Field Survey Report: Exposure Assessment of Peracetic Acid-Based Disinfectant Chemicals in a Pediatric Hospital During Terminal Room Cleaning [2025-DFSE-2041]

Details

• Personal Author:
  Dunn, Kevin H. ; Grant, Michael P. ; Omari, Amel ; Barnes, Christopher ; Garcia, Alberto
• Description:
  Background: Peracetic acid (PAA) is a chemical with growing use as a disinfectant, sterilant, and biocide. PAA, in a mixture with hydrogen peroxide (HP) and acetic acid (AA), is used in a wide variety of industrial sectors including the food and beverage industry, feed, animal housing, hospitals and healthcare, agriculture, water purification, wastewater and sewage treatment, textile bleaching, pharmaceuticals, oil and gas, laundry, cosmetics, and the chemical industry. PAA is a strong oxidant with higher oxidizing potential than other biocides and is highly reactive on contact with organic material. PAA is corrosive to the skin, mucous membranes, and respiratory tract; and it is a sensory irritant. Although opportunities for employee exposures are increasing, there is little published information on workplace exposures or appropriate risk management approaches for working with mixtures of PAA, HP, and AA. Scientists from the National Institute for Occupational Safety and Health (NIOSH) are conducting a study to assess worker exposures to PAA-based disinfectants in healthcare, including hospitals. This report describes exposures to environmental services (EVS) staff at a children's hospital that uses a PAA-based disinfectant during terminal (or discharge) room and Giraffe(TM) incubator/isolette cleanings. Assessment: NIOSH researchers conducted a site visit to assess worker exposures to the components of a PAA-based disinfectant during room cleaning tasks. EVS staff were monitored for exposure to PAA, HP and AA while conducting terminal room cleanings. These cleanings are performed when patients are discharged or moved to another room, and prior to the room being re-occupied. These cleaning procedures help reduce the likelihood of illness causing germs and bacteria from being spread from one patient to the next. During terminal room cleanings, EVS staff use the PAA-based disinfectant to clean and disinfect all low and high touch surfaces, including beds, bed rails, intravenous (IV) poles, tray tables, chairs, telephones, light switches, bathroom sinks and toilets as well as any other surface within the room. We collected 17 task-based air samples for HP, PAA, and AA on EVS staff performing terminal room cleaning activities. Each task was comprised of a terminal room cleaning and sample duration ranging from 15 to 53 minutes. We also collected 2 samples during the cleaning of isolettes. We observed EVS staff while they performed their regular cleaning duties and noted task duration, cleaning product use, and use of any personal protective equipment. Results: Acetic Acid: Worker personal air samples for AA ranged from 0.10 to 0.68 parts per million (ppm) during terminal room cleaning across the two days of sampling. The samples collected during the two isolettes cleanings ranged from 0.06 to 0.18 ppm. NIOSH and the American Conference of Governmental Industrial Hygienists (ACGIH®) have a short-term exposure limit (STEL) of 15 ppm. The STEL is a 15- minute Time Weighted Average (TWA) exposure that should not be exceeded at any time during a workday. Peracetic Acid: Worker personal air samples for PAA ranged from 0.04 to 0.51 ppm during terminal room cleaning across the two days of sampling. The samples collected during the two isolettes cleanings ranged from 0.02 to 0.08 ppm. ACGIH has a STEL of 0.4 ppm for PAA. The Occupational Safety and Health Administration (OSHA) and NIOSH do not have a STEL for PAA. Hydrogen Peroxide: Worker personal air samples for HP ranged from 0.10 to 0.65 ppm during terminal room cleaning across the two days of sampling. The samples collected during the two isolettes cleanings ranged from 0.09 to 0.24 ppm. ACGIH, OSHA and NIOSH do not have a STEL for HP. ACGIH, OSHA and NIOSH have a full shift TWA limit of 1 ppm for HP, although it is not applicable to these short-term samples. Conclusions and Recommendations: All measured levels of AA were below workplace safety limits for short term exposures. Two of the 19 short term sample results for PAA exceeded the ACGIH TLV-STEL of 0.40 ppm. There is no applicable short-term OEL for HP. We observed varying levels of the disinfectant in the cloth buckets, including many with standing levels of disinfectant and rags which were dripping with the disinfectant when removed from the bucket for use. Some workers mentioned that the use of the chemicals caused skin irritation and upper respiratory symptoms like runny or stuffy nose. We recommend that management ensure that employees understand potential hazards in the workplace and how to protect themselves. We also recommend that management ensure that employees have access and are informed of potential hazards and trained on the associated safe practices per the information found in the cleaning products' Safety Data Sheets (SDS). Specifically, employees should be educated on the documented health risks from exposure to HP, AA and PAA, as well as chemicals found in other cleaners at the hospital. We recommend that management work with employees to reinforce training on the proper use of disinfectant and other products used in terminal room cleanings. This discussion should include the amount of product that should be used in buckets containing the wetted cloths and help address the thought that "more is better." Further, we recommend that management require employees to wear extended cuff nitrile gloves or other compatible impervious gloves when using the disinfectant to minimize likelihood of skin exposure and irritation. Description provided by NIOSH
• Subjects:
  • Health Personnel
  • Hospitals
  • Occupational Exposure
  • Occupational Health
  • Peracetic Acid
  • Protective Clothing
  • Safety
  • Skin
• Keywords:
  • Peracetic acid; Acetic acid; Hydrogen peroxide; Disinfectants; Cleaning compounds; Health care workers; Occupational exposure; Air sampling; Respiratory irritants; Skin exposure; Gloves; Chemical safety; Exposure assessment; Hospital equipment
• Source:
  Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, EPHB Report No. 2025-DFSE-2041, 2025 May; :1-22
• DOI:
  10.26616/NIOSHEPHB2025DFSE2041
• Document Type:
  Text
• Genre:
  Field Study
• Place as Subject:
  Chicago Region OSHA ; Ohio
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DFSE - Division of Field Studies and Engineering
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  23 pdf pages
• NIOSHTIC Number:
  nn:20071682
• CAS Registry Number:
  • Acetic acid (CAS RN 64-19-7)
  • Hydrogen peroxide (CAS RN 7722-84-1)
  • Peracetic acid (CAS RN 79-21-0)
• Federal Fiscal Year:
  2025
• NORA Priority Area:
  Healthcare and Social Assistance ; Manufacturing
• Peer Reviewed:
  False
• Download URL:
  https://stacks.cdc.gov/view/cdc/259453/cdc_259453_DS1.pdf
• File Type:
  [PDF - 319.34 KB]
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:2f46d16ac057218e0018b79f2b138ae960523d5cbdd50c344650b5585571bb6cf57902a1c72ae4399fe9d9d5c0988200cb5342413a42cfc6173f66fdeab02560