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Choosing High-level Disinfectants

Goal: To study exposure, health impacts and organizational issues in the trial of a substitute for gluteraldehyde.
Additional Funders: OHSAH
Main Partners: OHSAH; University of British Columbia; Vancouver Island Health Authority

This goal of this project, funded by the Community Alliance for Health Research and conducted by researchers at the University of British Columbia, was to examine the aspects of substituting a known hazardous chemical with substitutes of unknown toxicity For the past 40 years, glutaraldehyde has been the chemical of choice for high-level disinfection. It is effective and easy to use, but it can lead to dermatitis, skin irritation, respiratory symptoms, and even occupational asthma among people who use it. Until recently there was no other choice. Since 1999, two new products have been advertised as safer products: ortho-phthalaldehyde (OPA) and hydrogen peroxide/peracetic acid.

The objectives of this study were to:
  • Predict the relative health effects of currently available chemicals used for high-level disinfection: glutaraldehyde, OPA, peracetic acid, and hydrogen peroxide.
  • Examine how high-level disinfectants are used in BC hospitals and how decisions are made related to these products.
  • Develop recommendations for minimizing employee health risks associated with the use of high-level disinfectants. This study was also intended to provide information to develop an in-depth study into exposures and health effects associated with the use of glutaraldehyde alternatives.
We surveyed BC hospitals and then predicted the health effects that might occur after exposure to each type of high-level disinfectant. We contacted regulatory agencies and product manufacturers to request health information and compared the chemical properties of each chemical.
Results
Information from regulators: Manufacturers are not routinely required to provide toxicology or health data to Health Canada in order to get a new high-level disinfectant approved in Canada.

Information from other sources: Numerous studies have confirmed glutaraldehyde’s negative health effects. OPA can cause skin and respiratory irritation and may be able to cause asthma. Peracetic acid and hydrogen peroxide are irritants but do not cause allergic reactions. Both alternatives appear to be less hazardous than glutaraldehyde. All high-level disinfectants, however, should be treated with caution.

Use of high-level disinfectants in BC hospitals: The use of glutaraldehyde alternatives is already widespread in BC hospitals. Of 51 hospitals that reported using high-level disinfectants, 26 (51%) were using alternatives and 18 (35%) used them exclusively. OPA was used most commonly. There is a lack of health information on new products and their effects on employee health. Alternatives were chosen based on the recommendations of sales representatives. Alternatives were used less frequently where occupational health or infection control departments or the health authority were involved in the decisions.


Related Resources

Result Summary:
Impact of Chemical Substitution on Employee Health and Organization
(15 kb, 5 pgs)
Fact Sheet :
Impact of Chemical Substitution on Employee Health and Organization
(1 kb, 1 pg)
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Last Updated: December 22, 2006.