[MCOH-EH] Disinfection product consisting of hydrogen peroxide, peroxyacetic acid, and acetic acid

[Hodgson, Michael - OSHA]

Interesting question.  NIOSH had published a prior peracetic acid in health care HHE, in 2009, not cited in the recent communication.   There are also multiple prior investigations.  OSHA has been exploring this agent in the world of poultry processing and is currently working on validating a field measurement method.   A recent UMd preventive medicine resident, (great work, Eldesia Granger, MD, thanks!) did a very nice review of the health issues and dug out some interesting previously (by us at least) unrecognized work suggesting mucosal irritation is in fact not trivial and quite common.  In fact, the trigger for the review was serious pulmonary toxicity after major exposure in one of our enforcement actions.   Those are likely very different from what is going to happen in health care.  As suggested in the MMWR  there may be some parallel / interaction issues with hydrogen peroxide measurement.


Bauermeister LJ, Bowers JWJ, Townsend JC, McKee SR. The microbial and quality properties of poultry carcasses treated with peracetic acid as an antimicrobial treatment. Poult Sci. 2008 2008/11;87(11):2390-8.
Carrasco G, Urrestarazu M. Green chemistry in protected horticulture: The use of peroxyacetic acid as a sustainable strategy. Int J Mol Sci. 2010 /;11(5):1999-2009.
Cristofari-Marquand E, Kacel M, Milhe F, Magnan A, Lehucher-Michel M-. Asthma caused by peracetic acid-hydrogen peroxide mixture. J Occup Health. 2007 /;49(2):155-8.
European Centre for Ecotoxicology and Toxicology of Chemicals (ECTOC). JACC No. 40 Peracetic Acid (CAS No. 79-21-0) and its Equilibrium Solutions.; 2001.  Available at: http://members.ecetoc.org/Documents/Document/JACC%20040.pdf#page=117. Accessed August 2013.
Gagnaire F, Marignac B, Hecht G, Hery M. Sensory irritation of acetic acid, hydrogen peroxide, peroxyacetic acid and their mixture in mice. Ann Occup Hyg. 2002 /;46(1):97-102.
Hecht G, Hery M. Generation of controlled atmospheres for the determination of the irritant potency of peroxyacetic acid. Ann Occup Hyg. 2002 /;46(1):89-96.
 "Indirect Food Additives: Adjuvants, Production Aids, and Sanitizers; Final Rule," 61 Federal Register 108 (4 June 1996), pp. 28051-28053.
Kindy K. USDA reviews whether bacteria-killing chemicals are masking salmonella. Washington Post. 2013 April 2, Available at:http://apps.washingtonpost.com/g/page/national/chemicals-may-be-masking-chicken-safety-test-results/342/. Accessed August 2013.
Nagel GM, Bauermeister LJ, Bratcher CL, Singh M, McKee SR. Salmonella and campylobacter reduction and quality characteristics of poultry carcasses treated with various antimicrobials in a post-chill immersion tank. Int J Food Microbiol. 2013 2013/08;165(3):281-6.
NIOSH [2009]. Health hazard evaluation report: evaluation of worker exposures to peracetic acid-based sterilant during endoscope reprocessing, Buffalo, NY. By Sylvain D, Gibbins J. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, NIOSH HETA No. 2006-0298-3090.
Tonini S, Dellabianca A, Costa C, Lanfranco A, Scafa F, Candura SM. Irritant vocal cord dysfunction and occupational bronchial asthma: Differential diagnosis in a health care worker. Int J Occup Med Environ Health. 2009 /;22(4):401-6.
You, Y., Z. Bai, L. Yan, and X. Gao. Peracetic Acid Exposure Assessment During Outbreak of SARS in Tianjin, China." Epidemiology. 2006/;17(6): S217-S218


There is also an EPA AEGLs document
https://www.epa.gov/aegl/peracetic-acid-results-aegl-program  from 2004


Michael
Michael J Hodgson, MD, MPH
Chief Medical Officer and Director,
Office of Occupational Medicine and Nursing
Occupational Safety and Health Administration
200 Constitution Ave NW N3457
Washington DC 20210
202.693.1768




From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Borkowski, Michael
Sent: Tuesday, May 10, 2016 3:37 PM
To: 'mcoh-eh at mylist.net'
Subject: [MCOH-EH] Disinfection product consisting of hydrogen peroxide, peroxyacetic acid, and acetic acid

http://www.cdc.gov/mmwr/volumes/65/wr/mm6515a3.htm?s_cid=mm6515a3_w#contribAff

Colleagues in Medical Center Occupational Health:

Interested in dialogue and insights from any of you working for systems that used, are using or considering use of the above product type for cleaning.  It is touted as exceptional in its eradication of C. diff I am told, but I have questions regarding its suitability for employees with active or passive exposures.  See the link above.

Have your systems had a positive or negative experience with this product, e.g. complaints or accident reports?
Any special handling, PPE or training required or made necessary because of complaints/concerns?

Thanks,

Michael

Michael Borkowski, MD, MPH
Medical Director, F&MCW Occupational Health Services
Phone:  262-253-8197  | Fax:  262-253-5152
Cell Phone:  414-881-3762
E-mail: michael.borkowski at froedtert.com<mailto:michael.borkowski at froedtert.com>

Froedtert & the Medical College of Wisconsin
Workforce Health / North Hills Health Center Building B First Floor
W129 N7055 Northfield Dr.
Menomonee Falls, WI 53051

froedtert.com


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