a Legislation

Will government write a new standard for ethylene oxide? W In spite of growing concern that the present government standard for ethylene oxide (EO) exposure is inadequate, federal agencies are having trouble deciding who is responsible for hospital employees who work around the gas. Jurisdiction over hospital use is awkwardly split between two agencies-the Occupational Safety and Health Administration (OSHA) and the Environmental Protection Agency (EPA). The present OSHA exposure limit of 50 parts per million (ppm) averaged over an eight-hour period has been commonly regarded as the standard applying to hospital workers.

Recently, though, OSHA has said that hos- pital workers who operate sterilizers do not fall under its rule. These employees, OSHA says, are covered by the EPA because it regulates use of EO as a sterilant and pesticide. The OSHA rule does not apply to employees “in- termittently exposed to EO in the workplace.” Presumably, that means EPA would cover employees who work directly with the steriliz- ers, and OSHA would cover those who walk by, for example, or are folding linen in the vicinity.

OSHA published a notice in the Jan 26 Fed- eral Register that it plans to reevaluate its 50 ppm standard. It called for scientific data and expert opinion to be submitted by March 31. The current rule was issued in 1971 before results of carcinogenicity studies were in. In 1977, the National Institute on Occupational Safety and Health (NIOSH) recommended an occupational exposure limit of a ceiling con-

centration of 75 ppm, determined during a 15-minute sampling period, in addition to the OSHA standard.

Originally, OSHA based its rule on a rec- ommendation from the American Conference of Governmental Industrial Hygienists. In 1981, the hygienist organization changed its recommended maximum exposure level to 10 ppm as a time-weighted average with no short-term exposure limit. The group has is- sued notice that it plans to lower this still further to 5 ppm.

A number of hospitals and companies have also voluntarily lowered their exposure limits. At Exxon and the American Hospital Supply Corporation, the limit is 10 pprn; at Shell Chem- ical Division, Union Carbide, and Medtronics, 5 ppm; at Dow Chemical and Celanese, 3 ppm; at Texaco, 2 ppm; and at Rohm and Haas and Johnson & Johnson, 1 ppm.

EPA’s approach to regulating EO is different from OSHA’s. EPA does not have an exposure limit; rather, it requires that hazardous sub- stances be properly labeled and suppliers reg- istered. The last regulatory action EPA took was in January 1978 when it published anotice that it was considering prohibiting use of EO. Reaction was so strong that the notice was never put into effect.

The split between the two agencies raises the question whether a new standard would be adequately enforced if it is eventually issued. How would OSHA monitor indirect exposure, and how would EPA enforce its rules? In fact, the enforcement powers of both agencies may be stretched beyond the limit by Reagan budget cuts and staff reductions.

Yet evidence of the potential hazards of EO exposure is mounting. Last year, a two-year industry-sponsored study conducted at the

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Bushy Run Research Center found that rats who had inhaled various amounts of EO (100, 33, and 10 ppm) had significantly higher rates of mononuclear cell leukemia and peritoneal mesothelioma. In recent years, EO has also been shown to cause genetic mutations in 13 species including man and reproductive prob- lems in rats and mice.

How many people are affected? The gov- ernment estimates that about 144,000 workers may be exposed to EO, and more than half (75,000) are health care workers who work in sterilization areas. Another 25,000 may be in- cidentally exposed. Yet only a fraction (0.24%) of total EO production is used by the health and medical products industries, and only about 0.02% is used for hospital sterilization.

The major use of the gas is in producing auto antifreeze and polyester fibers, films, and bot- tles. It is also used in making industrial sol- vents and household and industrial cleaning agents. Down the list are its use as a pesticide, fumigant, and sterilant.

Although most of EO production is used in industry, worker exposure is not as much of a concern there. Processing equipment is usu- ally kept outdoors, tightly sealed, and highly automated, so few workers come into direct contact with it.

With a new government standard far in the future and enforcement questionable, you might do well to learn as much as you can about EO exposure and your hospital’s monitoring system. This is another area where you may no longer be able to rely on the gov- ernment to look after your interests. A list of current sources is printed with this article.

The phrase “equal pay for equal work” is out. Taking its place is “equal pay for work of equal value,” or comparable worth. About 1,700 nurses at four San Jose, Calif, hospitals are putting the new concept to a test. Repre- sented by the California Nurses’ Association (CNA), they struck at Good Samaritan, O’Connor, Alexian Brothers, and San Jose Hospitals in January. A settlement was not in sight in mid-February.

The major issue is that nurses want to close the wage gap between themselves and other health professionals who have similar educa- tional requirements, responsibilities, and work- ing conditions, said Myra Snyder, RN, CNA

Boning up on €0 “EO exposure poses employee health

hazard.” AORN Journal 31 (June 1980) 1284. A news story.

National Institute for Occupational Safety and Health. Current Intelligence Bulletin 35: Ethylene Oxide. DHHS (NIOSH) publication no 81-130. Cincinnati: NIOSH, May 22, 1981. Discusses current evidence on EO and cancer. Available from NIOSH Publication Dissemination, Division of Technical Services, 4676 Columbia Parkway, Cincinnati, Ohio 45226.

Administration. “Occupational exposure to ethyleneoxide: Advance notice of proposed rule making.” federal Register 47 (Jan 26, 1982) 3566-3571. Summarizes government concern and current evidence on effects of EO exposure.

Occupational Safety and Health

executive director. Looking at entry level wages in their own hospitals, nurses found they are not paid comparably with pharma- cists, laboratory technicians, and physical therapists. Even engineers who run the hospi- tal boilers make more.

For example, nurses in San Jose make $1 7,900 to $22,600 to start. Pharmacists make $30,300 to $31,800. Nurses are asking for a 17% to 20% increase. In addition, they want a retirement plan and a career ladder, providing advancement opportunities to nurses who want to stay at the bedside.

Comparable worth is being called the new frontier in women’s rights. “Formerly, we al- ways compared nurses with nurses to deter- mine wage scales,” Snyder explained. “We would compare nurses in San Jose with nurses in San Francisco or Oakland.” That was the old idea of equal pay for equal work. Workers could only compare their salaries with workers of the same exact type.

“Now nurses are looking within their own hospitals to see what other professionals are making who do comparable work,” she said. They have found their wages have been kept artificially low.

What has been the hospitals’ response?

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“They have been extremely resistant,” Snyder commented. “They are concerned the issue will spread, since it has been called the wom- en’s issue of the 1980s.”

The nurses continued to negotiate in Feb- ruary with Good Samaritan, San Jose, and Alexian Brothers Hospitals. O’Connor repre- sentatives had not been to the table for two weeks. The hospitals’ current offer was a 71/2%

increase in salary. “Nurses are trimming their demands, and management is eking out per- centage points, but so far, they’re not even close,” Snyder said. She expected a long strike and a much longer struggle toward the long-term goal of comparable worth.

Patricia Patterson Associate editor

Film review Nursing Process: Evaluation Nursing Process: Evaluation by Lois Young, RN, describes the methodology and rationale for postoperative appraisal of intraoperative nursing care. The film illustrates that evaluation, defined as the comparison of actual results with expected patient outcomes, is necessary for successful use of the nursing process.

The film demonstrates immediate postoperative assessment in the recovery room, a home visit, telephone interview, and interaction with the patient in the physician’s office as methods of postoperative evaluations. Major emphasis is placed on the postoperative interview in the patient’s room. Steps shown in this evaluation process are reviewing the patient’s chart, assessing the postoperative condition, eliciting subjective responses, and documenting findings.

In the film, the operating room nurse visits several patients. After the visits, she is able to determine the degree to which her nursing care goals for the patient have been achieved. Finally, she gives feedback to the rest of the operating room nurses at a postoperative conference. Nursing care plans are evaluated by discussing patient outcomes.

Nursing Process: Evaluation had its premiere showing at the 1982 Congress in Anaheim. It is suitable for all operating room nurses, but especially for those who are committed to practicing perioperative nursing to its fullest extent. This presentation is available from the Davis + Geck Film and Videocassette Library, One Casper St, Danbury, Conn 06810. The 16

mm film may be rented for $1 5. Videotape versions in %-inch U-matic or M-inch Beta formats may be purchased for $100.

Katherine L Kern, RN Audiovisual Committee

Endowment to fund nursing professorship The nation’s first endowed professorship for nursing in psychiatric and mental health care has been established in the School of Nursing at the University of Pennsylvania, Philadelphia.

Claire M Fagin, dean of the School of Nursing, said that a generous gift from the van Ameringen Foundation of New York has established the van Ameringen Professorship in Psychiatric and Mental Health Nursing. A search is underway for a psychiatric nursing leader for the chair.

“This pioneering grant,” Fagin pointed out, “will contribute to a more equitable balance between the inpatient treatment and the community-type approaches to mental health nursing care. In addition, the chairholder will be seen as a role model for nurses who are pursuing a career in this field.”

The van Ameringen Foundation was established by Arnold Louis van Ameringen in 1950. Patricia Kind is currently president of the foundation, which was founded to promote mental health and social welfare through preventive measures, treatment, and rehabilitation.

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