ALDEHYDE DISINFECTANTS AND HEALTH IN ENDOSCOPY UNITS - THE REPORT OF A WORKING PARTY OF THE BRITISH SOCIETY OF GASTROENTEROLOGY ENDOSCOPY COMMITTEE

(1) Glutaraldehyde, used in most endoscopy units in the United Kingdom for the disinfection of flexible gastrointestinal endoscopes, is a to xic substance being an irritant and a sensitiser; symptoms associated with glutaraldehyde exposure are common among staff working in endosco py units. (2) The Control of Substances Hazardous to Health Regulation s 1988 (COSHH) obliges the employer to make a systematic assessment of risk to staff of exposure to glutaraldehyde and institute measures to deal effectively with exposure. (3) At present glutaraldehyde remains the first line agent for the disinfection of flexible gastrointestina l endoscopes. Other agents are being developed; a standard means of as sessment for flexible endoscope disinfectants should be devised. (4) E quipment and accessories that are heat stable should be sterilised by autoclaving; disposable accessories should be used wherever possible. (5) Flexible gastrointestinal endoscopes should be disinfected within automated washer/disinfectors; trays, bowls or buckets for this purpos e are unacceptable. (6) Local exhaust ventilation must be used to cont rol glutaraldehyde vapour. Extracted air may be discharged direct to t he atmosphere or passed over special absorbent filters and recirculate d. Such control measures must be regularly tested and records retained . (7) Endoscope cleaning and disinfection should be carried out in a r oom dedicated to the purpose, equipped with control measures to mainta in the concentration of glutaraldehyde vapour at a level certainly bel ow the current occupational exposure standard of 0.2 ppm and preferabl y below the commonly used working limit of 0.1 ppm. Sites other than t he endoscopy unit where endoscopy is regularly performed, such as the radiology department, should have their own fully equipped cleaning an d disinfection room. (8) COSHH limits the use of personal protective e quipment to those situations where other measures cannot adequately co ntrol exposure. Such equipment includes nitrile rubber gloves, apron, chemiCAl grade eye protection. and respiratory protective equipment fo r organic vapours. (9) Monitoring of atmospheric levels of glutaraldeh yde should be performed by a competent person such as an occupational hygienist; the currently preferred method of sampling uses a filtratio n technique, the commercially available meters being less reliable. (1 0) Health surveillance of staff is mandatory; occupational health reco rds must be retained for 30 years. (11) Endoscopy staff must be inform ed of the risks of exposure to glutaraldehyde and trained in safe meth ods of its control. Only staff who have completed such an education an d training programme should be allowed to disinfect endoscopes. (12) T he unsafe use of glutaraldehyde has significant health and legal conse quences; the safe use of glutaraldehyde may have revenue consequences that contribute significantly to the cost of gastrointestinal endoscop y.