From the Massachusetts Nurse Newsletter
June 2009 Edition
By Thomas P. Fuller, ScD, CIH, MSPH, MBA
After two years, the health hazard evaluation on the use of ultraviolet radiation in surgical suites at one hospital represented by MNA, has finally been released by the Department of Health and Human Services, National Institute of Occupational Safety and Health (NIOSH). The hospital has discontinued the use of ultraviolet radiation during surgeries and the lamps have been eliminated.
In 2003 several MNA nurses in the OR at this hospital reported sunburn and eye problems after working in the surgical suites with the UV radiation. The UV lamps used in this OR were installed so that the light was directed downward, exposing nurses and others. A labor/management health and safety committee was formed that included several hospital departments and the MNA to look into this concern. Collaboration with the hospital environmental affairs, safety and occupational health departments and the MNA, resulted in studies to measure the radiation exposure to the nurses and other workers. It was determined that the OR workers were being exposed to unsafe levels of ultraviolet radiation and a variety of safety controls were put in place. These included controls on the power settings of the lights, the identification of clothing that would protect the workers from hazardous levels, and the use of suntan lotion to be worn underneath the surgical scrubs. Training and education programs were developed and health screenings were instituted, both skin and eye screenings were conducted.
After a few years had passed, and the controls that had been put in place were shown to be ineffective, the hospital, at the suggestion of U. S. Department of Labor, OSHA, requested a health hazard evaluation from NIOSH. In the autumn of 2007 a team of government representatives visited the hospital and conducted their evaluation of the UV lights.
During the evaluation NIOSH;
- Met with management, MNA representatives, and employees
- Toured the ORs and observed the surgical staff at work
- Used personnel dosimeters to measure staff exposure to UV
- Evaluated the effectiveness of protective clothing
- Spoke with employees about possible skin and eye symptoms of overexposure
- Reviewed employee medical records
- Reviewed hospital policies for control of UV radiation.
As a result of the study NIOSH found that;
- UV radiation levels in the surgical suites were 28 times greater than NISOH recommended exposure limits
- Although some protective clothing provided by the hospital was effective at shielding the worker from hazardous levels of radiation, other masks and gowns worn by workers were not effective in stopping the harmful rays from reaching the skin
- Of the 14 surgical nurses interviewed during the study, nearly half of the workers had symptoms related to over exposure to UV radiation including eye irritation and actinic keratosis skin changes
- Most OR staff lacked training on UV radiation hazards
- The protective clothing and suntan lotion provided by the hospital was uncomfortable, cumbersome, and often unavailable, and many workers did not wear it
- Out of the 22 OR employees who received skin screening examinations, three had been diagnosed with melanoma, four with basal cell carcinoma, and five with actinic keratoses
The infection control benefits from these lighting systems has not been proven and other infection control techniques are much more effective, including the use of laminar flow ventilation, timely administration of antibiotics and good surgical technique. Unfortunately, despite the harmful effects of the ultraviolet radiation on surgical staff in this case, and the fact that this hospital discontinued the use of these lamps, these types of radiation systems are still being sold and installed in other hospitals, including hospitals in Massachusetts.
Other uses of UV for infection control
In March 2009 NIOSH published another related document “Environmental Control for Tuberculosis: Basic Upper-Room Ultraviolet Germicidal Irradiation Guidelines for Healthcare Settings.” In cases where UV radiation is proposed to be used as a germicide, NIOSH provides the following recommendations and limitations;
- UV bulbs should not be visible from any position in the room,
- Fixtures should contain baffles or louvers to direct UV to upper room,
- Safety switches should be near room normal lighting switches, but locked-out during maintenance,
- If unshielded UV is used in a room, automatic controls should shut the UV down when anyone enters the room either through motion sensors or controls on the doors.
- Systems should be installed by qualified professionals,
- Installers should have training on installation and placement,
- Engineers, industrial hygienists, health professionals, and health physicists should be be consulted prior to purchase and installation,
- System design should be coordinated with infection control criteria, ventilation systems, and surgical suite design and the proposed benefits should be quantified and compared against other viable infection control methodologies before being selected.
If you have comments, concerns or questions, please contact Evie Bain at firstname.lastname@example.org.