Health Risks of Glutaraldehyde and its Relation to Work Practices and Workplace Safety Measures among Health Care Workers at Ain Shams University Hospitals

Abstract

Glutaraldehyde (GA) is a broad spectrum biocidal agent for high level disinfection for heat sensitive equipment. It is widely used in hospitals especially in endoscopy units. GA is a known irritant and has a sensitizing effect on exposed health care workers. Many health risks are reported due to exposure to GA especially on eye, skin, respiratory tract and headache. Occupational asthma also reported due to exposure to GA especially in sensitized exposed workers. Ineffective workplace safety measures and poor work practices may lead to more exposure to GA and so more health risks. Thus this study aimed to identify health risks of GA and to determine the effect of work place safety measures and work practices on occurrence and severity of health risks among health care workers at Ain Shams University Hospitals. The current study wasa cross sectional study. HCWs were recruited from Ain Shams University hospitals and divided into 2 groups matched for age and sex (80 exposed to GA and 80 not exposed to GA). The GA exposed group was recruited from operating units(surgery and urology),endoscopy units (GIT and surgery), and gynecology endoscopy units, where GA solutions are used to disinfect heat sensitive equipment and the unexposed group was recruited from wards units where GA solutions are not used (surgery, urology, gynecology and GIT units). Both group had no history of chronic respiratory or dermatological conditions before admitted to work. Data were collected through an interview questionnaire from all HCWs included in the study (exposed and non-exposed groups) including personal history, occupational history and symptoms of health risks of GA as nasal, respiratory tract, ocular, skin, headache and other symptoms. Clinical examination and investigation by spirometry were done for both groups. Moreover observational checklist for work place safety measures of the work place where GA solution has been used and another observational checklist for work practices of the exposed HCWs were done. Results of the studyshowed thatthere were statistically significant differences between exposed and unexposed group regardingnasal symptoms (URT) (as nose irritation, dry nose, rhinorrhea, nosless (loss of smell), throat irritationand sore throat), lower respiratory tract symptoms (as dry cough, productive cough, dyspnea, wheezes, asthma and chronic bronchitis), ocular symptoms (as eye sore, eye irritation, redness eyeand eye tears), skin symptoms (as skin allergy, rash, redness, change of skin color, itching, dryness, oedema)and headache. Results also showed that exposed HCWs had significantly higher prevalence of other symptoms as nausea,nasal congestion (sinusitis), frequent attack of common cold, blurring in vision, fatigueand abdominal pain. The results of the study revealed that exposed HCWs had significantly higher impairment of PFTsas FVC, FVC%, FEV1, FEV1%, FEV1/FVC, FEV1/FVC%, PEF and PEF% than unexposed group whether before or after exposure. The results showed that work place safety measures in exposed areas as (effective general ventilation system with air exchange per hour > 15, automatic washer, specific area for GA disinfection with limiting access to only trained personal had a significant difference in reduction of health risks of GA as effective general ventilation system with air exchange per hour > 15 hada significant reduction of dyspnea, change of skin color, skin dryness, eye sore, lacrimation, frequent attack of common cold, fatigue, abdominal pain by history and redness eye by history and examinationand significant improvement ofFEV1/FVC=obstruction and FEV1/FVC%=obstruction% compared to mechanical ventilation without ACH and natural