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Substitution of a disinfectant in a residential home for elderly

Abstract

A residential institution for elderly used a disinfectant that contained, among other substances, triclosan and 2-butoxyethanol, classified as group 2B and 3 carcinogens respectively by the IARC). One of the workers suffered from throat irritation and respiratory problems. The disinfectant was substituted by a product based on didecyldimethylammonium chloride and ethoxylated alcohols, which have no significant effects on human health.

Substituted substance(s)

  1. Propylparaben

    CAS No. 94-13-3 EC No. 202-307-7 Index No. 
  2. Triclosan

    CAS No. 3380-34-5 EC No. 222-182-2 Index No. 604-070-00-9
  3. Methyl paraben

    CAS No. 99-76-3 EC No. 202-785-7 Index No. 
  4. 2-Butoxyethanol

    CAS No. 111-76-2 EC No. 203-905-0 Index No. 603-014-00-0

Alternative substance(s)

  1. Didecyldimethylammonium chloride

    CAS No. 7173-51-5 EC No. 230-525-2 Index No. 612-131-00-6
  2. Alcohols; C11-13-branched, ethoxylated

    CAS No. 68439-54-3 EC No.  Index No. 

Other type of alternative

Reliability of information

Evidence of implementation: there is evidence that the solution was implemented and in use at time of publication


Hazard assessment

Propylparaben is  endocrine disruptor (SIN List), endocrine disruptor cat. 1 (EU EDC database) as listed in the Substance Database according to SUBSPORT Screening Criteria (SDSC).
Triclosan is irritating to eyes and skin (R36/38), also it is very toxic to aquatic organisms, may cause long-term adverse effects in the aquatic environment (R50/53)
The substance is  endocrine disruptor (SIN List) as listed in the Substance Database according to SUBSPORT Screening Criteria (SDSC).

Methyl paraben is endocrine disruptor cat. 1 (EU EDC database) as listed in the Substance Database according to SUBSPORT Screening Criteria (SDSC).

2-Butoxyethanol is harmful by inhalation, in contact with skin and if swallowed (R20/21/22).Also it is irritating to eyes and skin (R36/38).

Alternative substance(s)

Didecyldimethylammonium chloride is harmful if swallowed (R22). The substance also causes burns (R34) an eye damage (H314)
Though the alternative has risks, these are much less important and the safety is improved.

The alternative must be handling with adequate measure protections.

» Check the Substance Database according to SUBSPORT Screening Criteria (SDSC)

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Substitution description

The substituted product was a commercial disinfectant used to clean the rooms of deceased patients. The product was sprayed with an automatic vaporiser which released specific doses. One of the workers who used the product regularly showed symptoms of throat irritation and respiratory problems. The union representative was informed about the situation and the regional union’s health and safety department (Cantabrian CC.OO.) explained the problem to the employers and began to look for alternatives with the assistance of the Union Institute of Work, Environment and Health (ISTAS). Several alternatives were assessed and the product was eventually substituted by a commercial solvent named Germosan-Ter, a compound based on didecyldimethylammonium chloride and ethoxylated alcohols, which has no significant health effects.

Advantages:

Improvement of labor relations and of the company’s social image.
Health risks were effectively reduced, as well as environmental damages.
Satisfactory acceptance by the employers and real cost-effectiveness.

Comments:

Excessively long substitution time.

Initially employers were reluctant to substitute the product and insisted on the fact that it did not contain any dangerous chemicals. Substitution was eventually made when the product was withdrawn from the market by the healthcare authority.

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Case/substitution evaluation

Advantages and disadvantages were studied during the assessment of alternatives.

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Other solutions

1. PERACETIC ACID (Peracetic acid has a quick effect on microorganisms).

Environmental and health effects: Peracetic acid is flammable, explosive. It is harmful by inhalation, and it affects the skin and the mucous membrane. The chemical is also highly toxic for water organisms.

Advantages:

  • Quick sterilisation cycle (30-45 minutes)
  • It decomposes in water, oxygen and acetic acid (loses toxicity)
  • No toxic residues
  • Compatible with a wide variety of materials and instruments
  • Quick sporicidal effect
  • It remains effective in presence of organic material
  • Sporicidal effect at low temperatures

Disadvantages:

  • Potentially incompatible with certain materials. It can be corrosive on certain metals (zinc, bronze, silver, steel, chrome) which can be corrected with pH-modifying additives.

Mechanism of action: Active principle is unknown but as other oxidising agents is supposed to cause the de-naturation of proteins and alter the permeability of cell walls. Peracetic acid oxides metabolites, enzymes and proteins. It also affects metals causing stains and opacity. The product has a 24 hour useful life cycle.

Microbiocidal activity: Peracetic acid eliminates Gram-positive bacteria and fungi in 5 minutes at 100 ppm. In presence of organic material it requires 200-500 (0.02-0.05%) ppm. The elimination of certain viruses like Polio requires great concentrations (1,500–2,250 ppm for 15 minutes). Spores break down at 1% concentration.

 

2- OZONE, CAS: 10028-15-6
Environmental and health effects: Ozone affects the skin and mucous membrane and can also have neurotoxic effects. Ozone also affects the cardio circulatory, immune and gastrointestinal systems. Regarding environmental effects Ozone is an air pollutant.

 

3- HYDROGEN PEROXIDE (7.5%)
Hydrogen peroxide is an effective micro biocide in concentrations between 6%-25%. The chemical is currently marketed as a product ready for use with 7.5% hydrogen peroxide and 0.85% phosphoric acid concentrations to maintain a low pH level. The product has micro bactericide activity but it also has a synergy effect on sporulating bacteria when combined with peracetic acid. It is stored in dark containers and it is used in high level disinfection.

Environmental and health effects: Explosive, flammable, corrosive and harmful by inhalation and ingestion. The product is a skin and membrane irritant. Hydrogen peroxide is an irritant of the respiratory and gastrointestinal systems. Classified as category 3 by the IARC: Not classifiable as to its carcinogenicity to humans, i.e.: the evidence of carcinogenicity is inadequate in humans and inadequate or limited in experimental animals. In terms of environmental effects Hydrogen Peroxide has low water toxicity.

Advantages:

  • No activation required
  • It may increase the elimination of organic material and organisms
  • Odorless, causes no irritation
  • Compatible with metals, plastic and elastomers.
  • Inactive with Cryptosporidium.

Disadvantages:

  • Doubtful structural and functional compatibility with certain materials (zinc, brass, copper and nickel/silver). It affects certain surfaces and metal finishes.
  • Long time to complete its activity (1- 2 hours) at high concentrations.

Mechanism of action: it destroys hydroxyl free radicals that may attack lipid membranes, DNA and other essential cell components. Bacteria that produce catalase may protect cells from the action of hydrogen peroxide and degrade it to water and oxygen. This bacterial defense raises certain concerns about the concentration used for disinfection.

Microbicidal activity: Hydrogen peroxide is an active agent against a wide group of microorganisms including bacteria, fungi, viruses and spores. Catalase-producing organisms (S. aureus, Serratia marcescens and Proteus mirabilis) require 30-60 minute exposure with a 0.6% hydrogen peroxide concentration; however, microorganisms which produce less catalase (E. coli, Streptococcus and Pseudomonas) only require 15 minute exposure. Useful hydrogen peroxide concentrations for high level disinfection are between 6% – 25%. The product is currently distributed ready for use with 7.5% hydrogen peroxide and 0.85% phosphoric acid concentrations to maintain a low pH level. The elimination of resistant TB micro-bacteria was observed after a 10 minute exposure of 7.5% hydrogen peroxide. Thirty minutes are required for the elimination of 99.9% of Polio and Hepatitis A viruses. However, with the use of an accelerator it only takes one minute to eliminate the virus of Hepatitis A. A new product with a 13.4% concentration (whose certification is still pending) proved to be an effective spore, fungi and virus eliminator. Data from hydrogen peroxide manufacturers show that the solution can sterilise in 30 minutes and produce high level disinfection in 5 min.

Uses: The product is highly recommended for the disinfection of inanimate surfaces at 3%. Dilution can be controlled by a regular testing of the minimum effective concentration between 6% – 7%.

 

4- MIXTURE OF PERACETIC ACID (0.08%) / HYDROGEN PEROXIDE (1%)
Both chemical sterilizers are available and both contain peracetic acid and hydrogen peroxide in different formulations according to each commercial brand. (e.g: 0.08% peracetic acid and 1% hydrogen peroxide; 0.23% peracetic acid and 7.35% hydrogen peroxide)

Advantages:

  • No activation required
  • Odor and irritation are insignificant

Disadvantages:

  • Doubts about the structural and functional compatibility with certain materials (lead, brass, copper, zinc).

Microbiocidal activity: Microbiocidal activity covers a wide rank of bacteria including atypical ones. It inactivates all microorganisms in 20 minutes except for bacterial spores. The mix containing 0.08% peracetic acid and 1% hydrogen peroxide proved effective to eliminate atypical bacteria resistant to glutaraldehyde.

 

5- PHTHALALDEHYDE (0.55%)
Phthalaldehyde (Ortho-phthalaldehyde) contains 0.55% 1,2-benzenedicarboxaldehyde (Ortho-phthalaldehyde), with pH 7.5.

Environmental and health effects: Phthalaldehyde (Ortho-phthalaldehyde) is not recommendable due to its acute toxicity according to EPA labeling. It is also highly toxic for water species and must not be disposed of through wastepipes.

Advantages:

  • Quick action as high level disinfectant
  • No activation required
  • No monitoring required
  • Odor is basically insignificant
  • Excellent compatibility with materials (non corrosive)
  • Excellent stability in a wide pH rank (3-9)
  • Activity depends on temperature

Disadvantages:

  • In presence of proteins it stains human skin, clothes and surfaces although stains gradually fade out if the object or the skin are cleaned and if there is no further contact with the product.

Mechanism of action: The product interacts with amino acids, proteins and microorganisms.

Microbiocidal activity: The product is effective against bacteria within 6 minutes, including the ones resistant to Glutharaldehyde. It is also effective against bacteria and viruses including Bacillus subtilis spores and it is used with exposure times between 5-12 minutes

Uses: The product is used as a high level disinfectant. It must be used on clean elements that must be rinsed thoroughly before they have contact with human skin and mucous membrane.

 

6- PENTANOL
Environmental and health effects: Pentanol is flammable, harmful by inhalation and irritant for the airways. Repeated exposure to Pentanol can cause skin dryness and cracks.

 

7- OTHER
Other alternative chemicals with disinfectant properties include: Sodium Sulfate and Propanol.

Further information

http://www.istas.net/risctox/gestion/estructuras/_3536.pdf

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Who provided the information

Type of information supplier
User

Contact 

www.cantabria.ccoo.es


Publication source

Type of publication and availability 


Comments from SUBSPORT users

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Publication or last update: 25.04.2012