Labcaire References

Toxic Toll

Toxic Toll

Article reproduced from Nursing Times,
June 16, Volume 95, No. 24 1999.

Glutaraldehyde is found in most hospitals, but if rules for its use are not followed, nurses' health can be irreparably damaged.

Rebecca Coombes reports

Maureen Spittles had to kiss her nursing career goodbye after her health was nearly destroyed by a toxic chemical at work. The culprit, a cleaning and sterilising agent called glutaraldehyde, has forced many other nurses to leave the health service.

Yet there are few excuses for trusts to claim ignorance of the dangers of glutaraldehyde. It is in daily use in hospitals, most commonly used as a cold disinfectant for heat-sensitive instruments, such as endoscopes, and there are plenty of health and safety laws and guidelines attached to its use.

If poorly controlled it can present a number of health risks to nurses, both through direct contact and from the harmful fumes that emanate if the chemical is not stored at the correct temperature.

It can irrigate your skin, eyes, throat and lungs, leading to dermatitis or exacerbating eczema. Nurses also run the risk of becoming sensitised to glutaraldehyde, so that even the smallest further exposure may cause rhinitis, conjunctivitis or asthma.

After developing asthma – she believes as a result of glutaraldehyde exposure over 20 years in her job – Ms Spittles quit in 1995 and became a thorn in the side of Northamptonshire's Kettering General Hospital NHS Trust. Backed by Unison, she sued. Earlier this year the trust paid a total of £100,000 to her and another affected nurse in an out-of-court settlement.

Ms Spittles was a senior theatre nurse but she now works on a customer helpdesk for a local security firm. She says of her changed lifestyle: “My health has improved, but I still have to be careful. If I want to go to the pub after work, I have to go early before it fills up with smoke. I also can't use a lot of cleaning agents, wear spray perfume or use talcum powder”.

She is not bitter about her experience but she urges other nurses to protect themselves before it is too late. “My advice to nurses is to make quite sure that all the safety guidelines are being adhered to. Don't be fobbed off. I know people worry about their job, but when it is your health – speaking as someone who has done it – you have to stand up and be counted.

‘My advice to nurses is to make quite sure that all the safety guidelines are being adhered to. Don't be fobbed off'

“Not enough was done to protect me by the hospital,” she claims. They had installed a washing machine (fir cleaning the endoscopes) but it was in a tiny room without an extraction system. There was no ventilation and I had to fight to get holes drilled into the bottom of the door to get some air in.

I did a radio phone-in a couple of years ago and the switchboard was jammed with nurses from as far away as the Isle of Wight. Some of them had far worse health problems then me.

“When I got compensation I saw the assistant director of the trust on television, and he did apologise. But I have never heard from them directly”, she adds.

Ian Mulkis is a London based solicitor who has won damages of up to £100,000 for about 10 affected nurses, mostly in out-of-court settlements. He questions whether the chemical even has a place in today's NHS.

Mr Mulkis first experience of the issue came when he took on cases for the Society of Radiographers: glutaraldehyde is used in X-ray film-processing and many radiographers have sued employers after developing health problems.

According to Mr Mulkis's “there have clearly been improvements over the years, but nurses are still being exposed to this chemical. It is unacceptable. Ideally, safe substitutes should be used. There is no need for it to be used at all.”

He says nurses who become sensitised to glutaraldehyde are left with few career options.” It is included in everyday substances, such as car fumes, solvents, perfumes and even photocopying materials, so that a nurse is unable to work in an office environment”.

Kate Woodhead, chair of the National Association of Theatre Nurses, is similarly gloomy.

“I have used glutaraldehyde many times,” she says. “It has a nasty and unpleasant smell and makes your eyes water and nose stream. But unfortunately it is a very effective chemical sterilising agent. It would be good not to have to use it.

“One of the key problems is the very unclear guidelines for nurses. We know that some of our members have had to change jobs and move out of theatre because of exposure.”

NHS trusts can reduce risks by following government guidelines under the Control of Substances Hazardous to Health regulations 1988. Under COSHH they have a duty to assess all the circumstances in which glutaraldehyde is used, including training, health checks and air sampling, and whether safer substitutes could be used.

From this March, new Health and Safety Executive controls have made it illegal for employers to expose workers to the chemical in the air above a certain minute level – the so-called maximum exposure limit.

HSE inspector Chris Taylor confirms that glutaraldehyde is a health and safety area that trusts commonly fall down on.

In the past 10 years the HSE has only prosecuted one employer, the Bristol and Weston Health Authority in 1989, for failure to control exposure to the chemical. It has, however, served many notices in which glutaraldehyde was one of a number of areas of concern.

“It is depressing for our inspectors that trusts still have some way to go in terms of glutaraldehyde.

“With the new maximum exposure limit trusts will have to look harder at eliminating exposure or there will be legal consequences,” Mr Taylor says.

According to him, all employers should be following a four-point action plan to protect staff from the risks of glutaraldehyde (see box below).

Mr Taylor adds: A lot of trusts fall down on one or two of these areas. This year inspectors have found that trusts are aware of the problem but are still failing to carry out all of these procedures. For example, they have old equipment with no extraction.

“The HSE serves something like 400 notices on the health care sector every year, and a substantial proportion of those are to do with the control of hazardous substances,” he says.

In August 1998 the Aberdeen Royal Hospitals NHS Trust was served with a rarely-used improvement notice by the HSE, partly because it had failed to protect nurses from exposure to glutaraldehyde. The trust was given the all-clear last month, but the case serves as a warning that glutaraldehyde is still very much a live peril for nurses.

As for Ms Spittles, she has ‘learnt to live with' her asthma and a life restricted by her health status.

“I looked for another job after I retired from nursing,” she says. “It was hard, as I hadn't done anything else since I left school. I don't know whether I still miss nursing, If I see Casualty or ER on television I feel a bit sad, but you have to move forward.”