Glutaraldehyde - Occupational Hazards in Hospitals
DHHS (NIOSH) Publication Number 2001-115
Glutaraldehyde is used as a cold sterilant to disinfect and clean heat-sensitive equipment such as dialysis instruments, surgical instruments, suction bottles, bronchoscopes, endoscopes, and ear, nose, and throat instruments. This chemical is also used as a tissue fixative in histology and pathology labs and as a hardening agent in the development of x-rays. Glutaraldehyde is a colorless, oily liquid with a pungent odor. Hospital workers use it most often in a diluted form mixed with water. The strength of glutaraldehyde and water solutions typically ranges from 1% to 50%, but other formulations are available. Trade names include Cidex®, Sonacide®, Sporicidin®, Hospex®, Omnicide®, Metricide®, and Wavicide®.
The purpose of this brochure is to:
- make you aware of the adverse health effects of glutaraldehyde
- describe how you can be exposed to glutaraldehyde
- provide and identify control methods and work practices to prevent or reduce your exposure to glutaraldehyde
The following health effects have been reported in hospital workers exposed to glutaraldehyde:
- Throat and lung irritation
- Asthma, asthma-like symptoms, and breathing difficulty
- Nose irritation, sneezing, and wheezing
- Burning eyes and conjunctivitis
- Rash-contact and/or allergic dermatitis
- Staining of the hands (brownish or tan)
Workers in hospitals who might be exposed to glutaraldehyde include the following:
- Hospital staff who work in areas with a cold sterilizing 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
- Central service (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 technicians who sterilize benchtops with glutaraldehyde solutions
- Workers who develop x-rays.
Workers can be exposed to glutaraldehyde by breathing it or by skin contact during the following procedures:
- Cold sterilization of instruments in endoscopy and surgical units
- when glutaraldehyde solution is poured into or out of the sterilizing pans
- when sterilized equipment is removed from the sterilizing pans
- Disinfection of histology/pathology laboratory table tops
- Mixing and activation of various glutaraldehyde solutions
- Tissue fixation in histology labs
- Development of x-rays
You can protect yourself by using the following control methods and work practices:
- Use local exhaust ventilation (capture velocity of at least 100 feet per minute) and at least 10 room air exchanges per hour.
- Keep glutaraldehyde baths under a fume hood where possible.
- Use only enough glutaraldehyde to perform the required disinfecting procedure.
- Avoid skin contact: use gloves and aprons made of nitrile or butyl rubber (latex gloves do not provide adequate protection).
- Wash gloved hands after handling glutaraldehyde.
- Wear goggles and face shields when handling glutaraldehyde.
- Seal or cover all containers holding glutaraldehyde solutions.
- Attend training classes in safety awareness about use of and exposure to glutaraldehyde.
- Become familiar with and be able to recognize sources of glutaraldehyde exposure.
- In case of skin or eye contact, wash with water immediately.
- Clean up spills immediately.
- Refer to ANSI/AAMI  for further information about emergency procedures in the event of a large spill.
CASE REPORT—Several nurses were working in an area where glutaraldehyde was stored in 1-liter baths on countertops and was used to disinfect bronchoscopes. They complained of hives, chest tightness, and watery eyes. Evaluation of the work area indicated that there was a separate (independent) recirculating ventilation system designed to provide 10% outside air. The nurses used no personal protective equipment (such as gloves). Measures were then taken to reduce exposures. These included changing glutaraldehyde containers to air-tight models, using appropriate gloves, and installing local ventilation hoods for glutaraldehyde stations. One month after the implementation of these measures, the nurses' symptoms subsided [Charney 1991].
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