Health and Safety Practices Survey of Healthcare Workers

High-Level Disinfectants

Here you will learn what we found regarding high-level disinfectants and best practices for minimizing exposure.

Overview

High-level disinfectants (HLDs) are used in healthcare to chemically disinfect reusable, medical and dental devices to prevent healthcare-associated infections among patients. The Food and Drug Administration (FDA)-cleared HLDs contain one or more of the following active ingredients¹ (this is not a full list): 

• Glutaraldehyde
• ortho-Phthaldehyde
• Peracetic acid
• Hydrogen peroxide
• Hypochlorous acid
• Hypochlorite

Acute health effects of exposure to HLDs include:

•  Dermatitis
•  Mucous membrane irritation
•  Skin and respiratory tract irritation
•  Aggravation of pre-existing asthma and asthma-like symptoms such as wheezing and shortness of breath.^3-6

Chronic exposure to HLDs may cause asthma and asthma-like symptoms.^7,8 Hydrogen peroxide has been shown to be potentially mutagenic in animals.⁹

The HLD survey module was completed by nurses, technologists and technicians, dental professionals, respiratory therapists and others who reported handling HLDs in the seven days prior to the survey. The survey found recommended safe handling practices were not always followed, underscoring the importance of improved employer and worker training and education regarding HLD hazards.

Best practices and study findings

Overall, findings from this survey show that best practices to minimize exposure to HLDs have not been universally implemented. Healthcare employers and employees share responsibility to ensure adherence to exposure control and best practices to minimize exposure to HLDs. 

What we found	What employers/employees should do
17% of respondents said they never received training and, of those who received training, 42% said that it was more than 12 months ago. 19% of respondents said that employer safe handling procedures were unavailable.	Have employees take training on the hazards of HLDs and utilize best practices for minimizing exposure prior to working in an area where HLDs are used.10
44% of respondents did not always wear a protective gown and 9% did not always wear protective gloves. 12% said they had skin contact with HLDs during the past week. Respondents who said they had skin contact were 4 times more likely to state that they did not always wear protective gloves.	Wear protective gloves and water-resistant gown or outer garment when handling HLDs.11-13
29% of respondents said that spill kits were not available or they did not know whether they were or not.	Ensure spill kits are available for appropriate clean-up of HLD spills.11

References

¹ FDA-cleared sterilants and high-level disinfectants with general claims for processing reusable medical and dental devices- March 2009

² Fowler JF, Jr. [1989] Allergic contact dermatitis from glutaraldehyde exposure. J Occup Med 31:852-853.

³ SGNA Guideline for use of high level disinfectants and sterilants for reprocessing flexible gastrointestional endoscopes

⁴ CDC – Peracetic acid. International chemical safety cards

⁵ NIOSH Workplace safety and health topics – Hydrogen peroxide

⁶ CDC – Sodium hypochlorite. International chemical safety cards

⁷ Di Stefano F, Siriruttanapruk S, McCoach J, Burge PS. [1999] Glutaraldehyde: an occupational hazard in the hospital setting. Allergy 54:1105-1109.

⁸ Cristofari-Marquand E, Kacel M, Milhe F, Magnan A, Lehucher-Michel MP. [2007] Asthma caused by peracetic acid-hydrogen peroxide mixture. J Occup Health 49:155-158.

⁹ Driessens N, Versteyhe S, Ghaddhab C, et al. [2009] Hydrogen peroxide induces DNA single- and double-strand breaks in thyroid cells and is therefore a potential mutagen for this organ. Endocr Relat Cancer. 16(3):845-56.

¹⁰ OSHA Hazard Communication Standard 1910.1200

¹¹ OSHA Best practices for the safe use of glutaradehyde in health care

¹² CDC Guideline for disinfection and sterilization in healthcare facilities, 2008

¹³ NIOSH Pocket guide to chemical hazards – Sodium hypochlorite

Survey and report

To request a copy of this survey, please email jmb4@cdc.gov.

Journal article