ATS Pulmonary Function Laboratory Manual

ATS Pulmonary Function Laboratory Management & Procedure Manual | 3rd Edition

b. Steam at atmospheric pressure c. Boiling water d. Dry heat under pressure e. Dry heat at atmospheric pressure f. Water below its boiling point (pasteurization) 4.2. Cold liquid: These generally refer to the group of glutaraldehydes, which kill by binding to amino groups of proteins in microorganisms, thereby interrupting metabolism and reproduction. 1. In general, these agents are bactericidal, tuberculocidal, fungicidal, and viracidal in 10 to 30 minutes and sporicidal in about 10 hours. 2. Healthcare workers can be exposed to elevated levels (> 0.2 ppm) of glutaraldehyde vapor when the cleaning process takes place in poorly ventilated areas or when spills occur. Healthcare workers can also be injured by skin or eye contact. 4.3. Gas: Ethylene oxide (ETO) is the alkylating agent used extensively in gas sterilization. However, this agent is unsafe for the environment and requires stringent material preparation and monitoring. 1. ETO residues may form on substances that have been previously gamma irradiated, a process which produces a tissue-irritating substance: ethylene chlorhydrin. 2. ETO residues are mutagenic for bacteria, and mutagenic and carcinogenic to humans. 4.4. Other liquid disinfectants: alcohol, quaternary ammonium compounds, acetic acid, formaldehyde, phenols, iodine, chlorine, and hydrogen peroxide. 1. Acetic acid solutions, quaternary ammonium compounds, and household bleach may be used for disinfecting respiratory equipment. However, available studies have not been performed to verify the usefulness of these agents (11). 2. Alcohol and hydrogen peroxide may be used for skin cleaning and disinfection (11, 12). 5. The regular use of in-line filters during PF testing are not mandated when appropriate precautions are fol- lowed (e.g., regular cleaning, environmental engineering controls, and testing at end of day for those with known transmissible diseases). However, the use of in-line filters in some equipment, particularly multi- purpose testing systems with valve manifolds, may be indicated (3, 10). The effect of these filters on flow measurements is not clear, but they may have an influence. If in-line filters are used, interpretation of the data should allow for the possibility that the filters may affect the data. Further, if filters are used, it is rec- ommended that equipment be calibrated with the filters in place (3). Even when in-line filters are used, the need for regular cleaning and decontamination of lung function equipment is not eliminated. Accident, Fire, and Evacuation Procedures Laboratory management is responsible for maintaining and ensuring a safe working environment (2) and comply- ing with the Occupational Safety and Health Administration (OSHA) and other federal, state, and local regulatory standards. A good hazardous waste and universal precautions program is necessary to meet this need. In addition, policies and procedures should be developed that address patient, visitor, and employee safety issues that comply with institutional edict. Measures should also be described that show how similar mishaps can be prevented (e.g., through education and follow-up, and environmental redesign).

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