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 glutaraldehyde used?

Glutaraldehyde is used in a variety of settings such as:

  • Endoscopy units (where scopes are used to look into the bowel via the mouth or rectum).
  • Theatre.
  • X-ray film processing.
  • Dental units.
  • Ear, nose and throat units.

What harm can glutaraldehyde 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 reaction 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 from glutaraldehyde?

Health and safety legislation requires that a risk assessment be made to evaluate the likelihood of exposure, which might lead to ill health and to assess the consequences of such exposure.

The measures required to control exposure must be clearly detailed in the risk assessment. Adherence to the MSDS (Material Safety Data Sheet) must also be ensured. The legislation in question includes the following:

  • Safety, Health and Welfare at Work Act 1989.
  • The Safety, Health and Welfare at Work (General Application) Regulations, 1993.
  • The Safety, Health and Welfare at Work (Chemical Agents) Regulations, 1994 and their associated Code of Practice.

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.

The 1999 Code of Practice for Safety, Health and Welfare at Work (Chemical Agents) Regulations, 1994, reduces the occupational exposure limit for glutaraldehyde from 0.2ppm to 0.1ppm.

What else can be done to reduce the risk from glutaraldehyde?

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-disinfectants, 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 to clean them.
  • Keep lids on any containers.
  • Provide personal protective equipment.
  • Dispose of it safely, using a pump or siphon, rather than pouring it down the sluice or drain.

What is personal protective equipment?

Personal protective equipment is equipment used to protect against the harmful effects of dangerous substances, including glutaraldehyde. It includes:

  • A solvent mask with charcoal filter which results in a minimal penetration factor. This should be used by one person only and marked with the name of the user. It should be stored in an area away from glutaraldehyde, as the filter will continue to absorb the fumes whilst not in use. Employees should receive instruction in the use of the mask. Paper masks do not give any protection. The filter should be changed according to manufacturer’s instructions.

Goggles or a face shield.

• A long, waterproof apron.

• Double gloves with minimal penetration.

What about disinfecting endoscopes?

The employer’s assessment may conclude that there are no reasonable 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 is the Material Safety Data Sheet?

Material Safety Data Sheet (MSDS) is detailed information available to the user of a chemical. It gives specific information about the safe use of a chemical and the potential risks involved in its use. It is vital that users of a chemical study the relevant MSDS, as the label on the container does not have the complete definitive information. The MSDS on glutaraldehyde produced by the manufacturers is available on request from Johnson and Johnson. The MSDS should be displayed in all workplaces.

How do you know what to do when using glutaraldehyde?

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 spillage.

• Arrangements for health checks/surveillance.

• Recognising the symptoms of sensitisation.

• Action needed if you think you are affected by glutaraldehyde.

Remember also that you have duties under the Health and Safety Legislation to make use of control measures and protective equipment provided, and to report any problems with them.

What about health surveillance?

Where the risk assessment indicates that health surveillance should be undertaken, then workers should have a baseline consultation with the Occupational Health Department before the initial exposure to glutaraldehyde. This should include an occupational respiratory questionnaire and a baseline spirometry (test of the air capacity of your lungs) should be performed. Repeat examinations should be carried out three months and 12 months after commencement of exposure, and yearly thereafter.

What should you do if you think there is a problem with glutaraldehyde?

If you work with glutaraldehyde or have been asked to work with it you should see your manager immediately or tell your trade union or employee health and safety representative if you encounter any of the following situations:

  • 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 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 article.
  • The ventilation in the work area is poor, or badly maintained.
  • The protective clothing is damaged or worn out.

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

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(Source: INO leaflet ‘What you need to know about Glutaraldehyde’)

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