When addressing ethylene oxide (EtO) in healthcare logistics, attention often focuses on the medical device itself. However, packaging, pallets, stretch film and logistics activities also play an important role in potential exposure. The way goods are packaged, stored and handled affects where EtO may be released and which activities require particular attention as part of the occupational risk assessment and exposure assessment.

Why do packaging and pallets affect exposure risk?

EtO does not enter a warehouse as a separate hazardous substance. It is present as a residual gas in and around EtO-sterilised medical devices. This makes the source of potential exposure less visible than with many other hazardous substances. During logistics processes, employees mainly handle materials such as:

• cardboard boxes;
• stretch film;
• pallets;
• crates;
• trays;
• labels;
• outer packaging.

These logistics materials can affect how long EtO continues to off-gas and when employees may come into contact with it.

How does packaging affect ethylene oxide emissions?

Packaging plays an important role in how EtO behaves around a product. A sealed pallet load, tightly wrapped stretch film or fully closed box retains the gas differently from opened packaging or a product that is being repacked. As a result, local EtO concentrations may vary even when the same products are being handled. Factors that may influence EtO emissions include:

• the type of packaging;
• the quantity of packaging material;
• storage duration;
• pallet configuration;
• air circulation;
• the point at which packaging is opened.

During which logistics activities can EtO be released?

Not every logistics activity presents the same potential exposure risk. Particular attention may be required during the following activities:

Why are general area measurements not always sufficient?

In large warehouses, assessments often focus on the average EtO concentration across the entire building. However, this does not always provide a realistic picture of employees’ actual exposure. Employees are not evenly distributed throughout the warehouse. They work in specific locations, such as:

• inbound and outbound docks;
• picking areas;
• value-added services (VAS) areas;
• quality assurance areas;
• staging areas.

Temporary peaks in EtO concentrations may occur at these hotspots. Measurements should therefore be carried out where employees actually work and where relevant logistics activities take place.

How can a warehouse identify these risks?

A practical assessment starts with five questions.

1. Which goods flows may involve EtO?
   Identify which products or product groups have been sterilised using ethylene oxide.
2. Where is packaging opened?
   Map all locations where boxes, stretch film or outer packaging are removed.
3. Where are large volumes held temporarily?
   Review staging areas, inbound buffers, quarantine zones and VAS areas.
4. What influence does the packaging material have?
   Include pallets, cardboard, stretch film and crates when assessing potential exposure points.
5. Are measurements taken where employees actually work?
   Take measurements in employees’ breathing zones and during logistics activities, rather than only measuring the general warehouse environment.

Points to consider in the occupational risk assessment

When assessing EtO risks within a warehouse, it is important not to focus solely on the medical device. The assessment should also consider:

• the form and type of packaging;
• pallet configuration;
• storage duration;
• handling activities;
• airflows;
• ventilation;
• workstation location;
• the time employees spend in the area.

Assessing these factors together provides a more realistic picture of the actual exposure risks.

Frequently asked questions

• Can EtO also be released from packaging?
  Yes. Following sterilisation, EtO may continue to off-gas from both the products and the packaging in which they are stored.
• Are pallets or stretch film themselves a source of EtO?
  No. Pallets and stretch film do not contain ethylene oxide. However, they can affect how the gas is retained and how it is released during logistics activities.
• Why is opening boxes an important exposure point?
  When packaging is opened, accumulated EtO may be released. This can temporarily result in higher local concentrations.
• Why are exposure hotspots important?
  The average concentration across a warehouse does not always reflect exposure at individual workstations. Monitoring hotspots provides a more accurate picture of the actual working environment.
• Which logistics areas require particular attention?
  Inbound docks, staging areas, VAS areas, quality assurance areas, returns departments and locations where packaging is opened should receive particular attention.

Need greater insight into ethylene oxide exposure in your warehouse?

A sound assessment starts with the full logistics context. Discuss your situation with one of our specialists to understand how packaging, storage conditions and logistics processes can be incorporated into a robust occupational exposure assessment.