ppm. Nitrous oxide does not have a ceiling limit and therefore 3X (75 ppm of up to 30 minutes) and 5X (125 ppm) excursion limits apply.
5.2.3 Passive Dosimeter Badges Passive dosimeters were given to 2 to 4 nurses at the beginning of their shift. In total 31 badges were used in this study. Three were blanks, exposure to nitrous oxide was captured for 16 of the badges and the remainder were worn but exposure to nitrous oxide did not occur during the shift. In the exposed badges (nitrous oxide exposure occurred during the shift) the values ranged from 1.3 ppm to 15.1 ppm for full shift readings (either 8 or 12 hour shifts).
is 10 cfm. The balance report also contained the flow rates for the two exhausts in the main room, which were 203 cfm each and the bathroom exhaust was 127 cfm. This gives a total of 9.9 air changes per hour for the room if the door was closed at all times. 6.0 DISCUSSION 6.1 Formaldehyde The results from the silica gel tubes and colorimetric tubes indicate that the levels of formaldehyde in the dirty core did not exceed the WCB OF BC 8 hour exposure limit of 0.3 ppm.
The average exposure data collected for the Miran were higher than the average exposure data collected by the Medigas 3010. This would be expected since the Miran was an environmental sample and was in the room with the patient for the entire labour and delivery. The nurse wearing the Medigas 3010 went in and out of the room during the early stages of labour and remained in the room during the active labour.
Delivery 4 and Delivery 5 labour and deliveries occurred simultaneously. Delivery 4 was monitored for the entire labour and delivery and after the baby was delivered at and the Medigas was moved into the Delivery 5 room. Delivery 6 used nitrous oxide from just before the Medigas 3010 unit was attached to the attending nurse and until 9:38 pm when the mother was taken to the high risk room and a cesarean section was performed under general anesthetic.
screaming causing the nurse to be exposed to high levels of nitrous oxide. In other cases nitrous oxide was used for a short period of time and then Demerol/Gravol or an epidural were given. Labour and delivery using nitrous oxide present a different situation than the gas is use in the operating room or the dental office. In this situation the mother controls the nitrous oxide administration. Hospital protocol states that the gas should only be used during contractions and not between them.
7.0 CONCLUSIONS Formaldehyde: • Although worker exposure to formaldehyde in the dirty core area did not exceed WCB of BC exposure limits, exposures must be maintained at levels as low as reasonably achievable below the exposure limit (designated as a suspected human carcinogen). Nitrous oxide: • Average exposures were below the 12 hr limit of 12.5 ppm with the exception of one nurse • 5 nurses’ personal data logged samples exceed the 5X excursion limit of 125 ppm.
8.0 RECOMMENDATIONS Formaldehyde: • Implement an exposure control plan as per OHS Reg 5.57 (2) – Designated Substances. This regulation states that substances designated as ALARA substances must be substituted, however, if it is not practicable then the employer must implement an exposure control plan to maintain workers’ exposure as low as reasonably achievable below the applicable exposure limit.
APPENDIX 1 SAMPLING LOCATION PLANS 25
Exhaust in ceiling Counter Double sink Dumbwaiter leading to central supply Sink Large deep sink Rubber bi Location of silica gel tubes Sample Shelves with empty containers Ox, CO2 and N2O cylinders Shelf with IV solution and empty buckets Formalin dispensing nozzle Formalin dispensing station 1 Doorway Sample Fridge
N2O supply and scavenging system Exhaust 0.5 m from floor Filter for Miran Miran location Door Fetal Bed Fresh air supply Window Fresh air supply Bathroom Exhaust 0.
APPENDIX 2 PHOTOGRAPHS 1
Plate 1: View of dirty core sample room on the 2nd Floor of Langley Memorial Hospital located in Langley, British Columbia. Exhaust Plate 2: View of the central portion of the dirty core room.
Plate 3: View of the left portion of the dirty core room. Plate 4: View of the formaldehyde dispensing station.
Plate 5: Close-up of formaldehyde bottle. Note: staining from leaking around the spout. Plate 1: View of typical labour and delivery room on the 3rd Floor of Langley Memorial Hospital located in Langley, British Columbia.
Plate 2: View of typical labour and delivery room. Plate 3: View of typical labour and delivery room.
Plate 4: View of typical labour and delivery room. Scavenging system N20 delivery system Plate 5: View of nitrous oxide delivery system and scavenging system. Plate 6: View of scavenging face mask.
Fresh air supply Plate 7: View of fresh air supply located in the ceiling of the labour and delivery room. Room exhaust Plate 8: View of room exhaust located approximately 40 cm from the floor.
APPENDIX 3 REFERENCES 8
ACGIH. 1992. Nitrous Oxide Criteria Document. 1134-1138. Ahlborg Jr. G, Hemminki K. 1995. Reproductive Effects of Chemical Exposures in Health Professions. JOEM 37: 8: 957-961. Axelson G, Ahlborg G Jr., Bodin L. 1996. Shift work, nitrous oxide exposure and spontaneous abortion among Swedish midwives. Occup Environ Med. 53: 374-378. Battacharya A, McGlothlin JD. 1999. Real-Time Exposure and Job Analysis Techniques to Solve Hazardous Workplace Exposures. Occupational Ergonomics Theory and Applications.
Heath BJ, Done M, Balog O, Ziccone S, Rosewarne F. 1994. The Effect of Scavenging on Nitrous Oxide Pollution in the Delivery Suite. Aust NZ J Obstet Gynaecol 34: 4: 484. Health Services Advisory Committee, Anaesthetic agents : controllling exposure under COSHH. 1995. HSE Books, Sudbury. Hoerauf KH, Koller C, Taeger K, Hobbhahn J. 1997. Occupational exposure to sevoflurane and nitrous oxide in operating room personnel. Int Arch Occup Environ Health 69:134-138.
Schumann D. 1990. Nitrous Oxide Anaesthesia: Risks to Health Personnel. Int Nurs Rev 37: 1: 214-7. Schuyt HC, Verberk MM. 1996. Measurement and Reduction of Nitrous Oxide in Operating Rooms. JOEM 38:10:1036-1040. Shortage-McCauley A. 1995. Reproductive hazards: an overview of exposures to health care workers. AAOHN J 43:12:614-621. Suruda A. 1997. Health Effects of Anesthetic Gases. Occ Med 12:4:627-635. Taskinen HK, KyyrOonen P, Sallmaen M, Virtanen SV, Liukkonen TA, Huida O, Lindbohm ML, Anttila A. 1999.
APPENDIX 4 FORMALDEHYDE GASTEC TUBE RESULTS 1
Langley Memorial Hospital, Formaldehyde Dispensing Station located in Dirty Core, July 12, 2001 Sample Time (Amount Number of Time Dispensing) 1 11:15 (5 sec) Tissue Type Nurse's Name uterus Volume Formalin (ml) 300 Nurse 1 Shift Length (hours) 8 Break Gastec Tube Lengths Type (hours) (Formaldehyde) 1x 0.5 and 91L 2X 0.25 1x 0.5 and 91LL 2X 0.25 N/A 91LL Reading (ppm) <0.2 2 11:40 (5 sec) gallbladder 250 Nurse 2 7.
APPENDIX 5 NITROUS OXIDE PASSIVE DOSIMETER RESULTS 1
Nurses' Exposure to Entonox in Labour and Delivery * Langley Memorial Hospital, Langley, British Columbia Nurse Identifier Date Field Sample Number Start Time Stop Time Length of shift (show # deliveries # N2O Badge Results length of breaks) in shift deliveries in problems? (ppm) shift Yes/no Nurse 1 7/26/01 BP1 7:45 19:27 12 hrs (1X1 hr and 2X 15 min) 0 0 no < 0.7 ug/sample Below detection limits (BDL) Nurse 2 7/26/01 BP02 7:45 15:15 8 (2 x 0.
Nurse's Name Date Field Sample Number Start Time Stop Time Length of shift (show # deliveries # N2O Badge Results length of breaks) in shift deliveries in problems? (ppm) shift Yes/no Comments Nurse 12 7/30/01 BP13 7:30 19:22 12 2 1 no 1.3 Delivery 5 Nurse 10 7/30/01 BP14 7:46 19:24 12 1 1 no 6.7 Delivery 4 Nurse 13 7/30/01 BP15 7:47 19:19 12 1 0 no 1.
Nurse's Name Date Field Sample Number Start Time Stop Time Length of shift (show # deliveries # N2O Badge Results length of breaks) in shift deliveries in problems? (ppm) shift Yes/no Nurse 16 8/1/01 BP27 19:44 7:00 12 0 0 no BDL Nurse 1 8/1/01 BP28 N/A N/A N/A N/A N/A N/A BDL Blank 8/2/01 BP29 N/A N/A N/A N/A N/A N/A BDL Nurse 19 8/2/01 BP30 7:52 19:32 12 1 1 yes 2.1 Nurse 20 8/2/01 BP31 7:51 19:27 12 0 0 yes 1.
APPENDIX 6 NITROUS OXIDE MIRAN GRAPHS 1
T im e 1 0:34:48 0:29:08 0:23:28 0:17:48 0:12:08 0:06:28 0:00:48 23:55:08 23:49:28 23:43:48 23:38:08 23:32:28 23:26:48 23:21:08 23:15:28 23:09:48 23:04:08 22:58:28 22:52:48 22:47:08 22:41:28 22:35:48 22:30:08 22:24:28 22:18:48 22:13:08 22:07:28 22:01:48 21:56:08 21:50:28 21:44:48 21:39:08 21:33:28 21:27:48 21:22:08 21:16:28 21:10:48 N2O Concentration (ppm) M ira n D e liv e ry 1 350 300 250 200 150 100 50 0
Time 2 9:57:28 9:45:08 9:32:48 9:20:28 9:08:08 8:55:48 8:43:28 8:31:08 8:18:48 8:06:28 7:54:08 7:41:48 7:29:28 7:17:08 7:04:48 6:52:28 6:40:08 6:27:48 6:15:28 6:03:08 5:50:48 5:38:28 5:26:08 5:13:48 5:01:28 4:49:08 4:36:48 4:24:28 4:12:08 3:59:48 3:47:28 3:35:08 3:22:48 3:10:28 2:58:08 2:45:48 2:33:28 2:21:08 N2O Concentration (ppm) Miran Delivery 2 350 300 250 200 150 100 50 0
18:36:28 18:38:08 18:39:48 18:41:28 18:43:08 18:44:48 18:46:28 18:48:08 18:49:48 18:51:28 18:53:08 18:54:48 18:56:28 18:58:08 18:59:48 19:01:28 19:03:08 19:04:48 19:06:28 19:08:08 19:09:48 19:11:28 19:13:08 19:14:48 19:16:28 19:18:08 19:19:48 19:21:28 19:23:08 19:24:48 19:26:28 19:28:08 19:29:48 19:31:28 19:33:08 N2O Concentration (ppm) MiranDelivery3 350 300 250 200 150 100 50 0 Time 3
13:29:28 13:32:48 13:36:08 13:39:28 13:42:48 13:46:08 13:49:28 13:52:48 13:56:08 13:59:28 14:02:48 14:06:08 14:09:28 14:12:48 14:16:08 14:19:28 14:22:48 14:26:08 14:29:28 14:32:48 14:36:08 14:39:28 14:42:48 14:46:08 14:49:28 14:52:48 14:56:08 14:59:28 15:02:48 15:06:08 15:09:28 15:12:48 15:16:08 15:19:28 15:22:48 15:26:08 15:29:28 15:32:48 15:36:08 15:39:28 15:42:48 N2O Concentration (ppm) Miran Delivery 4 350 300 250 200 150 100 50 0 Time 4
Time 5 21:44:08 21:40:48 21:37:28 21:34:08 21:30:48 21:27:28 21:24:08 21:20:48 21:17:28 21:14:08 21:10:48 21:07:28 21:04:08 21:00:48 20:57:28 20:54:08 20:50:48 20:47:28 20:44:08 20:40:48 20:37:28 20:34:08 20:30:48 20:27:28 20:24:08 20:20:48 20:17:28 20:14:08 20:10:48 20:07:28 20:04:08 20:00:48 19:57:28 19:54:08 19:50:48 19:47:28 19:44:08 N2O Concentration (ppm) Miran Delivery 6 350 300 250 200 150 100 50 0
5:57:28 6:04:08 6:10:48 6:17:28 6:24:08 6:30:48 6:37:28 6:44:08 6:50:48 6:57:28 7:04:08 7:10:48 7:17:28 7:24:08 7:30:48 7:37:28 7:44:08 7:50:48 7:57:28 8:04:08 8:10:48 8:17:28 8:24:08 8:30:48 8:37:28 8:44:08 8:50:48 8:57:28 9:04:08 9:10:48 9:17:28 9:24:08 9:30:48 9:37:28 9:44:08 9:50:48 9:57:28 N2O Concentration (ppm) Miran Delivery 7 350 300 250 200 150 100 50 0 Time 6
1:33:48 1:37:08 1:40:28 1:43:48 1:47:08 1:50:28 1:53:48 1:57:08 2:00:28 2:03:48 2:07:08 2:10:28 2:13:48 2:17:08 2:20:28 2:23:48 2:27:08 2:30:28 2:33:48 2:37:08 2:40:28 2:43:48 2:47:08 2:50:28 2:53:48 2:57:08 3:00:28 3:03:48 3:07:08 3:10:28 3:13:48 3:17:08 3:20:28 3:23:48 3:27:08 N2O Concentration (ppm) Miran Delivery 8 350 300 250 200 150 100 50 0 Time 7
10 :5 10 1:0 :5 8 10 4:2 :5 8 11 7:4 :0 8 11 1:0 :0 8 11 4:2 :0 8 11 7:4 :1 8 11 1:0 :1 8 11 4:2 :1 8 11 7:4 :2 8 11 1:0 :2 8 11 4:2 :2 8 11 7:4 :3 8 11 1:0 :3 8 11 4:2 :3 8 11 7:4 :4 8 11 1:0 :4 8 11 4:2 :4 8 11 7:4 :5 8 11 1:0 :5 8 11 4:2 :5 8 12 7:4 :0 8 12 1:0 :0 8 12 4:2 :0 8 12 7:4 :1 8 12 1:0 :1 8 12 4:2 :1 8 12 7:4 :2 8 12 1:0 :2 8 12 4:2 :2 8 12 7:4 :3 8 12 1:0 :3 8 12 4:2 :3 8 12 7:4 :4 8 12 1:0 :4 8 4: 28 N2O Concentration (ppm) Miran Delivery 9 350 300 250 200 150 100 50 0 Time 8
APPENDIX 7 NITROUS OXIDE MEDIGAS 3010 GRAPHS 1
2: 12 :0 2: 1 14 :0 2: 1 16 :0 2: 1 18 :0 2: 1 20 :0 2: 1 22 :0 2: 1 24 :0 2: 1 26 :0 2: 1 28 :0 2: 1 30 :0 2: 1 32 :0 2: 1 34 :0 2: 1 36 :0 2: 1 38 :0 2: 1 40 :0 2: 1 42 :0 2: 1 44 :0 2: 1 46 :0 2: 1 48 :0 2: 1 50 :0 2: 1 52 :0 2: 1 54 :0 2: 1 56 :0 2: 1 58 :0 3: 1 00 :0 1 N20 Concentration (ppm) Delivery 2 July 27, 2001 350 300 250 200 150 100 50 0 Time 1
17 :1 17 7:3 :2 0 17 1:3 :2 0 17 5:3 :2 0 17 9:3 :3 0 17 3:3 :3 0 17 7:3 :4 0 17 1:3 :4 0 17 5:3 :4 0 17 9:3 :5 0 17 3:3 :5 0 18 7:3 :0 0 18 1:3 :0 0 18 5:3 :0 0 18 9:3 :1 0 18 3:3 :1 0 18 7:3 :2 0 18 1:3 :2 0 18 5:3 :2 0 18 9:3 :3 0 18 3:3 :3 0 18 7:3 :4 0 18 1:3 :4 0 18 5:3 :4 0 18 9:3 :5 0 18 3:3 :5 0 19 7:3 :0 0 19 1:3 :0 0 19 5:3 :0 0 19 9:3 :1 0 19 3:3 :1 0 19 7:3 :2 0 19 1:3 :2 0 19 5:3 :2 0 9: 30 N2O Concentration (ppm) Delivery 3 July 27, 2001 350 300 250 200 150 100 50 0 Time 2
13 :3 13 5:0 :3 0 13 9:0 :4 0 13 3:0 :4 0 13 7:0 :5 0 13 1:0 :5 0 13 5:0 :5 0 14 9:0 :0 0 14 3:0 :0 0 14 7:0 :1 0 14 1:0 :1 0 14 5:0 :1 0 14 9:0 :2 0 14 3:0 :2 0 14 7:0 :3 0 14 1:0 :3 0 14 5:0 :3 0 14 9:0 :4 0 14 3:0 :4 0 14 7:0 :5 0 14 1:0 :5 0 14 5:0 :5 0 15 9:0 :0 0 15 3:0 :0 0 15 7:0 :1 0 15 1:0 :1 0 15 5:0 :1 0 15 9:0 :2 0 15 3:0 :2 0 15 7:0 :3 0 15 1:0 :3 0 15 5:0 :3 0 15 9:0 :4 0 15 3:0 :4 0 7: 00 N2O Concentration (ppm) Delivery 4 July 30, 2001 350 300 250 200 150 100 50 0 Time 3
15 :5 7 15 :00 :5 8 15 :00 :5 9 16 :00 :0 0 16 :00 :0 1 16 :00 :0 2 16 :00 :0 3 16 :00 :0 4 16 :00 :0 5 16 :00 :0 6 16 :00 :0 7 16 :00 :0 8 16 :00 :0 9 16 :00 :1 0 16 :00 :1 1 16 :00 :1 2 16 :00 :1 3 16 :00 :1 4 16 :00 :1 5 16 :00 :1 6 16 :00 :1 7 16 :00 :1 8: 00 N2O Concentration (ppm) Delivery 5 July 30, 2001 350 300 250 200 150 100 50 0 Time 4
19 :4 19 4:3 :4 0 19 8:3 :5 0 19 2:3 :5 0 20 6:3 :0 0 20 0:3 :0 0 20 4:3 :0 0 20 8:3 :1 0 20 2:3 :1 0 20 6:3 :2 0 20 0:3 :2 0 20 4:3 :2 0 20 8:3 :3 0 20 2:3 :3 0 20 6:3 :4 0 20 0:3 :4 0 20 4:3 :4 0 20 8:3 :5 0 20 2:3 :5 0 21 6:3 :0 0 21 0:3 :0 0 21 4:3 :0 0 21 8:3 :1 0 21 2:3 :1 0 21 6:3 :2 0 21 0:3 :2 0 21 4:3 :2 0 21 8:3 :3 0 21 2:3 :3 0 21 6:3 :4 0 21 0:3 :4 0 21 4:3 :4 0 8: 30 N2O Concentration (ppm) Delivery 6 July 31, 2001 350 300 250 200 150 100 50 0 Time 5
5: 57 6: :01 00 6: :01 03 6: :01 06 6: :01 09 6: :01 12 6: :01 15 6: :01 18 6: :01 21 6: :01 24 6: :01 27 6: :01 30 6: :01 33 6: :01 36 6: :01 39 6: :01 42 6: :01 45 6: :01 48 6: :01 51 6: :01 54 6: :01 57 7: :01 00 7: :01 03 7: :01 06 7: :01 09 7: :01 12 7: :01 15 7: :01 18 7: :01 21 7: :01 24 :0 1 N2O Concentration (ppm) Delivery 7, August 1, 2001 350 300 250 200 150 100 50 0 Time 6
APPENDIX 8 PATIENT CONSENT FORM 1
Patient Consent Form for study: Nurses’ Exposure to Nitrous Oxide Langley Memorial Hospital, the Workers’ Compensation Board of BC and McGill University are doing a research project concerning nurses’ exposure to nitrous oxide (laughing gas) during labour and delivery. Signing of this from acts as consent for Charlotte Ferguson, McGill Masters Student, to monitor the nurses during your delivery (only during nitrous oxide use). Your privacy will be respected at all times.
APPENDIX 9 PASSIVE DOSIMETER PRODUCT INFORMATION 3
4
5
APPENDIX 10 FORMALDEHYDE AND NITROUS OXIDE MSDS 6
Material Safety Data Sheet EMERGENCY NUMBERS: 255 Norman. Lachine (Montreal), Que H8R 1A3 (USA) CHEMTREC : 1(800) 424-9300 (24hrs) (CAN) CANUTEC : 1(613) 996-6666 (24hrs) (USA) Anachemia : 1(518) 297-4444 (CAN) Anachemia : 1(514) 489-5711 WHMIS Protective Clothing TDG Road/Rail WHMIS CLASS: D-1A D-2A Not controlled under TDG (Canada). PIN: Not applicable. PG: Not applicable. Section I. Product Identification and Uses Product name FORMALIN SOLUTION 10% CI# Not available.
Section III. Physical Data Physical state and appearance / Odor Clear, colorless liquid with formaldehyde odor. pH (1% soln/water) Not available. Odor threshold Not available. Percent volatile >90% (V/V) Freezing point Not available. Boiling point Not available. Specific gravity Not available. Vapor density Not available. Vapor pressure Not available. Water/oil dist. coeff. Not available. Evaporation rate Not available. Solubility Miscible in water.
Section V. Toxicological Properties Effects of Chronic Overexposure FORMALIN SOLUTION 10% page 3/4 Repeated or prolonged exposure to spray mist may produce respiratory tract irritation leading to frequent attacks of bronchial infection. Repeated exposure to an highly toxic material may produce general deterioration of health by an accumulation in one or many human organs. Rats chronically exposed to 14 ppm formaldehyde contracted nasal cancers.
Section VIII. Preventive Measures FORMALIN SOLUTION 10% page 4/4 Protective Clothing in case of spill and leak Wear self-contained breathing apparatus, rubber boots and heavy rubber gloves. Full suit. Spill and leak Evacuate and ventilate the area. Stay upwind: Keep out of low areas. Eliminate all sources of ignition. Absorb on sand or vermiculite and place in a closed container for disposal. Use non-sparking tools. Transport outdoors. Wash spill site after material pick up is complete.
APPENDIX 11 MEDIGAS 3010 PRODUCT INFORMATION 7
Instruction 19-9208 N2O Monitor Model 3010 P/N 19-7109 Operation & Maintenance Rev.
WARRANTY Bacharach, Inc. warrants to Buyer that at the time of delivery this Product will be free from defects in material and manufacture and will conform substantially to Bacharach Inc.’s applicable specifications. Bacharach’s liability and Buyer’s remedy under this warranty are limited to the repair or replacement, at Bacharach’s option, of this Product or parts thereof returned to Seller at the factory of manufacture and shown to Bacharach Inc.
N2O Monitor 3010 Contents SPECIFICATIONS ..................................................................................... ii 1.0 INTRODUCTION ................................................................................. 1 1.1 General ...................................................................................... 1 1.2 Main Features ........................................................................... 1 1.3 Units of Measurement ..........................................................
N2O Monitor 3010 SPECIFICATIONS Range & Resolution .......... 0 to 1,000 ppm N2O; 5 ppm resolution Battery Life ....................... Up to 9 hours on one charge Battery Recharge Time .... Approx. 2 hours Sensor ................................ Dual wavelength IR cell Operating Temperature ... 59 to 77 °F (15 to 25 °C) Zero Drift ...........................
N2O Monitor 3010 1.0 INTRODUCTION 1.1 General The Bacharach N2O Monitor 3010 is easy to use, but it is essential that this instruction manual be read and understood by all operators and maintenance personnel prior to using or servicing the monitor. The 3010 is a compact and lightweight N2O monitor that displays the current level of N2O gas in either the range of 0 to 1,000 ppm, or a Time Weighted Average (TWA) ppm value.
N2O Monitor 3010 1.3 Units of Measurement The monitor’s LCD shows N2O concentrations expressed as either a current (real time) ppm reading, or a time-weighted-average (TWA) ppm value. Note that the TWA ppm value is calculated using either the total elapsedtime period that the monitor was switched ON, or over a set 8-hour period. The method used to calculate TWA is set in software, and cannot be changed using the monitor’s front panel pushbuttons. Refer to Sections 2.5, 2.6, and 2.
N2O Monitor 3010 2.0 OPERATION 2.1 Important Note Always ensure that the monitor’s gas inlet connector (Figure 1, Item B) and outlet (Figure 1, Item D) are unobstructed and open to the atmosphere. Be careful not to breath directly on the monitor while taking a measurement; otherwise, inaccurate N2O readings will result. 2.2 Switching the Monitor ON/OFF Switch ON the monitor by momentarily pressing the button.
N2O Monitor 3010 2.3 Start-Up Display The display that appears when the monitor is first turned ON depends on what TWA format the monitor is currently in, and how long the monitor has been OFF. (Refer to Section 2.5 Time Weighted Average (TWA) Mode for a detailed description of the monitor’s two TWA formats.
N2O Monitor 3010 2.5 Time Weighted Average (TWA) Mode The monitor’s display is toggled between its normal and TWA display modes by pressing the f1 button. It is important to know that the time weighted average reading is available in two formats. This is designed to provide operators with the most appropriate data on their average ppm N2O exposure in the working environment. The two formats are identified by the appearance of the letters “TWA” or “twa” in the display.
N2O Monitor 3010 To start a new TWA reading after the monitor has been turned ON, press and hold down the f1 button for 3 seconds or more until the following display appears: Confirm that a new TWA is reading is desired by pressing and holding down the f2 button for 3 seconds or more. The message “New TWA Started” will appear while the f2 button is held down. Otherwise, press the f1 button to cancel this operation and return to the existing TWA. 2.
N2O Monitor 3010 Note: Only TWA values are displayed while in the autostablization mode—normal ppm readings are not available. While in the auto-stablization mode, and with a non-changing level of N2O being dectected, the monitor automatically cycles the pump ON and OFF for one minute intervals. Measurements taken during this time allow the monitor to automatically correct the readings for any drift.
N2O Monitor 3010 2.9 Pump Operation (ppm Mode only) Important! The restrictor (Figure 1, Item C) must be removed for the pump to operate in the ppm mode; otherwise, the monitor will automatically enter the auto-stablization mode as described in Section 2.7. With the monitor already switched ON, momentarily pressing the f3 button turns the internal pump ON. Pressing f3 again turns the pump OFF.
N2O Monitor 3010 2.11 Battery Low Display When the battery voltage falls below a pre-determined level, the display will alternate between its normal or TWA display and the following BattLow display: In addition, the monitor’s beeper will emit three rapid notes every 30 seconds. At this time the monitor should be given a full charge per Section 3.1 Battery Charging as soon as possible. 2.
N2O Monitor 3010 2.14 Flow Fail Warning When the pump is ON, a flow detector within the monitor will indicate when there is insufficient air flow, probably due to a blocked gas inlet or outlet. If a blockage occurs: the pump is automatically turned OFF, the monitor emits a beeping tone, and the following message flashes on the display. At this time the cause of the blockage should be removed before the pump is restarted. 2.
N2O Monitor 3010 3.0 MAINTENANCE 3.1 Battery Charging When the “BattLow” message is displayed (refer to Section 2.11), the monitor must be recharged using the supplied battery charger. Important! The battery has a long shelf life, but it is recommended that the battery be recharged once a month if left unused. Batteries that have not been charged for several months should be given at least two charge/discharge cycles before using the monitor.
N2O Monitor 3010 3.2 Cleaning Keep the monitor clean by wiping it with a soft cloth dampened with a mild detergent solution. The monitor can be sterilized by using isopropyl wipes. Do not immerse the unit in any sterilization agent. 3.3 Sunlight The unit should not be left out in direct sunlight, or in other areas where excessive heat exists, for long periods since component damage due to overheating may result. 3.4 Servicing There are no user-serviceable parts inside the monitor.
N2O Monitor 3010 WARNING! After resetting the monitor to its factory settings, a zero calibration must now be performed per Section 3.8 before the unit is used. 3.7 Response Check To ensure that the monitor is operating correctly, it is recommended that it be periodically exposed to N2O check gas as follows: 1. First perform a zero calibration per Section 3.8. 2. Connect a customer supplied cylinder of N2O check gas to a Bacharach regulator and hose as shown in Figure 2. 3.
N2O Monitor 3010 3.8 Zero Calibration There are two methods available to perform a zero calibration: • Fresh Air • Nitrogen Note that a span gas is not required. The monitor is digitally calibrated and has a linear curve relationship between 0 and 1,000 ppm N2O. Therefore a zero in fresh air or with Nitrogen will adjust the curve across its full reading range. Follow these guidlines when calibrating: • A calibration can be performed after the monitor’s initial 30 minute warm-up period has expired.
N2O Monitor 3010 3.8.1 Air Calibration 1. If not already done, switch ON the monitor per Section 2.2. 2. Press the f3 button to turn ON the pump. 3. Allow the pump to run at least 2 minutes to purge the monitor of all possible contamination. Make sure that the display reading is stable before continuing with Step 4. 4. Press and hold down the f2 button until the following displays appear: 5. Press the f1 button to zero the monitor using fresh ambient air.
N2O Monitor 3010 2. Using the Bacharach Calibration Kit with an N2 cylinder attached as shown in Figure 2, adjust the regulator for an outlet pressure of 2 psi (equivalent to a flow rate of approximately 120 cc/min.). Flow Nitrogen through the monitor for 2 minutes with the pump OFF before proceeding to Step 3. 3. Press and hold down the f2 button until the following displays appear: 4. Press the f1 button to zero the monitor using Nitrogen.
N2O Monitor 3010 4.0 PARTS & SERVICE 4.1 Replacement Parts and Accessories Replacement Parts 110/240 VAC USA & European Plug Charger ............................... 19-3312 Particulate Filter ............................................................................. 54-0548 Accessories 12 VDC In-Car Charger .................................................................. Carrying Case (large) ...................................................................... Carrying Case (small) ...............
N2O Monitor 3010 4.2 Bacharach Sales/Service Centers California 7281 Garden Grove Blvd., Suite H Garden Grove, CA 92841 Phone: (714) 895-0050 FAX: (714) 895-7950 E-Mail: calservice@bacharach-inc.com Indiana 8618 Louisiana Place Merrillville, IN 46410 Phone: (219) 736-6178 FAX: (219) 736-6269 E-Mail: indservice@bacharach-inc.com New Jersey 7300 Industrial Park Rt. 130, Bldg. 22 Pennsauken, NJ 08110 Phone: (609) 665-6176 FAX: (609) 665-6661 E-Mail: njservice@bacharach-inc.
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World Headquarters 625 Alpha Drive, Pittsburgh, PA 15238-2878 Ph: 412-963-2000 • Fax: 412-963-2091 • Toll Free: 800-736-4666 Website: www.bacharach-inc.com • E-mail: help@bacharach-inc.com Printed in U.S.A.
