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Glutaral
General information
Aldehydes such as glutaral (glutaraldehyde), formaldehyde, and glyoxal are used as solutions and vapors for disinfection and sterilization.
The safety and biocidal efficacy of glutaral has led to its endorsement by the CDC and WHO as a substitute for formaldehyde in high-level disinfection and cold sterilization [ , ]. Glutaral is used in a 2% aqueous solution buffered to a pH of about 8 for sterilization of endoscopic and dental equipment and for other equipment that cannot be sterilized by heat.
Occupational safety considerations for glutaral largely relate to its volatility, and stringent precautions in handling are especially needed in tropical climates [ ]. The lack of precautionary details for glutaral fumes, especially in warm climates is inadequate. Manufacturers should provide details of possible adverse effects that could arise from glutaral vapor, and of the precautions that should be taken to keep the air concentration below the recommended limit. The odor threshold for glutaral vapor is about 0.04 ppm, the irritation threshold about 0.3 ppm, and the recommended Ceiling Threshold Limit Value 0.2 ppm. It should not be exceeded at any time during the working day [ ]. It is likely that glutaral vapor will be smelt before reaching overexposure concentration, but there is an urgent need to develop affordable and effective methods of containing glutaral fumes.
Drug studies
Observational studies
Glutaral-based products are typically used in hospitals and clinics as cold sterilizers, to disinfect and clean heat-sensitive medical devices. Glutaral is a potent sensitizer and respiratory irritant, and it has been implicated as a cause of asthma in health-care workers. This has led to a search for alterative disinfectants for instrumental sterilization [ ].
However, glutaral continues to be used as a disinfectant and sterilizer, particularly in developing countries. This requires occupational health monitoring and establishment of safe practices for its use.
Of 169 nurses working in 17 hospitals, especially in endoscope units, 68% had symptoms, 38% two or more. The major complaints were eye irritation in 49%, skin discoloration or irritation in 41%, and cough or shortness of breath in 34% [ ]. Complaints were not related to habits, atopic status, or duration of exposure. In two hospitals, the time-weighted average concentrations were estimated. The 10-minute time-weighted average was below the UK occupational exposure standard of 0.2 ppm. In a similar survey of 150 staff in two Middlesex hospitals who were exposed to glutaral, the rate of complaints was in the same range [ ].
In a Canadian study to assess the effect of work practices and general ventilation systems on employees’ exposure to glutaral, air samples were taken in five hospitals [ ]. The presence of local or general ventilation, air changes per hour, the quantity of glutaral used, and work practices were recorded. Work practices constituted the most important factor affecting the degree of exposure to glutaral. In locations where “poor” or “unsafe” practices were employed, glutaral concentrations were much higher and there was an increased prevalence of headache and itchy eyes among employees.
Organs and systems
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