Acute Antimicrobial Pesticide
Related Illnesses Among Workers in
Health Care Facilities
Dr. Mark
Moskovitz and Gary Witman, MD
As we ramp up in providing
health care facilities with superior antimicrobial
protection by releasing the sale of DynacidalTM
impregnated swipes, known as Dyna-SwipeTM
(not approved for use at present in the United
States), it is important to recognize that all
antimicrobial pesticides should never be taken
lightly. They are powerful tools with extraordinary
chemical and biological activity. If antimicrobial
pesticides are not treated with respect they have
the ability to cause bodily injury and can lead to
adverse health effects. By eliminating the need for
using any existent active ingredients associated
with current antimicrobial pesticide we have been
able to reduce such risks.
Antimicrobial pesticides are
chemicals used to destroy or suppress the growth of
harmful microorganisms whether bacteria, viruses or
fungi on inanimate objects and surfaces. They
include products which are sterilizers,
disinfectants and sterilizers which are formulated
into sprays, liquids, concentrated powders and
gases. Of note, disinfectants are able to destroy or
irreversibly inactivate infectious fungi and
bacteria but not necessarily their spores. There are
approximately 5,000 antimicrobial pesticide products
containing 275 active compounds which are registered
with the Environmental Protection Agency, and nearly
2/3 of these are designed to control infections in
health care settings. Annual sales volume for these
products in the United States exceeds one billion
dollars.
The US Environmental Agency
classifies pesticide products into one of four
categories based on established criteria. Category I
is given for pesticides with the greatest toxicity
and Category IV for pesticides with the least
toxicity. The Center for Disease Control has
analyzed the data from the period of 2002 to 2007
from the four states which regularly collect date on
antimicrobial pesticide related illness (California,
Louisiana, Michigan and Texas). An antimicrobial
pesticide related illness is defined as any acute
adverse health effect resulting from exposure to an
antimicrobial pesticide product.
This report, published in the
May 10, 2010 edition of the Morbidity and Mortality
Weekly (59(18);551-556)) summarized the data from
the 401 cases of work related illness associated
with antimicrobial pesticide exposure in health
related facilities. Health care facilities use
anti-microbial pesticides to prevent pathogen
transmission from contaminated environmental
surfaces.
The most frequent occupations
reporting illness are janitors, housekeepers, nurses
and medical assistants. The most common mechanisms
of injury are splashes and spills, with only 15% of
health care workers reporting wearing protective
eyewear.
The most common active
ingredients responsible for illnesses are
quarternary ammonium compounds (QACs),
glutaraldehyde, and sodium hypochlorite. QACs are
widely used to disinfect environmental surfaces or
medical equipment designed for skin contact, such as
blood pressure cuffs. Glutaraldehyde is used as in
immersion chemical in disinfecting heat sensitive
medical equipment such as endoscopes. Sodium
hypochlorite is used in environmental sanitation.
The most common active
ingredients are listed in the CDC report:
Of note, 66% of cases occurred
in persons exposed while they handled antimicrobial
pesticides and 18% were in bystanders. Among workers
handling antimicrobial pesticides 74% wore a form of
personal protective equipment, with 60% wearing
specialty work clothes or gowns, 55% wearing gloves
and only 15% wearing protective eyewear including
safety glasses, goggles or face shields.
The recommendation from the CDC
is to educate workers about antimicrobial pesticide
hazards, promote the use of personal protective
equipment (PPE) and implement effective risk
communication strategies for antimicrobial pesticide
use to prevent bystander exposure. It is believed by
the CDC staff that this is a great underreporting of
injury and illness as such reporting is entirely
voluntary.
Health care facilities should
use less hazardous antimicrobial pesticide products
when available. DynacidalTM
impregnated materials, by reducing exposure to
common active ingredients may reduce antimicrobial
pesticide related injuries among health care
professionals.
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