醫院內戊二醛暴露之不良健康效應：系統性回顧與統合分析

Adverse Health Effects of Glutaraldehyde Exposure in Hospitals: Systemic Review and Meta-Analysis

王建楠(Jian-Nan Wang) ； 李璧伊(Pi-I Lee)

《中華職業醫學雜誌》 22卷2期 (2015/04) Pp. 89-98

摘要

戊二醛（gluraraldehyde）是一種有機化合物，本身是氧化物（oxides），其化學式為CH_2(CH2CHO)_2，是一種刺鼻無色油性液體，常用於消毒醫療與牙科設備，也用於工業水處理及食品防腐劑。平常應用時主要是以水溶液呈現，溶液中之醛基（aldehyde group）是在水合狀態（hydrated）。對於一些熱敏感之醫療設備，例如透析儀器、手術儀器、吸瓶、支氣管鏡（bronchoscopes）、內視鏡（endoscopes）、牙科設備及耳鼻喉儀器，經常會使用一種高程度冷消毒劑，戊二醛便是其中之一。至於其他醫療領域應用，如病理化驗室之組織固定液、X-ray顯影之硬化劑等。在醫院內工作人員通常會用水混合加以稀釋後使用，重量百分濃度從1%至50%不等，不同廠牌，其配方亦不同。在西元1960年代早期，戊二醛便開始上市使用，用來取代高毒性、刺激性及致癌性之甲醛（formaldehyde）消毒劑。雖不像環氧乙烷（ethylene oxide, EtO）屬第一組致癌物（carcinogen），但醫院工作人員暴露物戊二醛後產生嚴重健康效應之報告時有所聞，例如氣喘發作與呼吸困難、眼灼熱與結膜炎、頭痛、鼻刺激、打噴嚏、流鼻血、噁心、蕁麻疹、皮疹與過敏性皮膚炎、喉嚨與肺部刺激、手染色（棕色）等。醫院內可能暴露戊二醛之危險族群，如胃腸鏡檢查室、心導管室、開刀房、透析室、內視鏡使用單位（如耳鼻喉科、胸腔內外科等）、加護病房、中央供應室、健檢中心等，其他像藥局內準備組織固定液之藥師、實驗室技術員、病理化驗室、從事底片顯影之放射技師等工作人員。戊二醛並非目前唯一的冷消毒劑，一些以過氧化氫（hydrogen peroxide）、過氧乙酸（peracetic acid）及鄰苯二甲醛（ortho-phthalaldehyde）為基底之冷液高水平消毒劑，可用以取代戊二醛，已有十幾家醫院採用。在醫院戊二醛暴露之工作環境中，如何降低不良健康效應最為重要。根據美國之國家職業安全衛生研究所（National Institue of Occupational and Safety Health, NIOSH）建議，戊二醛暴露濃度限值為0.2 ppm（portions per million），而美國政府工業衛生學家會議（American Conference of Govermental Industrial Hygienists, ACGIH）最近才將戊二醛暴露閾限值（threshold limit value, TLV）降為0.05ppm。儘量使用局部排氣通風，補捉速度至少每分鐘100呎及每小時至少10個室內空氣交換。儘可能在通風櫃下操作戊二醛浸洗，洗滌溶液量夠消毒即可。避免皮膚接觸，操作時戴護目鏡及面罩，且戴手套及穿圍裙（最好是丁基橡膠材質，因乳膠手套保護力不夠），洗滌完後必須清洗雙手。所有盛裝戊二醛溶液之桶子必須密封或覆蓋，工作人員須定期參加安全意識訓練課程。

關鍵字

戊二醛 ； 冷消毒劑 ； 健康效應 ； 熱敏感設備 ； 閾限值

並列摘要

Glutaraldehyde is an organic compound with the formula CH2(CH2CHOH)2.It is pungent colorless oily liquid and used as a high-level cold sterilant to disinfect and clean heat-sensitive medical and dental equipment, such as dialysis instrument, surgical instruments, endoscopes, bronchoscopes, suction bottles, dental, and ear, nose, and throat instruments. This chemical is also used as a tissue fixative in histology and pathology labs and as a hardening agent in the development of x-rays.It is also used as a tanning agent for leather, for industrial water treatment, as a preservative, etc. It is widely used in the industrial, scientific and biomedical fields. Glutaraldehyde as a chemical sterilant was initially recognized in the early 1960s as the health care industry searched for a safer alternative to formaldehyde, which is regulated by OSHA(occupational safety and health administration) as a carcinogen. Glutaraldehyde is a strong irritant to the skin, eyes, and respiratory system. Many adverse health effects have been reported in association with biomedical use of glutaraldehyde in the form of 1%-2% aqueous alkaline solution. Health care workers can be exposed to glutaraldehyde through inhalation or skin contact. Glutaraldehyde vapor in the air can cause tearing eyes, burning nose, sneezing, nasal bleeding, sore throat, and headache. It can irritate the skin and cause dermatitis(skin rashes) with dryness, redness, flaking, and cracking of the skin. Repeated exposure to glutaraldehyde can cause asthma, clinical symptoms such as chest tightness, wheezing, shortness of breath, and coughing. To reduce the risk of exposure, engineering control such as local exhaust ventilation(hoods) is the most effective type of ventilation control. Personal protective equipment is also indispensible, such as wearing gloves, goggles, aprons or faceshields .Protective clothing should be made of a material that is resistant to glutaraldehyde, such as butyl rubber, neoprene, polyvinyl chloride. So far, several hydrogen peroxide-, peracetic acid-,and orthopalahaldehyde-based high-level disin-fectant solutions can be used to replace glutaraldehyde.

並列關鍵字

glutaraldehyde ； cold disinfectant ； health effects ； threshold limit value ； heat-sensitive equipment