A new document on this topic is currently being prepared for inclusion in the PPL.  Pending approval and publication of the new entry, information on this topic is available at

http://www.uq.edu.au/ohs/pdfs/HEALTH-Cyanide-FirstAid.pdf

http://www.safeworkaustralia.gov.au/sites/swa/about/publications/pages/cyanide-poisoning.aspx

Guidelines

Working Safely with Cyanide - Guidelines

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Body

1. Purpose and Objectives

This guideline outlines the hazards and safety considerations for the use of cyanide compounds.

2. Definitions, Terms and Acronyms

CNCl - Cyanogen chloride

HCN - Hydrogen cyanide

KCN - Potassium cyanide

NaCN - Sodium cyanide

SDS - Safety Data Sheets

SUSMP - Standard for the Uniform Scheduling of Medicines and Poisons

SCBA - Self contained breathing apparatus

3. Guideline Scope/Coverage

This guideline applies to all workers and students who work with cyanide and cyanide-containing compounds at The University of Queensland. This guideline should be read in conjunction with other related sections of PPL 2.70 Occupational Hygiene and Chemical Safety.

4. Guideline Statement

All workers and students at The University of Queensland have a duty under the Work Health and Safety Act 2011 to ensure that the risk of exposure to cyanide compounds is eliminated or minimised as far as possible. This includes avoiding potential exposure that could result in chronic health effects, as well as ensuring the workplace has suitable first aid procedures to preserve life if an acute cyanide exposure occurs.

This document should be read in conjunction with "Guide to Preventing and Responding to Cyanide Poisoning in the Workplace"- Safe Work Australia and with applicable UQ PPL documents in PPL 2.70 Occupational Hygiene and Chemical Safety.

5. Risk Management

5.1 Risk assessment and procedures

Cyanide is a rapidly acting, highly toxic chemical that exerts its toxic effect through chemical asphyxiation (depriving the body of oxygen). Cyanide can be found in compounds that may exist as a (1) gas, e.g. hydrogen cyanide and cyanogen chloride; (2) dusts, e.g. dispersed sodium cyanide and potassium cyanide salts (solid form); (3) Aqueous solutions, e.g. sodium or potassium cyanide salts dissolved in water. Be aware that cyanide compounds are labile and both solid and liquid forms may readily off-gas cyanide vapour.

Some cyanide compounds fall into the category of Regulated Poisons - Schedule 7 of the SUSMP and require specific permits and methods of storage. Refer to PPL 2.70.13 Drugs and Poisons and Health Drugs and Poisons Regulation Queensland. Before purchasing or commencing work with cyanide, a Prior to Working with Cyanide Compounds written risk assessment must be carried out and recorded. This risk assessment must be checked and approved by the research group's Supervisor. Management Plan and Permit Applications must be submitted and requirements stipulated by the permit should be in place as soon as is practicable on receipt of cyanide (Drugs and Poisons: Cyanide Management Plan and Permit Application Forms - Queensland Health). Cyanide compounds should be stored in a locked poisons cupboard as stipulated by Health (Drugs and Poisons) Regulation 1996, s240 Permit conditions.

If cyanide cannot be substituted, then high order controls such as isolation of work areas using glove box enclosures, or control of airborne cyanide compounds with local exhaust ventilation (fume cupboards), along with appropriate PPE as determined by risk assessment should be used.

Workplaces that have assessed their risk as significant should also stock a cyanide antidote kit. Cyanide antidote kits needed for infrequent use of cyanide may be borrowed from Chemical stores by prior arrangement for a fixed time period - contact the University Chemical Store, telephone 33654437 or email: chemorders@uq.edu.au

  • Personal Protective Equipment appropriate to the procedures carried must be provided to workers and students and be laundered regularly to prevent skin contact. All engineering controls must be operational when working with cyanide.
  • Risk Assessment, Safety Data Sheets (SDSs) and Standard Operating Procedure (SOP) documents must be made available to workers and students and training provided in safe work procedures.
  • Workers and students using cyanide must not work alone and it is recommended that work with cyanide occurs within normal work hours.
  • Procedures must be monitored and reviewed regularly to ensure they are effective.

5.2 Training and competency

All personnel working at the University are required to complete mandatory online general and fire safety training. Personnel working in laboratories with hazardous chemicals are required to complete additional online training modules for laboratory and chemical safety. These modules can be completed as part of online training and assessment programs. In addition to these online modules, workers dealing with hazardous compounds must be given appropriate safety training in the safe handling of cyanide by their supervisors, the safe use of any plant involved in the process, safe storage procedures and in the safe disposal and cleanup of spills or releases of the materials.

Workers and students using cyanide must have received specific training in its safe use and emergency procedures prior to work commencing - see link for guidance on suitable first aid training: Occupational first aid, and have successfully completed training in the correct use of positive pressure self contained breathing apparatus.

5.3 Spills and contamination

The category (minor or major) of spill likely to occur should be assessed as part of the risk assessment. Factors determining the category of spill include the quantity and physical form (solid, gas, solution) of the spill, the location and potential for exposure of workers and others, and other factors such as damage to the environment. A spill kit must be available in the immediate work area where the cyanide is being used.

The risk assessment, based on information in the SDS, provides information on laboratory spills and appropriate waste disposal. Cyanide and its compounds have serious environmental impacts and must be prevented from escaping into drains. If possible contain the spill using absorbent, clean up material, which should be disposed of in suitable containers labelled "Cyanide Contaminated Waste". For UQ waste disposal for specific chemicals contact the Chemical Store using this email link: Chemwaste.

Major spill

In the event of an unexpected spill of these materials, leave the area and ensure others leave too, then contact UQ Security on 33653333 or other emergency contact as designated on the campus emergency contact card for your location. Do not attempt to clean up any large spills of cyanide beyond the capacity of your available spill kit. If workers have been contaminated from the spill, the contaminant must be removed immediately - don PPE including gloves and remove any contaminated clothing from the person, then move them to a safety shower/eyewash and wash off the contaminants thoroughly (at least 20 minutes under shower or eyewash as appropriate). Contact your local First Aid officer and the UQ Health Service for advice.

Minor spill

Minor spills should be cleaned up immediately. Don appropriate PPE including respirator where dust/vapour is present. Collect waste into appropriate waste containers and label accordingly- dispose through the UQ Chemical Store.

5.4 Health effects and symptoms

5.4.1 Routes of exposure

  • Inhalation
  • Skin contact
  • Ingestion

5.4.2 Symptoms - local health effects

The vapour or liquid will cause irritation of the mucous membranes in the eye, nose and throat and may cause skin irritation.

5.4.3 Symptoms - general health effects

Symptoms of mild or early cyanide poisoning in addition to local health effects are general weakness, heaviness of the arms and legs, difficulty breathing, headaches, giddiness and rashes.

The odour of bitter almonds may be detected on the casualty's breath, but this characteristic cannot be relied upon as an indicator of cyanide exposure.

5.4.4 Symptoms of severe cyanide poisoning

  • Nausea and vomiting
  • Shortness of/ gasping for breath
  • Loss of consciousness
  • Convulsions
  • Death.

5.5 Emergency procedures

5.5.1 First Aid/medical emergency

Rescue action by fellow workers:

  • Call UQ Security on 336 53333 (St Lucia, Gatton) or ring 000. Note: internal emergency contact numbers may vary with each campus, refer to the campus emergency contact card for your location.
  • Request immediate paramedic assistance and supply details such as building number, room number and where the casualty is located.
  • Using a positive pressure self-contained breathing apparatus*, wearing appropriate PPE and working in pairs, remove the casualty from the contaminated area and into fresh air.
  • In the meantime, prevent further access to the contaminated area by workers.
  • Remove contaminated clothing and wash/wipe any parts of the body that have been splashed with cyanide or cyanide dust. Production of aerosols containing cyanide during the washing off process must be avoided.
  • Waste cloths must be collected into sealed plastic bags and labelled as cyanide waste.

*Specialist training is required to use positive pressure self-contained breathing apparatus (BA) - contact your local safety coordinator to enquire about the availability of suitable BA training courses.

5.5.2 Managing suspected cyanide poisoning - designated First Aid

First Aid Officers (trained to advanced level) and key workers in cyanide handling and storage areas must be trained to:

  • Carry out rescue in a hazardous environment
  • Recognise the signs and symptoms of cyanide poisoning
  • Implement first aid management of cyanide poisoning.

Workers and students who have Advanced First Aid training

  • If breathing has stopped, begin cardiopulmonary resuscitation using oxygen (at 15L/min) and bag and mask resuscitation equipment. Expired air resuscitation using an approved resuscitation facemask should only be used in the absence of oxygen equipment.
  • Continue resuscitation until medical assistance arrives.
  • Look for firm evidence that cyanide poisoning has actually occurred (i.e. cyanide splash or spill, breath smell of bitter almonds, several people affected, etc.).
  • Arrange urgent transfer to the nearest hospital or medical centre.
  • Maintain resuscitation if necessary and if an emergency cyanide kit is available, send the kit to hospital with the patient (see Cyanide antidote kit in section 5.5.3).
  • Request that a blood sample for cyanide be taken.
  • Identify the specific compound containing cyanide and arrange for a hard copy of the appropriate SDS and a copy of this guideline to be transferred with the patient to be passed on to medical staff.

Medical treatment by a medical practitioner only

  • Support breathing and circulation
  • Give 100% oxygen and continue until it is no longer required. Flow rate at 15L/min;
  • Equipment for emergency endo-tracheal intubation should be immediately available.

If a diagnosis of cyanide poisoning is confirmed and the patient is unconscious or lapsing into unconsciousness:

  • Insert in-dwelling cannula into vein;
  • Take blood to confirm the diagnosis later (into heparinised tube);
  • Prepare Cyanokit for infusion as per manufacturers instructions;
  • Continue oxygen and respiratory circulatory support for as long as necessary.

5.5.3 First Aid equipment checklist

At workplaces where a risk assessment has revealed a risk of cyanide poisoning, the following items should be kept in an accessible and convenient position.

  • Rescuer PPE;
  • A positive pressure resuscitation bag, valve and mask;
  • A source (cylinder) of oxygen, and oxygen flow delivery system;
  • Cyanide antidote kit.

*Operating a CPR bag/valve mask and oxygen for resuscitation is a skill which needs to be taught by a qualified instructor, usually as part of an Advanced First Aid Course.

Cyanide antidote kit

The antidote used at the University Health Service is called Cyanokit.

The kit should be contained in a clearly labelled box. If there is an incident the kit must be sent with the casualty with a copy of the SDS.

Cyanide Antidote Kit contents:

  • Approved Management of Cyanide Poisoning Information;
  • A copy of the appropriate SDS for the cyanide compound in use;
  • Guedel or Brooks Airway;
  • Elasticised tourniquet;
  • Disposable in-dwelling intravenous cannulae x 4 21G/23G;
  • 5ml, 10ml and 20ml sterile disposable syringes;
  • Assorted 23G/21G needles;
  • Heparinised blood sample tubes;
  • Skin prep swabs, dressing adhesive tape and scissors;
  • 2 x 100ml bags of IV Normal Saline 0.9%;
  • Cyanokit x 1 with instruction sheet.

Expiry dates should be regularly checked and stocks updated accordingly.

Cyanide antidote should ONLY be administered by a medical practitioner who is certain cyanide poisoning has occurred.

6. Obligations

6.1 Supervisors

  • Ensure that risks are eliminated or minimised as far as reasonably practicable.
  • Provide supervision and training in the safe use of these materials.
  • Provide assistance with the risk assessment process and to ensure the assessment is comprehensive and accurate.
  • Review and approve the risk assessment, and to ensure all controls outlined in the assessment are followed by workers.
  • Ensure that all appropriate safety systems and equipment are in place, fully operational and used correctly.
  • Ensure that all incidents involving these materials are investigated as soon as possible and that corrective actions (including review and modification of risk assessment and SOPs) are implemented to prevent recurrences.

6.2 Workers and students

  • Ensure that risks are eliminated or minimised as far as reasonably practicable.
  • Provide assistance with the risk assessment process, help ensure the assessment is comprehensive and accurate.
  • Follow safe operating procedures and use the controls outlined in the risk assessment.
  • Wear specified PPE and ensure it is maintained in good condition.
  • Immediately stop work and notify supervisor if there are any changes to procedures or deficiencies in equipment or work process.

7. Contacts for Further Information

Occupational Hygiene Advisors, Occupational Health Nurse Advisor: OHS Enquiries

University of Queensland Chemicals Store: https://chemstore.science.uq.edu.au/LoginStore.aspx

Chemwaste: chemwaste@chemistry.uq.edu.au

Custodians
Director, Occupational Health and Safety
Mr Jim Carmichael
Custodians
Director, Occupational Health and Safety
Mr Jim Carmichael