Glutaraldehyde Exposures and Symptoms among Endoscopy Nurses in South Australia

Abstract

Dermal, respiratory, and other health problems have been associated with the use of glutaraldehyde as a high level disinfectant for endoscopy procedures in hospitals. Given the increasing concern about the safety of glutaraldehyde, a cross-sectional study of exposures among 135 endoscopy nurses in 26 South Australian hospitals was undertaken. Nurses were interviewed with a health/work practice questionnaire, worksite inspections were undertaken, and exposure measurements were conducted. A control group of 132 unexposed nurses in the same hospitals was also interviewed. Inhalational exposure while using glutaraldehyde was determined using Occupational Safety and Health Administration Method 64, and dermal exposure was assessed with skin pads secured to the forearm. Personal inhalational exposures were generally low [overall geometric mean (GM) = 0.032 ppm]. Operating theaters showed significantly lower airborne concentrations than areas dedicated to endoscopy. Both in operating theaters and in endoscopy areas, personal exposures were significantly lower (GM = 0.014 and 0.022 ppm, respectively) where local exhaust ventilation was provided than where there was none (GM = 0.034 and 0.093 ppm, respectively). Exposures were also low where nurses were using auto-disinfectors. Nurses exposed to glutaraldehyde were significantly more likely to report headache, lethargy, and skin, eye, and throat symptoms compared with controls. However, the occurrence of skin, eye, and throat symptoms did not appear to correlate with airborne glutaraldehyde levels. Glutaraldehyde-related skin problems are less likely to be related to airborne exposures than to procedural factors, such as placing instruments into solution with ungloved hands. Eighty-six nurses (64%) had had accidents involving splashes to the skin. It is concluded that local exhaust ventilation should be provided when there is a high turnover of instruments requiring disinfection. Skin contact can be avoided by changes in work practices and equipment. Containers with clear lids and tight seals are recommended.