title: Occupational hazards associated with endoscope high-level disinfection: case vignettes, review of literature and recommendations for mitigation.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, MA, USA.
authors.forename: B H
authors.initials: BH
authors.lastname: Mobo
authors.affiliation: Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, MA, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Foster
authors.affiliation: Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, MA, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Rabesa
mesh_terms: D000328:Adult; D004202:Disinfectants / Q000032:analysis* / Q000633:toxicity; D004203:Disinfection; D019723:Endoscopes / Q000382:microbiology; D006804:Ergonomics; D005260:Female; D006261:Headache / Q000139:chemically induced; D006801:Humans; D007634:Keratitis / Q000139:chemically induced; D008875:Middle Aged; D009623:Noise, Occupational / Q000517:prevention & control; D009784:Occupational Diseases / Q000139:chemically induced*; D016273:Occupational Exposure / Q000009:adverse effects / Q000032:analysis* / Q000517:prevention & control*; D016272:Occupational Health; D014581:Urticaria / Q000139:chemically induced; D014691:Ventilation
chemical_list: D004202:Disinfectants
keywords: Endoscope technicians; denatonium benzoate; isopropyl alcohol; ortho-phthalaldehyde; proteinase subtilisin