Kako smo poboljšanim mjerama praćenja izloženosti i zaštite na radu snizili razine formaldehida u zraku u sveučilišnoj bolnici u Italiji: sažetak 20 godina iskustava

The last two decades have been crucial for the assessment of airborne formaldehyde (FA) exposure in healthcare environments due to changes in limits and reference values, definition of carcinogenicity, and new monitoring methods. The aim of this study was to analyse twenty years (1999–2019) of experience in automatic, continuous airborne FA monitoring in the Pathology Laboratory and operating rooms at the Careggi University Hospital, Florence, Italy. These 20 years saw gradual improvements in FA monitoring of exposed employees considered at maximum risk, including improvements in analytical methods of detection and sampling strategies, which came with changes in procedures and workflow operations. In 2019, after the adoption of safe practices, including a closed-circuit system using pre-loaded containers and a vacuum sealing, 94 % of the total measurements (FA concentrations) were lower than 16 μg/m3, and only 6 % ranged from 21 to 75 μg/m3. In the studied work units, the ratio between area and personal readings ranged from 0.9 to 1.0, both for long and short-term sampling. Personal sampling was simplified with a new workstation, which integrated different monitoring systems into an innovative ergonomic armchair equipped with personal sampling devices. Area monitoring was also improved with a real-time, continuous photoacoustic instrument. Over these 20 years, FA exposure significantly dropped, which coincided with optimised histology workflow and implementation of safety practices. For high-throughput screening and cost savings we propose an innovative ergonomic armchair station which allows remote continuous monitoring.Posljednja dva desetljeća bila su iznimno važna za procjenu izloženosti formaldehidu (FA) u zraku u zdravstvenim ustanovama zahvaljujući promjenama u preporučenim maksimalnim i referentnim vrijednostima, definiciji njegove kancerogenosti i novim metodama mjerenja/praćenja. Cilj je ovog istraživanja bio analizirati dvadeset godina (1999. – 2000.) iskustva u automatskom, kontinuiranom mjerenju razina FA-a u laboratoriju za patologiju i operacijskim dvoranama talijanske sveučilišne bolnice Careggi u Firenzi. Tijekom tih dvadeset godina bolnica je postupno poboljšavala metode praćenja razina FA-a i osoblja izloženoga najvećem riziku, analitičke metode detekcije i strategije uzorkovanja koje su bile popraćene promjenama u odgovarajućim postupcima i organizaciji rada. Nakon usvajanja novih postupaka zaštite na radu 2019., uključujući i zatvoreni sustav rukovanja spremnicima i sustav vakuumskoga zatvaranja, razine FA-a u 94 % izmjera bile su niže od 16 μg/m3, a samo 6 % izmjera kretalo se u rasponu od 21 do 75 μg/m3. Omjer izmjerenih razina prostornih i osobnih skupljača uzoraka u ispitanim scenarijima kretao se od 0,9 do 1,0, bez obzira na to je li posrijedi kratkoročno ili dugoročno mjerenje. Mjerenje osobnim mjeračima dodatno je pojednostavljeno novom radnom stanicom u obliku ergonomskoga radnog stolca, koji u sebi objedinjuje različite sustave praćenja i osobne mjerače. Nisu zaostala ni poboljšanja u prostornom mjerenju, budući da je uveden novi fotoakustični uređaj za kontinuirano mjerenje u stvarnom vremenu. U tih 20 godina izloženost FA-u drastično se smanjila, što je popraćeno poboljšanom organizacijom obrade histoloških uzoraka i zaštite na radu. Radnu stanicu u obliku ergonomskoga stolca svakako preporučujemo zbog velikog kapaciteta protoka za probirno mjerenje, značajnih ušteda i mogućnosti daljinskog upravljanja

Sigurnost rada u anatomskom laboratoriju s formalinom i inovativno praćenje procjene profesionalne izloženosti formaldehidu

This review is directed at preventive health professionals, anatomic pathologists and technicians to focus their attention on the rapidly growing field of safe formalin practices. An updated overview of the most recent improvements in preventive measures versus formaldehyde (FA) in the anatomic pathology laboratories (APL) is provided. The occupational hygienist role and the required knowledge for a modern and clear occupational exposure assessment are described. Real-time, in-continuous, commercial analyzers for repeated FA exposure assessment are considered to evaluate technical changes in air monitoring programs, introduced to mitigate FA emissions, in compliance with the adopted limit values. To better choose the adequate instrumentation, the main features of each FA monitoring instrument recently introduced on the market are listed. Moreover, the main features of the modern workflow setting in APL are summarized. A computer-based scientific and non-scientific reports search by key-words was performed on PubMed, Web of Science, Google Scholar and Google Patents databases, querying the following topics: i) grossing workstation for ergonomic layout, ii) commercially available direct reading tools to measure formalin, iii) real-time, in-continuous FA monitoring instruments for sale. This review represents a useful tool to summarize the technical requirements and expert know-how necessary to minimize FA emissions and produce an exhaustive FA assessment in the APL.Ovaj pregled usmjeren je na preventivne zdravstvene radnike, anatomske patologe i tehničare kako bi svoju pozornost usredotočili na brzo rastuće područje sigurnih formalinskih praksi. Ažurirani pregled nudi najnovija poboljšanja preventivnih mjera u odnosu na formaldehid (FA) u laboratorijima za anatomsku patologiju (APL). Opisana je uloga higijeničara na radu i potrebna znanja za modernu i jasnu procjenu izloženosti na radu. Komercijalni analizatori u stvarnom vremenu za kontinuiranu procjenu izloženosti FA razmatraju se za procjenu tehničkih promjena u programima praćenja zraka, uvedenim radi ublažavanja emisija FA, u skladu s prihvaćenim graničnim vrijednostima. Kako bi se bolje odabrala odgovarajuća instrumentacija, navedene su glavne značajke svakog instrumenta za praćenje FA koji je nedavno predstavljen na tržištu. Štoviše, sažete su glavne značajke suvremenih postavki tijeka rada u APL-u. Računalno zasnovano pretraživanje znanstvenih i neznanstvenih izvješća po ključnim riječima provedeno je u bazama podataka PubMed, Web of Science, Google Scholar i Google Patents, s težištem na sljedeće teme: i) prikupljanje radnih stanica za ergonomski raspored, ii) komercijalno dostupni alati za izravno očitanje mjerenja formalina, iii) instrumenti za kontinuirano praćenje FA u stvarnom vremenu u prodaji. Ovaj pregled predstavlja koristan alat za sažimanje tehničkih zahtjeva i stručnog znanja potrebnog za minimiziranje emisija FA i izradu iscrpne procjene FA u APL-u

Innovative monitoring of atmospheric gaseous hydrogen fluoride

Hydrogen fluoride (HF) is a basic raw material for a wide variety of industrial products, with a worldwide production capacity of more than three million metric tonnes. A novel method for determining particulate fluoride and gaseous hydrogen fluoride in air is presented herewith. Air was sampled using miniaturised 13 mm Swinnex two-stage filter holders in a medium-flow pumping system and through the absorption of particulate fluoride and HF vapours on cellulose ester filters uncoated or impregnated with sodium carbonate. Furthermore, filter desorption from the holders and the extraction of the pentafluorobenzyl ester derivative based on solid-phase microextraction were performed using an innovative robotic system installed on an xyz autosampler on-line with gas chromatography (GC)/mass spectrometry (MS). After generating atmospheres of a known concentration of gaseous HF, we evaluated the agreement between the results of our sampling method and those of the conventional preassembled 37 mm cassette (±8.10%; correlation coefficient: 0.90). In addition, precision (relative standard deviation for n=10, 4.3%), sensitivity (0.2 μg/filter), and linearity (2.0–4000 μg/filter; correlation coefficient: 0.9913) were also evaluated. This procedure combines the efficiency of GC/MS systems with the high throughput (96 samples/day) and the quantitative accuracy of pentafluorobenzyl bromide on-sample derivatisation

development of an innovative gas chromatography mass spectrometry method for assessment of formaldehyde in the workplace atmosphere

World consumption of formaldehyde (FA) is forecast to grow at an average annual rate of about 4% from 2015 to 2020 with world production to exceed 52 million tons in 2017. From the first day of January 2016, the Commission Regulation No. 91/2015 established the FA classification through an indication from European Chemical Agency as category 2 mutagenic and category 1B carcinogen. A novel method for the determination of gaseous FA in air is presented herewith. The sampling was carried out using a miniaturized cartridge by means of a medium-flow pumping system (1.0 L min-1, 5–60 min) and absorption of FA vapors on 2,4-dinitrophenylhydrazine. Cartridge desorption removing the excess derivatizing agent based upon solid-phase extraction was performed by an innovative xyz robotic system on-line with fast gas chromatography (GC)—mass spectrometry (MS). Through the generation of standard atmospheres of known concentration of FA, we evaluated the precision (relative standard deviation for n = 10, 8.8%), lower lim..

Assessment of occupational exposure to gaseous peracetic acid

Objectives In order to assess short-term exposure to peracetic acid (PAA) in disinfection processes, the Authors compared 4 industrial hygiene monitoring methods to evaluate their proficiency in measuring airborne PAA concentrations. Material and Methods An active sampling by basic silica gel impregnated with methyl p-tolyl sulfoxide (MTSO), a passive solid phase micro-extraction technique using methyl p-tolyl sulfide (MTS) as on-fiber derivatization reagent, an electrochemical direct-reading PAA monitor, and a novel visual test strip PAA detector doped with 2,2’-azino-bis (3-ethylbenzothiazoline)-6-sulfonate were evaluated and tested over the range of 0.06–16 mg/m3, using dynamically generated PAA air concentrations. Results The linear regression analysis of linearity and accuracy showed that the 4 methods were suitable for PAA monitoring. Peracetic acid monitoring in several use applications showed that the PAA concentration (1.8 mg/m3) was immediately dangerous to life or health as proposed by the National Institute of Occupational Safety and Health, and was frequently exceeded in wastewater treatment (up to 7.33 mg/m3), and sometimes during food and beverage processes and hospital high-level disinfection operations (up to 6.8 mg/m3). Conclusions The methods were suitable for the quick assessment of acute exposure in PAA environmental monitoring and can assist in improving safety and air quality in the workplace where this disinfectant is used. These monitoring methods allowed the evaluation of changes to work out practices to reduce PAA vapor concentrations during the operations when workers are potentially overexposed to this strong antioxidant agent. Int J Occup Med Environ Health 2018;31(4):527–53

Ažuriranje podataka o prožimanju zaštitnih medicinskih rukavica antineoplastičnim lijekovima

Occupational exposure to antineoplastic drugs (ADs) handling and administration is one of the main risks in the healthcare sector. Dermal absorption represents the primary route of exposure to ADs. Personal preventive equipment, especially medical gloves, is crucial to safeguard the workers health in ADs handling; thus, chemicals permeating through protective materials is an essential aspect to estimate and consider. Several studies on permeation through medical gloves reported that breakthrough time and permeation rate are the values that must be studied, observing that physical-chemical properties of drugs, PPE materials and thickness, and temperature are crucial features to estimate them. In the European Union, standardized permeation testing is not mandatory for gloves used in ADs manipulation, in contrast with the United States, that proposed stringent requirements in the American Society of Testing and Materials International standard D6978-05. This review would help identify the main characteristics of the best protective glove used by employees frequently exposed to ADs: the major aspects implicated in permeation, reported in the literature, are listed and discussed.Radna izloženost rukovanju i primjeni antineoplastičnih lijekova (AD) jedan je od glavnih rizika u zdravstvenom sektoru. Kožna apsorpcija predstavlja primarni put izlaganju AD-ima. Osobna preventivna oprema, posebno medicinske rukavice, presudna je za zaštitu zdravlja radnika u radu s AD-ima; prema tome, kemikalije koje prodiru kroz zaštitne materijale bitan su aspekt za procjenu i razmatranje. Nekoliko studija o prožimanju kroz medicinske rukavice izvijestilo je da su vrijeme proboja i brzina prodiranja vrijednosti koje se moraju proučavati, primjećujući da su fizičko-kemijska svojstva lijekova, OZO materijali i debljina i temperatura ključne značajke za njihovu procjenu. U Europskoj uniji, standardizirano ispitivanje prožimanja nije obvezno za rukavice koje se koriste u manipulaciji ADs, za razliku od Sjedinjenih Država koje su predložile stroge zahtjeve u međunarodnom standardu D6978-05 Američkog društva za ispitivanje i materijale. Ovaj pregled pomogao bi identificirati glavne karakteristike najbolje zaštitne rukavice koju koriste zaposlenici često izloženi AD-ima: glavni aspekti uključeni u prožimanje, priopćeni u literaturi, navedeni su i raspravljeni

Novi pristup procjeni profesionalne izloženosti antineoplasticima u bolničkom okruženju

Cytotoxic antineoplastic drugs (ADs) pose occupational risk and therefore require safe handling practices. We created, optimised, and validated an innovative monitoring protocol for simultaneously assessing 21 ADs in the healthcare environment, and also proposed surface exposure levels (SELs) to facilitate the interpretation of monitoring results, as there are currently no occupational exposure limits for ADs. The environmental AD monitoring data were collected in nine Italian hospitals between 2008 and 2017 and include 74,565 measurements in 4,814 wipe samples. Excellent overall recovery and sensitivity of the analytical methods along with innovative desorption automation make this protocol useful for routine monitoring. AD contamination was found in 3,081 measurements, confirming potential exposure in healthcare workers. Samples taken at the beginning and the end of work shifts, allowed to calculate 75th and 90th percentile values for each ADs both in preparation and administration units and we created a traffic-light colour-coding system to facilitate interpretation of the findings. The introduction of SELs will provide a solid basis for improving occupational safety and focusing on contamination control.Zbog profesionalnih rizika koje donose, s citotoksičnim antineoplasticima potrebno je sigurno rukovati. U ovom članku predstavljamo validirani inovativan protokol kojim se istodobno mogu pratiti razine dvadeset jednog antineoplastika u zdravstvenim ustanovama te predlažemo razine površinske izloženosti (engl. surface exposure levels, krat. SELs) koje bi trebale olakšati tumačenje dobivenih rezultata praćenja, budući da trenutačno nisu propisane granične vrijednosti profesionalne izloženosti antineoplasticima. Rezultate praćenja onečišćenja antineoplasticima prikupili smo od devet talijanskih bolnica od 2008. do 2017., a obuhvaćaju 74.565 mjerenja 4.814 uzoraka prikupljenih brisanjem površina namjenskim maramicama (brisom). Ovakav je protokol upravo zbog izvrsne iskorištenosti i osjetljivosti analitičkih metoda te inovativne automatizacije desorpcije pogodan za rutinsko praćenje izloženosti u bolničkom okruženju. Onečišćenje antineoplasticima utvrđeno je u 3.081 mjerenju, što potvrđuje rizik od izloženosti u zdravstvenih radnika. Uzimanjem uzoraka na početku i kraju radne smjene omogućen je izračun vrijednosti unutar 75. i 90. percentila za svaki antineoplastik za jedinice u kojima se oni pripremaju i primjenjuju. Na temelju tih izračuna osmislili smo semaforski sustav boja koji olakšava tumačenje rezultata, a predložene razine površinske izloženosti poslužit će kao dobar temelj za poboljšanje sigurnosti na radnome mjestu i smanjenje onečišćenja

Low-dose benzene exposure monitoring of oil refinery workers: inhalation and biomarkers

Airborne benzene in workplaces has progressively decreased due to preventive actions and the redesigning of facility processes. Professionals who assess occupational exposure should select techniques to detect benzene levels comparable to ambient air exposure. Thus, sensitive biomarkers are needed to discriminate the effects of confounding factors, such as smoking or sorbic acid (SA). In order to identify sensitive biomarkers and to study their correlation with confounding factors, 23 oil refinery workers were enrolled in the study; their airborne benzene exposures and biomarkers were monitored. Urinary benzene (U-B), t,t-muconic acid (t,t-MA), and S-phenylmercapturic acid (SPMA) were quantified. Urinary cotinine (U-C) and t,t-sorbic acid (t,t-SA) were evaluated to flag smoking and SA intake, respectively. The benzene measured in personal inhalation sampling ranged from 0.6 to 83.5 (median 1.7) µg/m3. The concentration range of the biomarkers, U-B, t,t-MA, and SPMA, were 18–4893 ng/m3, <10–79.4 µg/g creatinine, and <0.5–3.96 µg/g creatinine, respectively. Pearson tests were carried out; the best correlations were between airborne benzene and U-B (µg/L r = 0.820, p < 0.001) and between benzene and SPMA (g/L r = 0.812, p < 0.001), followed by benzene and t,t-MA (mg/L r = 0.465, p = 0.039). From our study, U-B and SPMA result to be the most reliable biomarkers to assess the internal number of low doses of benzene exposure, thanks to their specificity and sensitivity

Solid phase microextraction techniques used for gas chromatography: A review

In the last decade, the development and adoption of greener and sustainable microextraction techniques have been proved to be an effective alternative to classical sample preparation procedures. In this review, 10 commercially available solid-phase microextraction systems are presented, with special attention to the appraisal of their analytical, bioanalytical, and environmental engineering. This review provides an overview of the challenges and achievements in the application of fully automated miniaturized sample preparation methods in analytical laboratories. Both theoretical and practical aspects of these environment-friendly preparation approaches are discussed. The application of chemometrics in method development is also discussed. We are convinced that green analytical chemistry will be really useful in the years ahead. The application of cheap, fast, automated, "clever", and environmentally safe procedures to environmental, clinical, and food analysis will improve significantly the quality of the analytical data