Authors (including presenting author) :
Fong YL (1), Li KLR (2), Fung HTJ (2), Wong WSW(3), Li SKK (2)(3), Leung HCW (2)(3), Au Yeung KHS (4) Yeung KW (1), Wong WK (1), Fung HY (1), Yan KH (1), Chow WCK (2)(3)
Affiliation :
(1) Specialist Out-patient Department, Pok Oi Hospital (2) NTWC Chemical Safety Working Group (3) OSH team, NTWC Human Resources Department (4) Foreman Team, Pok Oi Hospital
Introduction :
The diagnostic and therapeutic roles of endoscopes have been ever increasing. There are around 60 endoscopes in SOPC of Pok Oi Hospital. To replace the potential health hazardous chemical disinfectant Cidex OPA, a new disinfectant Rapicide PA Solution (Rapicide) was introduced with the new endoscope processing machine Medivators® Automated Endoscope Reprocessor (AER). It is a single use high-level disinfectant & divided into Part A and Part B solution. Rapicide Part A solution (Part A) is composed of 3 ingredients: 9% Acetic Acid, 5% Peracetic Acid (PAA) & 22% Hydrogen Peroxide (H2O2), pH value was 0.8 (strong acid and corrosive). Preliminary risk assessment reveals that Part A does have potential risk in operation especially when the solution is spillage in a large scale. Firstly, manufacturer’s instructions on spill cleanup and disposal and proper personal protection equipment (PPE) adoption seem inadequate to meet the real situation. Secondly, the instructions were unclear and insufficient. Thirdly, local emergency response should be enhanced for handling the spillage. SOPC intended to work with OSH team and other stake holders to prepare a more comprehensive guideline with reference to the actual operation in local departments and central support from hospital emergency team.
Objectives :
1. To design SOP with workflow on handling (refill and disposal) Rapicide with reference to the actual operation, simulation conducted and its spillage by a multidisciplinary approach (SOPC, OSH, Chemical Safety, Supporting Service); 2. To share the SOP to common users in NTWC and extend the format of designing the SOP to other high risk chemicals.
Methodology :
The evaluation were divided in 3 parts, (i) Document review, including, local requirements and standards; (ii) Assessment of inhalation risk in spillage during simulation spillage in the AER room: Part A solution was filled as a thin layer in each of the 18nos of 0.3metre2 trays and the air concentration of the active ingredients were measured; (iii) Actual operation including replacing the used bottles with around 150ml residues; (iv) A review meeting was held to analyze the gap for the recommendations and feasibility on implementation of the proposed workflow.
Result & Outcome :
(i) Part A was classified as Dangerous Goods, Chemical Waste and high risk. Specific requirements on ventilation system (e.g. Air Changes per Hour, airflow and exhaust) were required for endoscope cleaning. Chemical resistant PPE was required; (ii) In the simulation, concentration of PAA was 2.05ppm while Part A was filled in 9nos of trays (2.5L, half bottle); PAA was 3.00ppm when filled in 18nos of trays (5L, whole bottle). The reference value for PAA was 0.4ppm. The NTWC SOP on handling Rapicide and its spillage was developed by incorporating the evaluation results and advices from cluster’s stakeholders and endorsed by NTWC OSH Management Committee in 4Q18. The chemical spill kits would also be enhanced. With the standardized cluster-wide SOP, spill kits and reviewing methods of all high risk chemicals, the hazard communication program would be rendered more effective.
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