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Precautionary Practices of Healthcare Workers Who Disinfect Medical and Dental Devices Using High-Level Disinfectants

  • Scott A. Henn (a1), James M. Boiano (a1) and Andrea L. Steege (a1)



High-level disinfectants (HLDs) are used throughout the healthcare industry to chemically disinfect reusable, semicritical medical and dental devices to control and prevent healthcare-associated infections among patient populations. Workers who use HLDs are at risk of exposure to these chemicals, some of which are respiratory and skin irritants and sensitizers.


To evaluate exposure controls used and to better understand impediments to healthcare workers using personal protective equipment while handling HLDs.


Web-based survey.


A targeted sample of members of professional practice organizations representing nurses, technologists/technicians, dental professionals, respiratory therapists, and others who reported handling HLDs in the previous 7 calendar days. Participating organizations invited either all or a random sample of members via email, which included a hyperlink to the survey.


Descriptive analyses were conducted including simple frequencies and prevalences.


A total of 4,657 respondents completed the survey. The HLDs used most often were glutaraldehyde (59%), peracetic acid (16%), and ortho-phthalaldehyde (15%). Examples of work practices or events that could increase exposure risk included failure to wear water-resistant gowns (44%); absence of standard procedures for minimizing exposure (19%); lack of safe handling training (17%); failure to wear protective gloves (9%); and a spill/leak of HLD during handling (5%). Among all respondents, 12% reported skin contact with HLDs, and 33% of these respondents reported that they did not always wear gloves.


Findings indicated that precautionary practices were not always used, underscoring the importance of improved employer and worker training and education regarding HLD hazards.

Infect Control Hosp Epidemiol 2014;00(0): 1–6


Corresponding author

Address correspondence to Scott A. Henn, MS, CIH, National Institute for Occupational Safety and Health, 1090 Tusculum Avenue, R-19, Cincinnati, OH 45226 (


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1. Food and Drug Administration. FDA-cleared sterilants and high-level disinfectants with general claims for processing reusable medical and dental devices—March 2009; 2009.
2. Fowler, JF Jr. Allergic contact dermatitis from glutaraldehyde exposure. J Occup Med 1989;31:852853.
3. Nethercott, JR, Holness, DL, Page, E. Occupational contact dermatitis due to glutaraldehyde in health care workers. Contact dermatitis 1988;18:193196.
4. Waters, A, Beach, J, Abramson, M. Symptoms and lung function in health care personnel exposed to glutaraldehyde. Am J Ind Med 2003;43:196203.
5. Bardazzi, F, Melino, M, Alagna, G, Veronesi, S. Glutaraldehyde dermatitis in nurses. Contact dermatitis 1986;14:319320.
6. Hansen, KS. Glutaraldehyde occupational dermatitis. Contact dermatitis 1983;9:8182.
7. Di Stefano, F, Siriruttanapruk, S, McCoach, J, Burge, PS. Glutaraldehyde: an occupational hazard in the hospital setting. Allergy 1999;54:11051109.
8. Gannon, PF, Bright, P, Campbell, M, O'Hickey, SP, Burge, PS. Occupational asthma due to glutaraldehyde and formaldehyde in endoscopy and x ray departments. Thorax 1995;50:156159.
9. Dimich-Ward, H, Wymer, ML, Chan-Yeung, M.. Respiratory health survey of respiratory therapists. Chest 2004;126:10481053.
10. Fujita, H, Ogawa, M, Endo, Y. A case of occupational bronchial asthma and contact dermatitis caused by ortho-phthalaldehyde exposure in a medical worker. J Occup Health 2006;48:413416.
11. Cristofari-Marquand, E, Kacel, M, Milhe, F, Magnan, A, Lehucher-Michel, MP. Asthma caused by peracetic acid-hydrogen peroxide mixture. J Occup Health 2007;49:155158.
12. Nayebzadeh, A. The effect of work practices on personal exposure to glutaraldehyde among health care workers. Ind Health 2007;45:289295.
13. Centers for Disease Control and Prevention. Glutaraldehyde—occupational hazards in hospitals. DHHS (NIOSH) Publication Number 2001-115; 2011.
14. Occupational Safety and Health Administration. Best practices for the safe use of glutarladehyde in health care. Washington DC: US Department of Labor, 2006.
15. Steege, AL, Boiano, JM, Sweeney, MH. NIOSH health and safety practices survey of healthcare workers: training and awareness of employer safety procedures. Am J Ind Med 2014;57:640652.
16. Sas Institute, Inc. SAS/STAT User's Guide, Version 9. Cary, NC, 2013.
17. Distinguishing public health research and public health nonresearch. Centers for Disease Control and Prevention website. Published 2010. Accessed November 6, 2013.
18. Niven, KJM, Cherrie, JW, Spencer, J. Estimation of exposure from spilled glutaraldehyde solutions in a hospital setting. Ann Occup Hyg 1997;41:691698.
19. Pisaniello, DL, Gun, RT, Tkaczuk, MN, Nitshcke, M, Crea, J. Safer use of glutaraldehyde. AORN J 1997;65:11141115.
20. Brullet, E, Ramirez-Armengol, JA, Campo, R. Cleaning and disinfection practices in digestive endoscopy in Spain: results of a national survey. Endoscopy 2001;33:864868.
21. Cheung, RJ, Ortiz, D, DiMarino, AJ Jr. GI endoscopic reprocessing practices in the United States. Gastrointest Endosc 1999;50:362368.
22. Gorse, GJ, Messner, RL. Infection control practices in gastrointestinal endoscopy in the United States: a national survey. Infect Control Hosp Epidemiol 1991;12:289296.
23. Rideout, K, Teschke, K, Dimich-Ward, H, Kennedy, SM. Considering risks to healthcare workers from glutaraldehyde alternatives in high-level disinfection. J Hosp Infect 2005;59:411.
24. Miyajima, K, Tabuchi, T, Kumagai, S. Occupational health of endoscope sterilization workers in medical institutions in Osaka Prefecture. J Occup Health 2006;48:169175.
25. Fratila, O, Tantau, M. Cleaning and disinfection in gastrointestinal endoscopy: current status in Romania. J Gastrointestin Liver Dis 2006;15:8993.


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