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Alphabetical Listing of Reference Documents by Title
NOTE: [PDF] links require Acrobat Reader from Adobe.
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.
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
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
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
Ethylene Oxide Emissions 1999 [PDF]
Abstract: This chart shows the sources of EtO emissions in 1999.
Ethylene Oxide Fact Sheet [PDF]
Abstract: Fact sheet written to give employers the information they need in order to manage staff exposure to EtO.
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
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
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
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)
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
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.
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
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
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
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.
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.
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
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.
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Hub Last Updated: 6/4/2013