Occupational hazards associated with endoscope high-level disinfection: Case vignettes, review of literature and recommendations for mitigation

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.