NIOSH issues information brochure on glutaraldehyde
NIOSH issues information brochure on glutaraldehyde
As the National Institute for Occupational Safety and Health (NIOSH) continues to work toward a new recommendation on safe limits for glutaraldehyde, the agency published a brochure with health warnings for health care workers. (See "Glutaraldehyde: Occupational hazards in hospitals" in this issue. The brochure also is available at www.cdc.gov/niosh/2001-115.html.) A more extensive technical manual, which will include a chapter on glutaraldehyde as well as other hazards, is nearing completion.
Glutaraldehyde has been implicated in cases of respiratory sensitization and may be a factor in the high rate of occupational asthma among health care workers, according to Edward Lee Petsonk, MD, senior medical officer in the division of respiratory disease studies at NIOSH in Morgantown, WV. (See related article, Hospital Employee Health, February 2001, p. 13.)
The NIOSH brochure alerts health care workers to the following symptoms of glutaraldehyde exposure and encourages to report the symptoms:
- throat and lung irritation;
- asthma, asthma-like symptoms, and breathing difficulty;
- 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.
NIOSH recommends local exhaust ventilation that provides at least 10 air room exchanges per hour. Employees should wear personal protective equipment when working with glutaraldehyde, including goggles, face shields, and gloves and aprons made of nitrile or butyl rubber. Latex gloves do not provide adequate protection, NIOSH says.
As medical studies showed a link between glutaraldehyde and occupational asthma, other countries, such as the United Kingdom, lowered their exposure limits. The American Conference of Governmental Industrial Hygienists reviewed the medical literature and the actions of other countries in 1997 and lowered its ceiling threshold limit value to .05 ppm, noting that it is an "airborne concentration that should not be exceeded during any part of the work shift."1
NIOSH is working on a new recommended exposure limit (REL), and the Occupational Safety and Health Administration (OSHA) is developing a permissable exposure limit (PEL). OSHA tried to establish exposure limits to glutaraldehyde as part of a 1989 air contaminants standard.
However, in 1992, the 11th Circuit Court ruled that OSHA hadn’t met its regulatory burden of showing substantial risk of harm from the current exposure limits to a variety of chemicals. The court voided the standard and then sent it back to OSHA for further work. In the case of glutaraldehyde, that meant the .2 ppm standard never became effective, and OSHA currently has no regulation requiring monitoring and maximum levels for the disinfectant.
The focus on glutaraldehyde is just one part of a broad NIOSH project. A manual titled Special Hazard Review: Occupational Hazards in Hospitals and Health Care Facilities will contain information from the health effects literature on specific hazards as well as preventive strategies.
The first issue, expected to become available sometime next year, will contain chapters on violence, stress, ergonomic stressors, waste anesthetic gases, nitrous oxide, glutaraldehyde, antineoplastic agents, ethylene oxide, tuberculosis, nonionizing radiation, latex allergy, and needlesticks. These chapters, although technical in nature, will be brief, a member of the NIOSH education staff says.
Reference
1. American Conference of Governmental Industrial Hygienists. Documentation of the Threshold Limit Values and Biological Exposure Indices, 6th Ed. 1999; Publication 0206, Cincinnati.
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