So you think you know about the risks from Formalin spills?

So you think you know about the risks from Formalin spills?

Original illustration for Healthcare-Arena by Fran Orford

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Formaldehyde is a colourless, corrosive gas, which has a pungent, irritating odour.1 When used at 5% solution with water as a disinfectant as it is effective in killing bacteria, fungi and viruses. Formalin, the most commonly used form of formaldehyde in healthcare, is the standard fixative for histological specimens.1 It is a solution of approximately 4% formaldehyde and water (known as 10% NBF) and is ubiquitous in clinical laboratories, pathology laboratories, and in operating rooms.

Despite Fischer’s 1905 publication demonstrating the adverse effects of formaldehyde and formalin2, it is only in recent years that both the International Agency for Research on Cancer (IARC)3 and the European Union4 have classified formaldehyde as a Class 1B carcinogen and Class 2 mutagen.

Other adverse effects, noted in Fischer’s paper,2 arise from exposure to formalin and formaldehyde such as irritation of the nose, throat and mouth if inhaled, burns and ulcers in the stomach or intestines if ingested, burns from vapour, redness, itching, rash and swelling of the skin from formaldehyde contact, and irritation, stinging, burning, tearing and eyelid spasms in eye contamination.1

Issues

In addition to the guidelines produced by the Control of Substances Hazardous to Human Health (COSHH) (Health and Safety Executive (HES)5 relating to the handling of hazardous substances, most healthcare organisations have local guidance on the collection, labelling and transport of specimens. These include:

  • Identifying the correct size of container for the specimen
  • Filling of the container with formalin
  • Wearing of protective clothing
  • Storing of specimen containers for collection

However, during biopsy procedure in the operating room, surgeons and nurses are always exposed to a certain level of risk; for example, formalin may accidentally spill on the skin, or its vapours might affect the respiratory system & the eyes when they handle biopsies with the traditional pre-filled containers. A study by Steeleman et al6, found that of 648 adverse events, an incorrect collection technique occurred in 3.5% of cases (n=23), which could lead to accidental exposure.

In addition to those problems, modern healthcare institutions often have multiple clinics, hospitals, operating rooms, and laboratories at separate geographic locations. This requires that surgical tissue samples be transported over significant distances in formalin-filled containers, greatly increasing the risk of spills.

Spill management

Being such a light and highly volatile molecule, formaldehyde has a tendency to evaporate very easily, whenever a spillage or a leakage occurs. Standard procedure in most hospital or laboratory environments would include cordoning off the spill area during clean-up, and potentially evacuating personnel to avoid exposure to fumes. However, ordinary formaldehyde neutralizers need a long time to take effect and there is a lack of solutions against ordinary formalin contamination.

Public Health England guidance recommends wet decontamination and removal of clothing for formaldehyde/formaldehyde solutions exposure, with spills to be managed using an appropriate decontamination kit.7

Weakness of current spill management solutions

It is not enough to be equipped with an emergency response kit solely for the management of large formalin spillages since much smaller scale spillages can occur daily. Ordinary clean-up procedures cannot completely remove the residual formalin as the surface will remain contaminated and continue to release formaldehyde gas into the environment. Even if the amount is not appreciable, it is still considered a safety concern. Furthermore, current response solutions take much longer to act on any residual formalin, leading to further safety concerns for staff who are required to deal with smaller spillages.

Any system that would minimize or eliminate the amount of fixative/formalin would be desirable.

The Complete Formalin Safety Solution for Hospital Pathology and Theatre Departments

Novok® is a patented (Patent No. 102018000002334) solution that can quickly decompose formaldehyde molecules on contact, without leaving any residual behind. It allows healthcare staff to perform a deep decontamination inside their workplace whenever necessary, and can be used as in the daily cleaning procedures promote a healthier work environment and minimum exposure to the hazardous substance.

The Novokit contains both the Novok-S® + Novok-Pow® sets, all the necessary cleaning material and personal protective equipment (PPE), minimising exposure to carcinogenic vapours during the spill management procedure.

Novok-Pow is a highly absorbent polymeric powder which, when applied to a formalin spill, rapidly inflates and solidifies the liquid mass. Novok-S is a liquid spray which has a high oxidizing power on formaldehyde particles. When Novok-S is sprayed on to the solid mass of Novok-Pow, they work in conjunction to rapidly eliminate formaldehyde particles in the environment and facilitate a quick and safe clean-up process.

Both Novok-S and Novok-Pow on their own can easily manage smaller spills up to 60ml without the need for any additional safety equipment. However, for any larger spillages, we recommend a full spill kit with additional safety equipment to protect staff from exposure to formalin during the clean-up process. We also supply the Novokit which contains enough Novok-S & Novok-POW to deal with spillages all the way up to six litres.

The contents of the Novokit include:

  • 500ml anti-formalin solution: novok-s®
  • 400g Formalin thickener: novok-pow®
  • A pair of nitrile gloves
  • Vented goggles
  • Scoop & scraper
  • Respirator with filters against formaldehyde
  • Absorbent pad
  • Disposable open back gown
  • Biohazard bag
  • Shoe covers
  • “Caution” sign
  • Instruction sheet
Conclusion

The use of these substances carries an inherent risk of exposure, so to protect users, an effective, efficient and safe method of dealing with exposure is vital. The Novokit can provide such assurance.

 

If you would like to comment on any of the issues raised by this article, particularly from your own experience or insight, Healthcare-Arena would welcome your views.

 

References
  1. PHE Compendium of Chemical Hazards: Formaldehyde. PHE publications gateway number: 2014790. 2017. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/661870/Formaldehyde_general_information_201117.pdf
  2. Fischer MH. The toxic effects of formaldehyde and formalin. J Exp Med. 1905 Feb 1; 6(4-6):487–518
  3. International Agency for Research on Cancer (June 2004). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 88 (2006): Formaldehyde, 2-Butoxyethanol and 1-tert-Butoxypropan-2-ol. Retrieved June 10, 2011, from: http://monographs.iarc.fr/ENG/Monographs/vol88/index.php
  4. Directive (EU) 2017/2398 of the European Parliament and of the Council of 12 December 2017 amending Directive 2004/37/EC on the protection of workers from the risks related to exposure to carcinogens or mutagens at work. 2017 Available at: http://data.europa.eu/eli/dir/2017/2398/oj
  5. Health and Safety Executive (HES). Safe working and the prevention of infection in clinical laboratories and similar facilities. HSE 2003. Available at: http://www.hse.gov.uk/pubns/clinical-laboratories.pdf
  6. Steeleman VM, Williams TL, Szekendi MK, Halverson AL, et al. A Descriptive Study of 648 Adverse Events and Near Misses. Arch Pathol Lab Med. 2016;140:1390–1396; doi:10.5858/arpa.2016-0021-OA
  7. Public Health England Centre for Radiation, Chemical and Environmental Hazards. Formaldehyde incident management. 2017. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/621533/Formaldehyde_incident_management.pdf

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