The hazards of formalin exposure

Formalin is a colorless but foul-smelling aqueous solution that usually consists of 37% to 40% formaldehyde gas, water, and a stabilizer such as methanol. In the OR, formalin is commonly used by staff to preserve and store biological specimens removed during surgery for subsequent pathological examination.

However, when OR staff dispense formalin manually, as has traditionally been the case, they can be exposed to hazardous fumes and spills that can cause respiratory irritation, allergic reactions, and long-term health issues.

Here’s some of what the U.S. Occupational Safety and Health Administration (OSHA) has to say about formalin exposure:

• Ingestion of formalin is uncommon, but if it occurs, OSHA says it can cause severe irritation and inflammation of the mouth, throat, and stomach, followed by severe stomach pains, “with possible loss of consciousness and death.”
• Inhalation of formalin is “highly irritating to the upper respiratory tract and eyes,” states OSHA. Over time, it can cause respiratory impairment. “Structural changes in the epithelial cells in the human nose” have been observed after prolonged exposure to formalin, notes OSHA. “Some persons have developed asthma or bronchitis following exposure to formaldehyde, most often as the result of an accidental spill involving a single exposure to a high concentration of formaldehyde.”
• Formalin is both a severe skin irritant and a sensitizer. States OSHA, “Contact with formalin causes white discoloration, smarting, drying, cracking, and scaling. Prolonged and repeated contact can cause numbness and a hardening or tanning of the skin. Previously exposed persons may react to future exposure with an allergic eczematous dermatitis or hives.”
• Formalin that splashes in the eye “can cause injuries ranging from transient discomfort to severe, permanent corneal clouding and loss of vision,” states OSHA. “The severity of the effect depends on the concentration of formaldehyde in the solution and whether or not the eyes are flushed with water immediately after the accident.”

OSHA also notes that your OR staff could build a dangerous sort of tolerance to the solution. “The perception of formaldehyde by odor and eye irritation becomes less sensitive with time as one adapts to formaldehyde,” states OSHA. “This can lead to overexposure if a worker is relying on formaldehyde’s warning properties to alert him or her to the potential for exposure.”

Repeated and prolonged exposure to formalin can cause, and has been associated with, cancer in humans, states OSHA, including cancers of the lung, nasopharynx and oropharynx, and nasal passages. According to the American Cancer Society, “several studies have found that embalmers and medical professionals who use formaldehyde have an increased risk of leukemia, particularly myeloid leukemia.”

As a perioperative leader, you carry a responsibility to minimize the risk to your surgical staff of formalin exposure. Fortunately, automated formalin dispensing systems now exist that eliminate staff exposure to the dangerous solution entirely.

Ryan Schromsky of AtlantiCare Regional Medical Center in Atlantic City, N.J., is one perioperative professional who has gained an increased feeling of safety from using an automated formalin dispenser. Calling it “very convenient and easy to use,” he adds that it is “comforting changing from manually filling containers with formalin to using this machine. Ever since the change I have yet to smell even a hint of the formalin.”