Ethylene oxide neurotoxicity: A cluster of 12 nurses with peripheral and central nervous system toxicity

A. Brashear, Frederick Unverzagt, M. O. Farber, Jose Bonnin, J. G N Garcia, E. Grober

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Abstract

Ethylene oxide (EO) is commonly used to sterilize heat-sensitive products used by hospital patients and personnel. Ethylene chlorohydrin (EC), a by- product, is considered highly toxic. We report a cluster of 12 operating- room nurses and technicians who developed symptoms after a 5-month exposure to high levels of EO and EC in disposable surgical gowns. All patients reported a rash on the wrist where contact was made with the gowns, headaches, and hand numbness with weakness. Ten of 12 patients complained of memory loss. Neurologic evaluation revealed neuropathy on examination in nine of the 12 patients, elevated vibration threshold in four of nine, abnormal pressure threshold in 10 of 11, atrophy on head MRI in three of 10, and neuropathy on conduction studies in four of 10. Neuropsychological testing demonstrated mild cognitive impairment in four of six patients. Sural nerve biopsy in the most severely affected patient showed findings of axonal injury. Several patients in this group display signs of peripheral and CNS dysfunction following exposure to EO. Possible mechanisms of neurotoxicity include direct exposure of peripheral nerves through cutaneous absorption and central involvement through inhalation and vascular dissemination. The frequency of central and peripheral nervous system symptoms, supported by objective testing in these EO-exposed patients, suggests other healthcare personnel may be at similar risk.

Original languageEnglish
Pages (from-to)992-998
Number of pages7
JournalNeurology
Volume46
Issue number4
StatePublished - Apr 1996

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Ethylene Oxide
Peripheral Nervous System
Central Nervous System
Nurses
Ethylene Chlorohydrin
Operating Room Technicians
Surgical Attire
Hospital Personnel
Skin Absorption
Sural Nerve
Hypesthesia
Poisons
Memory Disorders
Vibration
Exanthema
Wrist
Peripheral Nerves
Inhalation
Nervous System
Atrophy

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Ethylene oxide neurotoxicity : A cluster of 12 nurses with peripheral and central nervous system toxicity. / Brashear, A.; Unverzagt, Frederick; Farber, M. O.; Bonnin, Jose; Garcia, J. G N; Grober, E.

In: Neurology, Vol. 46, No. 4, 04.1996, p. 992-998.

Research output: Contribution to journalArticle

Brashear, A. ; Unverzagt, Frederick ; Farber, M. O. ; Bonnin, Jose ; Garcia, J. G N ; Grober, E. / Ethylene oxide neurotoxicity : A cluster of 12 nurses with peripheral and central nervous system toxicity. In: Neurology. 1996 ; Vol. 46, No. 4. pp. 992-998.
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