glutaraldehyde
The leading glutaraldehyde suppliers in China.
GLUTARALDEHYDE
Occupational Hazards
in Hospitals
DHHS (NIOSH) Publication No. 2001-115
May 2001
Also available in PDF format (538K - 16 pages).
Ordering Information
To receive documents or other information about occupational safety and health topics,
contact the National Institute for Occupational Safety and Health (NIOSH) at
or visit the NIOSH Web site at www.cdc.gov/niosh
This document is in the public domain and may be freely copied or reprinted.
Disclaimer: Mention of any company or product does not constitute endorsement by NIOSH.
Contents
Introduction
What health effects can exposure to glutaraldehyde cause?
Who might be exposed to glutaraldehyde in hospitals?
When are workers most likely to be exposed to glutaraldehyde in hospitals?
How can I protect myself from exposure to glutaraldehyde?
Safety Tips
Case Report
More information about glutaraldehyde
GLUTARALDEHYDE
Introduction
lutaraldehyde is used as a cold sterilant to disinfect and clean heat-sensitive equipment such as dialysis instruments, surgical instruments, suction bottles, bronchoscopes, endoscopes, and ear, nose, and throat instruments. This chemical is also used as a tissue fixative in histology and pathology labs and as a hardening agent in the development of x-rays. Glutaraldehyde is a colorless, oily liquid with a pungent odor. Hospital workers use it most often in a diluted form mixed with water. The strength of glutaraldehyde and water solutions typically ranges from 1% to 50%, but other formulations are available. Trade names include Cidex?, Sonacide?, Sporicidin?, Hospex?, Omnicide?, Metricide?, and Wavicide?.
The purpose of this brochure is to
¡ªmake you aware of the adverse health effects of glutaraldehyde,
¡ªdescribe how you can be exposed to glutaraldehyde, and
¡ªprovide and identify control methods and work practices to prevent or reduce your exposure to glutaraldehyde.
What health effects can exposure to glutaraldehyde cause?
The following health effects have been reported in hospital workers exposed to glutaraldehyde:
Throat and lung irritation
Asthma, asthma-like symptoms, and breathing difficulty
Nose irritation, sneezing, and wheezing
Nosebleed
Burning eyes and conjunctivitis
Rash¡ªcontact and/or allergic dermatitis
Staining of the hands (brownish or tan)
Hives
Headaches
Nausea
If you experience any of these symptoms when working with glutaraldehyde, report them to your supervisor or safety officer.
Who might be exposed to glutaraldehyde in hospitals?
Workers in hospitals who might be exposed to glutaraldehyde include the following:
Hospital staff who work in areas with a cold sterilizing procedure that uses glutaraldehyde (for example, gastroenterology and cardiology departments)
Hospital staff who work in operating rooms, dialysis departments, endoscopy units, and intensive care units where glutaraldehyde formulations are used in infection control procedures
Central service (supply) workers who use glutaraldehyde as a sterilant
Research technicians, researchers, and pharmacy personnel who either prepare the alkaline solutions or fix tissues in histology and pathology labs
Laboratory technicians who sterilize benchtops with glutaraldehyde solutions
Workers who develop x-rays.
When are workers most likely to be exposed to glutaraldehyde in hospitals?
Workers can be exposed to glutaraldehyde by breathing it or by skin contact during the following procedures:
Cold sterilization of instruments in endoscopy and surgical units
¡ªwhen glutaraldehyde solution is poured into or out of the sterilizing pans, and
¡ªwhen sterilized equipment is removed from the sterilizing pans
Disinfection of histology/pathology laboratory table tops
Mixing and activation of various glutaraldehyde solutions
Tissue fixation in histology labs
Development of x-rays.
How can I protect myself from exposure to glutaraldehyde?
You can protect yourself by using the following control methods and work practices:
Use local exhaust ventilation (capture velocity of at least 100 feet per minute) and at least 10 room air exchanges per hour.
Keep glutaraldehyde baths under a fume hood where possible.
Use only enough glutaraldehyde to perform the required disinfecting procedure.
Avoid skin contact: use gloves and aprons made of nitrile or butyl rubber (latex gloves do not provide adequate protection).
Wash gloved hands after handling glutaraldehyde.
Wear goggles and face shields when handling glutaraldehyde.
Seal or cover all containers holding glutaraldehyde solutions.
Attend training classes in safety awareness about use of and exposure to glutaraldehyde.
Safety Tips
Become familiar with and be able to recognize sources of glutaraldehyde exposure.
In case of skin or eye contact, wash with water immediately.
Clean up spills immediately.
Refer to ANSI/AAMI [1996] for further information about emergency procedures in the event of a large spill.
CASE REPORT¡ª¡ªSeveral nurses were working in an area where glutaraldehyde was stored in 1-liter baths on countertops and was used to disinfect bronchoscopes. They complained of hives, chest tightness, and watery eyes. Evaluation of the work area indicated that there was a separate (independent) recirculating ventilation system designed to provide 10% outside air. The nurses used no personal protective equipment (such as gloves). Measures were then taken to reduce exposures. These included changing glutaraldehyde containers to air-tight models, using appropriate gloves, and installing local ventilation hoods for glutaraldehyde stations. One month after the implementation of these measures, the nurses' symptoms subsided [Charney 1991].
More information about glutaraldehyde
ANSI/AAMI [1996]. American national standard: safe use and handling of glutaraldehyde-based products in health care facilities. Arlington, VA: American National Standards Institute, Inc., and Association for the Advancement of Medical Instrumentation, ANSI/AAMI ST58¨C1996.
Babb JR, Bradley CR [1995]. Endoscope decontamination: where do we go from here? J Hosp Infect 30(Suppl):543¨C551.
Ballantyne B, Berman B [1984]. Dermal sensitizing potential of glutaraldehyde: a review and recent observations. J Toxicol Cutaneous Ocul Toxicol 3:251¨C262.
Beauchamp RO Jr., St. Clair MBG, Fennell TR, Clarke DO, Morgan KT [1992]. A critical review of the toxicology of glutaraldehyde. Crit Rev Toxicol 22(3,4):143¨C174.
Butt G, Greenley P, Herrick R, DiBerardinis L [1999]. Exposure to glutaraldehyde vapors during endoscopic sterilization processes in a large research and teaching institution. Infect Control 3(4):172¨C179.
Charney W [1991]. Hidden toxicities of glutaraldehyde. In: Charney W, Schirmer J, eds. Essentials of modern hospital safety. Chelsea, MI: Lewis Publishers, Inc., pp. 71¨C81.
Evans PF, Elliott-Minty C, Saleem A, Morris L, Groves J, Pedersen R [1997]. Glutaraldehyde: Criteria document for an occupational exposure limit. London, United Kingdom: Health and Safety Executive (HSE).
Finucane EW [1993]. Monitoring aldehydes in the hospital. In: Charney W, Schirmer J, eds. Essentials of modern hospital safety. Vol. 2. Boca Raton, FL: Lewis Publishers, Inc., pp. 191¨C210.
NIOSH [1997]. NIOSH pocket guide to chemical hazards. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 97¨C140.
Norb?ck D [1988]. Skin and respiratory symptoms from exposure to alkaline glutaraldehyde in medical services. Scand J Work Environ Health 14:366¨C371.
Pisaniello DL, Gun RT, Tkaczuk MN, Nitshcke M, Crea J [1997]. Glutaraldehyde exposures and symptoms among endoscopy nurses in South Australia. Appl Occup Environ Hyg 12(3):171¨C177.
Scobbie E, Dabill DW, Groves JA [1996]. Chemical pollutants in x-ray film processing departments. Ann Occup Hyg 40(4):423¨C435.
Stenton SC, Beach JR, Dennis JH, Keaney NP, Hendrick DJ [1994]. Glutaraldehyde, asthma, and work¡ªa cautionary tale. Occup Med 44(2):95¨C98.
Waterman L [1992]. The hazards of health care¡ªglutaraldehyde: a review of its clinical use and abuse. The Safety & Health Practitioner, June, pp. 15¨C17.
GLUTARALDEHYDE
Summary
The hazard: Glutaraldehyde is a toxic chemical that is used for cold sterilization of medical and dental equipment. It is in Cidex and other products. Glutaraldehyde can cause severe irritation of the eyes, nose, throat, lungs, nausea, headaches, drowsiness, and dizziness. It can cause difficult breathing and other severe allergic reactions in workers who have become sensitized to glutaraldehyde.
Who is at risk: Workers who use glutaraldehyde to sterilize instruments and other tasks.
Prevention: Avoid using glutaraldehyde by using other chemicals or processes, enclose operations and use local exhaust ventilation, store and handle properly, use respirators and other personal protective equipment.
Laws: There is no Occupational Safety and Health Administration (OSHA) permissible exposure limit. The National Institute for Occupational Safety and Health (NIOSH) recommends that exposure to glutaraldehyde be under 0.2 ppm (parts per million).
WHAT IS GLUTARALDEHYDE?
Glutaraldehyde is a colorless liquid used to sterilize medical and dental equipment. It is in products including Cidex, Glutarex, and Sonacide. Glutaraldehyde is also used in leather tanning and water treatment, and as a chemical preservative.
WHAT ARE THE HEALTH EFFECTS OF GLUTARALDEHYDE?
Short term (acute) effects: Contact with liquid and vapor can severely irritate the eyes, and at higher concentrations burns the skin. Breathing glutaraldehyde can irritate the nose, throat, and respiratory tract, causing coughing and wheezing. Exposure to glutaraldehyde can cause nausea, headaches, drowsiness, and dizziness.
Long-term (chronic) effects: Glutaraldehyde is a sensitizer. This means some workers will become very sensitive to glutaraldehyde and have strong reactions if they are exposed to even small amounts. Workers may get sudden asthma attacks with difficult breathing, wheezing, coughing, and tightness in the chest. Prolonged exposure can cause a skin allergy and chronic eczema, and afterwards, exposure to small amounts produces severe itching and skin rashes.
WHO IS AT RISK?
Health care workers who use glutaraldehyde to cold sterilize medical, surgical, and dental devices. Glutaraldehyde is also used in tissue embalming, during X-ray film processing, and in electron microscopy. It is also commonly used in the paper and tanning industries, in the manufacture of adhesives and sealants, and as a biocide in water cooling towers.
HOW CAN EXPOSURE BE PREVENTED?
Avoid using the product (substitution): Where possible, the use of glutaraldehyde should be avoided by using less toxic chemicals or other processes for sterilization.
Use equipment to avoid exposure (engineering controls): Glutaraldehyde should be used in a contained process along with local exhaust ventilation. Automate the transfer of pure glutaraldehyde (crystal form) or pump liquid glutaraldehyde from drums or other storage containers to process containers and operations.
Work practices: The following steps can reduce exposure:
Store glutaraldehyde in closed containers in well ventilated areas. Post signs to remind staff to replace lids after using product.
Change into clean clothes if clothing becomes contaminated. Do NOT take contaminated clothing home.
Use eye wash fountains and emergency showers if there is skin contact with glutaraldehyde. Wash or shower for at least 15 minutes to remove chemical.
Do not eat, drink or smoke in any area where glutaraldehyde is handled or stored.
Use a vacuum or wet method to reduce dust during clean up for pure glutaraldehyde. DO NOT DRY SWEEP.
Respirators and protective gear (personal protective equipment): In addition to substituting other products, engineering controls and work practices, respirators or other personal protective equipment (PPE) may be necessary.
Gloves made of butyl rubber, neoprene or viton materials.
Protective clothing (suits, gloves, footwear, etc.) should be clean, available each day, and put on before work begins
Eye protection: for pure glutaraldehyde wear impact resistant eye protection with side shield or goggles. Wear indirect-vent impact and splash resistant goggles when working with liquids.
Respirators: as part of a written respiratory protection program that includes worker training, fit-testing, and medical exams. A positive pressure supplied air respirator is needed if other control measures do not keep exposure below 0.2 ppm.
WHAT LAWS TO PROTECT WORKERS FROM GLUTARALDEHYDE?
There is no Occupational Safety and Health Administration (OSHA) permissible exposure limit. The National Institute for Occupational Safety and Health (NIOSH) recommends that exposure to glutaraldehyde be under 0.2 ppm ( parts per million). The American Conference of Governmental Industrial Hygienists (ACGIH) recommends a limit of 0.05 ppm.
Glutaraldehyde
General Description
Glutaraldehyde is used in cold sterilization and disinfection in the health care industry as a 2% water solution. It is known by its synonym Cidex. It is a colorless liquid with a pungent smell. Glutaraldehyde is also used in X-ray processing solutions, so workers handling recently processed X-ray films may also be at risk of exposure.
Health Effects
The most common health effect of glutaraldehyde exposure is irritation of the nose, and to a lesser degree, irritation of the eyes and skin. It can also cause allergic contact dermatitis (skin sensitization). Gloves do not seem to help. In some cases, it has caused asthma. Glutaraldehyde has a low vapor pressure, so it is probably not inhaled as readily.
Exposure Limits
NIOSH, OSHA, and the American Conference of Governmental Industrial Hygienists have set an exposure limit of 0.2 parts per million (ppm). It has been found that short-term exposure to glutaraldehyde in concentrations of 0.3 ppm or higher results in significant risk of irritation to the eyes, nose, and throat. Even at low concentrations (below 0.2 ppm), studies have found that glutaraldehyde causes irritation symptoms. In a simulation of a cold-sterilization procedure, the worker exposure was 0.38 ppm.
Protective Measures
Workers using glutaraldehyde should have personal protective equipment to prevent skin and eye contact. Skin that comes in contact with the solution should be washed immediately. Eye wash fountains should be provided in case of accidental contact. Clothing that has become wet with solution should be removed and replaced.
(1.00) Glutaraldehyde: Health Effects of Glutaraldehyde
What are the main health hazards associated this chemical? Will it cause cancer? Will it cause effects on the fetus/unborn baby?
(0.97) Glutaraldehyde: Working Safely with Glutaraldehyde
What is the American Conference of Governmental Industrial Hygienists (ACGIH) recommended exposure limit? What are the fire and explosion dangers associated with this chemical? How can I work safely with this chemical?
(0.97) Glutaraldehyde: Basic Information on Glutaraldehyde
Briefly, what do I need to know in an emergency situation? What are some synonyms? Is there a unique identifier for this chemical?
(0.94) Glutaraldehyde: First Aid for Exposure to Glutaraldehyde
What should I do if someone becomes ill from breathing in this chemical? What do I do if someone gets it on their skin? What do I do if someone swallows this chemical?
(0.91) Glutaraldehyde: Personal Protective Equipment Information for Glutaraldehyde
If I need to wear a respirator, what kind should it be? What skin protection measures are recommended when working this chemical? What types of materials should my protective clothing be made of?
(0.91) Glutaraldehyde: International Hazard Classifications for Glutaraldehyde
Does this chemical meet any of the Canadian WHMIS hazard criteria? Is it classified by OSHA (U.S. Occupational Health and Safety Administration)? Does it meet the criteria for the European Union (EU) Classification and Labelling Information system?
(0.85) Glutaraldehyde: Source of Information on Glutaraldehyde
This information has been extracted from CCOHS's CHEMINFO database. CHEMINFO contains several hundred comprehensive, fully referenced reviews of the potential hazards and control measures of chemicals.
(0.72) Corrosive Materials: Corrosive Materials and their Hazards
What are corrosives? How are corrosives hazardous to my health? What is hazardous when corrosives touch metals?
(0.70) Occupations & Workplaces: Nurse (Registered)
What should I know before reading about this occupation? What, briefly, does a registered nurse do? What are some health and safety hazards associated with being a nurse?
(0.70) Diseases, Disorders & Injuries: Psittacosis
What is psittacosis? What are the signs of infection among birds? How do birds pass on the infection to humans?
