HEALTH SERVICES ADVISORY COMMITTEE

CONTENTS

 

GLUTARALDEHYDE and YOU

This leaflet tells you about the health problems that can arise when working with glutaraldehyde. It outline what your employer is expected to do and what you should do to protect your health.

This leaflet was prepared by the Health Services Advisory Committee and has been agreed by the Health and Safety Commission.

WHAT IS GLUTARALDEHYDE?

It is a powerful, cold disinfectant used widely in the health services. You may know it by a trade name such as:

  • Cidex;
  • Totacide;
  • Asep;

Whatever the trade name, any container used for glutaraldehyde should have a label which tells you that it contains a respiratory and skin sensitiser. If it contains more than 1% glutaraldehyde, the label should also mention glutaraldehyde.

WHERE IS IT USED?

Glutaraldehyde is used in a variety of settings, such as:

  • endoscopy units;
  • theatres;
  • X-ray film processing;
  • dental units;
  • ear nose and throat units.

WHAT HARM CAN IT DO TO YOUR HEALTH?

Glutaraldehyde can irritate your skin, eyes, throat and lungs. More importantly, it can sensitise your skin, lungs and respiratory system. Once you are sensitised, further exposure to even very small amounts of the substance can lead to:

  • dermatitis - allergic reactions to the skin;
  • rhinitis and conjunctivitis - symptoms typical of hay fever;
  • asthma - constriction of the airways.

If you experience irritation or more serious effects, you need to get advice through your GP or occupational health service. If the problem is a result of your exposure to glutaraldehyde, you may not be able to work with or near it any more.

WHAT SHOULD BE DONE TO PROTECT YOU?

Under the Control of Substances Hazardous to Health Regulations (COSHH), employers must assess all the circumstances in which glutaraldehyde is used. They have to decide how to either prevent or control the risks, and put precautions in place. This means they need to consider, for example:

  • whether safer substitutes or processes (eg autoclaving) must be used instead of glutaraldehyde;
  • how, where and when glutaraldehyde can be used without causing any harm to your health;
  • the information, instruction and training which you need to ensure that you can use it safely;
  • whether you need to be examined from time to time to check for any early signs of an effect on your health;
  • whether air sampling is needed now and again to check that controls are working.

Until January 1998, an occupational exposure limit for glutaraldehyde had been in force. It has been cancelled and to replace it, a maximum exposure limit (MEL) has been recommended to the Health and Safety Commission by the Advisory Committee on Toxic Substances. This is in the form of a concentration in air. It will then be illegal to expose people to concentrations of glutaraldehyde in air above this level.

However, subject to acceptance, this MEL will not come into force until 1999. Up to then, employers must prevent exposure if possible. If this is not possible, they must control exposure to as low a level as is reasonably practicable.

WHAT SHOULD THE EMPLOYER DO NEXT?

Wherever possible, glutaraldehyde should be replaced by a less hazardous substance. For a number of uses, including disinfection of some endoscopes, there are many safer alternatives available. Glutaraldehyde must not be used as a general wipe-down disinfectant.

In some situations there may be good reasons for using glutaraldehyde, including patient safety. If this is so, the employer must put in place precautions, based on the risk assessment. For example, you may have to:

  • use glutaraldehyde only in specially designed equipment, such as enclosed washer-disinfectors, or in specified places where there is extraction ventilation;
  • avoid skin contact, splashes and exposure to the fumes or droplets in the air, caused for example by syringing endoscopes;
  • keep lids on any containers;
  • use suitable gloves, apron, visor or goggles when handling glutaraldehyde;
  • dispose of it safely, using a pump or siphon, rather than pouring it down the sluice or drain.

WHAT ABOUT DISINFECTING ENDOSCOPES?

The employer's assessment may conclude that there are no reasonably practicable alternatives to using glutaraldehyde. If so, it should set out the precautions required wherever glutaraldehyde is used. These might include:

  • an enclosed automatic system for disinfecting endoscopes;
  • systems for ensuring good general ventilation in the area around automatic machines;
  • good mechanical exhaust ventilation where you cannot use an enclosed system;
  • arrangements for ensuring any ventilation equipment is kept in good working order;
  • precautions where short-term peaks of exposure may occur, for example where endoscopes are syringed and aerosols or fine droplets are generated;
  • procedures in the event of a spillage;
  • training, information and instruction for staff;
  • health checks for people working with glutaraldehyde.

The areas where people use most glutaraldehyde, or have to work with it for the longest time, are the highest priority for action. The assessment should identify these areas.

WHAT IF YOU WORK IN X-RAY FILM PROCESSING?

Based on the COSHH assessment, employers should ensure that:

  • substitutes are used, as far as possible;
  • safe methods of work are in place for handling developing chemicals, and for cleaning and maintaining automatic processors;
  • ventilation equipment is adequate and maintained in good working order;
  • if needed, gloves, visors and aprons are available and everyone is clear about when to wear them;
  • health checks are arranged, if needed.

HOW DO YOU KNOW WHAT TO DO?

Your employer should provide you with information, instruction and training on:

  • the risks of exposure to glutaraldehyde;
  • results of any air sampling;
  • safe working methods;
  • the purpose of extraction ventilation;
  • the use of protective equipment and clothing;
  • action required in case of a spillage;
  • arrangements for health checks/surveillance;
  • help in recognising the symptoms of sensitisation;
  • action needed if you think you are affected by glutaraldehyde.

And remember that you have duties under COSHH to make use of control measures and protective equipment provided, and to report any problems with them.

WHAT SHOULD YOU DO IF YOU THINK THERE IS A PROBLEM?

If you work with glutaraldehyde, or have been asked to work with it, and you are in a situation where:

  • the containers are unlabelled;
  • the container labels do not refer to the health risks from glutaraldehyde;
  • you have not been told about the results of the COSHH assessment or any air sampling;
  • you have not been told whether you need health checks;
  • you have had no information, instruction or training on the precautions you should take;
  • you feel that the information you have been given did not deal adequately with the matters raised in this leaflet;
  • the ventilation in the work area is poor, or badly maintained; or
  • the protective clothing is damaged or worn out.

See your manager immediately - tell your trade union or employee health and safety representative.

If you feel ill with a rash, itchy nose or eyes, $$Word$$ eyes, a runny nose, tight chest, wheezing or breathlessness (these symptoms might occur when you are not at work).

If you think this might be as a result of working with glutaraldehyde.

Then see your doctor and say that you work with a respiratory and skin sensitiser.

You should also go to your occupational health department. Remember that if you get help with early symptoms, you may be able to prevent more serious effects.

This leaflet is available in priced packs of 15 from HSE Books, ISBN 0 7176 1503 0. Single free copies are also available from HSE Books.

HSE priced and free publications are available by mail order from:

HSE Books, PO Box 1999, Sudbury, Suffolk CO 10 6FS

Tel: 01787 881165

HSE priced publications are also available from good booksellers.

For other enquiries ring HSE's InfoLine Tel: 0541 545500, or write to HSE's Information Centre, Broad Lane, Sheffield S3 7HQ

This leaflet contains notes on good practice which are not compulsory but which you may find helpful in considering what you may need to do.

This publication may be freely reproduced, except for advertising, endorsement or commercial purposes. The information is current at 1/98. Please acknowledge the source as HSE.

IAC64 (rev1) 1/98 C200

Printed and published by the Health and Safety Executive

 

Added to the HSE Web Site 27/9/1998