Glutaraldehyde getting attention from CA, OSHA

OSHA urges control of hazard

The hazards of glutaraldehyde are receiving renewed attention as California tightens its regulation and the U.S. Occupational Safety and Health Administration (OSHA) issues new guidance.

OSHA doesn't regulate an exposure limit for glutaraldehyde, a substance that can cause occupational asthma, skin irritation, and other symptoms. But about 10 states with their own occupational health programs maintain permissible exposure limits, and OSHA has issued detailed guidance for employers to monitor and reduce exposure to glutaraldehyde.

"Recognizing that we did not have an enforceable limit, we decided to at least get some information out," says Bill Perry, CIH, acting deputy director of OSHA's directorate of standards and guidance. "We wanted to provide more specific information that would give hospital employers [something] they could work with."

California has taken a tougher stand, as the standards board voted to lower the state's permissible exposure limit from 0.2 parts per million (ppm) to 0.05 ppm. Health care workers continued to experience symptoms from glutaraldehyde even at the level of 0.2 ppm, says John Mehring, health and safety specialist at the Service Employees International Union (SEIU) in San Francisco and a member of the Cal-OSHA Airborne Contaminants Advisory Committee.

In a 2004 survey, health care workers told the SEIU that they had become sensitized to glutaraldehyde, with asthma and allergy symptoms. Some said they were no longer able to work in an environment where glutaraldehyde was in use.

"There are a lot of people who are reporting they're not getting adequate training, they don't have adequate protective equipment, and they were experiencing symptoms," says Mehring.

In fact, the SEIU and other unions had actually asked Cal-OSHA to lower the standard to 0.015 ppm. They will continue to seek the lower limit, says Mehring. "We accepted this as a compromise, something we could achieve now," he says.

The new ceiling limit will take effect in 2008. Until then, exposure may not exceed 0.05 ppm as an eight-hour, time-weighted average.

A cause of occupational asthma

Glutaraldehyde is recognized as a cause of occupational asthma and may contribute to the relatively high rate of occupational asthma among health care workers. (Health care workers are diagnosed with occupational asthma more frequently than expected based on their work force representation, according to an analysis of 1,879 work-related asthma reports.1) It also can cause irritant symptoms at concentrations of less than 0.2 ppm and contact dermatitis from solutions containing as little as 0.1% glutaraldehyde.2

Glutaraldehyde is used as a high-level disinfectant of medical equipment, a fixative in histology and pathology labs, and a hardener in X-ray developing. While alternatives to glutaraldehyde are available, its use remains widespread in hospitals.

OSHA's efforts to regulate glutaraldehyde exposure were stymied in 1992 when the 11th Circuit Court overturned the agency's air contaminants standard, which would have revised some exposure limits and added a couple hundred new ones. Since then, OSHA has relied on voluntary compliance, although hospitals could be cited for failure to provide adequate personal protective equipment or hazard communication, notes Perry.

Meanwhile, concern about glutaraldehyde exposure has intensified. In 1997, the American Conference of Governmental Industrial Hygienists lowered its recommended exposure limit from 0.2 ppm to 0.05 ppm. In 1999, the United Kingdom set a maximum exposure limit of 0.05 ppm.

While the OSHA guidance is detailed and thorough, the agency should not rely on voluntary compliance, asserts Bill Borwegen, MPH, SEIU health and safety director in Washington, DC. "For OSHA not to use this as a basis for issuing a standard is an abdication of their professional responsibility to health care workers," he says.

Perry notes that standards "reflect the regulatory priorities of current administrations."

Hazard communication is key

It's important for employees to understand the hazards of glutaraldehyde and the possible symptoms related to exposure, which can include throat and lung irritation, breathing difficulty, burning eyes, rash, headache, or nausea.

"I'm always surprised by how many well- educated health care workers don't have basic knowledge about the chemicals they're working with," says Mehring. "Even though they're supposedly getting training or information about the chemicals, people aren't making the links between what they're experiencing and what the possible repercussions are of exposure to these chemicals."

The hazard communication standard requires employers to train employees about the safe use of hazardous chemical. (See box below.) Part of that education could include OSHA's new document, Best Practices for the Safe Use of Glutaraldehyde in Health Care, and a National Institute for Occupational Safety and Health brochure, Glutaraldehyde: Occupational Hazards in Hospitals (May 2001).

What to tell employees about glutaraldehyde

Citing the hazard communication standard, OSHA provides this guidance on educating employees about the hazards of glutaraldehyde:

Employee training must include, at a minimum, the following elements (29 CFR 1910.1200):
  • methods and observations that may be used to detect the presence or release of glutaraldehyde in the workplace;
  • the physical and health hazards of glutaraldehyde;
  • the measures employees can take to protect themselves, including specific procedures the employer has implemented to protect employees from exposure to glutaraldehyde, such as appropriate work practices, emergency procedures, and personal protective equipment;
  • an explanation of the material safety data sheet, the employer's labeling system, and how employees can obtain and use the appropriate hazard information.

Under the personal protective equipment (PPE) standard, employers must conduct a hazard assessment and have a written program describing the PPE use. OSHA notes that butyl rubber, nitrile, and Viton are the most impervious to glutaraldehyde, while latex, vinyl, and neoprene do not provide adequate skin protection.

Splash-proof goggles or safety glasses with full face shields must be worn if there is a potential for eye contact, OSHA says.

OSHA's guidance emphasizes engineering controls to minimize exposure. For example, automated processing equipment can significantly reduce exposures by enclosing the disinfection. However, ventilation, such as a ductless enclosure hood, is still necessary, and employers need to conduct exposure monitoring to make sure it's functioning correctly, OSHA says.

OSHA doesn't say how often monitoring should take place after initial exposure monitoring. But Perry suggests, "If there's a change in the process or a change in work practices, or sometimes a change in personnel, one might think about re-monitoring to make sure that's not having an adverse effect on exposures."

(Editor's note: Best Practices for the Safe Use of Glutaraldehyde in Health Care is available at www.osha.gov/Publications/glutaraldehyde.pdf. Glutaral-dehyde: Occupational Hazards in Hospitals is available at www.cdc.gov/niosh/2001-115.html.)

References

1. Pechter E, Davis LK, Tumpowsky C, et al. Work-related asthma among health care workers: Surveillance data From California, Massachusetts, Michigan, and New Jersey, 1993-1997. Am J Ind Med 2005; 47:265-275.

2. Occupational Safety and Health Administration. Best Practices for the Safe Use of Glutaraldehyde in Health Care. Washington, DC; May 2006.