Motherhood, Medicine, and the Patriarchy (or Who’s Going to Take Care of These Babies?)

The day I went into the student dean’s office at my medical school to tell her I was pregnant, I felt like I needed to apologize before even walking through the door. When I told her I was not only pregnant, but pregnant with twins, her response to me was, “And who’s going to take care of these babies?” I was 35 years old at the time and married. My husband and I had been desperately trying to get pregnant for two and a half years. After one abandoned cycle of IUI (intrauterine insemination), we tried IVF (in vitro fertilization). We put two embryos in, hoping to get one viable pregnancy. When that six-week intravaginal ultrasound showed us not just one, but two tiny specks on my uterus, my first thought was not, “Oh my god, we did it!” It was, “Shit, there goes my career.”

Part of me always knew that if my husband and I were successful in our quest to start a family, my career would probably suffer. But what was I to do? Not pursue an interesting and challenging career in medicine? Not pursue having a child? In the end, I figured it would all work itself out. 

When I found out I was pregnant with twins, my first thought was, “Shit, there goes my career.”

Alas, I had no idea what types of barriers existed for women who wanted to have it all. Even if one can overcome the external barriers, there are the internal ones—stress, pain, being pushed to your breaking point, not to mention having to tend to the needs of small humans. But certainly, I assured myself, since women have been procreating since the dawn of humankind, and fighting for equal rights for over a hundred years, our 21st century society would have some sort of ‘safeties’ put in place to help procreators achieve their potential outside the procreative role. I never saw my mother struggle with caring for me and my older brother. Perhaps she was lucky, perhaps she and my father found a way around whatever flaws may have existed in the system back in the 1970s and ‘80s. My mother was a school teacher who had summers off and my father was a college professor who had a pretty flexible schedule. Somehow I would be able to work out my life so I could be a successful career woman and a successful mom.

Pregnancy meant a lot more to me than just bringing new life into the world, a lot more, even, than changing the meaning of my existence. It felt like a way to unbreak a broken circle. I had lost my mother a few years earlier by way of a short and unexpected battle with a very rare cancer at a point in time when I felt our mother/daughter relationship was evolving, maturing. It was a point at which I could more fully understand her journey and offer her support the way she had always supported me. She was newly retired and pursuing her love of music, taking a leap to be a pianist for an amateur string quartet. At age 64, she was embarking on a new and exciting phase of her life. This gave me so much hope and joy to be able to see her do this. Unfortunately, she didn’t even get to go to the first rehearsal. It was her illness, subsequent medical mismanagement, and death that propelled me to go to medical school at that point in my life.

I had lost my mother a few years earlier by way of a short and unexpected battle with a very rare cancer…

So when the student dean, the faculty member that was supposed to be my advocate at the medical school, questioned by ability to care for the lives that were growing inside me, the lives that I had just that morning while sitting in immunology class felt to start gurgling in my belly, I was dumbfounded. But her reaction was not altogether unexpected.

Even though more than 50% of today’s medical students are women, medicine is still very much a man’s profession. From the portraits of old, white men that adorn the hallways of hospitals and medical schools, to the financial cost/benefit analysis of whether a given assay or treatment is worth it, to the demands of the three to seven years of post-graduate employment/training (residency) that is required to obtain a license to legally practice medicine, it’s a man’s, man’s, man’s world. In fact, the resident physician was originally called a house physician and was traditionally a young, single male who actually lived in the hospital and could be called upon day or night to tend to whatever problem was at hand. But today, with over half the pool of resident physicians being women of child-bearing age, this outdated system is presenting problems.

There is very little leniency for taking random days off when your child has a fever. In fact, at some of the hospitals where I rotated, there was a system whereby if a resident takes one day off, she would then owe two days back in return.

True, there are now duty hours restrictions in place, limiting the maximum average number of hours worked per week by a resident physician to 80 hours, with an average of one day off. It requires clarification, though, that an average of 80 hours could mean 90 hours worked one week and 70 the next, and the average of one day off could mean working for 12 straight days with two days off. There is very little leniency for taking random days off when your child has a fever. In fact, at some of the hospitals where I rotated, there was a system whereby if a resident takes one day off, she would then owe two days back in return. Not very mommy-friendly.

After that meeting with the student dean, I continued on in medical school through the rest of my pregnancy, which lasted only 7 months ending in an emergency C-section and a two-and-a-half week NICU stay for my babies. During that time, when I too was convalescing (I did just have major abdominal surgery), I didn’t stop studying.

I returned to the classroom for the next round of exams.

Navigating the infant and early childhood care system in America is not an easy task. Due to distance from family and the death of my mother, I had no support system and I had to figure it out myself. The first thing I learned was that daycare facilities do not accept infants under 16 weeks of age. This makes perfect sense. I mean, who is better at caring for these precious, fragile lifeforms than their parents? So I asked my husband to take advantage of his Fortune 10 company’s parental leave benefit.

He stared blankly at me.

“Doesn’t your job offer leave for new fathers?” I asked.

Turns out, there was no such benefit. There was a benefit for a reduced-pay leave for new mothers. But nothing for fathers—something my husband would have jumped at, not only to bond with his new babies, but also to relieve some of the burden on me. The fact that there was no comprehensive parental leave in such a large corporation was astounding to me. At that exact moment I came to the painful realization that just because I was a woman, I was the one who was supposed to sacrifice my career. And even though the Family Medical Leave Act was law, it does not provide paid leave. It just guarantees that a job will still be there when you return to work. Unpaid leave was not an option for us because I was a student earning no money. We all still wanted to eat.

“Doesn’t your job offer leave for new fathers?” I asked.

So I called a nanny service.

There’s nothing in this world that can describe the feeling of welcoming someone you’ve never met into your home and leaving your newborn babies with them. I felt numb and terrified and grateful and detached from my body and confused and a little sick to my stomach. 

During that meeting with the student dean, instead of being passive-aggressively upbraided for fucking (pardon my language) everything up by daring to procreate, I should have been counseled to take the time off I needed to care for my health, my children’s health, and (most relevant to the dean’s position) the health of my career. The good news is, I passed all my exams, including Step 1 of the official medical licensing exam. But merely passing the Step 1 exam is not the point; the score you get determines your career options, a higher score increases your likelihood of ‘matching’ to a top residency program or a preferred specialty. My score was good, but I could have done much better. I was lactating, coordinating childcare, studying like crazy, and lookin’ good while I was at it. I felt so much pressure to prove to everyone that this life change didn’t faze me one bit, to prove that I didn’t need to take a break.

I continued moving on through clinical rotations while also navigating the childcare system, trying to find a daycare that actually complied with immunization requirements, didn’t change diapers on the same surface used for food prep, and didn’t leave me with a sense of existential dread at the thought of leaving my two babies with them. The cost: $680 a week, and that was with the discount of being affiliated with a nearby hospital. I still remember the feeling—like watching a treasured balloon float away after you accidentally let the string slip through your childhood fingers—of handing over my credit card and watching more than $1300 of money we didn’t have get swiped away every two weeks.

For a year and a half after my twins were born I worked my ass off through rotation after rotation—neurology, pediatrics, internal medicine, surgery—performing as well as (some of my evaluations say better than) my peers, when I finally hit my breaking point. A combination of unbearable neck pain and exhaustion propelled me to swallow my pride and take a six-month leave of absence.

Apparently lots of parents depend on their jobs for income (who knew?) and can’t afford to take time off when their children get sick, so said sick children, along with their infectious diseases, invariably get dropped off at daycare.

Upon my return to clinical clerkships I was confronted with the same childcare issues. Really, just as my student dean asked, who is going to take care of these babies? We made the decision to put them in a local daycare. And that’s when they started getting sick. Apparently lots of parents depend on their jobs for income (who knew?) and can’t afford to take time off when their children get sick, so said sick children, along with their infectious diseases, invariably get dropped off at daycare. Six overnight hospitalizations for pneumonia and one negative cystic fibrosis test later, we decided we had better go back to having someone come to the house to care for the children.

As a mother in the medical education system, one experience stood out to me that still irks me to this day. During my Obstetrics and Gynecology rotation, there were 15 overnight shifts, but 8 students. As a way of sorting who would be the lucky student who had to put in only one overnight shift, the program director thought it would be fair to toss straws onto the table and have all the students race to pick up the short straw. The person with the short straw would be exempt from the overnight shift.

I did not get the short straw.

I met with the program director to ask, since two overnights weren’t required of all students in that clerkship, if I could be excused from one of the two overnight shifts assigned to me. This was the OB/GYN rotation and I explained to him that after fertility treatments, a high-risk twin pregnancy, and an emergency C-section, I had quite a bit of experience in the field that other students were lacking. Certainly missing one night shift that wasn’t required of all students wouldn’t terribly impact my knowledge base. I further explained to him how precious that extra time would be for me to be able to care for my family. In my mind, I made a cogent and convincing argument. He looked up at me from his desk and said, “Well, maybe your husband needs to step it up at home a little more.”

I couldn’t hold it together anymore. Tears burst forth through my tired eyes as I proceeded to ask this man how dare he insult my husband. He had no idea how hard the father of my children worked for our family. Furthermore, with his words, this obstetrician/gynecologist who is responsible for training future OB/GYNs dismissed my experience as a female patient who was under the care of an OB/GYN. With this zeitgeist among doctors tasked to care for women (believe me this obstetrician was not the only professor I encountered who exhibited this ethos), it’s no wonder my mother’s case was mismanaged.

It’s no secret that when a woman goes to the doctor, her symptoms are not treated as seriously as a man’s. An official medical diagnosis of hysteria (fr. hystera womb/uterus) for all manner of ailments affecting women was not uncommon at the turn of the 20th century. The cure? Genital massage until the woman experienced a hysterical paroxysm (aka an orgasm)… but I digress. It wasn’t until 1980 that the diagnosis of mental hysteria was removed from the DSM, the psychiatrist’s bible. Even as a teenager, when I consulted the medical reference book my family kept in our library looking for the cure for my menstrual cramps, it stated that menstrual cramps were the result of a woman being sexually unsatisfied.

Devaluing of women’s experience pervades the medical system.

At the turn of the 21st century, I saw my own mother’s illness characterized as a woman’s issue, instead of as part of a syndrome that would eventually take her life. She experienced hot flashes that persisted well past the age of menopause. Even so, the hot flashes were attributed to menopause instead of being investigated further. Those hot flashes, it turns out, were produced by serotonin-secreting tumors that had taken over her liver. By the time this was discovered, it was too late.

Devaluing of women’s experience pervades the medical system. From female patients to female medical trainees and beyond. Even in light of the fact that numerous recent studies have shown that female physicians provide better care than their male counterparts. But the devaluing of women’s experience in medicine does not occur in isolation. Rather, it is a symptom of a disease that has run rampant in society at large. 

Perhaps the disease will run its course, easing as the body politic heals itself. Perhaps, as more and more young people grow up inoculated against the effects of sexism, we will see a woman’s worth and all her procreative power honored. Until then, we must treat the symptoms and continue working toward a cure.

And who’s going to take care of these babies?

I graduated medical school six months after the rest of my class did. I was offered two resident physician positions at two different hospitals in the years that followed. I turned them both down.

On my 33rd birthday, just three months before she died, my mother gave me a card that said she hoped I got everything I deserved from this world. All I think I deserve is a little respect—for the knowledge my experience and education have given me, for my time which grows ever more valuable, and for my power as a mother to shape future society into one that will give my daughter everything she deserves in this world.

Power to the Poopers!

Today I took a tour of my local wastewater treatment facility. I recommend everyone does this. Wastewater treatment plants truly are marvels of modern engineering. And you really do need to know what happens to your poop after you flush. When I think about how far we’ve come since the 1800s when we threw our poop out the window into the street, when our waste mixed with our drinking water, and when disease from unsanitary conditions was rampant, to now—it’s amazing how far we’ve come.

Even though no one wants to think about what happens to our human waste, it’s important to acknowledge all the people who make our sullied waters clean enough to be gurgled back into our rivers and lakes again. But wait! The engineers, technicians, and maintenance people working at wastewater treatment plants are doing more than just making sure our communities are healthy and our most precious natural resource is safely recycled. My local wastewater treatment plant is running almost entirely on the power of… poop! That’s right, they’re using the poop to power the plant! It turns out, our poop is a largely untapped resource.

My local wastewater treatment plant is running almost entirely on the power of… poop! It turns out, our poop is a largely untapped resource.

Wastewater itself can have up to 10 times the amount of energy it takes to treat it. It seems incredibly wasteful to think that we’ve been using energy from the fossil fuel grid to process something that already has energy in it. The energy in wastewater comes in the form of organic matter and nutritional elements, like nitrogen and phosphorous, and thermal energy. That energy has been going to waste for a really long time.

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Bar screens trap the large pieces of debris that get washed into the sewer system. This is the first step in the wastewater treatment process.

There are many ways of turning wastewater into energy (more than I’ll mention here). First, hydropower can be harnessed by taking advantage of the physical flow of the influent (the water coming into the plant) and/or the effluent (the water flowing out of the plant). Or we can use wastewater to power microbial fuel cells. Or (and this is my favorite) if you let organic waste, or sludge, decompose in an anaerobic environment, it lets off methane, aka biogas.

 

But before we get to that, let’s talk a little about the wastewater treatment process, because before we get to the sludge we have to treat the water. Some municipalities have sewer systems dedicated only to brown water (the water that leaves our homes and places of business), others have combined stormwater and sewer systems. Either way, sometimes plastic, large pieces of paper, and other debris (don’t even think about flushing those “flushable” wipes) gets washed into the system and needs to be removed before the water gets processed. That’s the first step in wastewater treatment.

Then, we filter out our settleable solids. Things like sand and grit that settle out to the bottom of a tank full of wastewater. And we skim off the fats and oils that float to the top.

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A clarifier, in which heavy organic solids sink to the bottom and greases float to the top.

Now we’re ready to let some good aerobic, or oxygen-loving, bacteria go to work. They feast on our waste, breaking down the organic matter. When they’re done, we’re left with two things: water that is about 85% free of organic material, and sludge—a brown slurry of organic solids and sated bacteria that need to loosen their belts because they ate so much.

That sludge is thickened and sent to the final phase of solids treatment—the anaerobic, or oxygen-free, digester.

When organic waste decomposes in an anaerobic environment, biology and anaerobic bacteria do their thing and we’re left with methane. Methane is a potent greenhouse gas. We can either flare the methane, releasing the less potent carbon dioxide, or harness the methane to do work for us. The methane, or biogas, can be harnessed on-site to power the wastewater treatment plant. And as a bonus, the leftover sludge can be used as a soil nutrient supplement. Smaller facilities can add restaurant grease to supplement the sludge in the anaerobic digester to create more methane. Larger treatment plants can supply energy back to the grid.

 

To finish off the journey through our wastewater treatment plant we need to disinfect the water that was separated from the sludge before it can be released back into the natural water system. This can be done with chlorine, but wastewater treatment plants are opting for non-chemical ways of disinfecting the water. My local wastewater treatment plant opts for UV light which disrupts the DNA of the bacteria in the water and prevents them from reproducing. Another option is using ozone for the disinfection process.

Wastewater-to-energy systems provide renewable/sustainable energy, economic benefits in terms of savings on purchasing fossils fuels to power treatment plants, and reduced emissions.

The whole process of treating wastewater can, amazingly, be done without using any chemicals. Natural processes, gravity, and simple technology work wonders in these engineering marvels that keep us healthy, safe, and clean. And, with the help of energy from our poop, they could soon be supplying our electricity needs.

Poop Emoji Photo by Nicole Honeywill on Unsplash

Running for Local Office, My Journey – Week 1

Well, it’s the end of the first week of my officially announcing my run (I hope I’m doing it right) for a local county board office in a historically red county. Having never run for office before, I’ve learned a lot in that short amount of time. In the interest of transparency at all levels of government and the electoral process, I’d like to share what I’m learning.

First, let me tell you a little about my county. We’re located roughly 20 miles west of Chicago. According to census data, the population is approaching 930,000, 66% of whom are white, not Hispanic or Latino, 15% Hispanic or Latino, 13% Asian, 5% African American, and 2% two or more races. Median household income is $85,000, per capita $42,000, with 6.2% of the population living in poverty.

The county has been historically red until the 2018 election cycle when a Democrat (who also happens to be a woman) was the first Democrat elected to a county-wide position since 1934. Additionally, prior to 2018 there was only one Democrat on the county board out of 18 seats. Currently, seven of the 18 board members are Democrats and all of them are women.

The entire county is broken down into six districts. I’m running in one of the districts.

I still haven’t figured out exactly why, but my district’s primary is an incredibly hot race. I’m jumping in as a novice and there are currently four others running for the same spot on the ballot against the Republican incumbent, an attorney who attended the local high school, who has served since 2016.

More about my Democratic primary rivals: one came very close to defeating the Republican county board chairman last election, one is a 19-year-old who was featured in “Teen Vogue” magazine after she ran for a seat on the board last year, one has some experience with energy policy, and one I haven’t met or heard anything about.

Some Stuff I’ve Learned and Some Stuff I’ve Experienced

After downloading the paperwork from the county website, I learned that I needed about 150 unchallengeable signatures from people in my district in order for my name to appear on the ballot. I was advised to get at least 2-3 times that many signatures because the Republicans will challenge the ones they deem questionable. (I’m assuming the Dems do the same.)

Where are the young people? Where are the GenX’ers?

My first outing as a candidate was to a local Dem-leaning organization meeting—average age of attendees was about 10-20 years older than me (where are the young people? where are the GenX’ers?)—to kick things off and start getting some signatures.

Suffice it to say, it wasn’t a very positive start. I was told there was no way I could win and the next morning, after a night of mulling over the experience, I tweeted out this thread:

But I did end up with seven signatures and a political ally who is running for a different office in the same district.

But Wait… There’s More

In addition to canvassing neighborhoods to get signatures, the local township Democratic party and the county Democratic party offer opportunities for all candidates to have their petitions out at meetings to get signatures. (County, districts, townships, yikes! And the township is broken down into precincts. So many boundary lines.)

I attended the township meeting where the people were very much more welcoming than the last meeting I attended (and there were some people my age, i.e., middle aged). You would think in a healthy democracy any and all participation is encouraged. I was glad to see and feel this at the meeting after my experience at the first one. Anyway, all candidates were given a chance to stand up, introduce themselves, and make a 30-second elevator speech.

My speech, and candidacy, was apparently a big surprise to the others running for the same spot on the ballot. I smiled at them as I introduced myself thinking we could recreate something like the lovely Elizabeth Warren/Kamala Harris hug. But no such luck. I didn’t even get a smile in return.

I’m getting a little bored writing this now. That means you must be getting a little bored reading it, but let me share just one more thing.

Last night I took my kids to the county Democratic party office for another night of petition-signing. My petitions were sitting out on the table with everyone else’s, except my poor lonely ones didn’t have a single signature on them. (I’m making a sad, frowny face as I type this.)

I went out of my way to sign the petitions of my competitors and to show my children that I was doing so, as they shoved their faces full of candy. They asked why I was signing to help my rivals get on the ballot. And I said: Because it’s the right thing to do.

Why am I running? Because contributing to the conversation is a civic duty. No longer will I be afraid to have my voice heard. No longer will I selfishly keep all the knowledge I’ve gleaned throughout my life, my education, and my experience to myself. I’m going to use it to make things better in my little corner of the world.

It’s the right thing to do.

 

 

Photo by Randy Colas on Unsplash

An Open Memo to Medical Facilities using Ethylene Oxide as a Sterilant

Alternatives to the Use of Ethylene Oxide as a Medical Sterilant

From: Janette DeFelice, MD, MA
Subject: Reducing the Use of Ethylene Oxide as a Medical Sterilant
Date: August 10, 2019

Executive Summary

Hospitals are beacons of health and healing. Hospital practices should, above all, do no harm. As of the time of this writing, your hospital is participating in a practice that causes harm to workers, patients, and community members.

The use of ethylene oxide as a medical sterilant has been shown to cause pulmonary irritation and acute neurotoxic effects at best, explosions and cancer at worst. In fact, the 2014 National Air Toxics Assessment has shown that people in a community surrounding an ethylene oxide sterilization plant have a cancer risk of over 100 times the average.

Hospitals that have shifted away from the use of ethylene oxide as their method of sterilizing medical equipment have shown improvements not only in employee-, patient-, and community satisfaction, they have also seen increased efficiency and decreased cost.

Below, we recommend four options to explore:

  • the Amsco®V-PRO® maX Low Temperature Sterilization System (STERIS Corporation, Mentor, OH)
  • the STERRAD®100NX® Sterilizer (Advanced Sterilization Products, Irvine, CA)
  • the STERIZONE®125L+ Sterilizer (TSO3, Québec, Canada)
  • the Noxilizer (Baltimore, MD)

What is Ethylene Oxide?

Ethylene oxide (EtO) is an organic compound made up of two carbon atoms, 4 hydrogen atoms, and one oxygen atom. It is a highly-flammable gas at room temperature. In the past, EtO was mixed with chlorofluorocarbons (CFCs) as a diluent, but since concern over the effect of CFCs on the atmosphere, industry has shifted toward using 100% EtO for medical sterilization. This had the effect of reducing the adverse effects of the CFCs on the ozone layer, but also increased the toxic effects of the sterilant. Ethylene oxide has also been found to be carcinogenic (can be cancer-causing) [1], mutagenic (can cause changes in DNA of living organisms), and endocrine disrupting (can interfere with the normal activity of hormones, including sex-specific hormones) [2]. Despite this, and despite that fact that effective alternatives exist [3], since the 1950s ethylene oxide has been used as a medical sterilant, specifically for heat- or moisture-sensitive medical equipment.

Disadvantages of Ethylene Oxide

  • Inhalation can cause acute affects such as nausea/vomiting and neurological symptoms (lethargy, headache, dizziness, twitching)
  • Highly flammable, posing explosion risk
  • Cancer-causing
  • Mutagenic, causing changes in DNA
  • Endocrine disrupting, interfering with the normal function of hormones
  • Inefficient, long cycle time
  • Cost

Real-life Effects of Ethylene Oxide as a Medical Sterilant: Case Study

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The community of Willowbrook, IL has been suffering the ill-effects of the use of EtO to sterilize medical equipment thanks to a medical sterilization plant in the area called Sterigenics. As of the mid-1980s regulators knew that those who lived near the Sterigenics plant would be exposed to more than 14 times higher than safe levels of ethylene oxide[4]. The population exposed to this toxic chemical in Willowbrook, IL (as well as in Lake County, IL where another EtO sterilization plant exists) is estimated to be over 600,000 people. Furthermore, this map of the 2014 National Air Toxics Assessment clearly shows that people in the Willowbrook community surrounding the ethylene oxide sterilization plant have a cancer risk of over 100 times the average.

Alternatives to Using Ethylene Oxide as a Medical Sterilant

Several effective alternatives to using ethylene oxide as a medical sterilant are available. First, there is a process that uses vaporized hydrogen peroxide. It is called the Amsco® V-PRO® maX Low Temperature Sterilization System (STERIS Corporation, Mentor, OH). It uses something called a sterilization pulse, which utilizes a vacuum pulse to remove load moisture, then injects vaporized hydrogen peroxide into a chamber that is held at increased pressure, followed by air injection. The hydrogen peroxide is then converted to a harmless mixture of oxygen and water using a catalytic converter. This process does not require special venting.

The second option uses hydrogen peroxide vapor and gas plasma, called the STERRAD® 100NX® Sterilizer (Advanced Sterilization Products, Irvine, CA). Again, vaporized hydrogen peroxide is injected into a vacuum chamber. A gas plasma is then encouraged using a cycle of increased and decreased pressurization. Free radicals from the gas plasma aid in sterilization. Gases then go through a filter and are decomposed into oxygen and water vapor.

A third option, called the STERIZONE® 125L+ Sterilizer (TSO3, Québec, Canada), uses ozone and water vapor. This process also uses a vacuum chamber and hydrogen peroxide vapor. Hydroxyl radicals are then put to work to begin the sterilization process. Next, ozone is introduced for a number of cycles. Again, the exhaust is decomposed to oxygen and water. No special ventilation is needed.

Finally, the use of nitrogen dioxide is a fourth option, via the Noxilizer (Baltimore, MD). Nitrogen dioxide gas is injected into a chamber with a predetermined pressure to ensure the proper concentration of NO2gas. Then gas then enters the sterilization chamber for cycling. The nitrogen dioxide gas then goes through a neutralizing scrubber and can be vented safely.

Process Emissions
Ethylene Oxide 5-step process involving preconditioning and humidification, EtO gas introduction, exposure, evacuation, and air washes. Alkylating agent—disrupts DNA in microorganisms. This process requires special venting equipment. Ethylene Oxide is released into the atmosphere.
Amsco® V-PRO® maX Low Temperature Sterilization System Utilizes vaporized hydrogen peroxide (H2O2) at increased pressure. This process does not require special venting equipment. It uses a catalytic converter to convert H2O2 to O2 and H20.
STERRAD® 100NX® Sterilizer Utilizes vaporized hydrogen peroxide (H2O2) at increased pressure. Gas plasma is encouraged using cycle of increased and decreased pressurization. Free radicals aid in sterilization. Gases go through filter and are decomposed into O2and H2O vapor.
STERIZONE® 125L+ Sterilizer Utilizes ozone (O3), H2O vapor, and vaporized hydrogen peroxide (H2O2). O3 and hydroxyl radicals are used in sterilization process. This process does not require special venting equipment. Exhaust is decomposed to O2and H2O.
Noxilizer Utilizes nitrogen dioxide (NO2) gas NO2 gas goes through a neutralizing scrubber and can be vented safely. 

Benefits of Using Non-Ethylene Oxide Methods for Medical Sterilization

Aside from the health benefits conferred onto the surrounding community and staff, using non-ethylene oxide methods for medical sterilization has other benefits—namely, cost and efficiency.

Cost:Mary Hitchcock Memorial Hospital in Lebanon, New Hampshire took on the challenges of incorporating non-ethylene oxide methods for sterilization. They found that the cost of sterilizing per square foot with the non-EtO method was significantly less than the EtO method (EtO/CO2 mix = $12.00 per square foot, EtO/HCFC mix = $11.31 per square foot, Sterrad = $8.44 per square foot). They also found that sterilization time was less and labor needed to operate the system was less leading to increase cost savings and increased efficiency [5].

Efficiency:When St. Joseph’s Hospital and Medical Center in Phoenix, Arizona adopted the Amsco® V-PRO® maX Low Temperature Sterilization System to replace their EtO system, they also found that sterilization time was decreased. This decrease in sterilization time increased their output load by 250%. They also found that satisfaction among physicians and staff, as well as patients, increased.[6]

Making Changes in Your Healthcare Setting

Foster a culture of caring—Hospitals are places of respite, places of health and healing. Sterilization of medical equipment using ethylene oxide causes great harm to community members, including growing children, who are exposed to EtO emissions and to workers who are at risk of acute toxic effects, as well as being in a dangerous work environment with a flammable chemical. Look at your hospital’s mission statement and see if your hospital’s practices fit.

Open up to feedback from employees and the community—A hospital that puts the needs of the people it serves and the healthcare of its staff, workers that make hospital functioning possible, is a hospital that lives up to its purpose.

Make small changes at first—Add a non-EtO sterilization procedure to your current regime of EtO sterilizers. Measure efficiency, cost-effectiveness, employee-, patient- and community satisfaction.

Final Conclusions and Recommendations    

As a healthcare setting, your hospital has an unparalleled responsibility to look toward the health of others. Whether it be employees, patients, or members of the community, your primary duty is promoting health of well-being. As every physician who walks in through your door has taken the oath ‘Primum non nocere,’ ‘First do no harm,’ your ultimate goal should be not causing harm. As shown above, using ethylene oxide to sterilize medical equipment causes harm.

Our recommendation is that you choose one of the options presented above (the Amsco® V-PRO® maX Low Temperature Sterilization System, the STERRAD® 100NX® Sterilizer, the STERIZONE® 125L+ Sterilizer, or the Noxilizer) to add to your sterilization regimen. If your hospital is not prepared to make an investment in any additional equipment at this time, another option would be to outsource sterilization of medical equipment to a company that uses one of these methods.

References

  1. Jinot, J., et al., Carcinogenicity of ethylene oxide: key findings and scientific issues.Toxicol Mech Methods, 2018. 28(5): p. 386-396.
  2. Norman, S., Berlin, J., Soper, K., Middendorf, B., & Stolley, P. (1995). Cancer Incidence in a Group of Workers Potentially Exposed to Ethylene Oxide. International Journal of Epidemiology, 24(2).
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