Di Stefano F, Siriruttanapruk S, McCoach J S, Burge P S
Dept of Respiratory Medicine, Birmingham Heartlands Hospital, UK.
Monaldi Arch Chest Dis. 1998 Feb;53(1):50-5.
In recent years glutaraldehyde has emerged as the main cause of occupational asthma among healthcare workers. Presently glutaraldehyde is the best biocide agent for high-level disinfection and cold sterilization and its use has become widespread in hospitals. Surveillance schemes in the UK, Finland and the USA have reported an increasing number of cases of occupational asthma due to glutaraldehyde. The real magnitude of the problem is not well known as epidemiological studies carried out on a large scale among healthcare workers are not yet available. In countries where surveillance schemes are implemented, reports of occupational asthma cases due to glutaraldehyde should be circumstantiated by more diagnostic details and the diagnosis confirmed by objective means, to avoid an overestimation of frequency of disease. The pathogenetic mechanisms of occupational asthma due to glutaraldehyde are debatable as with other low molecular weight chemicals. A recent study has documented the first evidence of immunological sensitization in healthcare workers exposed to this chemical. Occupational asthma caused by glutaraldehyde can develop at levels of exposure well below the standards accepted in most countries. In the UK the Occupational Exposure Standard (OES) of this agent will be lowered from 0.2 ppm (parts of vapour per million parts of air by volume) to 0.05 ppm. Substitution of glutaraldehyde with an alternative agent is not currently feasible. Intervention in the workplace and education of personnel handling this chemical remain irreplaceable parts of any prevention strategy. Early detection of disease and prompt removal of personnel from further exposure are the only ways of avoiding any deterioration of occupational asthma.
近年来，戊二醛已成为医护人员职业性哮喘的主要病因。目前，戊二醛是用于高水平消毒和低温灭菌的最佳杀菌剂，其在医院中的使用已很普遍。英国、芬兰和美国的监测计划报告称，因戊二醛导致的职业性哮喘病例数量不断增加。由于尚未在医护人员中进行大规模的流行病学研究，该问题的实际严重程度尚不清楚。在实施监测计划的国家，戊二醛所致职业性哮喘病例报告应有更多诊断细节加以佐证，且诊断需通过客观手段确认，以避免高估疾病发生率。与其他低分子量化学物质一样，戊二醛所致职业性哮喘的发病机制存在争议。最近一项研究首次记录了接触这种化学物质的医护人员发生免疫致敏的证据。戊二醛引起的职业性哮喘可在远低于大多数国家所接受标准的接触水平下发生。在英国，该制剂的职业接触标准（OES）将从0.2 ppm（百万体积空气中的蒸汽体积份数）降至0.05 ppm。目前用替代剂取代戊二醛不可行。对工作场所进行干预以及对接触这种化学物质的人员进行教育仍是任何预防策略中不可或缺的部分。早期发现疾病并及时让人员脱离进一步接触是避免职业性哮喘病情恶化的唯一方法。
