From the Massachusetts Nurse Newsletter
September 2004 Edition
By Christine Pontus, MS, RN, COHN-S
Associate Director, Health & Safety
In early winter of 2003, the Massachusetts Nurse carried an article regarding our investigation of a possible formaldehyde substitute. With research and inquiry through individual Web sites and contacts at the University of Maryland, I was able to reach Dr. Stewart Lipton the owner/inventor/creator of a substitute formaldehyde product called NOTOXhisto (NOTOX). I spoke with Dr. Lipton and shared some of the MNA’s concerns associated with the use of formaldehyde, and we talked about the reasons why we were trying to find a safe and effective formaldehyde substitute available for hospitals, ambulatory care units, health care facilities and laboratories.
I asked Dr. Lipton if he knew if NOTOX was as effective in similar applications when used as a substitute for formaldehyde. He noted, "I believe NOTOX has different penetration times for different tissues when compared to formaldehyde." Dr. Lipton agreed to give me a list of health care facilities across the United States that recently used the product. My plan was to ask three facilities referenced by Dr. Lipton the following questions.
- Why did you change to NOTOX?
- How satisfied are you and how is it used in your facility?
- Would you be a reference contact for others interested in this product?
I called representatives from the first three facilities on Dr. Lipton’s list, and asked the previous questions.
- In response to question number one, two people responded that they were looking for a safer substitute and one person said they did not know why their faculty switched to NOTOX.
- In response to question number two, three people responded that they were satisfied with the product and that it was used on human tissue.
- In response to question number three, one person stated they would be a reference contact; two declined.
According to Thomas P. Fuller ScD, CIH and MSPH, "Anyone working with formaldehyde must receive training on the health effects and appropriate controls to be taken when working with the chemical."
The best safety control is to not use formaldehyde at all. Formaldehyde substitute chemicals such as Glyo-fixx, Prefer, Histofix and others have appeared on the market in recent years. Due to the chemical structures of these products they are safer than formaldehyde and perform equally as well.
Administrative controls for formaldehyde include chemical specific training programs, container labeling, monitoring programs, medical surveillance and good housekeeping.
Due to the hazardous nature of formaldehyde, the Occupational Safety and Health Administration has set the Permissible Exposure Level (PEL) for formaldehyde at 0.75 ppm for an eight hour work day. The formaldehyde Short Term Exposure Level (STEL) is 2.0 ppm for a time limit up to 15 minutes four times a day. The Action Level (AL) for formaldehyde is 0.5 ppm and represents the concentration which workers must enter the medical surveillance program and additional air monitoring. It is relatively easy to reach any of these levels during typical hospital activities where formaldehyde is used.
Although the medical community tends to be resistant to change, as the hazardous nature of formaldehyde becomes more and more evident, the need for product substitution and added safety precautions become more urgent. It is very difficult to meet OSHA and EPA safety and effluent restrictions without vigilant actions by a facility’s environmental health and safety office. Unless your facility is performing annual air monitoring, training, medical surveillance, and effluent testing, there is a good likelihood that it is not in compliance."
For further information on possible formaldehyde alternatives, contact Chris Pontus.
*SHP is the Sustainable Hospitals Project at UMass Lowell. It can be reached at www.sustainablehospitals.org.