Exposure of employees to glutaraldehyde. Glutaraldehyde is a toxic chemical that is used as a cold sterilant to disinfect and clean heat-sensitive medical, surgical and dental equipment. It is found in products such as Cidex, Aldesen, Hospex, Sporicidin, Omnicide, Matricide, Wavicide and others. Glutaraldehyde is also used as a tissue fixative in histology and pathology labs and as a hardening agent in the development of x-rays.
Institute for Occupational Safety and Health (NIOSH)
suggests ways in which health care workers may be exposed to glutaraldehyde including:
- Hospital staff who work in areas with a cold sterilizing procedure that uses glutaraldehyde
(e.g., gastroenterology or 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 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 workers who sterilize bench tops with glutaraldehyde solutions.
- Workers who develop x-rays.
Glutaraldehyde is used in a limited number of applications, rather than as a general disinfectant. Specific applications include use as a disinfecting agent for respiratory therapy equipment, bronchoscopes, physical therapy whirlpool tubs, surgical instruments, anesthesia equipment parts, x-ray tabletops, dialyzers, and dialysis treatment equipment (Air
Health effects of glutaraldehyde exposure include:
- Short term (acute) effects: Contact with glutaraldehyde 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, nausea, headaches, drowsiness, nosebleeds, 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. It has been implicated as a possible cause
of occupational asthma.
Limit exposure to glutaraldehyde through work practice, engineering controls and personal protective
equipment (PPE) including:
- Make sure that rooms in which glutaraldehyde is to be used are well ventilated and large enough to ensure adequate dilution of
vapor, with a minimum air exchange rate of 10 air changes per hour.
- Ideally, install local exhaust ventilation such as properly functioning laboratory fume hoods (capture velocity of at least 100
feet per minute) to control vapor.
- Keep glutaraldehyde baths under a fume hood where possible.
- Use only enough glutaraldehyde to perform the required disinfecting procedure.
- Store glutaraldehyde in closed containers in well ventilated areas. Air-tight containers are available. Post signs to remind staff
to replace lids after using product.
- Use specially designed, mobile, compact, disinfectant soaking stations to facilitate sterilization of heat sensitive equipment such
as endoscopes, or GI scopes. These soaking stations provide an enclosed area for sterilizing trays, and remove fumes from glutaraldehyde
and other disinfectants.
- Use appropriate PPE covered under
[29 CFR 1910.132(a)] including:
- Use gloves that are impervious to glutaraldehyde such as those made of Butyl Rubber, Nitrile, and Viton®, which have been shown to
provide full shift protection from glutaraldehyde.
- For shorter exposures, you can use gloves made of polyethylene. Do not use Neoprene and PVC gloves because they do not provide
adequate protection against glutaraldehyde and may actually absorb it.
- Do not use latex surgical exam gloves for skin protection against glutaraldehyde, except in situations where only short-term,
incidental contact is expected.
- Wear lab coats, aprons, or gowns made of appropriate materials such as polypropylene to provide additional protection.
- Wear splash-proof goggles and/or full face shields when working with glutaraldehyde to protect eyes.
- All employees who may be exposed to above the ceiling threshold limit value (TLV) of 0.05 ppm, should use appropriate respirators
for glutaraldehyde vapor during routine or emergency work. Respirator requirements are found in the OSHA respiratory protection
standard [29 CFR 1910.134]
- Provide eye wash fountains for immediate emergency use
[29 CFR 1910.151(c)].
- Use eye wash fountains and emergency showers if there is skin contact with glutaraldehyde. Flush area with water for at least 15
minutes to remove chemical.
- Change into clean clothes if clothing becomes contaminated.
- Clean up spills immediately.
- Refer to ANSI/AAMI  for further
information about emergency procedures in the event of a large spill.
- Do not eat, drink, or smoke in any area where glutaraldehyde is handled or stored.
- Use a vacuum or wet method to reduce dust while cleaning up pure glutaraldehyde. Do not dry sweep.
- Use less toxic products if feasible and available, or other processes for sterilization.
- Automate the transfer of pure glutaraldehyde or pump liquid glutaraldehyde from drums or other storage containers to appropriate
containers and operations, avoiding exposure to glutaraldehyde by keeping it in a contained process.
Standard [29 CFR 1910.1200] requires employers to ensure that the hazards of all chemicals are evaluated and that this information is transmitted to the
employees by means of a hazards communication program which includes, labeling, material safety data sheets, and employee training.
For additional information, see Healthcare Wide Hazards - PPE, and
- Best Practices for the Safe Use of Glutaraldehyde in Health Care. OSHA Publication 3258-08N, (2006).
- OSHA does not currently have a required permissible exposure level (PEL) for
- The American
Conference of Government Industrial Hygienists (ACGIH) has a recommended ceiling Threshold Limit Value (TLV) of 0.05 ppm (parts
per million). This represents an airborne concentration that should not be exceeded during any part of the work shift.
- NIOSH has established a recommended exposure limit of 0.2 ppm for glutaraldehyde vapor from either activated or unactivated
solutions. This TLV is based on the irritation threshold in humans.
Occupational Hazards in Hospitals. U.S. Department of Health Human
Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2001-115,
Air Contaminants. OSHA Preamble to Final Rules, (1989).
of Latex Surgical Exam Gloves for Protection Against Glutaraldehyde. OSHA Standard Interpretation, (October 3, 1997).
- American National Standards Institute/ Association for the Advancement of Medical Instrumentation (ANSI/AAMI)
- ST58-1996, Safe Use and Handling of Glutaraldehyde-based Products in Healthcare Facilities