Hierarchy of Controls
Workers can be protected from exposures to glutaraldehyde through engineering controls, administrative controls, and personal protective equipment.
- Engineering Controls: Engineering controls eliminate or reduce hazards through the design or redesign of tools, equipment, or machinery. They include biological safety cabinets (BSC), compounding aseptic containment isolators, closed system transfer devices, and needleless systems. Using engineering controls is considered the most effective way to control employee exposure to hazardous chemicals.
- Administrative Controls: Administrative controls eliminate or reduce exposure to hazards by controlling employee behaviors. They include implementing work practices, policies, and training programs to reduce worker risk. A medical monitoring program serves as a form of secondary prevention by identifying indicators of exposure or early disease. They are less effective than engineering controls because, to be effective, employees must comply with the controls.
- Personal Protective Equipment (PPE): PPE protects employees by setting up a barrier between the employee and the hazard. Employers are required to provide appropriate PPE, such as gloves, goggles, and splash aprons when employees are handling hazardous chemicals. The use of PPE is considered the least effective control method because, as with administrative controls, effectiveness depends on employee behaviors to prevent exposure.
The main goal of engineering controls is to prevent glutaraldehyde vapor from entering the workroom and the employee’s breathing zone. It does this by containing and removing it at the source of release.
The primary sources of employee exposure to glutaraldehyde during disinfection/sterilant activities include:
- pouring glutaraldehyde solutions into container systems
- opening soaking basins or reservoirs
- handling instruments containing residual glutaraldehyde
Engineering controls tailored for these exposure sources include ventilation, both general exhaust ventilation and local exhaust systems (such as laboratory chemical hoods), process automation, and isolation (e.g., basins with tight-fitting covers, dedicated centralized storage and use areas).
Personal Protective Equipment (PPE)
Employers must select and require employees to use appropriate hand protection when employees’ hands are exposed to potential skin absorption of substances such as glutaraldehyde (29 CFR 1910.138).
Use appropriate PPE covered under [29 CFR 1910.132(a)] including:
- Use gloves and aprons made of nitrile or butyl rubber (latex gloves do not provide adequate protection).
- Do not use latex surgical exam gloves for skin protection against glutaraldehyde, except in situations where only short-term, incidental contact is expected.
- Wear lab coats, aprons, or gowns made of appropriate materials such as polypropylene to provide additional protection.
- For shorter exposures, you can use gloves made of polyethylene. Do not use Neoprene and PVC gloves because they do not provide adequate protection against glutaraldehyde and may actually absorb it.
- Wear splash-proof goggles and/or full-face shields when working with glutaraldehyde to protect eyes (29 CFR 1910.133).
- Suitable emergency eyewash equipment must be immediately available for quick drenching or flushing of the eyes (for at least 15 minutes) in all glutaraldehyde usage locations. It is recommended that emergency eyewash units be accessible and located within a 10 second travel time of all affected areas.
Administrative Work Practice Controls
Poor work practices can contribute significantly to an employee’s glutaraldehyde exposure. The health care facility should evaluate each glutaraldehyde-using operation and observe employees’ work practices to determine all potential sources of exposure. Developing procedures for safe work practices may be useful for training and communication purposes. These procedures should emphasize prevention of employee contact with glutaraldehyde solution or vapors. Only trained, designated personnel should be responsible for handling glutaraldehyde.
Here are some more work practice controls to help protect healthcare workers:
- Provide eye wash fountains for immediate emergency use. [29 CFR 1910.151(c)]
- Use eye wash fountains and emergency showers if there is skin contact with glutaraldehyde. Flush area with water for at least 15 minutes to remove chemical.
- Change into clean clothes if clothing becomes contaminated.
- Clean up spills immediately.
- Do not eat, drink, or smoke in any area where glutaraldehyde is handled or stored.
- Use a vacuum or wet method to reduce dust while cleaning up pure glutaraldehyde. Do not dry sweep.
- Use less toxic products if feasible and available, or other processes for sterilization.
- Automate the transfer of pure glutaraldehyde or pump liquid glutaraldehyde from drums or other storage containers to appropriate containers and operations, avoiding exposure to glutaraldehyde by keeping it in a contained process.
Local Exhaust Ventilation
ANSI/AAMI ST58 recommends that local exhaust ventilation also be installed at the point of release of glutaraldehyde vapors. The health care facility must ensure that the ventilation system is operating properly and is not obstructed or disturbed by drafts from sources such as fans, supply air diffusers, open windows and doors, and heavily traveled aisles. Local exhaust ventilation located at the level of vapor discharge is the preferred method of reducing glutaraldehyde vapor concentrations because it captures and removes vapor at the source before it can escape into the general work environment. Local exhaust ventilation systems for glutaraldehyde-based activities may include a local exhaust hood (such as a laboratory fume hood) and the associated ductwork and fan; or, a self-contained, freestanding, recirculating exhaust ventilation system (i.e., ductless fume hood).
Reducing the release of glutaraldehyde vapor during transfer operations can be accomplished by the use of automated and enclosed equipment. For example, the transfer of glutaraldehyde from drums into process containers can be automated using pumps and closed transfer lines. Such automated equipment can help employees avoid glutaraldehyde exposure.
The use of automated processing equipment to disinfect instruments can significantly reduce the glutaraldehyde exposures of employees performing disinfection procedures, as well as of other employees and non-employees in the vicinity. However, exposure is still possible, especially when poor work practices are used, or the equipment is poorly designed or improperly installed.