Central Sterile Supply » Hazardous Chemicals

Hazardous chemicals are prevalent in the Central Sterile Supply. Examples include concentrated liquids with extreme pH levels, sterilization liquids and gases, plasma vapors, and other disinfecting liquids and aerosols.


Employee exposure to hazardous chemicals that are used in the initial washing of dirty instruments.

Requirements under OSHA's Hazard Communication Standard, 29 CFR 1910.1200

One purpose of OSHA’s Hazard Communication Standard (HCS) is to provide information to employees on the hazards of the chemicals they use at work.  Employers are required to ensure that employees are aware of the hazards associated with the chemicals to which they are exposed in the workplace and on the precautions to properly protect themselves.  The standard requires employers to:

Some Other OSHA Requirements Associated with Exposure to Hazardous Chemicals:

  • Control chemical hazards with the use of engineering controls (e.g., ventilation) or administrative controls when feasible (see, e.g., 29 CFR Part 1910.1000(e)).
  • Provide and ensure employees use PPE (e.g., goggles, gloves, splash aprons, as appropriate) under 29 CFR Part 1910 Subpart I.
    • Examples of when PPE is required:
      • When employees remove heated items or change out detergent from cleaning equipment, such as washer/decontaminators, or ultrasonic, tunnel or cart washers that automate the dispensing of washing chemicals.
      • When employees handle hazardous detergents and chemicals to clean equipment and surfaces.
    • Ensure workers use caution during the use, donning, and doffing of appropriate PPE (e.g., goggles, gloves, etc.) to avoid injury, illness, and infection.
    • For more information see OSHA Safety and Health Topics page - Personal Protective Equipment.
  • Medical services and first aid: Where the eyes or body of any person may be exposed to injurious corrosive materials, suitable facilities for quick drenching or flushing of the eyes and body must be provided within the work area for immediate emergency use. [29 CFR 1910.151(c)].
  • In addition to the Hazard Communication Standard, employee exposure to specific hazardous chemicals might be regulated by OSHA standards specific to those chemicals, e.g., ethylene oxide [29 CFR 1910.1047].

Additional Information

Photo of an Ethylene Oxide room monitor Photo of an Ethylene Oxide monitoring station

Exposure to Ethylene Oxide Gas (EtO)

Ethylene Oxide (EtO) is a colorless liquid below 51.7°F, or a gas that has an odor threshold of 430 ppm and is both flammable and highly reactive. EtO is used within the central sterilant supply as a sterilant for items that cannot be exposed to steam sterilization. Worker exposure usually results from improper aeration of the ethylene oxide chamber after the sterilizing process or during off-gassing of sterilized items or poor gas-line connections. Exposure can also occur during filling and cleaning equipment and as a result of chemical spills. Finally, exposure can occur in outpatient surgery clinics, cardiac catheterization laboratories, operating rooms, dental labs, autopsy labs and other areas.


Health Effects

  • In liquid form, EtO can cause eye irritation and injury to the cornea, frostbite, and severe irritation and blistering of the skin upon prolonged or confined contact.
  • Acute effects from inhaling EtO vapors include respiratory irritation and lung injury, headache, nausea, vomiting, diarrhea, shortness of breath, and cyanosis.
  • Exposure has also been associated with the occurrence of cancer, reproductive effects, mutagenic changes, neurotoxicity, and sensitization. Ethylene Oxide has been shown to cause cancer in laboratory animals and has been associated with higher incidences of cancer in humans. Adverse reproductive effects and chromosomal damage may also occur from EtO exposure. The National Institute for Occupational Safety and Health (NIOSH) recommends that ethylene oxide be regarded in the workplace as a potential occupational carcinogen (DHHS Publication Number 81-130).

Requirements under OSHA’s Ethylene Oxide Standard, 29 CFR 1910.1047

  • The standard applies to most occupational exposures to EtO.  The standard does not apply when employers reasonably rely on objective data that demonstrate that the processing, use, or handling of products containing EtO is not capable of releasing EtO in airborne concentrations at or above the standard’s “action level.”
  • Employers must conduct initial and periodic monitoring of employee exposure levels, as required by the standard.
    • The employer must ensure that no employee is exposed to an airborne concentration of EtO in excess of one (1) part EtO per million parts of air (1 ppm) as an (8)-hour time-weighted average (8-hour TWA)
    • The employer must ensure that no employee is exposed to an airborne concentration of EtO in excess of 5 parts of EtO per million parts of air (5 ppm) as averaged over a sampling period of fifteen (15) minutes.
    • Some of the employer’s duties under the standard (e.g., certain monitoring, medical surveillance, labeling, and information and training requirements) are triggered at or above the standard’s “action level,” or a concentration of airborne EtO of 0.5 ppm calculated as an eight (8)-hour time-weighted average.
    • The hierarchy of controls required by OSHA’s Ethylene Oxide Standard (29 CFR 1910.1047(f)) must be followed.

For additional requirements under OSHA’s EtO Standard, see 29 CFR 1910.1047.

Recognized Controls and Work Practices

  • Use proper ventilation with EtO gas. Typical operations that could cause worker exposure to EtO are removing sterilized items from the EtO sterilizer and changing bottles of EtO gas. Airborne concentrations of EtO can be controlled most effectively at the source of contamination by enclosing the operation and/or using local exhaust ventilation.
  • Reduce exposure to EtO during the sterilization process.
    • Prohibit employees from the sterilizer loading and mechanical rooms while operating the sterilizer unit.
    • Crack the door no more than two inches and allow the load to "off gas" before moving to transfer carts.
    • Install a ventilated exhaust hood above the sterilizer door.
    • Avoid close contact with newly sterilized unaerated loads.
  • Vent ethylene oxide through a non-recycled or dedicated ventilation system. For a discussion of ventilation of aeration units, sterilizer door areas and sterilizer relief valves, and ventilation during cylinder changes, see Appendix A to 29 CFR 1910.1047 (Ethylene Oxide).
  • To detect inadequate ventilation and cause automatic shutdown, have machine alarms in place.
  • Use engineering controls that maintain negative pressure so that contaminated air is drawn through the exhaust vents rather than circulating throughout the rest of the building.
  • Provide and ensure workers use appropriate PPE when changing cylinders (e.g., a butyl apron, gloves, and an appropriate respirator).
  • Use EtO detector systems and room monitors to signal any leakage of gas, and passive dosimeters for personal exposure monitoring.
  • Monitor for leaks at gas-line connectors. Use specialized gas-line connections to minimize EtO leakage during use and during change out of EtO cylinders.
  • Keep a written log for any detected leak and any service done on an ethylene oxide chamber. Replace sterilizer/aerator door gaskets, valves, and fittings when necessary.
  • Substitute less toxic cold sterilants for EtO. Use extreme care when selecting possible substitutes. It is necessary to fully evaluate possible health effects and exposure potentials of alternatives to EtO before making a selection. For more information, see Antimicrobial Products Registered with the EPA as Sterilizers. U.S. Environmental Protection Agency (EPA), (2014).

Additional Information

Hydrogen peroxide sterilization systems are also used within central supply for items that cannot be exposed to steam sterilization. In a typical vaporized hydrogen peroxide (VHP®, also known as hydrogen peroxide vapor) system, items to be sterilized are placed into a sterilization vacuum chamber that fills with hydrogen peroxide vapor. Hydrogen peroxide gas plasma (HPGP) systems use VHP® for sterilization and then apply a hydrogen peroxide plasma that contains microbicidal free radicals. Upon completion of the sterilization process in both VHP® and HPGP systems, the vapor or plasma is removed and filtered air is introduced into the chamber. The byproducts, such as water vapor and oxygen, are nontoxic (CDC Guideline for Disinfection and Sterilization in Healthcare Facilities (2008)).  In a recent survey of members of professional practice organizations representing central supply technicians, 84% of 373 respondents reported using HPGP systems, 38% reported using EtO systems, and 22% reported using both (Boiano and Steege, 2015).

Exposure to Hydrogen Peroxide

All of the HPGP sterilization systems reported in hospitals in the above-mentioned survey were automated closed-systems.  In an automated closed-system, under normal operating conditions, with proper maintenance, worker exposure to hydrogen peroxide should be minimal, as the liquid hydrogen peroxide source is typically in a sealed cassette that is not punctured until the chamber door is shut (Boiano and Steege, 2015). It is important that employees follow the manufacturer’s instructions and standard operating procedures.  Deviations could result in employee exposures.

Health Effects

  • Inhalation of hydrogen peroxide vapors can cause irritation of the eyes, nose, throat, and lungs.
  • Skin contact with liquid hydrogen peroxide can cause irritation, redness, and, for concentration solutions, burns (Boiano and Steege, 2015).

Recognized Controls and Work Practices

  • Provide initial and refresher training to workers on the hazards of hydrogen peroxide and the safe use of the sterilization system.
  • Ensure standard operating procedures (SOP’s) for the safe use of the sterilization system are in place and available to workers.
  • Ensure that the sterilization system is properly maintained and serviced according to the manufacturer’s instructions.

Additional Information

Glutaraldehyde is a colorless, oily, liquid-chemical with a pungent odor and is found in products used as cold sterilants.

Exposure to Glutaraldehyde

  • Hospital staff who work in areas with a cold terilizing 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
  • 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.


The following health effects have been reported in hospital workers exposed to glutaraldehyde:

  • Asthma, asthma-like symptoms, and breathing difficulty
  • Throat and lung irritation
  • Nose irritation, sneezing, and wheezing
  • Nosebleed
  • Burning eyes and conjunctivitis
  • Rash-contact and/or allergic dermatitis
  • Staining of the hands (brownish or tan)
  • Hives
  • Headaches
  • Nausea

Recognized Controls and Work Practices

Limit exposure to glutaraldehyde through engineering controls, administrative controls, work practices, and personal protective equipment (PPE), including:

  • Store glutaraldehyde-containing products in closed containers, in well-ventilated areas.
    • Ensure that air-tight containers are available.
    • Post signs to remind staff to replace lids after using product.
  • Ensure that rooms in which glutaraldehyde is used are well-ventilated and large enough to ensure adequate dilution of vapor.
    • 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.
  • 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 they remove vapors from glutaraldehyde and other disinfectants.
  • Provide and ensure the use of appropriate PPE, including:
    • 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 or PVC gloves because they do not provide adequate protection against glutaraldehyde and may actually absorb it.
      • When feasible, limit the use of latex gloves as much as possible, as latex gloves present their own hazards (e.g., dermatitis, sensitization, and allergic reactions).
    • Lab coats, aprons, or gowns made of appropriate materials, such as polypropylene, to provide additional protection.
    • Splash-proof goggles and/or full face shields to protect eyes.
      • 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.
  • 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.
  • Minimize exposure to glutaraldehyde by keeping the chemical in a contained process. For example, automate the transfer of pure glutaraldehyde, or pump liquid glutaraldehyde from drums or other storage containers to appropriate containers and operations.

Requirements under OSHA’s Personal Protective Equipment Standard, 29 CFR Part 1910 Subpart I

Following the hierarchy of controls (e.g., 29 CFR 1910.134), use engineering and work practice controls, supplemented by appropriate PPE, to control the hazard.  Examples of appropriate PPE includes:

  • Gloves
  • Splash-proof goggles and/or full-face shields when working with glutaraldehyde to protect eyes
  • Respiratory requirements are found in the OSHA Respiratory Protection Standard. [29 CFR 1910.134]

Other OSHA Requirements

  • Provide suitable facilities for quick drenching or flushing of the eyes and body (e.g., eye-wash fountains) within the work area for immediate emergency use. [29 CFR 1910.151(c)]
  • The Hazard Communication Standard [29 CFR 1910.1200] ensures that the hazards of all chemicals are evaluated and classified, and that information concerning the classified hazards is transmitted to the employees by means of a comprehensive hazard communication program that includes labeling and other forms of warning, safety data sheets, and employee training.

Additional Information