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As hospitals seek greater protections for workers from the hazards of glutaraldehyde, they reach an inevitable question: Should they spend money on additional ventilation and other controls, or should they switch to an alternative product or technology?
Public agencies such as the U.S. Occupational Safety and Health Administration (OSHA) avoid recommending the elimination of an approved substance, instead emphasizing the steps needed to control the hazard. But the Sustainable Hospitals Project at the University of Massachusetts in Lowell is seeking to educate hospitals about alternatives — as well as about the costs of keeping the status quo.
"If we have a [skin and respiratory] sensitizer that has alternatives that maintain quality infection control . . . and the true costs are similar, why not use [it]?" asks Jamie Tessler, MPH, research associate with the Sustainable Hospitals Project.
The Sustainable Hospitals Project has developed fact sheets for hospitals on alternative products and their properties, case studies of hospitals that have eliminated glutaraldehyde or improved their controls, and cost-accounting information. At all sites where glutaraldehyde is used, the hospital should have local exhaust ventilation, an emergency response program for spills, regular employee monitoring, and training programs.
Neutralizing agents can reduce exposure when employees pour the chemical down a sink, and neutralizing absorbent mats beneath bins can moderate the impact of a spill. Employees also need training on handling of glutaraldehyde and on proper response to a spill. "What we found is that most people who were working with glutaraldehyde had received no training at all on how to work safely with the chemical," says Tessler.
Safety issues prompted Geoff Kelafant, MD, MSPH, FACOEM, medical director of the occupational health department of the Sarah Bush Lincoln Health Center in Mattoon, IL, to use up supplies of glutaraldehyde and switch to an alternate product. "We’ve always tried to avoid [hazards] when we can," he says. "In the long run it’s cheaper because you don’t have to do any air monitoring or worry about anyone being exposed."
But convincing hospital administration to invest in new disinfecting technology may be difficult. When the Sustainable Hospitals Project conducted case studies of hospitals that had eliminated or reduced exposures, half of them had eliminated glutaraldehyde altogether and half had implemented comprehensive controls.
"Hospitals make cost decisions based on a variety of factors," notes Tessler, and they often do it without considering all the direct and indirect costs of each option. "Also, hospitals that have full-time industrial hygiene personnel feel less burdened by the costs of monitoring programs."
With a .05 ppm exposure limit likely to come from OSHA, hospitals may begin reevaluating the economics of keeping glutaraldehyde. "I think glutaraldehyde will get a lot more attention in this country," says Tessler. "Our mission is to provide the resources to hospitals that want to make changes, to provide them with links to new technologies and alternatives, and to help them think about the impact of risk-shifting as they make these changes."
[Editor’s note: For more information about alternatives to glutaraldehyde, see the Sustainable Hospitals Project Web site at www.sustainablehospitals.org. E-mail: firstname.lastname@example.org. Telephone: (978) 934-3386.]