Allergic contact dermatitis from glutaraldehyde in health‐care workers

Abstract

Glutaraldehyde is considered the disinfectant of choice for sterilizing medical and dental equipment. Unfortunately, glutaraldehyde has many toxic side-effects, including the ability to induce allergic contact dermatitis. In a 5-year study at the University of Kansas, 468 patients were patch tested to glutaraldehyde. A comparison of results was made between those employed in a healthcare related field and those who were not. Health-care workers (HCWs) were more than 8x more likely to be allergic to glutaraldehyde than their non-health-care working peers (NHCWs). Statistically significant differences between HCWs and NHCWs were seen in their reactivity to glutaraldehyde, thimerosal, benzalkonium chloride and methyl methacrylate. A higher than expected co-reactivity between glutaraldehyde and formaldehyde was also noted among HCWs and NHCWs, which cannot fully be explained by concomitant exposure. Allergic contact dermatitis from glutaraldehyde often causes persistent dermatitis, which frequently forces patients to leave their jobs. Although the National Institute of Occupational Safety and Health has published guidelines for safe handling of glutaraldehyde, allergy appears to continue to rise, especially among those employed in health-care professions. Until a less sensitizing disinfectant is developed, it is in the best interest of those in health-care professions, and other professions exposed to glutaraldehyde, to heighten occupational safety standards and to improve methods of barrier protection.

Dermatoses Ocupacionais

“…Allergic contact dermatitis is caused by working materials (gloves, metals, epoxy and acrylic resins) and other chemicals; for example, disinfecting agents for hygiene such as glutharaldeides 35 and drugs, that may also be irritants. Urticaria caused by latex in gloves is not rare 20 and additives used in the vulcanization process of rubber gloves (dialkyl thioureas) have been considered the most common sensitizing agents for health professionals 36 .…”

Glutaraldehyde exposure and its occupational impact in the health care environment

“…Patch-testing has shown that GA is also capable of inducing allergic contact dermatitis (39)(40)(41). Allergic contact dermatitis caused by workplace substances has important occupational repercussions, as it may lead to persistent dermatitis, which then requires a change of career (38). Nethercott et al for example, found that five of their patients with GA-related contact dermatitis were forced to change their occupation because of the disease (39).…”

“…The substance is a well-known sensitizer, with chronic exposure leading to sensitization in certain people who regularly come into contact with GA at work. In one study, health care workers were more than eight times as likely to be allergic to GA, than people who were not employed in health care (38). Patch-testing has shown that GA is also capable of inducing allergic contact dermatitis (39)(40)(41).…”

“…Automated film processing (33,38) • Laboratory technicians (33, 38) • Processing x-ray films (43,46) • X-ray technicians (31, 32) • Cleaning and disinfecting (34,40) • Cleaners, veterinarians (39, 40) Inhalation…”

“…• Cold disinfection of equipment (28,37) • Operating theater nurses (30, 36) • Fixing specimens for microscopy (33,38) • Laboratory technicians (33, 38) • Processing x-ray films (43,46) • X-ray technicians (43, 46) • Cleaning and disinfecting (34,40) • Cleaners, veterinarians (39,40) equipment, for example, generally uses a 2% GA solution diluted from a 50% concentrate (32). Exposure usually occurs when pouring chemicals into the machine, as well as via mists, vapors, leaks and evaporation from the film itself.…”