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].
ANSI/AAMI . American national standard: safe use and handling of glutaraldehyde-based products in health care facilities. Arlington, VA: American National Standards Institute, Inc., and Association for the Advancement of Medical Instrumentation, ANSI/AAMI ST58-1996.
Babb JR, Bradley CR . Endoscope decontamination: where do we go from here? J Hosp Infect 30(Suppl):543-551.
Ballantyne B, Berman B . Dermal sensitizing potential of glutaraldehyde: a review and recent observations. J Toxicol Cutaneous Ocul Toxicol 3:251-262.
Beauchamp RO Jr., St. Clair MBG, Fennell TR, Clarke DO, Morgan KT . A critical review of the toxicology of glutaraldehyde. Crit Rev Toxicol 22(3,4):143-174.
Butt G, Greenley P, Herrick R, DiBerardinis L . Exposure to glutaraldehyde vapors during endoscopic sterilization processes in a large research and teaching institution. Infect Control 3(4):172-179.
Charney W . Hidden toxicities of glutaraldehyde. In: Charney W, Schirmer J, eds. Essentials of modern hospital safety. Chelsea, MI: Lewis Publishers, Inc., pp. 71-81.
Evans PF, Elliott-Minty C, Saleem A, Morris L, Groves J, Pedersen R . Glutaraldehyde: Criteria document for an occupational exposure limit. London, United Kingdom: Health and Safety Executive (HSE).
Finucane EW . Monitoring aldehydes in the hospital. In: Charney W, Schirmer J, eds. Essentials of modern hospital safety. Vol. 2. Boca Raton, FL: Lewis Publishers, Inc., pp. 191-210.
NIOSH . NIOSH pocket guide to chemical hazards. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 97-140.
Norbäck D . Skin and respiratory symptoms from exposure to alkaline glutaraldehyde in medical services. Scand J Work Environ Health 14:366-371.
Pisaniello DL, Gun RT, Tkaczuk MN, Nitshcke M, Crea J . Glutaraldehyde exposures and symptoms among endoscopy nurses in South Australia. Appl Occup Environ Hyg 12(3):171-177.
Scobbie E, Dabill DW, Groves JA . Chemical pollutants in x-ray film processing departments. Ann Occup Hyg 40(4):423-435.
Stenton SC, Beach JR, Dennis JH, Keaney NP, Hendrick DJ . Glutaraldehyde, asthma, and work-a cautionary tale. Occup Med 44(2):95-98.
Waterman L . The hazards of health care-glutaraldehyde: a review of its clinical use and abuse. The Safety & Health Practitioner, June, pp. 15-17.
Glutaraldehyde – Occupational Hazards in Hospitalspdf icon [PDF – 650.55 KB]