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NIOSH questions one method of UV infection control


October 1, 2009

Overexposed eyes and skin

Ultraviolet-C light, when pointed straight down into a surgical site for infection control purposes, can cause skin and eye problems for employees when personal protective equipment (PPE) is not used properly—which is a difficult proposition at best, says a report published by the National Institute for Occupational Safety and Health (NIOSH).

This concern prompted NIOSH to investigate ultraviolet-C (UV-C) light use at Brigham and Women’s Hospital in Boston. UV-C refers to a band of light wavelength.

Although some of the report’s findings seem damning for UV-C as a technology, the study’s coauthor, Dave Sylvain, MS, CIH, points out that this was an unusual application of the light.

“Most hospitals do not use UV-C in this fashion. It’s a relatively rare application,” Sylvain says.

UV light, which has been used in hospitals for a century to control bacteria—Danish scientist Niels Finsen won the 1903 Nobel Prize for Medicine with his tuberculosis-killing UV rig—often is installed near ceilings, with the lights pointed upward. This method generally does not create dangerous exposures and falls outside the scope of the new NIOSH report.

Worker safety is the focus

Sylvain recommends hospitals that use UV-C lights pointed down, as Brigham and Women’s did, seek other means of infection control.

One option is laminar flow ventilation, an expensive but effective room air filtering system. Brigham and Women’s has since ceased using UV-C, opting instead for laminar flow ventilation. The hospital did not return our request for further comment.

Sylvain also points out that in the report, NIOSH is not weighing in on which infection control method is most effective, but rather which one is safest for employees.

“If you can eliminate the hazard and substitute a nonhazardous method of achieving a goal, that is the first choice. The second is [limiting exposures with] engineering controls,” he says. “Last on the list should be personal protective equipment. Not that it can’t be used properly, but it’s more cumbersome for the employees and the hospital.”

Nurses’ union decries old approach

Evelyn Bain, M Ed, RN, COHN-S, coordinator of the Massachusetts Nurses Association’s Occupational Safety and Health Program, says her organization has received reports that the type of UV-C gear that was subject of the NIOSH investigation may be in use at other Massachusetts hospitals and is soliciting member reports on it.

Hospitals don’t seem to be aware of the dangers or the fact that UV-C isn’t a particularly effective means of infection control, Bain says.

“It may have been in 1935, but by 1995 and certainly by 2005, there are other strategies that would far surpass that in effectiveness,” she says.

Like Sylvain, Bain stresses that using UV-C lights facing upward for germicidal purposes is an appropriate use of the technology, as are lights hidden away in HVAC ducts.

Eye irritation points to exposure

According to the NIOSH document, UV-C Exposure and Health Effects in Surgical Suite Personnel, investigators found exposures from UV-C that were six to 28 times greater than the NIOSH recommended exposure limit.

Some employees wore PPE during UV-C use, others didn’t, and still others donned masks and gowns that had little protective effect.

Bain says PPE protocols, including wearing UV-blocking clothing and sunscreen in the surgical suite, were established in 2003 after the lights had been in use. A committee was formed at Brigham and Women’s to examine the issue after employees complained of eye and skin issues, and the hospital contacted NIOSH to investigate in 2007.

“We did sampling to determine exposure levels during surgeries, and we found they would exceed NIOSH’s recommended exposure limit for eight hours in roughly two and a half to three minutes,” Sylvain says, adding that it appeared most of the hospital’s PPE measures effectively limited exposures.

However, Brigham and Women’s sometimes encountered problems getting employees to wear the proper PPE, Sylvain says.

As a result, the report says, five of 14 orthopedic operating room (OR) nurses and surgical technicians interviewed reported symptoms possibly related to UV overexposure: three had eye irritation, one had actinic keratoses (a precursor to skin cancer), and another had both conditions.

Further, despite PPE protocols in place, most OR staff members reported lack of training in UV-C hazards and did not wear sunscreen at work for a variety of reasons, including some workers who found such measures cumbersome and uncomfortable.

For that reason alone, it may fall to safety officers to take the helm in protecting workers (for related information, see “Safety officers must take the lead with UV-C” at right).

Other advice to consider

Bain and Sylvain offer the following advice to hospital safety managers:

Read the NIOSH report and understand the hazards of UV-C lighting rigs to nurses, technicians, surgeons, patients, and others who may be exposed to such rays

Beware of salespeople in the facility trying to sell this gear

Keep records of processes (e.g., exposure monitoring and PPE training)

Huddle with the infection control officer to determine whether UV-C is being used in your facility similar to how it was used at Brigham and Women’s

If it is, determine whether employees are getting proper training, PPE, and exposure monitoring, and adjust your policies and procedures accordingly

If UV-C lamps are used facing upward, test the rooms for radiation exposure to confirm the lights are installed properly and verify that workers who change the bulbs are trained on proper protection

“It’s like what came out recently about tanning booths,” Bain says, referring to a July announcement from the World Health Organization that elevated UV-powered tanning booths to its highest cancer risk category—up with arsenic and cigarettes.

Editor’s note: To read the full NIOSH report, go to www.cdc.gov/niosh and search for HHE 3082.

Safety officers must take the lead with UV-C

There are only recommendations—not regulatory firepower—in the National Institute for Occupational Safety and Health’s report on ultraviolet-C (UV-C) light use at Brigham and Women’s Hospital in Boston.

Similarly, organizations such as a union have no enforcement authority and can only get involved at the behest of its members, says Evelyn Bain, M Ed, RN, COHN-S, coordinator of the Massachusetts Nurses Association’s Occupational Safety and Health Program.

That leaves it to hospital safety officers and occupational safety and health leaders to make sure employees aren’t put in the same position as the Brigham and Women’s nurses. If left untended, UV-C exposures could lead to workplace injuries and sickness.

“I can truly say that doctors get things into hospitals that the safety committee or [safety] director doesn’t know anything about,” Bain says. “We believe the doctors get what they want, and [UV-C] is being promoted as an infection control strategy.”

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