Knowledge Is Safety
Continuing Education Program
Do you have tickets to the Peracetic Acid (PAA) show? Grab some popcorn, sit back, and enjoy a short reintroduction to this chemical and the important things you should know as a user in your industry. We'll put a spotlight on PAA uses, risks, and little known facts so that your team can better understand how it can be safely and effectively used to reprocess medical devices.
Also known as peroxyacetic acid, PAA is an organic chemical compound that is used in a mixture with acetic acid and hydrogen peroxide in water. It is a colorless liquid that has a strong vinegar like odor that can be smelt at very low levels. It is a very powerful oxidant that can actually corrode copper, brass, bronze, plain steel, and galvanize iron.
The process for using peracetic acid as a disinfectant takes place with a combination of hydrogen peroxide, acetic acid and water. The stronger the solution of Peracetic acid, the more effective it is as an antimicrobial, but the more dangerous to everyone around. This highly biocidial oxidizer removes surface contaminants, such as viruses and spores, in many different ways.
As a chemical, Peracetic Acid (PAA) is quite unique because it can be used as both a disinfectant and sterilant of medical devices -- depending on the particular equipment and applications being used. PAA functions as a disinfectant by oxidizing the outer cell membrane of microbes. The stronger the solution of Peracetic acid, the more effective it is as an antimicrobial, but the more dangerous to everyone around. This highly biocidial oxidizer removes surface contaminants, such as viruses and spores, in many different ways. As a biocide, peracetic acid shows good efficacy against a broad spectrum of pathogens. When used in a buffered mixture, PAA can be used as a chemical sterilant for certain medical devices.
Instrument categories that are often validated for Peracetic Acid application include*:
-Oxygen Port Connectors
*Always follow original manufacturer instructions for use (IFUs) for the reprocessing of any particular device.
Anytime you use a chemical like Peracetic Acid (PAA) that is corrosive to the respiratory tract, eyes, and skin you should be on high alert. Exposure can occur through contact with the liquid aerosol, and according to the National Institute for Occupational Safety and Health (NIOSH) symptoms of acute exposure to Peracetic Acid vapor can include cough, labored breathing, and shortness of breath; skin redness, pain, and blisters; severe deep burns to the eyes. Concentrations of 15% or higher, also give rise to fire and explosion hazards and reactivity issues. Because of this it is important to ensure that training, safety precautions, and monitoring for Peracetic Acid exposures are in place.
If you don't know the risks of the chemicals you use, you can't protect against them. The only way to know for sure that you and your workers are being exposed to unsafe levels of PAA is with a continuous monitoring system.
Just because chemicals have an odor, doesn't mean YOU can always smell it -- and it definitely doesn't mean that if you can't smell it then you must be safe from any overexposure. A major concern regarding Peracetic Acid is that the chemical has a vinegar type odor, even at low levels, so the practical challenge becomes knowing if your level of exposure is safe... whether you smell it or not.
If you are working around PAA and do not smell it, it's likely due to what is called "olfactory fatigue." Olfactory fatigue (also known as nose blindness or odor fatigue) is the inability to distinguish a particular odor after a prolonged exposure to an airborne compound. Since Sterile Processing and Endo professionals are around these chemicals for hours every day, it's no surprise we experience this olfactory fatigue on a regular basis. While making sure the items you're disinfecting are safe, make sure to keep track of peracetic acid safety where you work. Humans can suffer from olfactory fatigue, but sensor monitoring can ensure 24/7 measurements and employee safety no matter the actual smell...
If Hydrogen Peroxide (H2O2) were a person, would you know its middle name? As a highly corrosive chemical that you likely work with every day in Sterile Processing, this is one chemical coworker that is worth getting to know a little bit more -- both because of how it can help and how it could hurt you.
Over the next couple of weeks, ChemDAQ will be reintroducing you to this chemical, its uses, risks, and little known facts. And since this is just one of the many chemicals that can be found in our CS/SPD departments, we will spotlight a few of the other need-to-know sterilants and disinfectants that should be better understood to be used safely and effectively to reprocess medical devices.
Now back to H202. If you are doing low temperature sterilization in CS/SPD, you are likely using Hydrogen Peroxide. But why? This chemical is effective because it is a strong oxidizing agent that breaks down into oxygen and water leaving no harmful residues. It has been shown to be effective against all forms of microorganisms. Want to know more? We thought so.
How and why is Hydrogen Peroxide used in medical device sterilization? What makes a surgical instrument a "low temperature" device? Materials and devices that cannot tolerate the high temperatures and humidity of steam sterilization, such as some medical plastics, electrical devices, and corrosion-susceptible metal alloys, can be sterilized instead by means of hydrogen peroxide. This method has been shown to be compatible with over 95% of medical devices and materials tested. Like all sterilization processes, the effectiveness of H2O2 can be altered by lumen length, lumen diameter, and residual organic material.
Instrument categories that are often validated for Hydrogen Peroxide sterilization include*:
- Rigid endoscopes
- Small diameter flexible endoscopes
- Electrocautery instruments
- Fiber optic light cables
- Doppler probes
- Laser instruments
- Ophthalmic lenses
- Power batteries
- Harmonic scalpels
- Internal defibrillator paddles
- Laryngoscope blades
*Always follow original manufacturer instructions for use (IFUs) for the sterilization of any particular device.
Let's talk about the important risks of Hydrogen Peroxide that your frontline technicians and department leaders should be aware of if you use this chemical. One complicating factor is that Hydrogen Peroxide has NO SMELL at low concentrations, making it impossible for workers to know if they are being exposed based on smell alone. This is a big danger of Hydrogen Peroxide because you would never know if you are being overexposed to it, until it's too late.
Potential risks include:
- Respiratory distress : fluid in the lungs after high level of exposure
- Chemical burns on the skin
- Animal carcinogen with unknown relevance to humans
- Eye irritation : eye damage after prolonged exposure
- Nose and throat irritation
- Skin irritation dermatitis
- Skin & hair bleaching
If you don't know the risks, you can't protect against them. The only way to know for sure that you and your workers are being exposed to unsafe levels of H2O2 is with a continuous monitoring system.
There is a common myth about Hydrogen Peroxide sterilization in the Sterile Processing industry claiming this modality is less dangerous than Ethylene Oxide. In reality, that’s simply not true. The fact is, H2O2 sterilization and its effects on employees is simply less researched -- and more importantly, less monitored.
Hydrogen Peroxide actually has the same Occupational Safety and Health Administration (OSHA) permissible Exposure Limit (PEL) of 1ppm as EtO, but it has a lower threshold from National Institute for Occupational Safety and Health (NIOSH) Immediately Dangerous to Life and Health (IDLH) of only 75 parts per million (ppm) for H2O2 as compared to 800 ppm for EtO.
All chemicals have risks. But the biggest danger is not knowing what they are so that you can adequately ensure employee safety in your department.
In terms of sheer history in medical device reprocessing, Ethylene Oxide (EtO or EO) has been around for decades and is most recently well-known for it's ability to end the carbapenem-resistant Enterobacteriaceae (CRE) outbreak of 2014-2015 related to endoscopic reprocessing challenges.
ETO is absorbed by many materials. For this reason, following sterilization the item must undergo aeration to remove residual ETO. Guidelines have been promulgated regarding allowable ETO limits for devices that depend on how the device is used, how often, and how long in order to pose a minimal risk to patients in normal product use.
How and why is Ethylene Oxide used in medical device sterilization? What are all the conversations about EtO in the news? "For many medical devices, sterilization with ethylene oxide may be the only method that effectively sterilizes and does not damage the device during the sterilization process. Medical devices made from certain polymers (plastic or resin), metals, or glass, or that have multiple layers of packaging or hard-to-reach places (for example, catheters) are likely to be sterilized with ethylene oxide.
With the recent closure of a large ethylene oxide sterilization facility in Illinois (Sterigenics), the temporary closure of another large Sterigenics facility in Georgia, and the potential closure of a large Becton Dickinson sterilization facility in Georgia, the FDA is concerned about the future availability of medical devices and impending medical device shortages." [FDA source: https://www.fda.gov/medical-devices/general-hospital-devices-and-supplies/ethylene-oxide-sterilization-medical-devices]
The dangers of Ethylene Oxide, and the need to monitor ETO gas vapor, are well established. One of the biggest dangers of Ethylene Oxide gas is that EtO is a known human carcinogen and overexposure to EtO can pose many negative health effects. There should NEVER be a time when workers do not know how much Ethylene Oxide they're breathing in, especially because it is a known human carcinogen. Workers are also at risk while Ethylene Oxide off-gassing, and without monitoring the off-gassing in the air, your employees are at risk.
According to the CDC, "Acute exposure to ETO may result in irritation (e.g., to skin, eyes, gastrointestinal or respiratory tracts) and central nervous system depression. Chronic inhalation has been linked to the formation of cataracts, cognitive impairment, neurologic dysfunction, and disabling polyneuropathies. Occupational exposure in healthcare facilities has been linked to hematologic changes and an increased risk of spontaneous abortions and various cancers..."
The only way to know for sure that you and your workers are being exposed to unsafe levels of EtO is with a continuous monitoring system.
For those of us who work around Ethylene Oxide (EtO) every day, it might be easy to believe that our processing equipment can be trusted -- and that if anything ever went wrong, we would be able to recognize it when it did. This myth is not only wrong, but it's dangerously wrong. EtO is an odorless, colorless gas that is nearly impossible to recognize until the exposure levels are high enough to already hurt you. There's no plume of gas hanging in the air, no smell of burning rubber or ammonia, not necessarily any cracking or sizzling at the point of the leak.
Because of this, we should not expect our teams to be able to safely work with this chemical without the proper technology necessary to ensure exposure levels are constantly keep within acceptable ranges according to regulatory guidelines. All chemicals have risks. But the biggest danger is not knowing what they are so that you can adequately ensure employee safety in your department. ChemDAQ continuous monitoring technologies help give you the tools you need to protect your team from the things they can't see, hear, or smell.