Hydrogen Peroxide as a Risk Factor for Occupational Chemical Poisoning
Hydrogen peroxide, a strong oxidant, is widely used as a disinfectant in medical and chemical workplaces. While it is effective for sterilization and disinfection, it poses significant health risks, particularly when mishandled or when equipment malfunctions. This article delves into two cases of occupational hydrogen peroxide poisoning in China, highlighting the risks associated with its use and the importance of proper workplace safety measures.
Case 1 involves a staff member at Shiquan County Hospital in Ankang City, Shaanxi Province, who has been responsible for medical device disinfection and sterilization since 2016. The individual used a Baixiang PS low-temperature plasma sterilizer (PS) for this purpose. In December 2018, the patient began experiencing symptoms such as piercing throat pain, burning sensations, cough, and chest tightness. An engineer from the equipment supplier identified a medium leakage in the sterilizer on January 18, 2019. Despite the malfunctioning exhaust facilities in the operating room, the use of the PS continued. By January 20, the patient was diagnosed with pneumonia involving both lungs and bronchopneumonia, leading to hospitalization at Xi’an Central Hospital.
Case 2 involves another staff member at the same hospital who had been using the PS intermittently since May 2015. In December 2018, this individual also experienced symptoms such as dry mouth, piercing throat pain, and cough. On December 7, 2018, a malfunction in the sterilization cycle caused an intense irritating odor in the sterilization room, making it difficult for people to open their eyes. The odor could not be mitigated by disposable masks. From January to March 2019, the disinfection performer frequently noticed white residues on his hands and felt pain and burning in his fingers. In March 2019, he was diagnosed with bronchopneumonia and admitted to Shiquan County Hospital and Ankang Central Hospital.
In May 2019, Shaanxi Lifang Environmental Protection Technology Service Co., Ltd. tested the concentration of hydrogen peroxide in the Sterilization Supply Center of Shiquan County Hospital. The test concluded that the concentration of hydrogen peroxide in the air was within the occupational exposure limit. Before the test, the operating room was renovated, new windows were installed, a new axial-flow fan was mounted at the bottom, and an exhaust fan was installed at the top. Additionally, ventilation, gas defense, and protection facilities were completed, and operators were equipped with gas masks and other protective equipment.
From May 2016 to December 7, 2018, the hydrogen peroxide low-temperature plasma sterilizer operated properly in the Sterilization Supply Center. However, on December 7, 2018, the PS broke down during the sterilization cycle. An engineer from the manufacturer replaced the solenoid valve on December 13, and the sterilizer resumed normal operation. On January 17, 2019, staff members discovered white powders on their fingers and felt piercing pain when handling the loading basket. From December 2018 to March 2019, the PS was used for sterilization 101 times, with Patient 1 performing 15 of these and Patient 2 performing 36. The sterilizer used a special hydrogen peroxide cartridge with a concentration of over 58%. Staff members were equipped with face masks, latex gloves, and disposable masks.
On August 16, 2019, the Ankang Occupational Disease Diagnosis Agency organized a meeting with three experts to evaluate the cases. The experts considered the history of exposure to hydrogen peroxide (concentration ≥58%), workplace environmental test results, hospitalization certificates, and the patients’ denial of any family or personal history of infections. Following the “Diagnostic Criteria of Occupational Acute Toxic Respiratory System Diseases Caused by Chemicals” (GBZ73-2009), the experts concluded that both patients had moderate occupational hydrogen peroxide poisoning.
Hydrogen peroxide is a chemical oxidant that is extremely unstable under normal temperatures and easily breaks down into oxygen, releasing heat. Low-concentration (3%) hydrogen peroxide is commonly used for medical disinfection, while high-concentration (>10%) hydrogen peroxide is used in industrial settings. Thirty percent hydrogen peroxide is corrosive and can damage the skin, mucosa, and other local tissues. Thirty-five percent hydrogen peroxide can fully decompose into 3.5 liters of oxygen within 30 minutes. Inhalation of highly concentrated hydrogen peroxide can cause severe irritation and inflammation of mucous membranes, leading to symptoms such as coughing, dyspnea, shock, coma, convulsions, and pulmonary edema within 24 to 72 hours.
The two cases presented here illustrate the risks associated with hydrogen peroxide exposure in occupational settings. Both patients were exposed to high concentrations of hydrogen peroxide due to equipment malfunctions and inadequate ventilation. The onset of their symptoms correlated with their exposure to hydrogen peroxide, and their conditions were consistent with acute occupational poisoning.
To mitigate these risks, it is essential for medical institutions to strengthen their occupational health management. Proper ventilation, regular equipment maintenance, and the use of appropriate protective gear are critical to preventing hydrogen peroxide poisoning. Additionally, staff training on the safe handling of hydrogen peroxide and emergency response procedures can help reduce the incidence of such cases.
In conclusion, hydrogen peroxide is a significant risk factor for occupational chemical poisoning, particularly in settings where it is used for sterilization and disinfection. The cases discussed here underscore the importance of stringent safety measures and proper workplace practices to protect workers from the harmful effects of hydrogen peroxide exposure.
doi.org/10.1097/CM9.0000000000001336
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