Safe Use of Glutaraldehyde in Health Care

The US-American Institute of Occuaptional Safety and Health recently posted to
its Web site a new handbook. "Best Practices for the Safe Use of Glutaraldehyde
in Health Care" helps employers and employees understand and control exposures
to glutaraldehyde, a toxic chemical used to disinfect and clean heat-sensitive
medical, surgical and dental equipment.

Glutaraldehyde is used widely as a cold sterilant to disinfect a variety of
heat-sensitive instruments, such as endoscopes, bronchoscopes, and dialysis
equipment (NIOSH, 2001). In addition, health care employees may be exposed to
glutaraldehyde in its uses as a hardener in x-ray developing and as a tissue
fixative in histology and pathology labs.

Glutaraldehyde's properties as a chemical sterilant were initially recognized
in the early 1960s as the health care industry searched for a safer alternative
to formaldehyde. In the years since its introduction as a
disinfectant/sterilant, glutaraldehyde has been linked with a variety of health
effects ­ ranging from mild to severe ­ including asthma, breathing
difficulties, respiratory irritation, and skin rashes.

The most serious adverse health effect documented among workers exposed to
glutaraldehyde vapor is occupational asthma, a chronic condition characterized
by bronchial hyperresponsiveness. Reactions can be either immediate or delayed,
with a latent period ranging from a few weeks to several years from the onset
of exposure. Human studies on the effects of glutaraldehyde exposure consist of
many case reports in the published literature, some identified by both American
and British health surveillance systems, and symptom surveys of American health
care workers, all of which document an association between exposure to
glutaraldehyde and the development of asthma.

In addition, a few cross-sectional studies also show that an increased
prevalence of irritant symptoms, including itching of the eyes with increased
lacrimation (tearing), and rhinitis, is reported by health care workers who are
exposed to short-term (15-minute) concentrations well below 0.2
parts-per-million (ppm) in air, predominantly in the range of about 0.005 to
0.050 ppm. In addition to causing respiratory effects, glutaraldehyde acts as a
contact allergen, giving rise to contact dermatitis, usually on the hands but
occasionally on the face. Skin sensitization from contact with glutaraldehyde
has been documented in endoscopy nurses, dental assistants, x-ray technicians,
hospital maintenance and cleaning staff, and funeral service workers.

Individuals who have become sensitized to glutaraldehyde can develop dermatitis
after contacting solutions containing as little as 0.1 percent glutaraldehyde.
In contrast, simple skin irritation typically occurs on contact with solutions
containing more than 2 percent glutaraldehyde. In one study of health care
workers who had developed allergic contact dermatitis from glutaraldehyde, ten
workers who were followed for six months after initial diagnosis continued to
have persistent hand eczema, although five of these workers had left their jobs
because of this health problem.

More info

AplusA-online.de - Source: U.S. Department of Labor  Occupational Safety & Health Administration