Is it time to say goodbye to ALDEHYDE-BASED DISINFECTANTS?
The hospital environment is exposed to various pathogens, including bacterial spores that can survive in extreme conditions, such as radiation, alkalinity and acidity. These emphasize the need for effective disinfection in healthcare organizations for controlling pathogens from transmitting infections.
Disinfection of surfaces in healthcare centres’ is crucial to control the spread of pathogens and microbial infections. Some aldehydes are utilized for disinfecting hospital environments to keep nosocomial infections at bay. Aldehydes are chemical compounds consisting of -CHO (carboxyl group) bonded to one hydrogen atom. There are different types of aldehydes, such as formaldehyde, bonded formaldehyde, glutaraldehyde and o-phthalaldehyde. Here, we will focus on formaldehyde and glutaraldehyde majorly for surface disinfection application.
Formaldehyde (HCHO) is a chemical compound that is also found in all life forms, including microorganisms. It is a widely used sporicide that can be applied with different combinations with other chemicals, including potassium permangate, hydrogen peroxide and glutaraldehyde. Formaldehyde is widely utilized in fumigation, a process performed by adding formalin to potassium permanganate and creating fumes. Formaldehyde sterilization finds its application in cases where equipment sterilization by steam or high temperature is not possible. Examples of such instruments are rigid or flexible endoscopes and cryo instruments. Additionally, formaldehyde has been used as a cleaning agent to mop floors.
Glutaraldehyde (C5H8O2) is a transparent, oily liquid having a pungent odour [1]. It has been applied as a high-level disinfectant and chemical sterilant for more than 50 years [2]. Disinfection with glutaraldehyde is employed to destroy harmful microbes adhered onto surfaces and surgical instruments.
Wondering about their mode of Action?
Formaldehyde works by inactivating the microbes through alkylation of amino and sulfhydral groups of proteins and ring nitrogen atoms of purine bases. In other words, it destroys the structure of microorganisms by protein denaturation within a few minutes. [3] This helps formaldehyde to exhibit strong bactiericidal, sporicidal and microbicidal activities.
However, the concentrations of formaldehyde required to be effective against pathogens, including spores, can be hazardous to humans, animals and plant tissues.
Glutaraldehyde shows more rapid action at alkaline than at acidic pH. As the external pH shifts from acidic to alkaline, more reactive sites are formed at the cell surface of microorganisms. Glutaraldehyde may also have mycobactericidal properties that are yet to be explored. Additionally, it is also a powerful sporicidal and virucidal agent.
Why you must Say No to Formaldehyde and Glutaraldehyde?
Although formaldehyde is commonly used for disinfection, it is a highly-toxic compound that can cause serious health issues even in extremely low quantities, and can take several years to dissipate completely. One of the crucial properties of this compound is its flammability. Formaldehyde is flammable at 7.75% dry air and it can form an explosive air-vapour mixture at more than 600oC. Hence, the fumigation conditions need to be specific for producing formaldehyde vapours that can be harmful to living cells and tissues, thereby causing health risks.
Exposure to the compound can increase allergic reactions among people, making them allergic to almost anything. In some cases, formaldehyde can permanently impair the health and wellbeing of individuals.
Formaldehyde is corrosive to instruments and equipment and a strong irritant. It can cause irritation of the eyes, nose and throat, even upon exposure at low concentrations for a short span. [4] Prolonged exposure to the compound in the atmosphere can cause death from throat swelling or chemical burns to the lungs. When formaldehyde comes in direct contact with the skin, eyes, or gastrointestinal tract, it can result in severe burns.
The harmful effects of formaldehyde do not end here. The severity of the impacts increases with exposure to high levels of formaldehyde.
People, who exhibit sensitivity to compounds in the environment, can develop a skin rash or breathing difficulties due to small exposures. Consuming low doses of formaldehyde, such as 30 ml or nearly 2 tablespoons can cause death. [4]
Due to irritant & allergic nature of Formaldehyde along with proven reports of being associated with cancer in humans and animals, end users are against its use.
According to laboratory studies in 1980, exposure to formaldehyde was reported to potentially cause cancer in rats.[5] In 1987, the U.S. EPA identified formaldehyde as a probable carcinogen in humans when exposed to high or extremely high concentrations. Contact with high levels of formaldehyde can lead to myeloid leukaemia and rare cancers, including cancers of the paranasal sinuses, nasal cavity and nasopharynx.
Similar to formaldehyde, exposure to glutaraldehyde can cause severe irritation to the skin, mucous membranes and respiratory system. Vapours of glutaraldehyde have been linked to occupational asthma. Exposure to it can also cause other ailments, such as throat and lung irritation, asthma, difficulty to breather, dermatitis, nasal irritation, sneezing, wheezing, burning eyes and conjunctivitis. The U.S. EPA prohibits the utilization of glutaraldehyde as a surface disinfectant due to its toxic and corrosive properties. Moreover, Cal/OSHA regulates glutaraldehyde as a hazardous airborne chemical contaminant. [6]
For these health and safety concerns, formaldehyde and glutaraldehyde have been banned in the U.S, Sweden and Japan. The minimal inhibitory concentration (MIC) of formaldehyde is 39 to 246 mg/L and its maximum exposure limit (MEL) has been set to 2 ppm and 0.1% for glutaraldehyde.[6] Unfortunately, some products may deceive users by disguising formaldehyde as bonded formaldehyde. Furthermore, despite the severe health effects and restrictions/ban in its use, formaldehyde and glutaraldehyde are used in some countries like China and India, for instance. There are various reasons, including but not limited to being cheap, easy to set up the disinfection process, age-old practice, lethargic management, rigid mindset, myopic thought process and resistance to change.
Why emerging products are better than formaldehyde and glutaraldehyde
The most effective way to combat the harmful effects of formaldehyde and glutaraldehyde is to remove and replace them with safe options. There are also other alternatives to formaldehyde and glutaraldehyde in the healthcare sector, like Quaternary Ammonium Compounds (QACs), Hydrogen Peroxide and combinations, etc.
Quaternary Ammonium Compounds (QACs)
These belong to the family of 1st to 7th generation compounds; typically most traditional brands use 1st to 3rd generation QACs, making them low-level disinfectants. QACs are used in disinfectants to provide a wide range of efficiency while being cost-effective. They are cationic disinfectants that can bind to or get absorbed by surfaces, materials and fibers. Older generation QACs usually take 10-30 minutes to disinfect and these must be utilized with cleaning tools they are compatible with.
Hydrogen Peroxide & Combinations
Additionally, hydrogen peroxide and its combinations with silver, silver nitrate, peracetic acid, etc. is effective against various pathogens, such as bacteria, yeasts, fungi, viruses and spores. Peracetic acid can also be chosen as a viable alternative to formaldehyde. It can inactivate gram-positive and gram-negative bacteria, fungi and yeasts. However, acidic pH, corrosive nature, blacking of the walls and argyria along with high cost are few of the side-effects.
Conclusions
The use of formaldehyde for sterilization may seem like a convenient, established and cheap approach, but it has serious consequences. Disinfection with formaldehyde can be hazardous and cause various health ailments, including cancer. Fumigation with formaldehyde is banned in many developed nations due to the toxicity and health risks posed by the chemical compound. That is why, new and safe alternatives must be used instead. Quaternary ammonium compounds (QACs) are highly-efficient against all pathogens, including ESKAPE without causing any adverse health impacts.
Bioguard products with the latest generation QACs with the power of BIOCHEM® -patented compound for high-performance cleaning & disinfection makes it more effective than alternative ‘local brands’ is now available in the market.
Highlighting the benefits of QACs- Bioguard associated with the renowned microbiologist Dr. Tim Sandle, where he discusses the advantages of quaternary ammonium compounds for disinfection and infection control.
Click here to know more- https://www.clinicalservicesjournal.com/story/37627/advantages-of-quaternary-ammonium-compounds
Benefits of Bioguard Products:
- Trusted & Proven – Used by healthcare professionals across the UK, Europe, GCC & India in high-risk environments. Independently tested to the highest European and British standards against high-risk organisms.
- Powerful – Microbiological efficacy means our products are effective against a wide variety of organisms such as Clostridium Difficile (spores & bacteria), Hepatitis, Tuberculosis, Norwalk virus, HIV, MRSA, and Avian Flu & ESKAPE Pathogens under 30 Seconds*.
- Safe – Products are non-hazardous and non-toxic and have been MEA tested to ensure they are safe and will not harm users.
- Multi-surface – Usable on virtually all surfaces (including fabrics and furnishings), so can decontaminate whole environments without causing degradation to surfaces.
- Alcohol free – Zero alcohol content (with no compromise on performance) ensures product is gentle on skin and also meets certain users’ religious observances.
- Patented Compound - All products are powered by Biochem®, a unique compound for high performance cleaning & disinfection; effective against bacteria, viruses & spores including Covid-19.
- Manufacturing Excellence - Having full control over the entire research & development manufacturing processes ensures we produce the highest quality products made to our exacting quality standards as well as the latest ISO & GMP registration standards.
Here’s what people are saying about our product:
“Bioguard hand & body foaming cleanser is really effective for cleaning and disinfecting patients who are bed-bound” - Nursing-home Professional
“Bioguard hand & body foaming cleanser is more effective than alternate surgical gels and is less of a health and safety risk” - NHS Nurse
“A much better and more economical alternative to hand gels” - GP Practice Manager
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