• Formaldehyde can be used in healthcare settings as a disinfectant or a sterilant.
• Exposure to formaldehyde can cause acute eye, nose and throat irritation and respiratory problems over time. It is also a cancer hazard.

The Occupational Safety and Health Administration (OSHA) has a standard on formaldehyde at 1910.1048. The standard and equivalent regulations in states with OSHA-approved state plans applies to all occupational exposures to formaldehyde from formaldehyde gas, its solutions, and materials that release formaldehyde.

In healthcare settings, formaldehyde can be used as a disinfectant or a sterilant. It is often found mixed in water and referred to as formalin. Formaldehyde can be used to prepare viral vaccines, as an embalming agent, as a tissue fixative, and in the sterilization of medical equipment. Paraformaldehyde (a solid polymer of formaldehyde) can be heat vaporized for the gaseous decontamination of laminar flow biologic safety cabinets.

Formaldehyde is a sensitizing agent that can cause an immune system response upon initial exposure. It is also a cancer hazard. Acute exposure is highly irritating to the eyes, nose, and throat and can make anyone cough and wheeze if exposed. Subsequent exposure may cause severe allergic reactions of the skin, eyes, and respiratory tract. Ingestion of formaldehyde can be fatal, and long-term exposure to low levels in the air or on the skin can cause asthma-like respiratory problems and skin irritation such as dermatitis and itching. Concentrations of 100 parts per million (ppm) are immediately dangerous to life and health (IDLH).

In general, OSHA requires covered employers to:

• Identify all workers who may be exposed to formaldehyde at or above the action level or short-term exposure limit (STEL) through initial monitoring and determine their exposure. The action level (which is the standard’s trigger for increased industrial hygiene monitoring and initiation of worker medical surveillance) is 0.5 parts formaldehyde per million parts of air (0.5 ppm) when calculated as an eight-hour time-weighted average (TWA). The standard includes a STEL of 2 ppm which is the maximum exposure allowed during a 15-minute period. The permissible exposure limit (PEL) for formaldehyde is 0.75 ppm measured as an eight-hour TWA.
• Reassign workers who suffer significant adverse effects from formaldehyde exposure to jobs with significantly less or no exposure until their condition improves. Reassignment may continue for up to six months until the worker is determined to be able to return to the original job or to be unable to return to work, whichever comes first.
• Implement feasible engineering and work practice controls to reduce and maintain worker exposure at or below the eight-hour TWA and the STEL. If these controls cannot reduce exposure to or below the PELs, employers must provide workers with respirators.
• Label all mixtures or solutions composed of greater than 0.1 percent formaldehyde and materials capable of releasing formaldehyde into the air at concentrations reaching or exceeding 0.1 ppm. For all materials capable of releasing formaldehyde at levels above 0.5 ppm during normal use, the label must contain the words “potential cancer hazard.”
• Train all workers exposed to formaldehyde concentrations of 0.1 ppm or greater at the time of initial job assignment and whenever a new exposure to formaldehyde is introduced into the work area. Repeat training annually.
• Select, provide and maintain appropriate personal protective equipment (PPE). Ensure that workers use PPE such as impervious clothing, gloves, aprons, and chemical splash goggles to prevent skin and eye contact with formaldehyde.
• Provide showers and eyewash stations if splashing is likely.
• Provide medical surveillance for all workers exposed to formaldehyde at concentrations at or above the action level or exceeding the STEL, for those who develop signs and symptoms of overexposure, and for all workers exposed to formaldehyde in emergencies.
• Keep adequate records. Retain exposure records for 30 years. Retain medical records for 30 years after employment ends. Allow access to medical and exposure records to current and former workers or their designated representatives upon request. Note: Healthcare employers may also be subject to requirements, standards, and guidance from other federal, state, and local agencies and organizations, such as The Joint Commission (TJC), the Centers for Disease Control and Prevention (CDC), and the Environmental Protection Agency (EPA).