Affiliations: Beth Israel Deaconess Medical Center-Harvard Medical
School, Boston, MA, USA
Note: [] Corresponding author: Ben Hur P. Mobo, Jr., Medical Director,
BIDMC Employee Occupational Health Service, 110 Francis Street, Suite 6C,
Boston, MA 02215, USA. Tel.: +1 617 632 7817; Fax: +1 617 632 0906; E-mail: jaymobo@yahoo.com
Abstract: BACKGROUND: High-level disinfection is crucial in preventing
instrument-related infections. However, inadequate process and practice may
expose technicians to chemicals and other hazards. OBJECTIVE: The aim of this article is to describe the health effects related to high-level
disinfection, the process of identifying hazards and safer practice
recommendations. PARTICIPANTS: Two endoscope technicians with different
clinical presentations were evaluated for workplace exposures. METHODS: In addition to acute clinical care, corroborative information was obtained
through walkthrough and observing patients performing their daily tasks,
interview of co-workers, environmental assessment and review of published
literature. Recommendations for improvement and clinical follow up were made. RESULTS: Clinical evaluation and workplace assessment identified
potential exposures to: denatonium benzoate, ortho-phthalaldehyde, proteinase
subtilisin, and isopropyl alcohol. Environmental monitoring showed adequate
ventilation but with potential for acute high-level exposure to high-level
disinfectants. Ergonomic stressors and noise were addressed. Following work
restrictions and work practice changes, both patients were able to return to
work without recurrence of symptoms. CONCLUSION: The occupational hazards of working in an endoscopy disinfection unit include chemicals that are
irritants and/or allergenic. In addition to bioengineering controls,
administrative controls and proper respiratory and dermal protections may
mitigate exposure and allow workers to continue working safely.
