Epidemiologic Notes and Reports Symptoms of Irritation Associated with Exposure to Glutaraldehyde -- Colorado

During an evaluation by the National Institute for Occupational Safety and Health (NIOSH) of exposures to formaldehyde at a biomedical research hospital in Denver, Colorado, several employees complained of irritation from using another substance, glutaraldehyde (1). At the hospital, glutaraldehyde was present in solutions used for tissue fixation, histologic examinations, and disinfection and/or cold-sterilization of respiratory therapy equipment. In October 1983, NIOSH investigated these complaints.

To measure airborne levels of glutaraldehyde, the investigator collected eight samples from personal breathing zones of employees and 13 samples from area air during procedures scheduled especially for the evaluation. The employees' symptoms were recorded during informal interviews and on medical questionnaires.

Glutaraldehyde concentrations in personal breathing zones ranged from non-detectable (ND) to 1.5 mg/m((3)); six of the eight samples exceeded the ceiling threshold limit value (TLV) of 0.7 mg/m((3)) set by the American Conference of Governmental Industrial Hygienists. Concentrations in area air ranged from ND to 1.5 mg/m((3)); six of the 13 samples exceeded the TLV. The Occupational Safety and Health Administration has no standard and NIOSH has no recommended exposure limit for occupational exposure to glutaraldehyde.

Nine of the 11 nurses who were using solutions containing glutaraldehyde as a disinfectant had symptoms of some type of irritation. Eight reported skin symptoms, ranging in severity from itching or irritation to cracking and bleeding; seven reported eye irritation; six, throat discomfort; five, nasal discomfort; five, chest tightness or other pulmonary discomfort; four, cough; and two, headache (2).

Another NIOSH study currently in process indicates that the Denver experience is not unique. Preliminary data from this study conducted in Morristown, Pennsylvania, reveal glutaraldehyde exposure concentrations and reported irritation symptoms that closely resemble those from the Denver evaluation (3). Reported by: NIOSH Region VIII, Hazard Evaluations and Technical Assistance Br, Div of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC.

Editorial Note

Editorial Note:Glutaraldehyde is a saturated dialdehyde with the formula CHO-CH((2))-CH((2))-CH((2))-CHO and a molecular weight of 100.12. It has a pungent odor with a threshold recognition level of 0.04 parts per million (ppm) by volume in air; eye and respiratory irritation are noted at a level of 0.3 ppm (4).

In health care facilities, glutaraldehyde is used as an active ingredient in a number of chemical reagents and germicides. Evidence indicates that glutaraldehyde can be a relatively strong irritant to the nose and a severe irritant to the eyes (4,5). It can produce skin staining and may be slightly irritating to the skin (4,6). It can also cause skin sensitization (allergic contact dermatitis) from occasional or incidental occupational exposures (CDC, unpublished data) (4). However, no epidemiologic studies on adverse effects of glutaraldehyde have been reported in the literature. Recent information suggests that although glutaraldehyde should not be considered mutagenic or carcinogenic (7,8), it may produce fetotoxicity in animals (7,9).

Within the past 10 years, the use of chemical germicides containing glutaraldehyde has increased. Originally developed as a quick-acting sporicidal agent that lacked the undesirable health effects associated with formaldehyde, glutaraldehyde-based germicides are now used primarily to disinfect and/or sterilize a variety of medical and dental equipment.

During the National Occupational Exposure Survey (NOES) of 1981-1983, NIOSH found that glutaraldehyde was used not only in several areas of the medical industry, but also in photography, shoe repair, and tanning operations and in the manufacture of dyes (CDC, unpublished data). The survey estimated that 14,000 workers were then being exposed to glutaraldehyde in the industries described. These data probably underestimate exposures because the ingredients of many trade name products identified during NOES have yet to be determined.

Because of the widespread and increasing use of glutaraldehyde in many areas, public health professionals should be aware of its potential for producing adverse health effects.

References

1. National Institute for Occupational Safety and Health, CDC. Health hazard evaluation report no. HETA 83-074-1525. Cincinnati, Ohio: US Department of Health and Human Services, Public Health Service, 1984.

2. National Institute for Occupational Safety and Health, CDC. Health hazard evaluation report no. HETA 83-048-1347. Cincinnati, Ohio: US Department of Health and Human Services, Public Health Service, 1983.

3. National Institute for Occupational Safety and Health, CDC. Health hazard evaluation report no. HETA 86-226-1769. Cincinnati, Ohio: US Department of Health and Human Services, Public Health Service, 1987.

4. American Conference of Governmental Industrial Hygienists. Documentation of the threshold limit values and biological exposure indices. 5th ed. Cincinnati, Ohio: American Conference of Governmental Industrial Hygienists, 1986.

5. Stonehill AA, Krop S, Borick PM. Buffered glutaraldehyde--a new chemical sterilizing solution. Am J Hosp Pharm 1963;20:458-65.

6. Jordan WP Jr, Dahl MV, Albert HL. Contact dermatitis from glutaraldehyde. Arch Dermatol 1972;105:94-5.

7. National Institute for Occupational Safety and Health, CDC. Registry of toxic effects of chemical substances. Cincinnati, Ohio: US Department of Health and Human Services, Public Health Service, 1982; DHHS publication no. (NIOSH)81-116.

8. Van Lente F, Jackson JF, Weintraub H. Identification of specific cross linked histones after treatment of chromatin with formaldehyde. Cell 1975;5:45-50.

9. Marks TA, Worthy WC, Staples RE. Influence of formaldehyde and Sonacide (potentiated acid glutaraldehyde) on embryo and fetal development in mice. Teratology 1980;22:51-8.

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