Glutaraldehyde Control in Hospitals

"Our Hospital wants to Eliminate or reduce our dependence on glutaraldehyde as a high level disinfectant. What are our options?"

• Invest in new enclosed equipment technologies that eliminate the need for glutaraldehyde altogether while protecting worker health and safety. Examples include: (1) Steris, (2) Sterrad and (3) Sterilox. See Table 1 entitled "Alternatives to Glutaraldehyde" for more information about these systems.

• Use a different liquid chemical disinfectant instead of glutaraldehyde. Examples include (1) Cidex OPA (.55% ortho-phthalaldehyde), (2) Peracetic Acid and Hydrogen Peroxide mix and (3) Hydrogen Peroxide solutions. See Table 1 for more information.

"Our Hospital is not in a position to eliminate all of the glutaraldehyde soaking stations right now. What can we do in the meantime to protect employees from hazardous exposures?"

See Table 2 for more information about the products referenced in this section.

• Consider modifications in ventilation systems and work organization:

1. Centralize glutaraldehyde stations into a few key locations. Provide emergency eyewash units. Utilize work practice aids such as absorbent mats and safety nozzles.
2. Install Local Ventilation systems to exhaust glutaraldehyde vapors before workers can breathe them. Purchase or design enclosed work stations and fume hoods (ducted or ductless) to control vapors. In addition, Improve General Ventilation in all work areas where glutaraldehyde is used to improve the overall air quality in the work area.

• Enhance your overall Environmental and Occupational Health and Safety Program:

1. Train affected employees. All workers who work directly with glutaraldehyde should be included in a chemical safety awareness training program as per the requirements of OSHA’s Hazard Communication Standard (29 CFR 1910.1000)
2. Monitor employee exposure to glutaraldehyde utilizing a direct-reading instrument. Note: other monitoring methods greatly understate actual glutaraldehyde exposure levels.
3. Purchase and train employees to use the appropriate personal protective equipment. Latex gloves do not protect skin from glutaraldehyde exposure; Nitrile and Butyl Rubber are recommended. Splash goggles and face shields will be needed. Protective clothing - - such as gowns and lab coats - - are recommended as well. Check with the manufacturer to assure that the protective clothing is impervious to glutaraldehyde (as per ASTM Permeation Protocols).
4. Maintain a well-trained Glutaraldehyde Spill Emergency Team with updated Spill kits and a corresponding Written Plan. The requirements of OSHA’s Respiratory Protection Standard (29 CFR 1910.134) must be fulfilled when preparing team personnel, selecting appropriate respirators, and providing personal protective equipment. Response team personnel require head-to-toe glutaraldehyde-impervious protective gear.
5. Utilize glutaraldehyde waste solution neutralizers. These products eliminate the toxic exposure to workers during disposal activities. In addition, some publicly operated treatment works (POTWs) require aldehyde neutralization before disposing of effluent.

"Wow. These recommendations sound expensive. How do they compare with the costs of purchasing alternative liquid chemical disinfectants or enclosed disinfection equipment systems?"

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TABLE 1: Alternatives to Glutaraldehyde for Hospital High Level Disinfection (HLD) Tasks  

Note: Several chemical disinfectants have been excluded: Phenolics and Iodophors have unproven efficacy for HLD; isopropyl and ethyl alcohols are unable to inactivate bacterial spores. Ethyl alcohol cannot inactivate hydrophilic viruses. The alcohols are also flammable. The hypochlorites have corrosive effects on many medical devices. The quaternary ammonium compounds are suitable for non-critical disinfection tasks but not for HLD (BSG 1998, Rutala 1996). All products listed below have FDA Pre-market (510K) Approval unless noted otherwise.

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RESOURCES

2.       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.
http://www.rcn.org.uk/index.html

3.       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. http://www.fda.gov/cdrh/ode/germlab.html

4.       British Society of Gastroenterology (BSG) Endoscopy Committee (1998) Cleaning and Disinfection of equipment for gastrointestinal Endoscopy: Report of a Working Party of the British Society of Gastroenterology Endoscopy Committee. Gut 42:585-593.

5.       Rutala WA (1996) APIC Guideline for Selection and Use of Disinfectants. American Journal of Infection Control 24:313-42.

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Table 2: Products to Control Worker Exposure To Glutaraldehyde

Note: Information has been provided by the named vendors. The Sustainable Hospitals Project does not endorse any products or take responsibility for the accuracy of the information or for product performance. Contact vendors directly to purchase or to obtain more information. This table is a work-in-progress and feedback may be sent by email to shp@uml.edu or by phone to 978-934-3386,

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RESOURCES

For more information on reducing occupational and environmental hazards contact the SHP at shp@uml.edu or 978-934-3386.

1. JCAHO’s Video entitled "Hazardous Vapors: Risks, Reduce, Replace" is available from the Customer Service Center. (630) 792-5800 or www.JCAHO.org
2. AAMI (1996). Safe use and Handling of Glutaraldehyde-based Products in Health Care Facilities: Proposed Recommended Practice Standard. Association for the Advancement of Medical Instrumentation. January 22, 1996.
3. Tellus Institute. Healthy Hospitals: Environmental Improvements Through Environmental Accounting. Tel: 617-266-5400. http://www.tellus.org
4. Michigan Health and Hospital Association (MHHA) & Service Corporation, Occupational Health and Environmental Safety. The Safe Use of Glutaraldehyde in the Healthcare Industry. (undated). Lansing, Michigan.
5. Notarianni FL. Glutaraldehyde Safety Action Plan. Logan Associates, Inc., Novi, Michigan. Downloaded on 5/6/99 from http://www.cea.purdue.edu/IAHCSMM/32Lesson.HTM

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