Assessment of exposure to hydrogen peroxide in a parenteral nutrition unit: occupational risks involved?

Objective
In order to meet the specific nutritional needs of paediatrics, our parenteral nutrition unit prepares à la carte binary mixtures as well as lipid syringes, in a controlled atmosphere zone (ZAC) under laminar flow hoods (class A in B).
To do this, a disinfection of surfaces by air (DSVA) with hydrogen peroxide (H2O2) of the ZAC is carried out and the material necessary for the preparation is disinfected by H2O2 bath, in the laundry, before being returned to the clean area. Given the toxicity of H2O2, occupational exposure limit values (OELV) in workplace air were set by ANSES at 5 ppm for a brief exposure of 15 minutes and 1 ppm for an 8-hour day. The objective of this study was to assess the exposure of personnel to H2O2 in order to ensure the safety of all.

Material and Method
H2O2 levels were measured using the Dräeger® X-am 5100® detector (measuring range: 0.1 and 20 ppm; sensitivity: 0.1 ppm), over a 3-hour period and over several days:
* in the laundry: at the worker’s neck, at a fixed point on a shelf, above the disinfection bin
* in clean production area: in the middle of the room, at the neck of the manipulator aid, at a fixed point of a shelf, at the level of the flat pocket passat
* control lab, in the entrance, the middle of the room and the pharmacist’s office.

Results and discussion
The results were consistent in the clean room, in the pharmacist’s office and the control laboratory with measured rates between 0.2 and 0.4 ppm. Results were non-compliant in the laundry when disinfecting equipment by bath: average rates were 6.13 ± 0.59 ppm at the agent neck, 1.36 ± 0.59 ppm on the shelf, 2.77 ± 0.39 ppm above the open bin and 0.98 ± 0.54 ppm above the bin 30 to 90 minutes after closing. After contacting the professional risk prevention advisor, an action plan was quickly initiated with the implementation of professional personal equipment (PPE) more suitable in the laundry: wearing nitrile gloves long sleeves, cartridge mask with filter ABEKP3.

Conclusion
H2O2 is essential for its sporicidal activity. Although not identified as carcinogenic, OELVs must be observed to ensure the safety of staff. The rates found in the laundry were non-compliant and the PPE was previously insufficient for disinfection of the equipment by bath with H2O2. The PPE now used during the disinfection of the equipment is not very comfortable, a source capture system (fume hood) and a continuous H2O2 rate recorder installation were requested from the equipment plan. This study showed the importance of assessing staff exposure to H2O2 routinely.

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