The National Institute for Occupational Safety and Health (NIOSH) has extended the comment period until Oct. 1, 2017, regarding the potential hazards of occupational exposures to peracetic acid used as a sterilant and diluted as a cleaner in some hospitals.

The action follows a 2015 NIOSH draft report entitled “Immediately Dangerous to Life or Health (IDLH) Value Profiles” for 14 chemicals, including peracetic acid (aka peroxyacetic acid).

“Comments received from stakeholders raised concerns about the limited data used as the basis of the NIOSH recommendations,” says Scott Dotson, PhD, NIOSH lead health scientist and contact for the request for information. “In response, NIOSH launched a cross-institute research project aimed at collecting the data required to develop an IDLH value and other workplace recommendations aimed at protecting the lives and health of workers.”

According to NIOSH, the public comments indicated that the proposed IDLH value was “overprotective,” the data available for peracetic acid are of low quality, and issues exist with the sampling and analysis of air samples for the chemical in the workplace.

“With peracetic acid, what we have found is that we don’t have occupational exposure limits — we don’t know what we don’t know about this particular product,” notes John Martinelli, healthcare practice director at Forensic Analytical Consulting Services in Citrus Heights, CA. “We know we get a lot of complaints when people are using it. It smells like vinegar, eye irritation, that sort of stuff. But we really don’t know if there is a [serious] health effect associated.”

Speaking recently in Portland at the annual meeting of the Association for Professionals in Infection Control and Epidemiology (APIC), Martinelli said a NIOSH IDLH designation could require more stringent respiratory protection for those working with peracetic acid.

“You do not go into this IDLH environment with a purifying respirator,” he says. “You have to be on supplied air to use that product at the IDLH level.”

To clarify the risk, NIOSH is seeking worker exposure information and adverse reaction reports from employee health professionals and other clinicians regarding peracetic acid.

“Information on worker exposures to peracetic acid in hospitals and other healthcare settings is of interest,” Dotson says. “Although available data indicate that peracetic acid is used as a sterilant in hospitals, NIOSH currently does not have sufficient information to characterize the scope and magnitude of the use of peracetic acid in healthcare settings.”

Likewise, NIOSH currently does not have specific recommendations on the use of peracetic acid in healthcare settings, he adds, noting that recommendations on the use of chemicals, including alternative sterilants, is available on the CDC website at: http://bit.ly/2uW0PPE.

According to NIOSH, peracetic acid is routinely used as a sterilant during the cleaning of endoscopes and other medical devices, as a disinfectant in food processing, as a bleaching agent, and in the synthesis of other chemicals. Last year, NIOSH published a report that a cleaning product containing acetic acid, peracetic acid, and hydrogen peroxide was linked to wheezing, watery eyes, and asthma-like symptoms in healthcare workers.1

NIOSH is requesting the following information to inform an occupational risk assessment of peracetic acid in healthcare settings:

  • workplace exposure data for peracetic acid;
  • possible health effects observed in workers exposed to peracetic acid;
  • workplaces and products in which peracetic acid may be found;
  • description of work tasks and scenarios with a potential for exposure to peracetic acid;
  • reports and findings from in vitro and in vivo toxicity studies with peracetic acid;
  • data applicable to the quantitative risk assessment of health effects associated with acute, subchronic, and chronic workplace exposures to peracetic acid, sampling, and analytical methods for peracetic acid;
  • control measures, including engineering controls, work practices, and PPE, that are being used in workplaces where there is potential for exposure to peracetic acid.

Editor’s note: Employee health professionals can submit comments electronically by entering CDC–2017–0015 and docket number NIOSH 295, at the federal eRulemaking Portal: http://www.regulations.gov. Follow the instructions for submitting comments.

REFERENCE

  1. CDC/NIOSH. Notes from the Field: Respiratory Symptoms and Skin Irritation Among Hospital Workers Using a New Disinfection Product — Pennsylvania, 2015. MMWR 2016;65(15);400–401.