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P2Rx™ Topic Hubs

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P2 for Hospital Sterilizers: Complete List of Reference Documents
Table of Contents
Background and Overview
Operations
Reasons for Change
P2 Opportunities
Glossary of Terms
Where to Go for P2 Help
Acknowledgements
Complete List of Links

Browse by Keyword
Accidents - Prevention / Administrative agencies / Air monitoring / Air pollution / Air pollution control / Air quality / Air quality control / Air quality management / Alternative technologies / Bacteria / Bactericides / Best management practices / Biological monitoring / Body fluids / Cancer / More Keywords...

Browse by Resource Type
Article/report (18) / Fact sheet/checklist (6) / List (3) / Other resources (4) / Software/electronic tool (1) / Web site (9)

NOTE: [PDF] links require Acrobat Reader from Adobe.


- Article/report -    Top of Page

APIC State-of-the-Art Report: The role of infection control during construction in health care facilities
Abstract: This report reviews issues related to construction and renovation projects in health care facilities that can help prevent transmission of infectious agents to vulnerable patient populations, health care workers, and visitors.
Source: Association for Professionals in Infection Control and Epidemiology, Inc.
URL: http://www.apic.org/AM/Template.cfm?Section=Home&TEMPLATE=/C
M/ContentDisplay.cfm&CONTENTID=6369

Best Management Practices for Hospital Waste [PDF]
Abstract: Report: Comprehensive 392 page document handling all types of hospital waste. Includes section on air quality and sterilizer alternatives and vendors, WA state permitting information and complete list of air toxics found in hospitals.
Source: Washington Department of Ecology
URL: http://www.ecy.wa.gov/pubs/0504013.pdf

Best Practices for Cleaning, Disinfection and Sterilization - In All Health Care Settings [PDF]
Abstract: Thorough overview of best practices including a glossary of terms, assistance with selecting SUD resprocessers, a sterilization decision tree etc.
Source: Provincial Infectious Diseases Advisory Committee (PIDAC)
URL: http://www.oahpp.ca/resources/documents/pidac/2010-02%20BP%2
0Cleaning%20Disinfection%20Sterilization.pdf

Best Practices for Cleaning, Disinfection and Sterilization - In All Health Care Settings [PDF]
Abstract: Thorough overview of best practices including a glossary of terms, assistance with selecting SUD resprocessers, a sterilization decision tree etc.
Source: Provincial Infectious Diseases Advisory Committee (PIDAC)
URL: http://www.oahpp.ca/resources/documents/pidac/2010-02%20BP%2
0Cleaning%20Disinfection%20Sterilization.pdf

Cleaning, Disinfection and Sterilization Procedures
Abstract: Good article with basic methods elaborated for veteranary facilities, however is relevant to human health care facilities as well.
Source: Veteranary Technician
URL: http://delhisurgery.pbworks.com/w/page/17174402/Cleaning,%20
Disinfection,%20and%20Sterilization%20Procedures%20--%20
Veterinary%20Technician%20Article%20

EtO and Glutaraldehyde alternatives
Abstract: A report on the health risks of non-eco friendly disinfectants used in hospitals and better alternatives for them.
Source: Healthcare Environmental Resource Center
URL: http://www.hercenter.org/hazmat/steril.cfm

Evaluation of the Carcinogenicity of Ethylene Oxide (External Review Draft)
Abstract: This draft assessment document characterizes the potential for a carcinogenic health hazard from human inhalation exposure to EtO.
Source: EPA's National Center for Environmental Assessment
URL: http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=157664

Final Regulation Order: Ethylene Oxide Airborne Toxic Control Measure (ATCM)
Abstract: Final rule promulgated in 1999 by CARB shows an example of a state law regulating EtO sources over 25 lbs/year.
Source: California Air Resources Board
URL: http://www.arb.ca.gov/toxics/atcm/etoatcm.htm

Guidelines for Environmental Infection Control in Health-Care Facilities
Abstract: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC).
Source: CDC, HICPAC, American Society for Healthcare Engineering/American Hospital Association, vol. 2004
URL: http://www.apic.org/AM/Template.cfm?Section=Home&TEMPLATE=/C
M/ContentDisplay.cfm&CONTENTID=1174

Healthy Hospitals: Environmental Improvements Through Environmental Accounting [PDF]
Abstract: Discussion of environmental improvements for the health care industry.
Source: EPA
URL: http://www.epa.gov/oppt/library/pubs/archive/acct-archive/pu
bs/hospitalreport.pdf

Mortality among workers exposed to ethylene oxide
Abstract: Article describing a study of mortality in 18,254 U.S. workers exposed to ethylene oxide at 14 plants producing sterilized medical supplies and spices and results of research.
Source: New England Journal of Medicine
URL: http://www.nejm.org/doi/full/10.1056/NEJM199105163242004

Mortality study of ethylene oxide workers in chemical manufacturing: a 10-year update
Abstract: Mortality study on men assigned to units at a Union Carbide plant in Connecticut producing ethylene oxide by the chlorohydrin or direct oxidation processes from 1940 to 1988. (Full text of article requires online subscription.)
Source: National Center for Biotechnology Information
URL: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&d
b=PubMed&list_uids=8398856&dopt=Citation

Proper Sterilization of Instruments is Essential to Patient Safety
Abstract: Includes a brief discussion of the essential steps for ensuring patient safety by properly sterilizing instruments.
Source: Association for Professionals in Infection Control and Epidemiology, Inc.
URL: http://www.apic.org/Content/NavigationMenu/Publications/Infe
ctionConnection/Proper_Sterilization.htm

Recent Developments in Sterilization Technology
Abstract: Detailed description of sterilation technologies including their uses and advantages and disadvantages.
Source: Medical Device Link
URL: http://www.mddionline.com/article/recent-developments-steril
ization-technology

Recommended Practices for Surveillance
Abstract: The purpose of this document is to provide a framework for the development of epidemiological-based surveillance systems for use in health care settings.
Source: American Journal of Infection Control
URL: http://www.apic.org/AM/Template.cfm?Section=Surveillance_Def
initions_Reports_and_Recommendations&Template=/CM/Conten
tDisplay.cfm&ContentFileID=2710

Replacing Ethylene Oxide and Glutaraldehyde [PDF]
Abstract: Gives an overview of where EtO and glutaraldehyde are used in hospitals, the reasons to find alternatives and a case study that shows a cost benefit analysis of switching to alternate sterilization/disinfection methods and products.
Source: EPA
URL: http://www.epa.gov/region9/waste/p2/projects/hospital/glutar
eth.pdf

Rule and Implementation Information for Commercial Sterilizers
Abstract: Website with list of documents regarding the history and status of the EPA rules for commercial sterilizers. Includes Rule Information, Technical Information and Implementation Information.
Source: EPA
URL: http://www.epa.gov/ttn/uatw/eo/eopg.html

What Are Antimicrobial Pesticides?
Abstract: Fact sheet describing the categorization of ethylene oxide as a sterilizer in the antimicrobial pesticide group. Links to other resources such as chemical composition and laws affecting the use of these chemicals.
Source: EPA
URL: http://www.epa.gov/oppad001/ad_info.htm


- Fact sheet/checklist -    Top of Page

Environmental Self-Assessment for Health Care Facilities
Abstract: A quick and easy checklist of pollution prevention measures for health care facilities.
Source: New York State Department of Environmental Conservation Pollution Prevention Unit
URL: http://www.glrppr.org/contacts/fullrecord.cfm?sectordocid=93
2

Ethylene Oxide (EtO) Fact Sheet [PDF]
Abstract: Fact sheet gives resources to find out if you are working with EtO, how EtO enters and affects your body, tests for exposure and how to reduce exposure. Also lists additional resources.
Source: California Department of Health Services
URL: http://www.cdph.ca.gov/programs/hesis/Documents/eto.pdf

Ethylene Oxide Fact Sheet [PDF]
Abstract: Fact sheet written to give employers the information they need in order to manage staff exposure to EtO.
Source: OSHA
URL: http://www.osha.gov/OshDoc/data_General_Facts/ethylene-oxide
-factsheet.pdf

Fact sheet and information papers about Ethylene Oxide (EtO) Sterilizers [PDF]
Abstract: Fact Sheet: Background of regulations concerning EtO. Presents alternatives that can be used. *Note that hospital exemption is no longer valid.*
Source: Hazardous and Medical Waste Programs, Aberdeen Proving Ground, MD
URL: http://www.drozek.us/documents%20on%20Web%20site/Teaching/ar
ticles%20and%20topics/surgery%20misc/EOS/EtOSterilizers.pdf

Frequently-Asked-Questions about the Reprocessing and Reuse of Single-Use Devices by Third-Party and Hospital Reprocessors
Abstract: If a hospital is reprocessing or having a provider reprocess single use devices as an alternative to using EtO to sterilize reusable devices, this document provides guidance on selecting and evaluating a provider.
Source: Food and Drug Administration (FDA)
URL: http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidanc
e/GuidanceDocuments/ucm070916.htm

Proposed Air Toxic Standards for Hospital Sterilizers
Abstract: The Clean Air Act Amendments of 1990 require EPA to regulate sources of 187 listed toxic air pollutants. The Clean Air Act also requires EPA to identify industrial or "source" categories that emit one or more of these pollutants.
Source: EPA
URL: http://epa.gov/ttncaaa1/t3/fact_sheets/hosp_strlzr_fs_110106
.html


- List -    Top of Page

Disinfection and Sterilization High Level Disinfectants & Sterilants
Abstract: Lists alternative sterilization and disinfecting products and resources.
Source: Sustainable Hospitals
URL: http://www.sustainablehospitals.org/cgi-bin/DB_Report.cgi?px
=W&rpt=Cat&id=28

Disinfection and Sterilization High Level Disinfectants & Sterilants
Abstract: Lists alternative sterilization and disinfecting products and resources.
Source: Sustainable Hospitals
URL: http://www.sustainablehospitals.org/cgi-bin/DB_Report.cgi?px
=W&rpt=Cat&id=28

Infectious Diseases in Healthcare Settings
Abstract: Lists infectious diseases that may be transmitted and/or acquired in healthcare settings and links with suggestions about how to minimize risk for each disease.
Source: Center for Disease Control and Prevention (CDC)
URL: http://www.cdc.gov/hai/


- Other resources -    Top of Page

CAA SECTION 112 NESHAP: Ethylene Oxide Commercial Sterilization and Fumigation Operations
Abstract: APPENDIX 112H of the Clean Air Act that governs EtO for large sources.
Source: EPA
URL: http://www.epa.gov/EPA-AIR/1999/December/Day-03/a31354.htm

Detox Sterilization and Disinfection [PDF]
Abstract: PowerPoint about balance between sporicidal, viricidal, and bactericidal effectiveness, human and environmental health, compatibility with delicate devices and repair costs. Design tips to promote success and assure patient and health care worker safety.
Source: Hospitals for a Healthy Environment: Sharing Successes
URL: http://practicegreenhealth.org/pubs/sharing/SHC_InfectionCon
trolPolicy_7%2010CleaningofEquipment.pdf

Ethylene Oxide Emissions 1999 [PDF]
Abstract: This chart shows the sources of EtO emissions in 1999.
Source: EPA
URL: http://www.epa.gov/ttn/atw/nata1999/99pdfs/ethoxide.pdf

Infection Control Guidelines
Abstract: This collection of guidelines pertains to keeping patients and healthcare workers in healthcare settings protected from infectious diseases.
Source: Center for Disease Control and Prevention (CDC)
URL: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5210a1.htm


- Software/electronic tool -    Top of Page

Hospital eTool: Central Supply Module
Abstract: Virtual tour of hospital hazards. Covers the health effects of ethylene oxide gas exposure and options for reducing use.
Source: OSHA
URL: http://www.osha.gov/SLTC/etools/hospital/central/central.htm
l#ExposuretoEthyleneOxideGas


- Web site -    Top of Page

Association for Professionals in Infection Control and Epidemiology (APIC)
Abstract: Website: APIC's mission is to improve health and patient safety by reducing risks of infection and other adverse outcomes. Resources include practical guidelines and publications.
Source: Association for Professionals in Infection Control and Epidemiology (APIC)
URL: http://www.apic.org/AM/Template.cfm?Section=Home

Association for Professionals in Infection Control and Epidemiology (APIC)
Abstract: Website: APIC's mission is to improve health and patient safety by reducing risks of infection and other adverse outcomes. Resources include practical guidelines and publications.
Source: Association for Professionals in Infection Control and Epidemiology (APIC)
URL: http://www.apic.org/AM/Template.cfm?Section=Home

FDA-Cleared Sterilants and High Level Disinfectants with General Claims for Processing Reusable Medical and Dental Devices
Abstract: Alternative Disinfectants: A roster of FDA cleared steriliants and high-level disinfectants (HLDs) and conditions for their use.
Source: Food and Drug Administratio (FDA)
URL: http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidanc
e/ReprocessingofSingle-UseDevices/UCM133514

Guidance for Industry and FDA Staff: for Reprocessed Single-Use Medical [PDF]
Abstract: Website with information regarding regulations for the reprocessing of single-use medical devices (as an alternative to in-house sterilization of durable devices using EtO).
Source: FDA
URL: http://www.fda.gov/OHRMS/DOCKETS/98fr/03d-0309-gdl0001.pdf

NIOSH Alert: Preventing Worker Injuries and Deaths from Explosions in Industrial Ethylene Oxide Sterilization Facilities
Abstract: Website about Ethylene Oxide including; background, industrial sterilization process, safety, current standards, case reports, conclusions, recommendations, abbreviations a glossary and information about occupational illnesses, injuries, and deaths.
Source: National Institute for Occupational and Safety and Health (NIOSH)
URL: http://www.cdc.gov/niosh/docs/2007-164/

NIOSH Alert: Preventing Worker Injuries and Deaths from Explosions in Industrial Ethylene Oxide Sterilization Facilities
Abstract: Website about Ethylene Oxide including; background, industrial sterilization process, safety, current standards, case reports, conclusions, recommendations, abbreviations a glossary and information about occupational illnesses, injuries, and deaths.
Source: National Institute for Occupational and Safety and Health (NIOSH)
URL: http://www.cdc.gov/niosh/docs/2007-164/

Nurses' Health and Workplace Exposures
Abstract: Caring for patients during a typical workday, nurses handle dozens of chemicals, drugs, and other agents that are designed to prevent, diagnose, control, or cure diseases and other health conditions. These therapeutic agents can heal, but have side effects as well. For most patients, the benefits of tightly controlled doses usually outweigh the risks. But the same may not be true for nurses.
Source: Environmental Working Group
URL: http://www.ewg.org/research/nurses-health

Practice Guidance
Abstract: Website with links to a wide variety of infection control guidelines from specific to a single disease to general.
Source: Association for Professionals in Infection Control and Epidemiology (APIC)
URL: http://www.apic.org/AM/Template.cfm?Section=Guidelines&Templ
ate=/TaggedPage/TaggedPageDisplay.cfm&TPLID=6&ContentID=519

Sterilants and Disinfectants in Healthcare Facilities
Abstract: Website dedicated to those who want to go beyond mere compliance. Describes properties of sterilants and disinfectants, risks, compliance requirements, alternatives and disposal methods as well as listing additional resources.
Source: Hospitals for a Healthy Environment: Sharing Successes
URL: http://www.hercenter.org/hazmat/steril.cfm

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Hub Last Updated: 6/4/2013