Sustainable Hospitals


10 Reasons To Eliminate Glutaraldehyde

 
Hospital Disinfection is serious business. When glutaraldehyde was first marketed in the early 1960's 1, it was good news. Effective alternatives were sought to the highly toxic, irritating and carcinogenic disinfectant formaldehyde. However, reports of serious health effects from glutaraldehyde exposure were published shortly thereafter2 and ever since. Today, 40 years later, there are alternatives that offer high level disinfection while protecting health care workers and the environment.
  1. Glutaraldehyde (GA) is a potent occupational skin irritant and sensitizer3 4.
     
  2. Glutaraldehyde exposure in hospitals is a recognized cause of occupational asthma 5 6 7 8 9 10 in many industrialized nations (England, Australia and others) although it is not regulated in the United States. Studies demonstrate that adverse respiratory health effects may occur at levels below 0.2 ppm, the current NIOSH Recommended Exposure Limit (REL)11 12.
     
  3. Anecdotal reports suggest that GA exposure has been associated with the development of chemical sensitization disorders 13. This condition results in an intolerance not only to glutaraldehyde, a sensitizer, but to many other classes of chemicals as well.
     
  4. Patients, visitors, and hospital staff may be needlessly exposed to glutaraldehyde vapors in patient rooms and clinical areas where open bins or poorly ventilated reprocessing units are in use.
     
  5. Alternatives to glutaraldehyde are available that maintain infection control standards 14 15 16 17 and do not cause undue wear and tear on sensitive medical devices.
     
  6. Alternatives to glutaraldehyde are available that are safer both for workers (the risk of skin and respiratory sensitization is avoided) and for the environment.
     
  7. It's smart to stay ahead of the game. OSHA is currently developing a Permissible Exposure Limit (PEL) for glutaraldehyde. Observers suggest that a 0.05 ppm ceiling limit may result due to evidence that respiratory sensitization can still occur at the NIOSH Recommended Exposure Limit of 0.2 ppm. Other countries have lowered or are in the process of lowering their "ceiling" limits to 0.1 ppm or 0.05 ppm.. In the U.S., the American Congress of Government Industrial Hygienists (ACGIH) recently lowered their Threshhold Limit Value (TLV - 15 min STEL) to 0.05 ppm18.
     
  8. The alternatives will be cheaper in the long run:
    Direct costs of using glutaraldehyde include: special ventilation hoods, improved general ventilation, construction or purchase of enclosed disinfection stations, personal protective equipment, education and training programs, ongoing monitoring programs, chemical neutralization solutions, maintenance of a glutaraldehyde emergency spill team, and work practice aids such as absorbent mats, pouring nozzles, etc.
     
    Indirect costs -- largely overlooked -- include: employees with occupational dermatitis, employees with occupational asthma, lost work time, workers' compensation, costs of replacement labor, costs of managing staff, patient and community relations. Future costs may include: compliance with a new OSHA PEL and action from local POTWs (publicly operated treatment works) regarding the dumping of aldehydes, such as glutaraldehyde, down the drain.19 20
  9. A plan to eliminate or phase-out glutaraldehyde is consistent with a public health approach: PREVENTION. It makes sense to eliminate highly toxic and sensitizing substances from the hospital environment when alternatives exist that are feasible, effective and sustainable.
     
  10. Glutaraldehyde has successfully been eliminated -- or dramatically reduced -- in dozens of hospitals. The success of these hospitals is the best testimony for the benefits of change.
 
For more information...
Contact the Sustainable Hospitals Project (SHP) by phone (978) 934-3386, email at shp@uml.edu, or mail: Sustainable Hospitals Project, Kitson 200, One University Avenue, Lowell, MA 01854.
 
Footnotes:
(1) Stonehill AA, Drop S. Borick PM (1963). Buffered glutaraldehyde -- a new chemical sterilizing solution. Am J Hosp Pharm 20:459-65.
 
(2) Jordan WP Jr, Dahl MV, Albert HL (1972). Contact Dermatitis from Glutaraldehyde. Arch Dermatol 105: 94-95.
 
(3) Jordan WP Jr, Dahl MV, Albert HL (1972). Contact Dermatitis from Glutaraldehyde. Arch Dermatol 105: 94-95.
 
(4) Nethercott JR et al (1988). Occupational contact dermatitis due to glutaraldehyde in health care workers. 18:193-6.
 
(5) Werley MS, Burleigh-Flayer HD, Ballantyne B (1995). Respiratory Peripheral Sensory Irritation and Hypersensitivity studies with Glutaraldehyde Vapor. Toxicology and Industrial Health 11(5): 489-501.
 
(6) Di Stefano F et. al (1998) Occupational asthma due to glutaraldehyde, Monaldi Archives of Chest Diseases 53:50-5.
 
(7) Corrado OJ, Osman J, Davies RJ (1986). Asthma and Rhinitis after exposure to Glutaraldehyde in Endoscopy Units. Human Toxicology 5 (5): 328-8.
 
(8) Chan-Yeung M, McMurren T, Catonio-Begley F, Lam S (1993). Occupational asthma in a technologist exposed to glutaraldehyde. J Allergy Clin Immunol 91(5): 974-8.
 
(9) Gannon PFG et al. (1994) Occupational asthma due to glutaraldehyde and formaldehyde in endoscopy and x ray departments. Thorax 50: 156-159.
 
(10) Di Stefano F, Siriruttanapruk S, McCoach J, Sherwood Burge P. (1999) Glutaraldehyde: an occupational hazard in the hospital setting. Allergy 54:1105-1109.
 
(11) ACGIH (1998). Glutaraldehyde. Draft chemical summary and recommendations. American Congress of Government Industrial Hygienists. November 16, 1998.
 
(12) MMWR. Epidemiologic notes and reports: Symptoms of irritation associated with exposure to glutaraldehyde -- Colorado. April 3, 1987/36(12): 190-1.
 
(13) Ziem G, McTamney J (1997). Profile of Patients with Chemical Injury and Sensitivity. Environmental Health Perspectives 105 (supplement 2): 417-36.
 
(14) Rutala WA (1996) APIC Guideline for Selection and Use of Disinfectants. American Journal of Infection Control 24:313-42.
 
(15) CDRH (2000). Sterilants and High Level Disinfectants Cleared by FDA in a 510(k) as of January 28, 2000 with General Claims for processing Reusable Medical and Dental devices. Center for Devices and Radiological Health Office of Device Evaluation, Division of Dental, Infection Control and General Hospital Devices. Internet Download on 7/11/00. http://www.fda.gov/cdrh/ode/germlab.html
 
(16) Royal college of Nursing (2000). Is There an Alternative to Glutaraldehyde? A Review of Agents used in Cold Sterilisation. Royal College of Nursing Working Well Initiative. November, 2000.
 
(17) Crow S (1993). Peracetic Acid - Asking the Right Questions. Today's O.R. Nurse, May/June 1993: 47 - 49.
 
(18) ACGIH (1999). Documentation of the Threshold Limit Values and Biological Exposure Indices, 6th Ed. American Conference of Governmental Industrial Hygienists; Publication 0206, Cincinnati, OH.
 
(19) Rutala WA (1996) APIC Guideline for Selection and Use of Disinfectants. American Journal of Infection Control 24:313-42.
 
(20) Dartmouth Hitchcock Medical Center (DHMC). Glutaraldehyde Waste Minimization Report. Unpublished report, 1997. Lebanon, New Hampshire.


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