How improvements in monitoring and safety practices lowered airborne formaldehyde concentrations at an Italian university hospital: a summary of 20 years of experience.

The last two decades have been crucial for the assessment of airborne formaldehyde (FA) exposure in healthcare environments due to changes in limits and reference values, definition of carcinogenicity, and new monitoring methods. The aim of this study was to analyse twenty years (1999-2019) of experience in automatic, continuous airborne FA monitoring in the Pathology Laboratory and operating rooms at the Careggi University Hospital, Florence, Italy. These 20 years saw gradual improvements in FA monitoring of exposed employees considered at maximum risk, including improvements in analytical methods of detection and sampling strategies, which came with changes in procedures and workflow operations. In 2019, after the adoption of safe practices, including a closed-circuit system using pre-loaded containers and a vacuum sealing, 94 % of the total measurements (FA concentrations) were lower than 16 μg/m3, and only 6 % ranged from 21 to 75 μg/m3. In the studied work units, the ratio between area and personal readings ranged from 0.9 to 1.0, both for long and short-term sampling. Personal sampling was simplified with a new workstation, which integrated different monitoring systems into an innovative ergonomic armchair equipped with personal sampling devices. Area monitoring was also improved with a real-time, continuous photoacoustic instrument. Over these 20 years, FA exposure significantly dropped, which coincided with optimised histology workflow and implementation of safety practices. For high-throughput screening and cost savings we propose an innovative ergonomic armchair station which allows remote continuous monitoring. Posljednja dva desetljeća bila su iznimno važna za procjenu izloženosti formaldehidu (FA) u zraku u zdravstvenim ustanovama zahvaljujući promjenama u preporučenim maksimalnim i referentnim vrijednostima, definiciji njegove kancerogenosti i novim metodama mjerenja/praćenja. Cilj je ovog istraživanja bio analizirati dvadeset godina (1999. – 2000.) iskustva u automatskom, kontinuiranom mjerenju razina FA-a u laboratoriju za patologiju i operacijskim dvoranama talijanske sveučilišne bolnice Careggi u Firenzi. Tijekom tih dvadeset godina bolnica je postupno poboljšavala metode praćenja razina FA-a i osoblja izloženoga najvećem riziku, analitičke metode detekcije i strategije uzorkovanja koje su bile popraćene promjenama u odgovarajućim postupcima i organizaciji rada. Nakon usvajanja novih postupaka zaštite na radu 2019., uključujući i zatvoreni sustav rukovanja spremnicima i sustav vakuumskoga zatvaranja, razine FA-a u 94 % izmjera bile su niže od 16 μg/m