Nitrous Oxide: Staff Safety

Response to this request is long overdue. By law, under all circumstances, The Dudley Group NHS Foundation Trust should have responded by now (details). You can complain by requesting an internal review.

Dear The Dudley Group NHS Foundation Trust,

Staff working in maternity are at principal risk of exposure to Nitrous Oxide (Entonox). Potential health effects from prolonged exposure to Nitrous Oxide are:

> Can affect a woman's fertility.
> Bodin et al (1999) found an association between exposure and reduced birthweight and an increase in SFGA babies
>Developmental toxicity on the developing foetus and an increase in miscarriage.
> Permanent inactivation of the body's stores of vital Vitamin B12. Prolonged exposure can result in chronic illness from a multitude of debilitating symptoms and includes myleoneuropathy and sub acute degeneration.
> Megablastic bone marrow changes
>Folate metabolism and DNA synthesis is impaired (RCM Entonox Guideline 2018)

Under The Control of Substances Hazardous to Health (COSHH) Regulations , employers have a legal duty to monitor staff exposure to nitrous oxide and to ensure that their exposure to these substances are kept to a minimum. To do so, the following should be carried out:

> Assessment of the risk (Nitrous oxide is a substance with a WEL as listed in the HSE publication EH40/2005 Workplace Exposure Limits)

>Methods of achieving control of the risk (this substance presents a high risk to people's health and measures should be put in place to minimise, control and regularly monitor exposure to this substance).

> Personal monitoring for exposure to substances hazardous to health (The Trust should be aware that midwives work for long hours in unventilated rooms).

Currently, the Trust do not provide gas scavenging units to birth rooms where exposure is high but which are provided in Obstetric theatre, where staff exposure is relatively low.

The Trust also does not provide personal monitoring badges to maternity staff that are exposed to Nitrous Oxide. It is recommended that exposure does not exceed 100ppm over 8 hours in any 24 hour period (COSHH)

I am writing to you to request Health and Safety evidence/guidance/policy documentation which supports why the Trust does NOT provide gas scavenging units to each birth room on your maternity unit and evidence as to why it is deemed acceptable to ONLY measure ambient air levels (which is inappropriate due to the ways in which midwives work, in comparison to other clinicians) ?

I would also like to request any evidence which supports why maternity staff are NOT provided with personal monitoring badges by the Trust. The provision of these badges would ensure their exposure is not greater than 100ppm. (Without them, this level CANNOT be monitored and presents a serious risk).

Information re COSHH obtained from www.hse.gov.uk/pubns/indg136.pdf

Yours faithfully,
Karen

Foi (THE DUDLEY GROUP NHS FOUNDATION TRUST), The Dudley Group NHS Foundation Trust

1 Attachment

Good Morning

 

Please find attached acknowledgement of your request.

 

Kind Regards

Information Governance Office

 

 

 

 

 

 

 

If you are not the intended recipient of this email (and any attachment),
please inform the sender by return email and destroy all copies.
Unauthorised access, use, disclosure, storage or copying is not permitted.
Communication by internet email is not secure as messages can be
intercepted and read by someone else. Therefore we strongly advise you not
to email any information, which if disclosed to unrelated third parties
would be likely to cause you distress. If you have an enquiry of this
nature please provide a postal address to allow us to communicate with you
in a more secure way. If you want us to respond by email you must realise
that there can be no guarantee of privacy.
Any email including its content may be monitored and used by the Trust for
reasons of security and for monitoring internal compliance with Trust
policy on staff use. Email monitoring or blocking software may also be
used. Please be aware that you have a responsibility to ensure that any
email you write or forward is within the bounds of the law.
The Trust cannot guarantee that this message or any attachment is virus
free or has not been intercepted and amended. You should perform your own
virus checks.

 

 

 

 

 

 

 

 

 

 

 

show quoted sections

Foi (THE DUDLEY GROUP NHS FOUNDATION TRUST), The Dudley Group NHS Foundation Trust

1 Attachment

Good Morning

 

Please find attached acknowledgement of your request.

 

Kind Regards

Information Governance Office

 

 

 

 

 

 

 

If you are not the intended recipient of this email (and any attachment),
please inform the sender by return email and destroy all copies.
Unauthorised access, use, disclosure, storage or copying is not permitted.
Communication by internet email is not secure as messages can be
intercepted and read by someone else. Therefore we strongly advise you not
to email any information, which if disclosed to unrelated third parties
would be likely to cause you distress. If you have an enquiry of this
nature please provide a postal address to allow us to communicate with you
in a more secure way. If you want us to respond by email you must realise
that there can be no guarantee of privacy.
Any email including its content may be monitored and used by the Trust for
reasons of security and for monitoring internal compliance with Trust
policy on staff use. Email monitoring or blocking software may also be
used. Please be aware that you have a responsibility to ensure that any
email you write or forward is within the bounds of the law.
The Trust cannot guarantee that this message or any attachment is virus
free or has not been intercepted and amended. You should perform your own
virus checks.

 

 

 

 

 

 

 

 

 

 

 

show quoted sections

Dear Foi (THE DUDLEY GROUP NHS FOUNDATION TRUST),
Then may i bring to your attention the following sections of the HBN
Ventilation??
11.4 Each maternity theatre suite should ideally be
served by its own air handling plant, provided with
standby set-back control.
11.5 In birthing rooms and recovery areas where
analgesic and anaesthetic gases are exhaled, the
ventilation rate should be of sufficient capacity to
control substances within the appropriate
occupational exposure limits (COSHH). In order
to optimise the ventilation efficiency to minimise
the amount of ventilation required, consideration
should be given to low-level extract at the bedhead
in recovery areas and to proprietary scavenging
systems in birthing rooms.
11.6 See also Health Technical Memorandum 03-01 –
‘Specialised ventilation for healthcare premises’,
Parts A and B.
11 Specific engineering considerations
Table 1 Birthing room ventilation design criteria
Ventilation Air-change
rates per
hour
Pressure
(Pascals)
Supply
filter
Noise
(NR)
Temperature
(°C)
Comments
Birthing
room
Supply and
extract
15 Negative G4 40 18–25 In birthing rooms, the use of
anaesthetic gas is controlled on
demand by the patient. This may
result in significant leakage that – in
order to reduce staff exposure – will
need to be controlled by establishing
a clean air-flow path. A supply at high
level at the foot-end of the bed with
extract at low level at the head-end
will provide such a path

I also request information as to how and where these tests are carried out.

Yours sincerely,

Karen Brighton

Foi (THE DUDLEY GROUP NHS FOUNDATION TRUST), The Dudley Group NHS Foundation Trust

Good Morning

Thank you for your request.

You are asking how and where the tests are carried out, could you please specify what tests you are referring to.

The points listed below seem to be statements I cannot see what the question refers to.

Kind Regards
Information Governance office

show quoted sections

Dear Foi (THE DUDLEY GROUP NHS FOUNDATION TRUST),
I apologise for not making myself clear. At this point i do not require the answer to the question i thought i asked.

Yours sincerely,

Karen Brighton