Glutaraldehyde: an occupational hazard in the hospital setting

Background: We report a series of 24 health-care workers with respiratory s ymptoms suggestive of occupational asthma due to glutaraldehyde exposure. Methods: The history of asthmatic symptoms was investigated with peak expir atory flow rate (PEFR) monitoring, and in eight of the subjects, the specif ic bronchial provocation test (SBPT) was applied as reference standard for diagnosis of occupational asthma. Levels of glutaraldehyde were monitored i n the challenge chamber during the SEPT. Work environmental levels of gluta raldehyde were measured from air samples collected at least once during the PEFR monitoring of endoscopy and theatre nurses. Specific IgE antibodies t o glutaraldehyde were measured with a series of glutaraldehyde modified pro teins. Results:ln the eight workers who underwent SEPT, the diagnosis of occupatio nal asthma was confirmed by a positive reaction (late and dual reaction in five and in three subjects, respectively). The mean level of glutaraldehyde observed during the challenge tests was 0.075 mg/m(3) (range 0.065-0.084 m g/m(3)). In 13 out of the 16 remaining workers, the serial PEFR monitoring showed a work-related effect. In three workers, there was no physiological confirmation of occupational asthma. Levels of glutaraldehyde from the air samples collected in the workplace were as follows: personal short-term sam ples (mean 0.208 mg/m(3); median 0.14 mg/m(3); range 0.06-0.84 mg/m(3)), pe r sonal long-term samples (mean 0.071 mg/m(3); median 0.07 mg/m(3); range 0 .003-0.28 mg/m(3)). Measurements of specific IgE antibodies to glutaraldehy de-modified proteins were positive in seven patients (29.1%) according to a cutoff value of 0.88% RAST binding. The presence of atopy to common enviro nmental allergens and smoking was not associated with specific IgE positivi ty (P>0.05; Fisher's exact test). Conclusions: Our report indicates the importance of glutaraldehyde as an oc cupational hazard among exposed health-care workers. Intervention in the wo rkplace, training of personnel handling this chemical, and accurate health surveillance may reduce the risk of developing occupational asthma due to g lutaraldehyde.