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Lee S, Povey A, Seed M, van Tongeren M. Inconsistent health hazard information across safety data sheets for substances in cleaning products used in healthcare centres. Heliyon 2024; 10:e35763. [PMID: 39170133 PMCID: PMC11337044 DOI: 10.1016/j.heliyon.2024.e35763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 07/30/2024] [Accepted: 08/02/2024] [Indexed: 08/23/2024] Open
Abstract
Safety Data Sheets (SDSs) are used to inform downstream users of any hazardous substances in chemical products and advise on how to manage the risks from using these products. It is therefore important that information on the SDS is accurate and consistent. This study investigates the accuracy and consistency of hazard information included in the SDSs of cleaning products used in the healthcare sector in England and Wales. Data on cleaning products used in the National Health Service (NHS) in England and Wales and their chemical composition and any hazard information (as H-statements) were collected from the products' SDSs obtained from the NHS supply online catalogue. By each hazard, mainly respiratory hazards, the number of hazardous substances specified as hazardous in all SDSs was identified. Moreover, we investigated hazard characteristics of substances identified by only SDS (at least one SDS) or only through Harmonised Classifications and Labeling (CLH) or by SDS and through CLH simultaneously. In total, 229 unique chemical substances were found in 473 cleaning products' SDSs. All 4 respiratory sensitisiers were identified in all SDSs and through CLH. However, only 14 of the 25 respiratory irritants (56.0 %) were consistently labelled across all SDSs. Although respiratory irritation characteristics of 3 substances were classified through CLH, it was not identified by any of the relevant SDSs. Substantially incorrect and inconsistent health hazard information for the same substances was identified across SDSs. Therefore, healthcare workers and their managers may not receive accurate information on the presence of and potential for exposure to hazardous substances in the cleaning products they are using.
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Affiliation(s)
- Sewon Lee
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, 4th Floor, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Andrew Povey
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, 4th Floor, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Martin Seed
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, 4th Floor, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, 4th Floor, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
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2
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Betancur S, Leak Bryant A, Conklin J, Walton A. Occupational exposure to chemical substances and health outcomes among hospital environmental services workers: A scoping review of international studies. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2024; 21:287-309. [PMID: 38451466 PMCID: PMC11172402 DOI: 10.1080/15459624.2024.2311870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Environmental services (EVS) workers are essential to preventing the spread of disease in hospitals. However, their exposure to hazardous chemicals and drugs is understudied. This scoping review will synthesize literature on hazardous chemical exposures and adverse health outcomes among EVS workers to identify research gaps and trends for further investigation. The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure complete and accurate reporting. The scoping review included 25 studies on occupational exposure to chemicals among EVS workers in hospitals. Most studies focused on exposure to cleaning products, which led to dermal, respiratory, and ocular symptoms, oxidative stress, and inflammation. While personal protective equipment (PPE), training, education, and policies have the potential to enhance safety, further research is required to examine the long-term impacts of exposure and the cost-effectiveness of interventions. Future studies should utilize longitudinal approaches and self-reported data collection methods, such as diaries and interviews, to comprehensively assess exposure risks and develop effective interventions and policies. Future research is needed to understand the potential health risks faced by EVS workers from exposure to chemicals in hospitals. Longitudinal studies with objective exposure assessments and larger sample sizes should be conducted. Policies and interventions must be developed and implemented to improve safe work practices and reduce negative health outcomes.
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Affiliation(s)
- Stephanie Betancur
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ashley Leak Bryant
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Jamie Conklin
- The University of North Carolina at Chapel Hill Health Sciences Librarian and Liaison to Nursing, Chapel Hill, North Carolina
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Patel J, Gimeno Ruiz de Porras D, Mitchell LE, Carson A, Whitehead LW, Han I, Pompeii L, Conway S, Zock JP, Henneberger PK, Patel R, De Los Reyes J, Delclos GL. Cleaning Tasks and Products and Asthma Among Health Care Professionals. J Occup Environ Med 2024; 66:28-34. [PMID: 37801602 PMCID: PMC10841035 DOI: 10.1097/jom.0000000000002990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
OBJECTIVE Health care workers are at risk for work-related asthma, which may be affected by changes in cleaning practices. We examined associations of cleaning tasks and products with work-related asthma in health care workers in 2016, comparing them with prior results from 2003. METHODS We estimated asthma prevalence by professional group and explored associations of self-reported asthma with job-exposure matrix-based cleaning tasks/products in a representative Texas sample of 9914 physicians, nurses, respiratory/occupational therapists, and nurse aides. RESULTS Response rate was 34.8% (n = 2421). The weighted prevalence rates of physician-diagnosed (15.3%), work-exacerbated (4.1%), and new-onset asthma (6.7%) and bronchial hyperresponsiveness symptoms (31.1%) were similar to 2003. New-onset asthma was associated with building surface cleaning (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.10-3.33), use of ortho-phthalaldehyde (OR, 1.77; 95% CI, 1.15-2.72), bleach/quaternary compounds (OR, 1.91; 95% CI, 1.10-3.33), and sprays (OR, 1.97; 95% CI, 1.12-3.47). CONCLUSION Prevalence of asthma/bronchial hyperresponsiveness seems unchanged, whereas associations of new-onset asthma with exposures to surface cleaning remained, and decreased for instrument cleaning.
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Affiliation(s)
- Jenil Patel
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
- Center for Pediatric Population Health, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth Houston), Dallas, TX, USA
| | - David Gimeno Ruiz de Porras
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health in San Antonio, The University of Texas Health Science Center at Houston (UTHealth Houston), San Antonio, TX, USA
- Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Laura E. Mitchell
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
| | - Arch Carson
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
| | - Lawrence W. Whitehead
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
| | - Inkyu Han
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA
| | - Lisa Pompeii
- Research in Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jan-Paul Zock
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Paul K. Henneberger
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Riddhi Patel
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
| | - Joy De Los Reyes
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
| | - George L. Delclos
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
- Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
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Moosavi SS, Zolghadr AR. Effect of quaternary ammonium surfactants on biomembranes using molecular dynamics simulation. RSC Adv 2023; 13:33175-33186. [PMID: 37954424 PMCID: PMC10634318 DOI: 10.1039/d3ra05030k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023] Open
Abstract
Research conducted both prior to and after the emergence of the COVID-19 pandemic reveals a notable rise in human exposure to cleaning products, hand sanitizers, and personal care items. Moreover, there has been a corresponding increase in the environmental release of these chemicals. Cleaning and disinfecting products often contain quaternary ammonium compounds (QACs) with alkyl chains as long as 8-12 carbon atoms. The attachment of quaternary ammonium surfactants to the membrane resulted in the deformation of the bilayer and membrane disruption. Before interactions with cell membranes, these surfactant molecules may form different aggregates depending on their architecture. Interaction of surfactant monomers or clusters with the cell membrane changes the physiochemical properties of the biomembranes. To investigate this interaction and its influence on membrane properties, we conducted molecular dynamics simulations of cationic quaternary ammonium surfactants interacting with dipalmitoylphosphatidylcholine (DPPC) membranes. Our simulations revealed significant interactions between the surfactants and the phospholipids, leading to substantial alterations in the structure of the bilayer. The results are compared with the simulated anionic (SDS) and nonionic surfactants/bilayer systems. Various aspects were considered, including the aggregation process, migration behavior, and eventual equilibrium of these molecules at the interface between the membrane and water. This analysis used various techniques such as density profiles, distribution functions, cluster analysis, order parameters, hydrogen bonding (H-bonding), and mean-square displacements. The results indicate that while surfactants with shorter alkyl tails (N-(2-hydroxyethyl)-N,N-dimethyloctan-1-aminium chloride (HEDMOAC)) make strong hydrogen bonds with the phosphate group and ester oxygen of the phosphatidylcholine bilayer and enter toward the bilayer in the monomer form, surfactants of longer alkyl tails aggregated on the membrane head-water interface and interact minimally with the head groups of the DPPC bilayer. For DDEDMEAC, a quaternary ammonium surfactant with a hydrophobic alkyl chain consisting of two decanoate groups, alteration of the structural and dynamical properties of the bilayer is expected to be governed by two different factors. First, the structural order of DPPC increases as surfactant aggregates interact with the membrane head group. Second, the decrease in the order of the bilayer occurs due to the insertion of surfactant monomers within the hydrophobic region of the bilayer. Strong interactions between constituents of tetraoctylammonium bromide (TOABr) and lipid head groups lead to a reduction in interlipid interactions and order, which further results in increased porosity of cellular membranes. Understanding the extent of these interactions plays a pivotal role in the toxicological assessment of these surfactants.
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Affiliation(s)
- Sedigheh Saddat Moosavi
- Department of Chemistry, Shiraz University Shiraz 71946-84795 Iran +98 713 646 0788 +98 713 613 7157
| | - Amin Reza Zolghadr
- Department of Chemistry, Shiraz University Shiraz 71946-84795 Iran +98 713 646 0788 +98 713 613 7157
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Mai Y, Wang Z, Zhou Y, Wang G, Chen J, Lin Y, Ji P, Zhang W, Jing Q, Chen L, Chen Z, Lin H, Jiang L, Yuan C, Xu P, Huang M. From disinfectants to antibiotics: Enhanced biosafety of quaternary ammonium compounds by chemical modification. JOURNAL OF HAZARDOUS MATERIALS 2023; 460:132454. [PMID: 37703742 DOI: 10.1016/j.jhazmat.2023.132454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
The excessive use of quaternary ammonium compounds (QACs) following the COVID-19 pandemic has raised substantial concerns regarding their biosafety. Overuse of QACs has been associated with chronic biological adverse effects, including genotoxicity or carcinogenicity. In particular, inadvertent intravascular administration or oral ingestion of QACs can lead to fatal acute toxicity. To enhance the biosafety and antimicrobial efficacy of QACs, this study reports a new series of QACs, termed as PACs, with the alkyl chain of benzalkonium substituted by a phthalocyanine moiety. Firstly, the rigid phthalocyanine moiety enhances the selectivity of QACs to bacteria over human cells and reduces alkyl chain's entropic penalty of binding to bacterial membranes. Furthermore, phthalocyanine neutralizes hemolysis and cytotoxicity of QACs by binding with albumin in plasma. Our experimental results demonstrate that PACs inherit the optical properties of phthalocyanine and validate the broad-spectrum antibacterial activity of PACs in vitro. Moreover, the intravascular administration of the most potent PAC, PAC1a, significantly reduced bacterial burden and ameliorated inflammation level in a bacteria-induced septic mouse model. This study presents a new strategy to improve the antimicrobial efficacy and biosafety of QACs, thus expanding their range of applications to the treatment of systemic infections.
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Affiliation(s)
- Yuhan Mai
- College of Chemistry, Fuzhou University, Fuzhou, Fujian 350116, PR China
| | - Zhiyou Wang
- College of Chemistry, Fuzhou University, Fuzhou, Fujian 350116, PR China
| | - Yang Zhou
- College of Chemistry, Fuzhou University, Fuzhou, Fujian 350116, PR China
| | - Guodong Wang
- College of Chemistry, Fuzhou University, Fuzhou, Fujian 350116, PR China
| | - Jingyi Chen
- College of Chemistry, Fuzhou University, Fuzhou, Fujian 350116, PR China
| | - Yuxin Lin
- College of Chemistry, Fuzhou University, Fuzhou, Fujian 350116, PR China
| | - Panpan Ji
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian 350108, PR China
| | - Wei Zhang
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian 350108, PR China
| | - Qian Jing
- College of Chemistry, Fuzhou University, Fuzhou, Fujian 350116, PR China
| | - Liyun Chen
- College of Chemistry, Fuzhou University, Fuzhou, Fujian 350116, PR China
| | - Zheng Chen
- College of Chemistry, Fuzhou University, Fuzhou, Fujian 350116, PR China
| | - Haili Lin
- Department of Pharmacy, The Peoples Hospital of Fujian Province, Fuzhou, Fujian 350004, PR China
| | - Longguang Jiang
- College of Chemistry, Fuzhou University, Fuzhou, Fujian 350116, PR China
| | - Cai Yuan
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian 350108, PR China; Fujian Key Laboratory of Marine Enzyme Engineering, Fuzhou University, Fuzhou, Fujian 350108, PR China
| | - Peng Xu
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian 350108, PR China; Fujian Key Laboratory of Marine Enzyme Engineering, Fuzhou University, Fuzhou, Fujian 350108, PR China.
| | - Mingdong Huang
- College of Chemistry, Fuzhou University, Fuzhou, Fujian 350116, PR China.
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Sonday Z, Baatjies R, Mwanga HH, Jeebhay MF. Prevalence of work-related skin symptoms and associated factors among tertiary hospital workers exposed to cleaning agents in Southern Africa. Contact Dermatitis 2023; 89:178-189. [PMID: 37401107 PMCID: PMC10530256 DOI: 10.1111/cod.14374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Working with cleaning products is associated with occupational contact dermatitis in health workers (HWs), but information on predictors for these outcomes is limited. OBJECTIVES This study investigated the prevalence of work-related skin symptoms (WRSS) and associated factors in HWs exposed to cleaning agents in two Southern African tertiary hospitals. METHODS A cross-sectional study of 697 HWs used an interviewer-administered questionnaire and assessed for atopy using Phadiatop. RESULTS HWs' median age was 42 years, 77.0% were female and 42.5% were atopic. The prevalence of WRSS in the last 12 months was 14.8%, 12.3% had probable contact dermatitis (PCD) and 3.2% had probable contact urticaria (PCU). Technicians (ORadj 3.91) and tasks involving cleaning and disinfection of skin wounds (ORadj 1.98) were associated with WRSS in the past year. Factors associated with PCD included sterilizing instruments, disinfecting skin before procedures and use of wound adhesives. Factors associated with PCU included specimen preparation using formalin, medical instrument sterilization tasks, and skin/wound cleaning and disinfection. Appropriate glove use when performing patients' skin/wound care was protective against WRSS. CONCLUSIONS Tasks involving cleaning and disinfecting patients' skin and wounds were associated with WRSS in HWs, especially when performed without gloves.
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Affiliation(s)
- Zahida Sonday
- Occupational Medicine Division, School of Public HealthUniversity of Cape TownCape TownSouth Africa
| | - Roslynn Baatjies
- Occupational Medicine Division, School of Public HealthUniversity of Cape TownCape TownSouth Africa
- Department of Environmental and Occupational Studies, Faculty of Applied SciencesCape Peninsula University of TechnologyCape TownSouth Africa
| | - Hussein H Mwanga
- Occupational Medicine Division, School of Public HealthUniversity of Cape TownCape TownSouth Africa
- Department of Environmental and Occupational Health, School of Public Health and Social SciencesMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Mohamed F Jeebhay
- Occupational Medicine Division, School of Public HealthUniversity of Cape TownCape TownSouth Africa
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Blackley BH, Nett RJ, Cox-Ganser JM, Harvey RR, Virji MA. Eye and airway symptoms in hospital staff exposed to a product containing hydrogen peroxide, peracetic acid, and acetic acid. Am J Ind Med 2023; 66:655-669. [PMID: 37221450 PMCID: PMC10431326 DOI: 10.1002/ajim.23488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Sporicidal products containing hydrogen peroxide (HP), peracetic acid (PAA), and acetic acid (AA) are used widely in multiple industries, including healthcare. Despite widespread use in healthcare, few studies have assessed associations between exposures to HP, PAA, and AA, and work-related symptoms in these settings. METHODS In 2018, we performed a health and exposure assessment at a hospital where a sporicidal product consisting of HP, PAA, and AA, was used as the primary cleaner on hospital surfaces. We collected 56 personal and mobile air samples for HP, PAA, and AA on participants while they performed their regular cleaning duties; collected area samples for HP (n = 28), PAA (n = 28), and AA (n = 70) in multiple hospital locations where cleaning was performed; and administered a postshift survey to assess eye, skin, and upper and lower airway symptoms that occurred cross-shift or in the previous 4 weeks. RESULTS Full-shift exposure levels for HP (range: <3-559 ppb), PAA (range: <0.2-8 ppb), and AA (range: <5-915 ppb) were all below US occupational exposure limits. We observed positive associations (p < 0.05) between shift, departmental average, and departmental 95th percentile exposures to HP, PAA, and AA vapors, and work-related acute (cross-shift) and chronic (previous 4 weeks) eye, upper airway, and lower airway symptoms after adjusting for age, gender, smoking status, use of other cleaning products containing sensitizers and irritants, allergic status, and stress. CONCLUSIONS Our observations of work-related upper and lower airway symptoms among hospital workers exposed to vapors from a sporicidal product containing HP, PAA, and AA indicate a need for a combination of engineering, administrative, and PPE controls to reduce exposure. Additionally, alternative nonchemical disinfection technologies should be further investigated as a means to simultaneously reduce healthcare workers' exposure to disinfectants while also minimizing costly healthcare-acquired infections.
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Affiliation(s)
- Brie Hawley Blackley
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Randall J. Nett
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Fort Collins, Colorado, USA
| | - Jean M. Cox-Ganser
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Robert Reid Harvey
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Mohammed Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
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8
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Mwanga HH, Baatjies R, Jeebhay MF. Occupational risk factors and exposure-response relationships for airway disease among health workers exposed to cleaning agents in tertiary hospitals. Occup Environ Med 2023; 80:361-371. [PMID: 37137692 DOI: 10.1136/oemed-2022-108763] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/20/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES This study investigated occupational risk factors and exposure-response relationships for airway disease among health workers (HWs) exposed to cleaning agents in two tertiary hospitals in South Africa and Tanzania. METHODS In this cross-sectional study, 697 participants completed questionnaire interviews while 654 underwent fractional exhaled nitric oxide (FeNO) testing. Asthma Symptom Score (ASS) was computed based on the sum of answers to five questions on asthma-related symptoms in the past 12 months. For exposure-response analyses, cleaning agent-related self-reported exposure variables were categorised into three levels (cleaning product not used; use of a cleaning product for up to 99 min per week and use of a cleaning product for ≥100 min per week). RESULTS Asthma-related outcomes (ASS and FeNO) demonstrated positive associations with medical instrument cleaning agents (orthophthalaldehyde and enzymatic cleaners) and tasks (instruments precleaning and changing sterilisation solutions) as well as patient care activities (disinfection prior to procedures and disinfecting wounds). A particularly pronounced dose-response relationship was observed between work-related ocular-nasal symptoms and medical instrument cleaning agents (orthophthalaldehyde, glutaraldehyde, enzymatic cleaners, alcohols and bleach) (OR range: 2.37-4.56) and tasks (OR range: 2.92-4.44). A strong association was also observed between ASS and use of sprays for fixed surface cleaning (mean ratio 2.81; 95% CI 1.41 to 5.59). CONCLUSIONS Specific agents for medical instrument disinfection for example, orthophthalaldehyde and enzymatic cleaners, patient care activities and use of sprays are important occupational risk factors for airway disease among HWs.
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Affiliation(s)
- Hussein H Mwanga
- Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa
- Department of Environmental and Occupational Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Roslynn Baatjies
- Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa
- Department of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, Western Cape, South Africa
| | - Mohamed Fareed Jeebhay
- Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa
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Suleiman AM. Comparison of ConsExpo estimated exposure levels to glycol ethers during professional cleaning work to existing regulatory occupational exposure limit values. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2023; 29:604-612. [PMID: 35363595 DOI: 10.1080/10803548.2022.2061150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives. Researchers have shown that cleaning workers have an increased risk of asthma and rhinitis, mainly due to exposure to chemical substances present in the cleaning products they use. Among the important substances are glycol ethers, increasingly used as components in cleaning products. This study aimed to assess exposure levels of glycol ether in professional cleaning products and compare them to existing regulatory exposure limit values. Methods. Information from safety data sheets of the products is used to identify the glycol ethers present in the cleaning products and their respective concentrations. Other sources were used to obtain the relevant data required for use in the tool to generate exposure assessments. Exposure levels for various cleaning work exposure scenarios were estimated using the ConsExpo Web tool. Results. The estimated exposure values are significantly lower than the existing regulatory occupational exposure limit (OEL) values for the different glycol ethers. Conclusions. The study showed that the risk of exposure to glycol ethers by inhalation from professional cleaning products is minimal as exposure estimates were much below the regulatory OEL values.
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Arnold W, Blum A, Branyan J, Bruton TA, Carignan CC, Cortopassi G, Datta S, DeWitt J, Doherty AC, Halden RU, Harari H, Hartmann EM, Hrubec TC, Iyer S, Kwiatkowski CF, LaPier J, Li D, Li L, Muñiz Ortiz JG, Salamova A, Schettler T, Seguin RP, Soehl A, Sutton R, Xu L, Zheng G. Quaternary Ammonium Compounds: A Chemical Class of Emerging Concern. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:7645-7665. [PMID: 37157132 PMCID: PMC10210541 DOI: 10.1021/acs.est.2c08244] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 05/10/2023]
Abstract
Quaternary ammonium compounds (QACs), a large class of chemicals that includes high production volume substances, have been used for decades as antimicrobials, preservatives, and antistatic agents and for other functions in cleaning, disinfecting, personal care products, and durable consumer goods. QAC use has accelerated in response to the COVID-19 pandemic and the banning of 19 antimicrobials from several personal care products by the US Food and Drug Administration in 2016. Studies conducted before and after the onset of the pandemic indicate increased human exposure to QACs. Environmental releases of these chemicals have also increased. Emerging information on adverse environmental and human health impacts of QACs is motivating a reconsideration of the risks and benefits across the life cycle of their production, use, and disposal. This work presents a critical review of the literature and scientific perspective developed by a multidisciplinary, multi-institutional team of authors from academia, governmental, and nonprofit organizations. The review evaluates currently available information on the ecological and human health profile of QACs and identifies multiple areas of potential concern. Adverse ecological effects include acute and chronic toxicity to susceptible aquatic organisms, with concentrations of some QACs approaching levels of concern. Suspected or known adverse health outcomes include dermal and respiratory effects, developmental and reproductive toxicity, disruption of metabolic function such as lipid homeostasis, and impairment of mitochondrial function. QACs' role in antimicrobial resistance has also been demonstrated. In the US regulatory system, how a QAC is managed depends on how it is used, for example in pesticides or personal care products. This can result in the same QACs receiving different degrees of scrutiny depending on the use and the agency regulating it. Further, the US Environmental Protection Agency's current method of grouping QACs based on structure, first proposed in 1988, is insufficient to address the wide range of QAC chemistries, potential toxicities, and exposure scenarios. Consequently, exposures to common mixtures of QACs and from multiple sources remain largely unassessed. Some restrictions on the use of QACs have been implemented in the US and elsewhere, primarily focused on personal care products. Assessing the risks posed by QACs is hampered by their vast structural diversity and a lack of quantitative data on exposure and toxicity for the majority of these compounds. This review identifies important data gaps and provides research and policy recommendations for preserving the utility of QAC chemistries while also seeking to limit adverse environmental and human health effects.
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Affiliation(s)
- William
A. Arnold
- University
of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Arlene Blum
- Green
Science Policy Institute, Berkeley, California 94709, United States
- University
of California, Berkeley, California 94720, United States
| | - Jennifer Branyan
- California
Department of Toxic Substances Control, Sacramento, California 95814, United States
| | - Thomas A. Bruton
- California
Department of Toxic Substances Control, Sacramento, California 95814, United States
| | | | - Gino Cortopassi
- University
of California, Davis, California 95616, United States
| | - Sandipan Datta
- University
of California, Davis, California 95616, United States
| | - Jamie DeWitt
- East
Carolina University, Greenville, North Carolina 27834, United States
| | - Anne-Cooper Doherty
- California
Department of Toxic Substances Control, Sacramento, California 95814, United States
| | - Rolf U. Halden
- Arizona
State University, Tempe, Arizona 85287, United States
| | - Homero Harari
- Icahn
School of Medicine at Mount Sinai, New York, New York 10029, United States
| | | | - Terry C. Hrubec
- Edward Via College of Osteopathic Medicine, Blacksburg, Virginia 24060, United States
| | - Shoba Iyer
- California Office of Environmental Health Hazard Assessment, Oakland, California 94612, United States
| | - Carol F. Kwiatkowski
- Green
Science Policy Institute, Berkeley, California 94709, United States
- North Carolina State University, Raleigh, North Carolina 27695 United States
| | - Jonas LaPier
- Green
Science Policy Institute, Berkeley, California 94709, United States
| | - Dingsheng Li
- University
of Nevada, Reno, Nevada 89557, United States
| | - Li Li
- University
of Nevada, Reno, Nevada 89557, United States
| | | | - Amina Salamova
- Indiana University, Atlanta, Georgia 30322, United States
| | - Ted Schettler
- Science and Environmental Health Network, Bolinas, California 94924, United States
| | - Ryan P. Seguin
- University of Washington, Seattle, Washington 98195, United States
| | - Anna Soehl
- Green
Science Policy Institute, Berkeley, California 94709, United States
| | - Rebecca Sutton
- San Francisco Estuary Institute, Richmond, California 94804, United States
| | - Libin Xu
- University of Washington, Seattle, Washington 98195, United States
| | - Guomao Zheng
- Southern University of Science and Technology, Shenzhen, Guangdong 518055, China
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11
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Ndlela NH, Naidoo RN. Job and exposure intensity among hospital cleaning staff adversely affects respiratory health. Am J Ind Med 2023; 66:252-264. [PMID: 36611285 DOI: 10.1002/ajim.23456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/22/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Occupational exposure to various types of cleaning agents may increase the risk of adverse respiratory health among cleaners. This study investigated the relationship between exposure to cleaning and disinfecting agents, using a job-task and exposure intensity metric, and respiratory outcomes among cleaners. METHODS A sample of 174 cleaners was selected from three public hospitals in Durban. A questionnaire was used to collect demographic and occupational information, and spirometry, including post-bronchodilator measures, was conducted according to the American Thoracic Society guidelines and skin prick testing were performed. Exposure metrics for job tasks and chemical exposures were created using frequency and employment-lifetime duration of exposure. Multivariate analysis regression models used job task and exposure intensity metrics. RESULTS Doctor-diagnosed asthma prevalence was 9.8%. Breathlessness with wheeze (22.4%) was the prevalent respiratory symptom. Positive responses to skin prick testing were seen in 74 (43.2%). There was a statistically significant increased risk for shortness of breath with exposure to quaternary ammonium compounds (odds ratio [OR]: 3.44; 95% confidence interval [CI]: 1.13-10.5) and breathlessness with exposure to multipurpose cleaner (OR: 0.34; CI: 0.12-0.92). The losses in percent-predicted forced expiratory volume in 1 s (FEV1) ranged from 0.3%-6.7%. Results among the bronchodilator-positive (8.6%) showed lung function losses twofold greater when compared to the total study population with percentage predicted FEV1 (-22.6 %; p < 0.000). CONCLUSION Exposure to certain cleaning and disinfectant agents adversely affects respiratory health, particularly lung function. This effect, while seen generally among cleaning workers, is more pronounced among those with pre-existing reversible obstructive lung disease.
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Affiliation(s)
- Nana Happiness Ndlela
- Occupational Health and Safety, RK Khan Hospital, Chatsworth, Chatsworth, South Africa.,Discipline of Occupational and Environmental Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Rajen N Naidoo
- Discipline of Occupational and Environmental Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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12
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Lovén K, Gudmundsson A, Assarsson E, Kåredal M, Wierzbicka A, Dahlqvist C, Nordander C, Xu Y, Isaxon C. Effects of cleaning spray use on eyes, airways, and ergonomic load. BMC Public Health 2023; 23:99. [PMID: 36639638 PMCID: PMC9840290 DOI: 10.1186/s12889-022-14954-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Cleaning workers are exposed to chemicals and high physical workload, commonly resulting in airway problems and pain. In this study the response in the upper airways and the physical workload following airborne and ergonomic exposure of cleaning spray was investigated. METHODS A survey was answered by professional cleaning workers to investigate their use of cleaning sprays and the perceived effects on eyes, airways and musculoskeletal pain. A human chamber exposure study was then conducted with 11 professional cleaning workers and 8 non-professional cleaning workers to investigate the airborne exposure, acute effects on eyes and airways, and physical load during cleaning with sprays, foam application and microfiber cloths premoistened with water. All cleaning products used were bleach, chlorine, and ammonia free. The medical assessment included eye and airway parameters, inflammatory markers in blood and nasal lavage, as well as technical recordings of the physical workload. RESULTS A high frequency of spray use (77%) was found among the 225 professional cleaning workers that answered the survey. Based on the survey, there was an eight times higher risk (p < 0.001) of self-experienced symptoms (including symptoms in the nose, eyes and throat, coughing or difficulty breathing) when they used sprays compared to when they cleaned with other methods. During the chamber study, when switching from spray to foam, the airborne particle and volatile organic compound (VOC) concentrations showed a decrease by 7 and 2.5 times, respectively. For the whole group, the peak nasal inspiratory flow decreased (-10.9 L/min, p = 0.01) during spray use compared to using only water-premoistened microfiber cloths. These effects were lower during foam use (-4.7 L/min, p = 0.19). The technical recordings showed a high physical workload regardless of cleaning with spray or with water. CONCLUSION Switching from a spraying to a foaming nozzle decreases the exposure of both airborne particles and VOCs, and thereby reduces eye and airway effects, and does not increase the ergonomic load. If the use of cleaning products tested in this study, i.e. bleach, chlorine, and ammonia free, cannot be avoided, foam application is preferable to spray application to improve the occupational environment.
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Affiliation(s)
- Karin Lovén
- grid.4514.40000 0001 0930 2361Ergonomics and Aerosol Technology, Lund University, Lund, Sweden
| | - Anders Gudmundsson
- grid.4514.40000 0001 0930 2361Ergonomics and Aerosol Technology, Lund University, Lund, Sweden
| | - Eva Assarsson
- grid.4514.40000 0001 0930 2361Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Monica Kåredal
- grid.4514.40000 0001 0930 2361Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Aneta Wierzbicka
- grid.4514.40000 0001 0930 2361Ergonomics and Aerosol Technology, Lund University, Lund, Sweden
| | - Camilla Dahlqvist
- grid.4514.40000 0001 0930 2361Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Catarina Nordander
- grid.4514.40000 0001 0930 2361Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Yiyi Xu
- grid.8761.80000 0000 9919 9582Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Christina Isaxon
- grid.4514.40000 0001 0930 2361Ergonomics and Aerosol Technology, Lund University, Lund, Sweden
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13
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Wang G, Yang L, Jiang L, Chen J, Jing Q, Mai Y, Deng L, Lin Y, Chen L, Chen Z, Xu P, Jiang L, Yuan C, Huang M. A new class of quaternary ammonium compounds as potent and environmental friendly disinfectants. JOURNAL OF CLEANER PRODUCTION 2022; 379:134632. [PMID: 36246409 PMCID: PMC9552062 DOI: 10.1016/j.jclepro.2022.134632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/29/2022] [Accepted: 10/07/2022] [Indexed: 05/21/2023]
Abstract
Quaternary ammonium compounds (QACs) are inexpensive and readily available disinfectants, and have been widely used, especially since the COVID-19 outbreak. The toxicity of QACs to humans has raised increasing concerns in recent years. Here, a new type of QACs was synthesized by replacing the alkyl chain with zinc phthalocyanine (ZnPc), which consists of a large aromatic ring and is hydrophobic in nature, similar to the alkyl chain of QACs. Three ZnPc-containing disinfectants were synthesized and fully characterized. These compounds showed 15-16 fold higher antimicrobial effect against Gram-negative bacteria than the well-known QACs with half-maximal inhibitory (IC50) values of 1.43 μM, 2.70 μM, and 1.31 μM, respectively. With the assistance of 680 nm light, compounds 4 and 6 had much higher bactericidal toxicities at nanomolar concentrations. Compound 6 had a bactericidal efficacy of close to 6 logs (99.9999% kill rate) at 1 μM to Gram-positive bacteria, including MRSA, under light illumination. Besides, these compounds were safe for mammalian cells. In a mouse model, compound 6 was effective in healing wound infection. Importantly, compound 6 was easily degraded at working concentrations under sunlight illumination, and is environmentally friendly. Thus, compound 6 is a novel and promising disinfectant.
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Affiliation(s)
- Guodong Wang
- College of Chemistry, Fuzhou University, Fujian, 350108, China
| | - Ling Yang
- College of Chemistry, Fuzhou University, Fujian, 350108, China
| | - Libin Jiang
- College of Chemistry, Fuzhou University, Fujian, 350108, China
| | - Jingyi Chen
- College of Chemistry, Fuzhou University, Fujian, 350108, China
| | - Qian Jing
- College of Chemistry, Fuzhou University, Fujian, 350108, China
| | - Yuhan Mai
- College of Chemistry, Fuzhou University, Fujian, 350108, China
| | - Lina Deng
- College of Chemistry, Fuzhou University, Fujian, 350108, China
| | - Yuxin Lin
- College of Chemistry, Fuzhou University, Fujian, 350108, China
| | - Liyun Chen
- College of Chemistry, Fuzhou University, Fujian, 350108, China
| | - Zheng Chen
- College of Chemistry, Fuzhou University, Fujian, 350108, China
| | - Peng Xu
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian, 350108, China
| | - Longguang Jiang
- College of Chemistry, Fuzhou University, Fujian, 350108, China
| | - Cai Yuan
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian, 350108, China
| | - Mingdong Huang
- College of Chemistry, Fuzhou University, Fujian, 350108, China
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14
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Mwanga HH, Baatjies R, Singh T, Jeebhay MF. Work-related allergy and asthma associated with cleaning agents in health workers in Southern African tertiary hospitals. Am J Ind Med 2022; 65:382-395. [PMID: 35267214 DOI: 10.1002/ajim.23344] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/10/2022] [Accepted: 02/25/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Health workers (HWs) are exposed to diverse cleaning agents in large hospitals. This study determined the prevalence of work-related symptoms, allergic sensitization, and lung function abnormalities in HWs of two tertiary hospitals in Southern Africa. METHODS A cross-sectional study of 699 HWs (South Africa: SAH, n = 346; Tanzania: TAH, n = 353) was conducted. Health outcomes were assessed using a standardized ECRHS questionnaire, immunological tests (specific IgE antibody to common aero-allergens and to occupational allergens: natural rubber latex [NRL] Hev b5 and Hev b6.02, chlorhexidine, and ortho-phthalaldehyde [OPA]), spirometry [pre-and post- bronchodilator], methacholine challenge, and fractional exhaled nitric oxide (FeNO). RESULTS A large proportion of participants (78%) were women. Median age was 42 years, with 76% nurses, 12% cleaners, and 5% administrative workers. Current smoking was more common in SAHWs (12%) than TAHWs (1%). The overall prevalence of doctor-diagnosed asthma was 7%. Atopy was present in 43% of HWs, while 4% were sensitized to OPA, 2% to NRL, and 1% to chlorhexidine. Prevalence of work-related ocular-nasal symptoms (16%) was higher than skin (12%) and chest (7%) symptoms. TAHWs had significantly lower mean lung volumes, higher degrees of significant airflow obstruction and impaired lung function. The prevalence of bronchial hyperresponsiveness in SAHWs (14%) was high. Overall, 23% of HWs had abnormal FeNO; 6% having high (>50 ppb) levels. FeNO was positively associated with sensitization to occupational allergens, primarily OPA and NRL. CONCLUSIONS HWs from both hospitals had similar prevalence of work-related respiratory symptoms. Sensitization to OPA and NRL appears to be contributing to allergic airway inflammation in these HWs.
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Affiliation(s)
- Hussein H. Mwanga
- Division of Occupational Medicine, Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine University of Cape Town Cape Town South Africa
- Department of Environmental and Occupational Health, School of Public Health and Social Sciences Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
| | - Roslynn Baatjies
- Division of Occupational Medicine, Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine University of Cape Town Cape Town South Africa
- Department of Environmental and Occupational Studies, Faculty of Applied Sciences Cape Peninsula University of Technology Cape Town South Africa
| | - Tanusha Singh
- National Institute for Occupational Health National Health Laboratory Services Johannesburg South Africa
- Department of Environmental Health, School of Health Sciences University of Johannesburg Johannesburg South Africa
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology University of the Witwatersrand Johannesburg South Africa
| | - Mohamed F. Jeebhay
- Division of Occupational Medicine, Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine University of Cape Town Cape Town South Africa
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15
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Dang KTL, Garrido AN, Prasad S, Afanasyeva M, Lipszyc JC, Orchanian‐Cheff A, Tarlo SM. The relationship between cleaning product exposure and respiratory and skin symptoms among healthcare workers in a hospital setting: A systematic review and meta‐analysis. Health Sci Rep 2022; 5:e623. [PMID: 35509379 PMCID: PMC9059197 DOI: 10.1002/hsr2.623] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/17/2022] [Accepted: 03/28/2022] [Indexed: 11/12/2022] Open
Abstract
Background and Aims Several studies from multiple work settings have reported an increase in asthma and asthma‐like respiratory symptoms in workers exposed to cleaning or disinfecting agents. Hospital workers perform many cleaning and disinfecting activities and may be vulnerable to respiratory and skin symptoms caused by these agents. This systematic review and meta‐analysis aim to quantify the risk of asthma and asthma‐like symptoms in hospital workers exposed to cleaning/disinfecting agents. A secondary aim is to assess associated risks of skin symptoms in those studies. Methods MEDLINE, EMBASE, CDSR, CENTRAL, CINAHL databases, and references of relevant review articles were searched. NHLBI quality assessment tools were used to assess the quality of the included studies. A total of 2550 articles were retrieved and 34 studies met criteria to be included. The software R version 4.0.5 was used to perform the meta‐analysis. The random‐effects model was used to pool the results due to within‐studies heterogeneity. Results Meta‐analysis of 10 studies evaluating the association between occupational cleaning exposures and asthma demonstrated a 35% increased risk in exposed hospital workers (meta‐RR = 1.35, 95% CI: 1.09–1.68). The risk of asthma increased when workers were exposed to bleach compared with nonexposed workers (meta‐RR = 1.51, 95% CI: 0.54–4.18), but was not statistically significant. Two studies investigated the relationship between respiratory and skin symptoms and produced mixed results. Conclusions The results suggest a need for preventive practices to reduce the risk of asthma and asthma‐like symptoms in hospital workers exposed to occupational cleaning/disinfecting agents. Trial registration number: CRD42020137804.
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Affiliation(s)
- Kelly T. L. Dang
- Departments of Medicine University of Toronto Toronto Ontario Canada
| | - Ameth N. Garrido
- Departments of Medicine University of Toronto Toronto Ontario Canada
- Departments of Medicine University of Toronto Institute for Medical Sciences Toronto Ontario Canada
- Toronto, Departments of Medicine University Health Network Toronto Ontario Canada
| | - Shivonne Prasad
- Monash University School of Public Health and Preventive Medicine Melbourne Victoria Australia
| | - Marina Afanasyeva
- Departments of Medicine Humber River Hospital, Toronto Toronto Ontario Canada
- Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
| | - Joshua C. Lipszyc
- Departments of Medicine University of Toronto Toronto Ontario Canada
| | - Ani Orchanian‐Cheff
- Toronto, Departments of Medicine University Health Network Toronto Ontario Canada
| | - Susan M. Tarlo
- Departments of Medicine University of Toronto Toronto Ontario Canada
- Departments of Medicine University of Toronto Institute for Medical Sciences Toronto Ontario Canada
- Toronto, Departments of Medicine University Health Network Toronto Ontario Canada
- Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
- St Michael's Hospital Toronto Ontario Canada
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16
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OUP accepted manuscript. Ann Work Expo Health 2022; 66:998-1009. [DOI: 10.1093/annweh/wxac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 11/14/2022] Open
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17
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Mwanga HH, Baatjies R, Singh T, Jeebhay MF. Asthma Phenotypes and Host Risk Factors Associated With Various Asthma-Related Outcomes in Health Workers. FRONTIERS IN ALLERGY 2021; 2:747566. [PMID: 35386991 PMCID: PMC8974710 DOI: 10.3389/falgy.2021.747566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/21/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Work-related asthma phenotypes in health workers (HWs) exposed to cleaning agents have not been investigated extensively as other occupational exposures. This study aimed to describe asthma phenotypes and to identify important host risk factors associated with various asthma-related outcomes. Methods: A cross-sectional study of 699 HWs was conducted in two large tertiary hospitals. A total of 697 HWs completed questionnaire interviews. Sera collected from 682 HWs were analyzed for atopy (Phadiatop) and IgE to occupational allergens (NRL—Hev b5, Hev b6.02; chlorhexidine and ortho-phthalaldehyde—OPA). Methacholine (MCT), bronchodilator challenge (BDR) and fractional exhaled nitric oxide (FeNO) were performed. An asthma symptom score (ASS) used five asthma-related symptoms reported in the past 12 months. Current asthma was based on use of asthma medication or an asthma attack or being woken up by an attack of shortness of breath in the past 12 months. Nonspecific bronchial hyperresponsiveness (NSBH) was defined as having either a positive MCT or a significant bronchodilator response. Two continuous indices of NSBH [continuous index of responsiveness (CIR) and dose-response slope (DRS)] were calculated. Results: The prevalence of current asthma was 10%, atopic asthma (6%) and non-atopic asthma (4%). Overall, 2% of subjects had work-related asthma. There was a weak positive association between NSBH and FeNO [CIR: Beta coefficient (β) = 0.12; CI: 0.03–0.22 and DRS: β = 0.07; CI: 0.03–0.12]. Combining FeNO ≥ 50 ppb with a BDR [mean ratio (MR) = 5.89; CI: 1.02–34.14] or with NSBH (MR = 4.62; CI: 1.16–18.46) correlated better with ASS than FeNO alone (MR = 2.23; CI: 1.30–3.85). HWs with current asthma were twice as likely to be atopic. FeNO was positively associated with atopy (OR = 3.19; CI: 1.59–6.39) but negatively associated with smoking status (GMR = 0.76; CI: 0.62–0.94). Most HWs sensitized to occupational allergens were atopic. Conclusion: Atopic asthma was more prevalent than non-atopic asthma in HWs. Most asthma-related outcomes were positively associated with allergic predictors suggesting a dominant role for IgE mechanisms for work-related symptoms and asthma associated with sensitization to OPA or chlorhexidine.
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Affiliation(s)
- Hussein H. Mwanga
- Division of Occupational Medicine and Center for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Environmental and Occupational Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Roslynn Baatjies
- Division of Occupational Medicine and Center for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Tanusha Singh
- National Institute for Occupational Health, National Health Laboratory Services, Johannesburg, South Africa
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Mohamed F. Jeebhay
- Division of Occupational Medicine and Center for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- *Correspondence: Mohamed F. Jeebhay
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18
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He W, Guo Y, Liu J, Yue Y, Wang J. Filtration Performance Degradation of In-Use Masks by Vapors from Alcohol-Based Hand Sanitizers and the Mitigation Solutions. GLOBAL CHALLENGES (HOBOKEN, NJ) 2021; 5:2100015. [PMID: 34497717 PMCID: PMC8414512 DOI: 10.1002/gch2.202100015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/07/2021] [Indexed: 06/13/2023]
Abstract
In the current COVID-19 pandemic, wearing masks and hand disinfection are widely adopted hygiene practices. Alcohol-based sanitizers are commonly used for hand disinfection, however, the alcohol vapors can dissipate the charges on electrostatic filters. In the present study, the effects of alcohol vapors from alcohol-based sanitizers during hand disinfection on the in-use masks are studied. The results show that the negative effects are not significant for nonelectrostatic cotton masks or N95 respirators with multiple charged layers, but noticeable for surgical masks. After five rounds of hand disinfection, the filtration efficiencies of the filtering materials of the surgical masks decrease by more than 8% for 400 and 500 nm particles and by 3.7 ± 1.8% for 1 µm particles, the effective filtration efficiency of the surgical masks worn by the volunteers (with leakage considered) decreases by about 5% for ambient aerosol. In another process to imitate intensive disinfection procedures by healthcare workers, a 30 min surface cleaning process using alcohol-based sanitizer is performed, and the effective efficiency of the N95 respirators worn by the volunteers decreases by nearly 9%. The simple practice of avoiding vapor during hand disinfection could mitigate the effects of alcohol vapor, which is demonstrated on two brands of surgical masks.
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Affiliation(s)
- Weidong He
- Filter Test Center Northeastern University Shenyang Liaoning CN-110819 China
- Institute of Environmental Engineering ETH Zürich Zürich CH-8093 Switzerland
- Lab of Advanced Analytical Technologies Empa Dübendorf CH-8600 Switzerland
| | - Yinghe Guo
- Filter Test Center Northeastern University Shenyang Liaoning CN-110819 China
- Institute of Environmental Engineering ETH Zürich Zürich CH-8093 Switzerland
- Lab of Advanced Analytical Technologies Empa Dübendorf CH-8600 Switzerland
| | - Jingxian Liu
- Filter Test Center Northeastern University Shenyang Liaoning CN-110819 China
| | - Yang Yue
- Institute of Environmental Engineering ETH Zürich Zürich CH-8093 Switzerland
- Lab of Advanced Analytical Technologies Empa Dübendorf CH-8600 Switzerland
| | - Jing Wang
- Institute of Environmental Engineering ETH Zürich Zürich CH-8093 Switzerland
- Lab of Advanced Analytical Technologies Empa Dübendorf CH-8600 Switzerland
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19
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Dewey HM, Jones JM, Keating MR, Budhathoki-Uprety J. Increased Use of Disinfectants During the COVID-19 Pandemic and Its Potential Impacts on Health and Safety. ACS CHEMICAL HEALTH & SAFETY 2021. [DOI: 10.1021/acs.chas.1c00026] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Hannah M. Dewey
- Department of Textile Engineering, Chemistry and Science, Wilson College of Textiles, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Jaron M. Jones
- Department of Textile Engineering, Chemistry and Science, Wilson College of Textiles, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Mike R. Keating
- Department of Textile Engineering, Chemistry and Science, Wilson College of Textiles, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Januka Budhathoki-Uprety
- Department of Textile Engineering, Chemistry and Science, Wilson College of Textiles, North Carolina State University, Raleigh, North Carolina 27695, United States
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20
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Andrianjafimasy MV, Febrissy M, Zerimech F, Dananché B, Kromhout H, Matran R, Nadif M, Oberson-Geneste D, Quinot C, Schlünssen V, Siroux V, Zock JP, Le Moual N, Nadif R, Dumas O. Association between occupational exposure to irritant agents and a distinct asthma endotype in adults. Occup Environ Med 2021; 79:155-161. [PMID: 34413158 DOI: 10.1136/oemed-2020-107065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 07/22/2021] [Indexed: 11/04/2022]
Abstract
AIM The biological mechanisms of work-related asthma induced by irritants remain unclear. We investigated the associations between occupational exposure to irritants and respiratory endotypes previously identified among never asthmatics (NA) and current asthmatics (CA) integrating clinical characteristics and biomarkers related to oxidative stress and inflammation. METHODS We used cross-sectional data from 999 adults (mean 45 years old, 46% men) from the case-control and familial Epidemiological study on the Genetics and Environments of Asthma (EGEA) study. Five respiratory endotypes have been identified using a cluster-based approach: NA1 (n=463) asymptomatic, NA2 (n=169) with respiratory symptoms, CA1 (n=50) with active treated adult-onset asthma, poor lung function, high blood neutrophil counts and high fluorescent oxidation products level, CA2 (n=203) with mild middle-age asthma, rhinitis and low immunoglobulin E level, and CA3 (n=114) with inactive/mild untreated allergic childhood-onset asthma. Occupational exposure to irritants during the current or last held job was assessed by the updated occupational asthma-specific job-exposure matrix (levels of exposure: no/medium/high). Associations between irritants and each respiratory endotype (NA1 asymptomatic as reference) were studied using logistic regressions adjusted for age, sex and smoking status. RESULTS Prevalence of high occupational exposure to irritants was 7% in NA1, 6% in NA2, 16% in CA1, 7% in CA2 and 10% in CA3. High exposure to irritants was associated with CA1 (adjusted OR aOR, (95% CI) 2.7 (1.0 to 7.3)). Exposure to irritants was not significantly associated with other endotypes (aOR range: 0.8 to 1.5). CONCLUSION Occupational exposure to irritants was associated with a distinct respiratory endotype suggesting oxidative stress and neutrophilic inflammation as potential associated biological mechanisms.
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Affiliation(s)
- Miora Valérie Andrianjafimasy
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, Île-de-France, France
| | - Mickaël Febrissy
- LIPADE, Université Paris 5 Descartes, Paris, Île-de-France, France
| | - Farid Zerimech
- Univ. Lille, ULR 4483 - IMPECS, CHU Lille, F-59000 Lille, Lille, France.,Institut Pasteur de Lille, F-59000, Lille, France
| | | | - Hans Kromhout
- Utrecht University, Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht, Netherlands
| | - Régis Matran
- Univ. Lille, ULR 4483 - IMPECS, CHU Lille, F-59000 Lille, Lille, France.,Institut Pasteur de Lille, F-59000, Lille, France
| | - Mohamed Nadif
- LIPADE, Université Paris 5 Descartes, Paris, Île-de-France, France
| | | | - Catherine Quinot
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, Île-de-France, France
| | - Vivi Schlünssen
- Aarhus University, Department of Public Health, Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus, Denmark.,National Research Centre for the Working Environment, Kobenhavn, Denmark
| | - Valérie Siroux
- Universite Grenoble Alpes, Inserm, CNRS, Team of environmental epidemiology applied to Reproduction and Respiratory health, IAB, Grenoble, France
| | - Jan-Paul Zock
- Institute for Global Health (ISGlobal) and Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, Île-de-France, France
| | - Rachel Nadif
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, Île-de-France, France
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, Île-de-France, France
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21
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Romero Starke K, Friedrich S, Schubert M, Kämpf D, Girbig M, Pretzsch A, Nienhaus A, Seidler A. Are Healthcare Workers at an Increased Risk for Obstructive Respiratory Diseases Due to Cleaning and Disinfection Agents? A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105159. [PMID: 34068014 PMCID: PMC8152277 DOI: 10.3390/ijerph18105159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022]
Abstract
Several reviews have reported an increased risk of obstructive respiratory diseases in workers exposed to cleaning or disinfection agents, but they have focused mainly on professional cleaners. Cleaning and disinfecting are frequently performed activities by healthcare workers. We conducted a systematic review with meta-analysis to quantify the risk of obstructive respiratory diseases in healthcare workers exposed to cleaning and disinfection agents. We searched the Medline and Embase databases until 4 February 2021 to find adequate primary studies. Two independent reviewers screened the titles/abstracts and the full texts of the studies, as well as performing data extraction and quality assessment. The literature search yielded 9432 records, and 8 studies were found through a hand search. After screening, 14 studies were included in the review. All had a high risk of bias, and most studies dealt with nurses, asthma, and hyperresponsiveness (BHR)-related symptoms. Only one study investigated COPD. The meta-analysis estimated an increased risk of new-onset asthma for nurses (Effect size (ES) = 1.67; 95% CI 1.11–2.50) compared with other occupations and found an increase in the risk of new-onset asthma for nurses exposed to cleaning and disinfecting surfaces (ES = 1.43; 95% CI 1.09–1.89) and instruments (ES = 1.34; 95% CI 1.09–1.65). Exposure to specific chemicals such as bleach and glutaraldehyde (GA) increased the risk of asthma in nurses (bleach ES = 2.44; 95% CI 1.56–3.82; GA ES = 1.91, 95% CI 1.35–2.70). A higher risk for BHR-related symptoms was observed for nurses exposed to cleaning surfaces (ES = 1.44; 95% CI 1.18–1.78). Although the overall evidence was rated as low, the limitations found in this review hint at a potential underestimation of the real risk. These findings highlight the need for reinforced prevention practices with regard to healthcare workers. Similar research investigating these associations among other healthcare workers such as rescue service and nursing home personnel is needed.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
- Institute of Sociology, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, Thüringer Weg 9, 09126 Chemnitz, Germany
- Correspondence:
| | - Sophie Friedrich
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
| | - Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
| | - Daniel Kämpf
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
| | - Maria Girbig
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
| | - Anna Pretzsch
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
| | - Albert Nienhaus
- Department of Occupational Medicine, Toxic Substances and Health Research, Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW), 22089 Hamburg, Germany;
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
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22
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Rai R, El‐Zaemey S, Dorji N, Fritschi L. Occupational exposures to hazardous chemicals and agents among healthcare workers in Bhutan. Am J Ind Med 2020; 63:1109-1115. [PMID: 33047357 DOI: 10.1002/ajim.23192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Occupational exposures to hazardous chemicals among healthcare workers can result in long-term adverse health outcomes. Research on such exposures from low- and middle-income countries is limited. The aim of this study was to estimate the prevalence of exposures to a range of chemicals used in healthcare settings among Bhutanese healthcare workers. METHODS A cross-sectional study was conducted among healthcare workers (n = 370) working in three hospitals in the western region of Bhutan. Demographic and occupational information was collected, and exposures to asthmagens, carcinogens, ototoxic and other agents were assessed using a web-based tool. The prevalence of exposure to these chemicals was calculated and the circumstances resulting in such exposures were examined. RESULTS The prevalence of exposure to one or more asthmagen, carcinogen, and ototoxic agent was 98.7%, 28.1%, and 7.6%, respectively; and was 6.2% for anesthetic gases and 2.2% for antineoplastic drugs. The most common exposures were to latex, and cleaning and disinfecting agents in the asthmagens group; formaldehyde in the carcinogens group; and p-xylene among ototoxic agents. The circumstances resulting in exposures were using latex gloves, using bleach and chlorhexidine for cleaning, using formaldehyde as a disinfectant and in the laboratory, and using p-xylene in the laboratory. CONCLUSIONS The results indicate that a large proportion of Bhutanese healthcare workers are occupationally exposed to chemicals linked to chronic diseases, with exposure prevalence higher than in high-income countries. The study provides information that can be used to formulate policies and to implement control measures to protect healthcare workers.
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Affiliation(s)
- Rajni Rai
- School of Public Health Curtin University Bentley Western Australia Australia
| | - Sonia El‐Zaemey
- School of Public Health Curtin University Bentley Western Australia Australia
| | - Nidup Dorji
- Faculty of Nursing and Public Health Khesar Gyalpo University of Medical Sciences of Bhutan Thimphu Bhutan
| | - Lin Fritschi
- School of Public Health Curtin University Bentley Western Australia Australia
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23
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Virji MA, Liang X, Su FC, LeBouf RF, Stefaniak AB, Stanton ML, Henneberger PK, Houseman EA. Peaks, Means, and Determinants of Real-Time TVOC Exposures Associated with Cleaning and Disinfecting Tasks in Healthcare Settings. Ann Work Expo Health 2020; 63:759-772. [PMID: 31161189 DOI: 10.1093/annweh/wxz043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 04/27/2019] [Accepted: 05/08/2019] [Indexed: 11/14/2022] Open
Abstract
Cleaning and disinfecting tasks and product use are associated with elevated prevalence of asthma and respiratory symptoms among healthcare workers; however, the levels of exposure that pose a health risk remain unclear. The objective of this study was to estimate the peak, average, and determinants of real-time total volatile organic compound (TVOC) exposure associated with cleaning tasks and product-use. TVOC exposures were measured using monitors equipped with a photoionization detector (PID). A simple correction factor was applied to the real-time measurements, calculated as a ratio of the full-shift average TVOC concentrations from a time-integrated canister and the PID sample, for each sample pair. During sampling, auxiliary information, e.g. tasks, products used, engineering controls, was recorded on standardized data collection forms at 5-min intervals. Five-minute averaged air measurements (n = 10 276) from 129 time-series comprising 92 workers and four hospitals were used to model the determinants of exposures. The statistical model simultaneously accounted for censored data and non-stationary autocorrelation and was fit using Markov-Chain Monte Carlo within a Bayesian context. Log-transformed corrected concentrations (cTVOC) were modeled, with the fixed-effects of tasks and covariates, that were systematically gathered during sampling, and random effect of person-day. The model-predicted geometric mean (GM) cTVOC concentrations ranged from 387 parts per billion (ppb) for the task of using a product containing formaldehyde in laboratories to 2091 ppb for the task of using skin wipes containing quaternary ammonium compounds, with a GM of 925 ppb when no products were used. Peak exposures quantified as the 95th percentile of 15-min averages for these tasks ranged from 3172 to 17 360 ppb. Peak and GM task exposures varied by occupation and hospital unit. In the multiple regression model, use of sprays was associated with increasing exposures, while presence of local exhaust ventilation, large room volume, and automatic sterilizer use were associated with decreasing exposures. A detailed understanding of factors affecting TVOC exposure can inform targeted interventions to reduce exposures and can be used in epidemiologic studies as metrics of short-duration peak exposures.
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Affiliation(s)
- M Abbas Virji
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Respiratory Health Division, Morgantown, WV, USA
| | - Xiaoming Liang
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Respiratory Health Division, Morgantown, WV, USA
| | - Feng-Chiao Su
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Respiratory Health Division, Morgantown, WV, USA
| | - Ryan F LeBouf
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Respiratory Health Division, Morgantown, WV, USA
| | - Aleksandr B Stefaniak
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Respiratory Health Division, Morgantown, WV, USA
| | - Marcia L Stanton
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Respiratory Health Division, Morgantown, WV, USA
| | - Paul K Henneberger
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Respiratory Health Division, Morgantown, WV, USA
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24
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Arnold S, Ramachandran G, Kaup H, Servadio J. Estimating the time-varying generation rate of acetic acid from an all-purpose floor cleaner. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2020; 30:374-382. [PMID: 31089245 PMCID: PMC8075870 DOI: 10.1038/s41370-019-0142-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/27/2019] [Accepted: 03/14/2019] [Indexed: 06/09/2023]
Abstract
Understanding the relationship between consumer product use and risk of adverse health outcomes facilitates appropriate risk management and product stewardship. A preferred method for estimating the systemic and respiratory tract exposure and dose tailored to cleaning products use has been proposed, refining previously issued exposure guidance. Consistent with other exposure and risk-assessment frameworks, it is dependent upon high-quality exposure determinant data that also serve as model inputs. However, as publicly available exposure determinant data are scarce, the risk assessor is left with the option of estimating determinants such as the generation rate or employing empirical methods to estimate them. When the exposure scenario involves a chemical mixture, estimating the generation rate may not be feasible. We present an approach for estimating the time-varying generation rate of an aqueous acetic acid mixture representative of the base formulation for many consumer and DIY cleaning products that was previously assessed in a screening-level assessment. The approach involved measuring the evaporation rate for a reasonable worst-case scenario under controlled conditions. Knowing the mass applied, a time-varying generation rate was estimated. To evaluate its portability, a field study was conducted in a home where measurements were collected in an all-purpose room with the exterior door open (Room 1) and closed (Room 2), and a bathroom (Room 3) using a portable Fourier Transform Infrared (FTIR) spectrophotometer. Acetic acid concentrations were modeled using two common indoor air models, the Well Mixed Room model. Measured and modeled acetic acid concentrations were compared, with the WMR 95% confidence intervals encompassing measured concentrations for all three rooms, supporting the utility of the approach used and portability of the generation rate derived from it.
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Affiliation(s)
- Susan Arnold
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, MMC 807, Room 1239, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Gurumurthy Ramachandran
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Hannah Kaup
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, MMC 807, Room 1239, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Joseph Servadio
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, MMC 807, Room 1239, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
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25
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LaKind JS, Goodman M. Methodological evaluation of human research on asthmagenicity and occupational cleaning: a case study of quaternary ammonium compounds ("quats"). Allergy Asthma Clin Immunol 2019; 15:69. [PMID: 31832071 PMCID: PMC6873500 DOI: 10.1186/s13223-019-0384-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/05/2019] [Indexed: 02/07/2023] Open
Abstract
In this paper, we review methodological approaches used in studies that evaluated the association between occupational exposure to quaternary ammonium compounds (quats) and occupational asthma. This association is of interest because quats are a common active ingredient of disinfectants and have been linked to work-related asthma in some circumstances. However, any evidence-based assessment of an exposure-outcome association needs to consider both strengths and limitations of the literature. We focus on publications cited by various US and international organizations. Eighteen investigations included in the review fall into two broad categories: case reports and challenge studies of individual patients and population studies that examined the association between quats and asthma occurrence in groups of subjects. We evaluated these studies guided by questions that address whether: exposure data on specific quat(s) and other agents that may cause asthma were included, new asthma cases were differentiated from asthma exacerbation, and information on respiratory sensitivity versus irritation was given. We also assessed consistency across studies. Studies of individual patients, particularly those that provided detailed information on challenge test results, document cases of asthma induced by exposure to quats. By contrast, studies of occupational groups with the highest potential for quats exposure (e.g., cleaners and farmers) do not consistently report increased incidence of asthma due specifically to quats. The unresolved methodological issues include: poor understanding of exposure pathways considering that quats are non-volatile, lack of quantitative data allowing for identification of an asthmagenicity threshold, insufficient information on whether quats are sensitizers or act via dose-dependent irritation or some other mechanism, and inability to quantify risk of new-onset asthma attributable to quats. Another important area of uncertainty is the lack of information on the specific quats being used. There is also a lack of data capable of distinguishing the effects of quats from those of other chemical and biological workplace exposures. The current state-of-the-science does not allow a proper assessment of the potential link between quats and occupational asthma.
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Affiliation(s)
- Judy S LaKind
- LaKind Associates, LLC, 106 Oakdale Avenue, Catonsville, MD 21228 USA.,2University of Maryland School of Medicine, Baltimore, MD USA
| | - Michael Goodman
- 3Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
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26
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Ruokolainen J, Hyttinen M. Cleaning workers' exposure to volatile organic compounds and particulate matter during floor polish removal and reapplication. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2019; 16:685-693. [PMID: 31389760 DOI: 10.1080/15459624.2019.1646915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The floor polish removal (FPR) and reapplication (FPA) are important cleaning tasks in public buildings that have hard floor surfaces. Usually, the FPR and FPA are conducted once or twice a year, during the periodic cleaning of these buildings. The FPR can be performed either chemically (CFPR) or by using dry scrubber (DFPR), when the polish is ground from the floor. In this study, cleaning workers' exposure to volatile organic compounds (VOCs) and particulate matter (PM) during the FPR and FPA, and the differences in the exposures between the two FPR methods were investigated. In total, three buildings located in Central Finland were included, and total of six cleaning workers (two per building) participated in the study. In Buildings 1 and 2, the CFPR and FPA were performed and in Building 3, the DFPR was conducted. TVOC (total volatile organic compounds) concentrations in the breathing zone of the workers during the CFPR were 8,740 and 390 µg/m3 (SD 3,290 and 180 µg/m3) for Buildings 1 and 2, respectively. During the DFPR in Building 3, the average TVOC concentration was 400 µg/m3 (SD 180 µg/m3, stationary sampling). The TVOC concentrations during the FPA were high, 1,640 and 2,170 µg/m3 on average (SD 1,570 and 930 µg/m3) for Buildings 1 and 2, respectively. Glycol ethers were the most prominent VOCs during the CFPR and FPA, whereas carboxylic acids were the most common during the DFPR. The inhalable dust concentrations in the workers' breathing zone were noticeably higher during the DFPR (1.55 mg/m3 on average, SD 0.01 mg/m3) than the CFPR (0.24 mg/m3 on average, SD 0.05 mg/m3). Finnish occupational exposure limit value for organic inhalable dust is 5 mg/m3. As the products used during the CFPR and FPA contain glycol ethers and ethanolamines that are absorbed via the skin as well, the use of skin protection is recommended. Whereas the use of FFP3 respirators and skin protection are recommended during the DFPR to prevent the PM exposure.
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Affiliation(s)
- Joonas Ruokolainen
- Department of Environmental and Biological Sciences, University of Eastern Finland , Kuopio , Finland
| | - Marko Hyttinen
- Department of Environmental and Biological Sciences, University of Eastern Finland , Kuopio , Finland
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27
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Su FC, Friesen MC, Stefaniak AB, Henneberger PK, LeBouf RF, Stanton ML, Liang X, Humann M, Virji MA. Exposures to Volatile Organic Compounds among Healthcare Workers: Modeling the Effects of Cleaning Tasks and Product Use. Ann Work Expo Health 2019; 62:852-870. [PMID: 29931140 DOI: 10.1093/annweh/wxy055] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/30/2018] [Indexed: 11/12/2022] Open
Abstract
Objectives Use of cleaning and disinfecting products is associated with work-related asthma among healthcare workers, but the specific levels and factors that affect exposures remain unclear. The objective of this study was to evaluate the determinants of selected volatile organic compound (VOC) exposures in healthcare settings. Methods Personal and mobile-area air measurements (n = 143) from 100 healthcare workers at four hospitals were used to model the determinants of ethanol, acetone, 2-propanol, d-limonene, α-pinene, and chloroform exposures. Hierarchical cluster analysis was conducted to partition workers into groups with similar cleaning task/product-use profiles. Linear mixed-effect regression models using log-transformed VOC measurements were applied to evaluate the association of individual VOCs with clusters of task/product use, industrial hygienists' grouping (IH) of tasks, grouping of product application, chemical ingredients of the cleaning products used, amount of product use, and ventilation. Results Cluster analysis identified eight task/product-use clusters that were distributed across multiple occupations and hospital units, with the exception of clusters consisting of housekeepers and floor strippers/waxers. Results of the mixed-effect models showed significant associations between selected VOC exposures and several clusters, combinations of IH-generated task groups and chemical ingredients, and product application groups. The patient/personal cleaning task using products containing chlorine was associated with elevated levels of personal chloroform and α-pinene exposures. Tasks associated with instrument sterilizing and disinfecting were significantly associated with personal d-limonene and 2-propanol exposures. Surface and floor cleaning and stripping tasks were predominated by housekeepers and floor strippers/waxers, and use of chlorine-, alcohol-, ethanolamine-, and quaternary ammonium compounds-based products was associated with exposures to chloroform, α-pinene, acetone, 2-propanol, or d-limonene. Conclusions Healthcare workers are exposed to a variety of chemicals that vary with tasks and ingredients of products used during cleaning and disinfecting. The combination of product ingredients with cleaning and disinfecting tasks were associated with specific VOCs. Exposure modules for questionnaires used in epidemiologic studies might benefit from seeking information on products used within a task context.
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Affiliation(s)
- Feng-Chiao Su
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
| | - Melissa C Friesen
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Aleksandr B Stefaniak
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
| | - Paul K Henneberger
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
| | - Ryan F LeBouf
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
| | - Marcia L Stanton
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
| | - Xiaoming Liang
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
| | - Michael Humann
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
| | - M Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
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28
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Jiang Z, Wang J, Guo X, Feng L, Yu M, Zhou J, Ye Y, Mei L, Ju L, Yu D, Shi L, Lu Alex C, Yu W, Lou J. Menstrual disorders and occupational exposures among female nurses: A nationwide cross-sectional study. Int J Nurs Stud 2019; 95:49-55. [PMID: 31059897 DOI: 10.1016/j.ijnurstu.2019.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 04/04/2019] [Accepted: 04/15/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND The regularity of menstrual cycles is one of the important indicators of female reproductive health. However, the current evidence on the association of occupational exposures and menstrual disorders is scarce. OBJECTIVES This study aims to elucidate the relationship between occupational hazards and menstrual characteristics in female nurses and non-nurse health care workers in China. DESIGN We conducted a national cross-sectional study on the reproductive health of female nurses in China. SETTINGS A total of 1, 300 medical institutions in 15 provincial administrative regions in China participated in the study. PARTICIPANTS There were 8, 904 nurses and 3, 977 non-nurse health care workers who were selected using simple random sampling method. METHODS All participants were administered a face-to-face standardized questionnaire, including personal socio-demographic information, occupational activities, and self-reported menstrual characteristics. Univariate and multivariate logistic regressions were used for statistical analyses. RESULTS The results demonstrated that 41% of nurses experienced menstrual disorders. We found handling disinfectants was the most significant risk factor for menstrual disorders (OR = 1.53, 95% CI: 1.39-1.68), followed by abnormal workload (OR = 1.28, 95% CI: 1.19-1.39), and occupation as a nurse (OR = 1.28, 95% CI: 1.18-1.40). Noise, prolonged standing or frequent heavy lifting, night work, anti-cancer drug exposure, and overtime work were moderately associated with the occurrence of menstrual disorder (OR > 1). CONCLUSIONS This national-wide cross-sectional study has revealed the significant association between menstrual disorders and occupational hazards among female nurses in China.
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Affiliation(s)
- Zhaoqiang Jiang
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, China.
| | - Jing Wang
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, China.
| | - Xinnian Guo
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, China
| | - Lingfang Feng
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, China
| | - Min Yu
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, China
| | - Jianhong Zhou
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, 1 Xueshi Road, Hangzhou, 310006, China.
| | - Yan Ye
- Department of Occupational Health, Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Liangying Mei
- Hubei Provincial Center for Disease Control and Prevention, Wu Han, China
| | - Li Ju
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, China
| | - Dandan Yu
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, China
| | - Li Shi
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, China
| | - Chensheng Lu Alex
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA 02115, USA
| | - Wenlan Yu
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, 29 South Latitude Road, Xicheng District, Beijing, 100050, China.
| | - Jianlin Lou
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, China.
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29
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Holm SM, Leonard V, Durrani T, Miller MD. Do we know how best to disinfect child care sites in the United States? A review of available disinfectant efficacy data and health risks of the major disinfectant classes. Am J Infect Control 2019; 47:82-91. [PMID: 30172610 DOI: 10.1016/j.ajic.2018.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/24/2018] [Accepted: 06/25/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Children in child care settings have a high infectious burden. They are frequently exposed to sanitizing and disinfecting agents, whose toxicities have not been studied in these settings. Current guidance on the preferred disinfection agents for child care is vague. METHODS This article combines 2 different sources of information: the Environmental Protection Agency registration data on the efficacy of hospital-grade disinfectants and a review of the research on the toxicities of the most common of these disinfectants to summarize information that could be used for more evidence-based early care and education disinfection regulations and guidelines. RESULTS Coverage of these organisms varied both between disinfectant classes (defined by active ingredient), as well as within classes. The 3 most common active ingredients in the database-quaternary ammonias, bleaches, and hydrogen peroxides-had 251, 63, and 31 products, respectively. Quaternary ammonias and bleaches are both known asthmagens, with the potential for toxic gas release when mixed. Quaternary ammonias may also cause reproductive toxicity. Disinfectant-grade peroxides have relatively low inhalational toxicity. CONCLUSIONS A clear rationale is needed to establish policies for determining preferable disinfection products for use in child care settings, based on efficacy against relevant pathogens, toxicity, ease of use, and cost. When other factors are equal, the use of peroxide-based disinfectant products is recommended to minimize inhalational toxicity.
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Caridi MN, Humann MJ, Liang X, Su FC, Stefaniak AB, LeBouf RF, Stanton ML, Virji MA, Henneberger PK. Occupation and task as risk factors for asthma-related outcomes among healthcare workers in New York City. Int J Hyg Environ Health 2018; 222:211-220. [PMID: 30327176 DOI: 10.1016/j.ijheh.2018.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/23/2018] [Accepted: 10/04/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous studies have suggested an association of asthma onset and exacerbation with cleaning and disinfecting activities in a number of industries, including healthcare. The objective of the current study was to investigate the association of asthma and related outcomes with occupations and tasks in urban healthcare workers in the United States. METHODS A questionnaire was implemented in a sample of workers from nine healthcare occupations in New York City. We used regression models to examine the association of post-hire asthma, current asthma, exacerbation of asthma, a symptom algorithm for bronchial hyper-responsiveness (BHR-related symptoms), a symptom-based asthma score, and the symptom wheeze with occupation and four healthcare tasks, while adjusting for other risk factors and potential confounders. RESULTS A total of 2030 participants completed the questionnaire. The task of cleaning fixed surfaces was significantly associated with most outcome variables, including current asthma (odds ratio (OR) = 1.84, 95% confidence interval (CI) 1.26-2.68), moderate exacerbation (OR = 3.10, 95% CI 1.25-7.67), and BHR-related symptoms (OR = 1.38, 95% CI 1.08-1.77). In comparison to nursing assistants, the occupations environmental service workers and registered nurses were at higher risk for current asthma, and licensed practical nurses were at higher risk for moderate exacerbation. Other tasks associated with outcomes were administering aerosolized medications with current asthma and moderate exacerbation, and sterilizing medical equipment with BHR-related symptoms. CONCLUSIONS These findings add to the growing body of evidence for the association of asthma with cleaning and other activities in healthcare. Further research is especially needed to investigate the association of asthma-related outcomes with exposure metrics based on tasks, products, and chemical exposures in healthcare.
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Affiliation(s)
- Morgan N Caridi
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, United States
| | - Michael J Humann
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, United States
| | - Xiaoming Liang
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, United States
| | - Feng-Chiao Su
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, United States
| | - Aleksandr B Stefaniak
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, United States
| | - Ryan F LeBouf
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, United States
| | - Marcia L Stanton
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, United States
| | - M Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, United States
| | - Paul K Henneberger
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, United States.
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Houseman EA, Virji MA. A Bayesian Approach for Summarizing and Modeling Time-Series Exposure Data with Left Censoring. Ann Work Expo Health 2018; 61:773-783. [PMID: 28810680 DOI: 10.1093/annweh/wxx046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective Direct reading instruments are valuable tools for measuring exposure as they provide real-time measurements for rapid decision making. However, their use is limited to general survey applications in part due to issues related to their performance. Moreover, statistical analysis of real-time data is complicated by autocorrelation among successive measurements, non-stationary time series, and the presence of left-censoring due to limit-of-detection (LOD). A Bayesian framework is proposed that accounts for non-stationary autocorrelation and LOD issues in exposure time-series data in order to model workplace factors that affect exposure and estimate summary statistics for tasks or other covariates of interest. Method A spline-based approach is used to model non-stationary autocorrelation with relatively few assumptions about autocorrelation structure. Left-censoring is addressed by integrating over the left tail of the distribution. The model is fit using Markov-Chain Monte Carlo within a Bayesian paradigm. The method can flexibly account for hierarchical relationships, random effects and fixed effects of covariates. The method is implemented using the rjags package in R, and is illustrated by applying it to real-time exposure data. Estimates for task means and covariates from the Bayesian model are compared to those from conventional frequentist models including linear regression, mixed-effects, and time-series models with different autocorrelation structures. Simulations studies are also conducted to evaluate method performance. Results Simulation studies with percent of measurements below the LOD ranging from 0 to 50% showed lowest root mean squared errors for task means and the least biased standard deviations from the Bayesian model compared to the frequentist models across all levels of LOD. In the application, task means from the Bayesian model were similar to means from the frequentist models, while the standard deviations were different. Parameter estimates for covariates were significant in some frequentist models, but in the Bayesian model their credible intervals contained zero; such discrepancies were observed in multiple datasets. Variance components from the Bayesian model reflected substantial autocorrelation, consistent with the frequentist models, except for the auto-regressive moving average model. Plots of means from the Bayesian model showed good fit to the observed data. Conclusion The proposed Bayesian model provides an approach for modeling non-stationary autocorrelation in a hierarchical modeling framework to estimate task means, standard deviations, quantiles, and parameter estimates for covariates that are less biased and have better performance characteristics than some of the contemporary methods.
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Affiliation(s)
- E Andres Houseman
- Oregon State University, College of Public Health and Human Sciences, 101 Milam Hall, 2520 SW Campus Way, Corvallis, OR 97331, USA
| | - M Abbas Virji
- National Institute for Occupational Safety and Health, Respiratory Health Division, 1095 Willowdale Rd, Morgantown, WV 26505, USA
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Shane HL, Lukomska E, Stefaniak AB, Anderson SE. Divergent hypersensitivity responses following topical application of the quaternary ammonium compound, didecyldimethylammonium bromide. J Immunotoxicol 2018; 14:204-214. [PMID: 29124973 PMCID: PMC6391722 DOI: 10.1080/1547691x.2017.1397826] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Didecyldimethylammonium bromide (DDAB) is a fourth generation dialkyl-quaternary ammonium compound (QAC) that is used in numerous products for its antimicrobial properties. While many QACs have been associated with allergic disease, the toxicity and sensitization of DDAB have not been thoroughly investigated. The purpose of these studies was to evaluate the irritancy and sensitization potential of DDAB following dermal application in a murine model. DDAB induced significant irritancy (0.0625-2%), evaluated by ear swelling in female BALB/c mice. Initial evaluation of the sensitization potential was conducted using the local lymph node assay (LLNA) at concentrations ranging from 0.0625% to 2%. A concentration-dependent increase in lymphocyte proliferation was observed with a calculated EC3 value of 0.057%. Immune cell phenotyping along with local and systemic IgE levels were evaluated following 4 and 14 days of dermal application. Phenotypic analyses revealed significant and dose-responsive increases in the absolute number of B-cells, CD4+ T-cells, CD8+ T-cells, and dendritic cells in the draining lymph nodes (DLNs) following 4 and 14 days of dermal exposure with significant increases in the number of activated B-cells and dendritic cells. However, increased activation of CD4+ T-cell and CD8+ T-cells was only observed following four days of DDAB exposure. Exposure to DDAB also induced increased production of IgE as evaluated by phenotypic analysis of DLN B-cells (IgE+ B-cells) and measurement of total serum IgE levels following 14 days but not four days of dermal application. Significant increases in gene expression were observed in the DLN (Il-4, Il-10, and ox40l) and ear (tslp) following 4 and 14 days of DDAB exposure. These results demonstrate the potential for development of irritation and hypersensitivity responses to DDAB following dermal exposure and raise concerns about the effects of exposure duration on hypersensitivity responses.
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Affiliation(s)
- Hillary L Shane
- a Health Effects Laboratory Division , National Institute for Occupational Safety and Health , Morgantown , WV , USA
| | - Ewa Lukomska
- a Health Effects Laboratory Division , National Institute for Occupational Safety and Health , Morgantown , WV , USA
| | - Aleksandr B Stefaniak
- b Respiratory Health Division , National Institute for Occupational Safety and Health , Morgantown , WV , USA
| | - Stacey E Anderson
- a Health Effects Laboratory Division , National Institute for Occupational Safety and Health , Morgantown , WV , USA
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Quinot C, Amsellem-Dubourget S, Temam S, Sevin E, Barreto C, Tackin A, Félicité J, Lyon-Caen S, Siroux V, Girard R, Descatha A, Le Moual N, Dumas O. Development of a bar code-based exposure assessment method to evaluate occupational exposure to disinfectants and cleaning products: a pilot study. Occup Environ Med 2018; 75:668-674. [PMID: 29760172 DOI: 10.1136/oemed-2017-104793] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/27/2018] [Accepted: 04/21/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Healthcare workers are highly exposed to various types of disinfectants and cleaning products. Assessment of exposure to these products remains a challenge. We aimed to investigate the feasibility of a method, based on a smartphone application and bar codes, to improve occupational exposure assessment among hospital/cleaning workers in epidemiological studies. METHODS A database of disinfectants and cleaning products used in French hospitals, including their names, bar codes and composition, was developed using several sources: ProdHyBase (a database of disinfectants managed by hospital hygiene experts), and specific regulatory agencies and industrial websites. A smartphone application has been created to scan bar codes of products and fill a short questionnaire. The application was tested in a French hospital. The ease of use and the ability to record information through this new approach were estimated. RESULTS The method was tested in a French hospital (7 units, 14 participants). Through the application, 126 records (one record referred to one product entered by one participant/unit) were registered, majority of which were liquids (55.5%) or sprays (23.8%); 20.6% were used to clean surfaces and 15.9% to clean toilets. Workers used mostly products with alcohol and quaternary ammonium compounds (>90% with weekly use), followed by hypochlorite bleach and hydrogen peroxide (28.6%). For most records, information was available on the name (93.7%) and bar code (77.0%). Information on product compounds was available for all products and recorded in the database. CONCLUSION This innovative and easy-to-use method could help to improve the assessment of occupational exposure to disinfectants/cleaning products in epidemiological studies.
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Affiliation(s)
- Catherine Quinot
- INSERM, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, U1168, F-94807, Villejuif, France.,UVSQ, UMR-S 1168, University Versailles St-Quentin-en-Yvelines, F-78180, Montigny le Bretonneux, France
| | | | - Sofia Temam
- INSERM, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, U1168, F-94807, Villejuif, France.,UVSQ, UMR-S 1168, University Versailles St-Quentin-en-Yvelines, F-78180, Montigny le Bretonneux, France.,Faculty of Medicine, University Paris-Sud, Le Kremlin-Bicêtre, France
| | | | - Christine Barreto
- ProdHyBase, CClin Sud-Est, Saint-Genis-Laval, France.,ProdHyBase, Unit of Hygiene and Epidemiology, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Arzu Tackin
- AP-HP UVSQ, Equipe opérationnelle d'hygiène hospitalière, University Hospital of Poincaré, Garches, France
| | | | - Sarah Lyon-Caen
- INSERM, CNRS, Université Grenoble Alpes, U1209, Institute for Advanced Biosciences (IAB), Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Grenoble (La Tronche), France
| | - Valérie Siroux
- INSERM, CNRS, Université Grenoble Alpes, U1209, Institute for Advanced Biosciences (IAB), Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Grenoble (La Tronche), France
| | - Raphaële Girard
- ProdHyBase, Unit of Hygiene and Epidemiology, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Alexis Descatha
- INSERM, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, U1168, F-94807, Villejuif, France.,UVSQ, UMR-S 1168, University Versailles St-Quentin-en-Yvelines, F-78180, Montigny le Bretonneux, France.,AP-HP UVSQ, Occupational Health Unit/Population-Based Epidemiological Cohorts Unit, UMS 011, University Hospital of Poincaré, Garches, France
| | - Nicole Le Moual
- INSERM, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, U1168, F-94807, Villejuif, France.,UVSQ, UMR-S 1168, University Versailles St-Quentin-en-Yvelines, F-78180, Montigny le Bretonneux, France
| | - Orianne Dumas
- INSERM, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, U1168, F-94807, Villejuif, France.,UVSQ, UMR-S 1168, University Versailles St-Quentin-en-Yvelines, F-78180, Montigny le Bretonneux, France
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Heederik D. Occupational exposure and asthma control. Eur Respir J 2017; 50:50/4/1701951. [PMID: 29074549 DOI: 10.1183/13993003.01951-2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Dick Heederik
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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Abstract
PURPOSE OF REVIEW Asthma due to cleaning products has been known for 20 years, and the interest in this topic is still large because of the number of cleaning workers with respiratory problems. In this review, we sought to highlight the most recent findings on the relationship between exposure to cleaning products and asthma and to summarize the specific literature published between 2013 and 2016. RECENT FINDINGS Women are confirmed as most of workers exposed to cleaning products and have a higher frequency than men of work-related respiratory symptoms and diseases. Many cases of asthma due to cleaning products occur in healthcare occupations. The increased risk of asthma has been shown to be related to the number of years in the job and to early life disadvantage. Recent evidence suggests that predisposition to adult-onset asthma may be related to interaction between genes and occupational exposure to low-molecular weight agents/irritants. There is some evidence that an irritant mechanism is more common, although several case reports showed animmunologic mechanism (e.g. disinfectants, amine compounds, aldehydes and fragrances). SUMMARY The review updated recent findings on epidemiology, cleaning agents and their mechanism, and prevention of asthma due to cleaning agents. This article provides new information on the level of exposure, which is still high in professional cleaners and even more in domestic cleaners, and on the frequency of asthma in professional and domestic cleaners. An irritant mechanism is more common, although an immunological mechanism is possible, especially in healthcare workers exposed to disinfectants.
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Kurth L, Virji MA, Storey E, Framberg S, Kallio C, Fink J, Laney AS. Current asthma and asthma-like symptoms among workers at a Veterans Administration Medical Center. Int J Hyg Environ Health 2017; 220:1325-1332. [PMID: 28923472 DOI: 10.1016/j.ijheh.2017.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Healthcare workers are at increased risk for respiratory disorders. The purpose of our respiratory health survey was to estimate the prevalence of current asthma and asthma-like symptoms and their association with workplace exposures and tasks among healthcare workers at a Veterans Administration (VA) Medical Center. MATERIAL AND METHODS Information on respiratory health and work characteristics, including tasks performed, products used, and exposures, were collected by questionnaire from a convenience sample of workers employed at the VA Medical Center during 2012-2014. Associations of asthma and asthma-like symptoms with cleaning and disinfecting tasks and products as well as exposure to dampness and molds, and construction dust were evaluated using log-binomial regression. RESULTS The prevalence of current asthma was 17.6% and almost half of all workers reported asthma-like symptoms. We observed elevated prevalence of current asthma among the VA healthcare workers compared to the U.S. general and working adult populations. Asthma and asthma-like symptoms were significantly associated with mold, dampness, and construction material exposures; cleaning and disinfecting products; and cleaning or disinfecting tasks. CONCLUSIONS Workplace exposures and tasks associated with current asthma and asthma-like symptoms were identified but further research is needed to investigate the temporal association between workplace exposures and current asthma and asthma-like symptoms.
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Affiliation(s)
- Laura Kurth
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA.
| | - Mohammed Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Eileen Storey
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Susan Framberg
- Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
| | - Christa Kallio
- Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
| | - Jordan Fink
- Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
| | - Anthony Scott Laney
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
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Arnold SF, Shao Y, Ramachandran G. Evaluation of the well mixed room and near-field far-field models in occupational settings. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2017; 14:694-702. [PMID: 28609192 DOI: 10.1080/15459624.2017.1321843] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Drawing appropriate conclusions about a scenario for which the exposure is truly unacceptable drives appropriate exposure and risk management, and protects the health and safety of those individuals. To ensure the vast majority of these decisions are accurate, these decisions must be based upon proven approaches and tools. When these decisions are based solely on professional judgment guided by subjective inputs, however, they are more than likely wrong, and biased, underestimating the true exposure. Models have been shown anecdotally to be useful in accurately predicting exposure but their use in occupational hygiene has been limited. Possible reasons are a general lack of guidance on model selection and use and scant model input data. The lack of systematic evaluation of the models is also an important factor. This research is the second phase of work building upon the robust evaluation of the Well Mixed Room (WMR) and Near Field Far Field (NF-FF) models under controlled conditions in an exposure chamber, [5] in which good concordance between measured and modeled airborne concentrations of three solvents under a range of conditions was observed. In real world environments, the opportunity to control environmental conditions is limited and measuring the model inputs directly can be challenging; in many cases, model inputs must be estimated indirectly without measurement. These circumstances contribute to increased model input uncertainty and consequent uncertainty in the output. Field studies of model performance directly inform us about how well models predict exposures given these practical limitations, and are, therefore, an important component of model evaluation. The evaluation included ten diverse contaminant-exposure scenarios at five workplaces involving six different contaminants. A database of parameter values and measured and modeled exposures was developed and will be useful for modeling similar scenarios in the future.
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Affiliation(s)
- Susan F Arnold
- a Division of Environmental Health Sciences, School of Public Health , University of Minnesota , Minneapolis , Minnesota
| | - Yuan Shao
- a Division of Environmental Health Sciences, School of Public Health , University of Minnesota , Minneapolis , Minnesota
| | - Gurumurthy Ramachandran
- b Department of Environmental Health and Engineering, Bloomberg School of Public Health , Johns Hopkins University , Baltimore , Maryland
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Ioannou S, Andrianou XD, Charisiadis P, Makris KC. Biomarkers of end of shift exposure to disinfection byproducts in nurses. J Environ Sci (China) 2017; 58:217-223. [PMID: 28774612 DOI: 10.1016/j.jes.2017.06.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/24/2017] [Accepted: 06/24/2017] [Indexed: 06/07/2023]
Abstract
Increased disinfectant use commonly takes place in hospitals and other health care settings. A cross-sectional study among active nurses in two Cypriot public hospitals (n=179) was conducted to examine the prevalence of exposure to disinfection byproducts (DBPs), such as trihalomethanes (THMs) using both self-reported information and biomarker measurements. The objectives of this study were to: i) quantify the magnitude and variability of occupational exposure to disinfectants/DBPs in nurses, ii) generate job exposure matrices (JEM) and job task exposure matrices (JTEM) for disinfectants, and iii) assess the major determinants of urinary THMs in nurses. End of shift urinary total THM values showed high variability among the nurses, but did not differ between hospitals. The disinfectant group of alcohols/phenols was used by >98% of nurses, followed by octenidine (82%), iodine and chlorine (39%, each), chlorhexidine (25%), formaldehyde (12%), hydrogen peroxide (11%), and peracetic acid/ammonia/quaternary ammonium compounds (QACs), all being <8% each. Chlorine use during the past 24hr was associated with significantly (p<0.05) lower brominated THMs (BrTHMs) after adjusting for age, gender and BMI, while a positive association was shown for TCM and the sum of all THMs (TTHMs), albeit not significant. Nurses were exposed to nearly double the levels of TTHMs and BrTHMs (median and IQR, 1027 [560, 2475] ng/g and 323 [212, 497] ng/g, respectively) when compared to those of the general population (552 [309,989] ng/g and 152 [87,261] ng/g, respectively). This was the first occupational health dataset reporting measurements of biomarkers of end of shift exposures to disinfectants/DBPs.
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Affiliation(s)
- Solomon Ioannou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3041, Cyprus
| | - Xanthi D Andrianou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3041, Cyprus
| | - Pantelis Charisiadis
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3041, Cyprus
| | - Konstantinos C Makris
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3041, Cyprus.
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Abstract
Healthcare workers (HCWs) are exposed to a range of high and low molecular weight agents that are allergic sensitizers or irritants including cleaners and disinfectants, natural rubber latex, and various medications. Studies have shown that exposed HCWs are at risk for work-related rhinitis and asthma (WRA). Work-related rhinitis may precede development of WRA and should be considered as an early marker of WRA. Avoidance of causative exposures through control strategies such as elimination, substitution, engineering controls, and process modification is the preferred primary prevention strategy for preventing development of work-related allergic diseases. There is limited evidence for the effectiveness of respirators in preventing occupational asthma. If sensitizer-induced WRA is diagnosed, it is important to avoid further exposure to the causative agent, preferably by more rigorous application of exposure control strategies to the workplace. This review focuses on allergic occupational respiratory diseases in HCWs.
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Scott D, Kane H, Rankin A. 'Time to clean': A systematic review and observational study on the time required to clean items of reusable communal patient care equipment. J Infect Prev 2017; 18:289-294. [PMID: 29344098 DOI: 10.1177/1757177417714046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/12/2017] [Indexed: 11/17/2022] Open
Abstract
Background Concerns have been raised over poor standards of hospital cleanliness and insufficient time for staff to clean reusable communal patient care equipment. These items may then act as vectors for the transmission of nosocomial pathogens between hospital patients. Aim To evaluate the impact of cleaning duration on nosocomial infection rates and estimate the time required to clean care equipment in accordance with national specifications (i.e. a 'time to clean'). Methods A systematic review of the published literature on cleaning times and an observational study in which nine healthcare workers cleaned seven items of care equipment while the duration of time taken to clean each item was measured. Results A limited volume of low-quality evidence indicates that increased cleaning times in hospitals can reduce the incidence of healthcare-associated infections (HCAIs). The mean 'time to clean' for care equipment ranged from 166.3 s (95% confidence interval [CI] = 117.8-214.7) for a bed frame to 29.0 s (95% CI = 13.4-44.6) for a blood pressure cuff. Discussion 'Time to clean' estimates for care equipment provide an indication of how much protected time is necessary to ensure acceptable standards of cleanliness. Clinical trials are needed to further evaluate the impact of increased cleaning times on nosocomial infection rates.
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LeBouf RF, Virji MA, Ranpara A, Stefaniak AB. Air and Surface Sampling Method for Assessing Exposures to Quaternary Ammonium Compounds Using Liquid Chromatography Tandem Mass Spectrometry. Ann Work Expo Health 2017; 61:724-736. [PMID: 28927165 PMCID: PMC5826613 DOI: 10.1093/annweh/wxx037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 05/11/2017] [Indexed: 11/13/2022] Open
Abstract
This method was designed for sampling select quaternary ammonium (quat) compounds in air or on surfaces followed by analysis using ultraperformance liquid chromatography tandem mass spectrometry. Target quats were benzethonium chloride, didecyldimethylammonium bromide, benzyldimethyldodecylammonium chloride, benzyldimethyltetradecylammonium chloride, and benzyldimethylhexadecylammonium chloride. For air sampling, polytetrafluoroethylene (PTFE) filters are recommended for 15-min to 24-hour sampling. For surface sampling, Pro-wipe® 880 (PW) media was chosen. Samples were extracted in 60:40 acetonitrile:0.1% formic acid for 1 hour on an orbital shaker. Method detection limits range from 0.3 to 2 ng/ml depending on media and analyte. Matrix effects of media are minimized through the use of multiple reaction monitoring versus selected ion recording. Upper confidence limits on accuracy meet the National Institute for Occupational Safety and Health 25% criterion for PTFE and PW media for all analytes. Using PTFE and PW analyzed with multiple reaction monitoring, the method quantifies levels among the different quats compounds with high precision (<10% relative standard deviation) and low bias (<11%). The method is sensitive enough with very low method detection limits to capture quats on air sampling filters with only a 15-min sample duration with a maximum assessed storage time of 103 days before sample extraction. This method will support future exposure assessment and quantitative epidemiologic studies to explore exposure-response relationships and establish levels of quats exposures associated with adverse health effects.
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Affiliation(s)
- Ryan F. LeBouf
- Field Studies Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, 1095 Willowdale Road, Morgantown, WV 26505, USA
| | - Mohammed Abbas Virji
- Field Studies Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, 1095 Willowdale Road, Morgantown, WV 26505, USA
| | - Anand Ranpara
- Field Studies Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, 1095 Willowdale Road, Morgantown, WV 26505, USA
| | - Aleksandr B. Stefaniak
- Field Studies Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, 1095 Willowdale Road, Morgantown, WV 26505, USA
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Anderson SE, Long C, Dotson GS. OCCUPATIONAL ALLERGY. EUROPEAN MEDICAL JOURNAL 2017; 2:65-71. [PMID: 30976662 PMCID: PMC6454566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
An estimated 11 million workers in the USA are potentially exposed to agents that can become a cause of allergic diseases such as occupational asthma and allergic contact dermatitis, which can adversely affect health and well-being. Hundreds of chemicals (e.g. metals, epoxy and acrylic resins, rubber additives, and chemical intermediates) and proteins (e.g. natural rubber latex, plant proteins, mould, animal dander) present in virtually every industry have been identified as causes of allergic disease. In general, allergens can be classified as low molecular weight (chemical) allergens and high molecular weight (protein) allergens. These agents are capable of inducing immunological responses that are both immunoglobulin E and non-immunoglobulin E-mediated. Interestingly, the same chemical can induce diverse immune responses in different individuals. As new hazards continue to emerge, it is critical to understand the immunological mechanisms of occupational allergic disease. Specific understanding of these mechanisms has direct implications in hazard identification, hazard communication, and risk assessment. Such efforts will ultimately assist in the development of risk management strategies capable of controlling workplace exposures to allergens to prevent the induction of sensitisation in naïve individuals and inhibit elicitation of allergic responses. The purpose of this short review is to give a brief synopsis of the incidence, agents, mechanisms, and research needs related to occupational allergy.
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Affiliation(s)
- Stacey E. Anderson
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Carrie Long
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - G. Scott Dotson
- Education and Information Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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Anderson S, Long C, Dotson GS. Occupational Allergy. EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10311285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
An estimated 11 million workers in the USA are potentially exposed to agents that can become a cause of allergic diseases such as occupational asthma and allergic contact dermatitis, which can adversely affect health and well-being. Hundreds of chemicals (e.g. metals, epoxy and acrylic resins, rubber additives, and chemical intermediates) and proteins (e.g. natural rubber latex, plant proteins, mould, animal dander) present in virtually every industry have been identified as causes of allergic disease. In general, allergens can be classified as low molecular weight (chemical) allergens and high molecular weight (protein) allergens. These agents are capable of inducing immunological responses that are both immunoglobulin E and non-immunoglobulin E-mediated. Interestingly, the same chemical can induce diverse immune responses in different individuals. As new hazards continue to emerge, it is critical to understand the immunological mechanisms of occupational allergic disease. Specific understanding of these mechanisms has direct implications in hazard identification, hazard communication, and risk assessment. Such efforts will ultimately assist in the development of risk management strategies capable of controlling workplace exposures to allergens to prevent the induction of sensitisation in naïve individuals and inhibit elicitation of allergic responses. The purpose of this short review is to give a brief synopsis of the incidence, agents, mechanisms, and research needs related to occupational allergy.
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Affiliation(s)
- Stacey Anderson
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Carrie Long
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - G. Scott Dotson
- Education and Information Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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Dumas O, Wiley AS, Henneberger PK, Speizer FE, Zock JP, Varraso R, Le Moual N, Boggs KM, Camargo CA. Determinants of disinfectant use among nurses in U.S. healthcare facilities. Am J Ind Med 2017; 60:131-140. [PMID: 27862135 DOI: 10.1002/ajim.22671] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Disinfectant use among healthcare workers has been associated with respiratory disorders, especially asthma. We aimed to describe disinfectants used by U.S. nurses, and to investigate qualitative and quantitative differences according to workplace characteristics and region. METHODS Disinfectant use was assessed by questionnaire in 8,851 nurses. Hospital characteristics were obtained from the American Hospital Association database. RESULTS Working in a hospital was associated with higher disinfectant use (OR: 2.06 [95%CI: 1.89-2.24]), but lower spray use (0.74 [0.66-0.82]). Nurses working in smaller hospitals (<50 beds vs. ≥200 beds) were more likely to use disinfectants (1.69 [1.23-2.32]) and sprays (1.69 [1.20-2.38]). Spray use was lower in the West than in the Northeast (0.75 [0.58-0.97]). CONCLUSION Disinfectant use was more common among nurses working in smaller hospitals, possibly because they perform more diverse tasks. Variations in spray use by hospital size and region suggest additional targets for future efforts to prevent occupational asthma. Am. J. Ind. Med. 60:131-140, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Orianne Dumas
- INSERM, VIMA: Aging and Chronic Diseases; Epidemiological and Public Health Approaches; Villejuif France
- Univ Versailles St-Quentin-en-Yvelines; Montigny le Bretonneux France
| | - Aleta S. Wiley
- Channing Division of Network Medicine; Department of Medicine; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| | - Paul K. Henneberger
- Respiratory Health Division National Institute for Occupational Safety and Health; Morgantown West Virginia
| | - Frank E. Speizer
- Channing Division of Network Medicine; Department of Medicine; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| | - Jan-Paul Zock
- ISGlobal; Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
- Universitat Pompeu Fabra (UPF); Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); Madrid Spain
| | - Raphaëlle Varraso
- INSERM, VIMA: Aging and Chronic Diseases; Epidemiological and Public Health Approaches; Villejuif France
- Univ Versailles St-Quentin-en-Yvelines; Montigny le Bretonneux France
| | - Nicole Le Moual
- INSERM, VIMA: Aging and Chronic Diseases; Epidemiological and Public Health Approaches; Villejuif France
- Univ Versailles St-Quentin-en-Yvelines; Montigny le Bretonneux France
| | - Krislyn M. Boggs
- Channing Division of Network Medicine; Department of Medicine; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| | - Carlos A. Camargo
- Channing Division of Network Medicine; Department of Medicine; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
- Department of Emergency Medicine; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
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45
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Weber DJ, Rutala WA. Response to letter to the editor regarding "Occupational health risks associated with the use of germicides in health care". Am J Infect Control 2017; 45:97-98. [PMID: 27856071 DOI: 10.1016/j.ajic.2016.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 09/24/2016] [Indexed: 11/29/2022]
Affiliation(s)
- David J Weber
- Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - William A Rutala
- Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC
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46
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Pechter E, Rosenman KD. Occupational health risks associated with use of environmental surface disinfectants in health care. Am J Infect Control 2016; 44:1755-1756. [PMID: 27776821 DOI: 10.1016/j.ajic.2016.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 11/26/2022]
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Quinot C, Dumas O, Henneberger PK, Varraso R, Wiley AS, Speizer FE, Goldberg M, Zock JP, Camargo CA, Le Moual N. Development of a job-task-exposure matrix to assess occupational exposure to disinfectants among US nurses. Occup Environ Med 2016; 74:130-137. [PMID: 27566782 DOI: 10.1136/oemed-2016-103606] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 06/29/2016] [Accepted: 08/02/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Occupational exposure to disinfectants is associated with work-related asthma, especially in healthcare workers. However, little is known about the specific products involved. To evaluate disinfectant exposures, we designed job-exposure (JEM) and job-task-exposure (JTEM) matrices, which are thought to be less prone to differential misclassification bias than self-reported exposure. We then compared the three assessment methods: self-reported exposure, JEM and JTEM. METHODS Disinfectant use was assessed by an occupational questionnaire in 9073 US female registered nurses without asthma, aged 49-68 years, drawn from the Nurses' Health Study II. A JEM was created based on self-reported frequency of use (1-3, 4-7 days/week) of 7 disinfectants and sprays in 8 nursing jobs. We then created a JTEM combining jobs and disinfection tasks to further reduce misclassification. Exposure was evaluated in 3 classes (low, medium, high) using product-specific cut-offs (eg, <30%, 30-49.9%, ≥50%, respectively, for alcohol); the cut-offs were defined from the distribution of self-reported exposure per job/task. RESULTS The most frequently reported disinfectants were alcohol (weekly use: 39%), bleach (22%) and sprays (20%). More nurses were classified as highly exposed by JTEM (alcohol 41%, sprays 41%, bleach 34%) than by JEM (21%, 30%, 26%, respectively). Agreement between JEM and JTEM was fair-to-moderate (κ 0.3-0.5) for most disinfectants. JEM and JTEM exposure estimates were heterogeneous in most nursing jobs, except in emergency room and education/administration. CONCLUSIONS The JTEM may provide more accurate estimates than the JEM, especially for nursing jobs with heterogeneous tasks. Use of the JTEM is likely to reduce exposure misclassification.
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Affiliation(s)
- C Quinot
- INSERM, U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, F-94807, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
| | - O Dumas
- INSERM, U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, F-94807, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France.,Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - P K Henneberger
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - R Varraso
- INSERM, U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, F-94807, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
| | - A S Wiley
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - F E Speizer
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - M Goldberg
- INSERM, U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, F-94807, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France.,INSERM-UVSQ, UMS 011, Villejuif, France
| | - J P Zock
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - C A Camargo
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - N Le Moual
- INSERM, U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, F-94807, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
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Maier A, Vincent MJ, Parker A, Gadagbui BK, Jayjock M. A tiered asthma hazard characterization and exposure assessment approach for evaluation of consumer product ingredients. Regul Toxicol Pharmacol 2015; 73:903-13. [PMID: 26416168 DOI: 10.1016/j.yrtph.2015.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 11/19/2022]
Abstract
Asthma is a complex syndrome with significant consequences for those affected. The number of individuals affected is growing, although the reasons for the increase are uncertain. Ensuring the effective management of potential exposures follows from substantial evidence that exposure to some chemicals can increase the likelihood of asthma responses. We have developed a safety assessment approach tailored to the screening of asthma risks from residential consumer product ingredients as a proactive risk management tool. Several key features of the proposed approach advance the assessment resources often used for asthma issues. First, a quantitative health benchmark for asthma or related endpoints (irritation and sensitization) is provided that extends qualitative hazard classification methods. Second, a parallel structure is employed to include dose-response methods for asthma endpoints and methods for scenario specific exposure estimation. The two parallel tracks are integrated in a risk characterization step. Third, a tiered assessment structure is provided to accommodate different amounts of data for both the dose-response assessment (i.e., use of existing benchmarks, hazard banding, or the threshold of toxicological concern) and exposure estimation (i.e., use of empirical data, model estimates, or exposure categories). Tools building from traditional methods and resources have been adapted to address specific issues pertinent to asthma toxicology (e.g., mode-of-action and dose-response features) and the nature of residential consumer product use scenarios (e.g., product use patterns and exposure durations). A case study for acetic acid as used in various sentinel products and residential cleaning scenarios was developed to test the safety assessment methodology. In particular, the results were used to refine and verify relationships among tiered approaches such that each lower data tier in the approach provides a similar or greater margin of safety for a given scenario.
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Affiliation(s)
- Andrew Maier
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Melissa J Vincent
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ann Parker
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bernard K Gadagbui
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael Jayjock
- The LifeLine Group, 4610 Quarter Charge Dr, Annandale, VA, 22003, USA
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Cochrane SA, Arts JHE, Ehnes C, Hindle S, Hollnagel HM, Poole A, Suto H, Kimber I. Thresholds in chemical respiratory sensitisation. Toxicology 2015; 333:179-194. [PMID: 25963507 DOI: 10.1016/j.tox.2015.04.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 12/26/2022]
Abstract
There is a continuing interest in determining whether it is possible to identify thresholds for chemical allergy. Here allergic sensitisation of the respiratory tract by chemicals is considered in this context. This is an important occupational health problem, being associated with rhinitis and asthma, and in addition provides toxicologists and risk assessors with a number of challenges. In common with all forms of allergic disease chemical respiratory allergy develops in two phases. In the first (induction) phase exposure to a chemical allergen (by an appropriate route of exposure) causes immunological priming and sensitisation of the respiratory tract. The second (elicitation) phase is triggered if a sensitised subject is exposed subsequently to the same chemical allergen via inhalation. A secondary immune response will be provoked in the respiratory tract resulting in inflammation and the signs and symptoms of a respiratory hypersensitivity reaction. In this article attention has focused on the identification of threshold values during the acquisition of sensitisation. Current mechanistic understanding of allergy is such that it can be assumed that the development of sensitisation (and also the elicitation of an allergic reaction) is a threshold phenomenon; there will be levels of exposure below which sensitisation will not be acquired. That is, all immune responses, including allergic sensitisation, have threshold requirement for the availability of antigen/allergen, below which a response will fail to develop. The issue addressed here is whether there are methods available or clinical/epidemiological data that permit the identification of such thresholds. This document reviews briefly relevant human studies of occupational asthma, and experimental models that have been developed (or are being developed) for the identification and characterisation of chemical respiratory allergens. The main conclusion drawn is that although there is evidence that the acquisition of sensitisation to chemical respiratory allergens is a dose-related phenomenon, and that thresholds exist, it is frequently difficult to define accurate numerical values for threshold exposure levels. Nevertheless, based on occupational exposure data it may sometimes be possible to derive levels of exposure in the workplace, which are safe. An additional observation is the lack currently of suitable experimental methods for both routine hazard characterisation and the measurement of thresholds, and that such methods are still some way off. Given the current trajectory of toxicology, and the move towards the use of non-animal in vitro and/or in silico) methods, there is a need to consider the development of alternative approaches for the identification and characterisation of respiratory sensitisation hazards, and for risk assessment.
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Affiliation(s)
- Stella A Cochrane
- Unilever Safety and Environmental Assurance Centre, Colworth Science Park, Sharnbrook, Bedfordshire, Mk44 1LQ, UK.
| | | | - Colin Ehnes
- BASF SE, GUP/PB - Z470, 67056 Ludwigshafen, Germany
| | - Stuart Hindle
- Dow Europe GmbH, Bachtobelstrasse 3, CH-8810 Horgen, Switzerland
| | - Heli M Hollnagel
- Dow Europe GmbH, Bachtobelstrasse 3, CH-8810 Horgen, Switzerland
| | - Alan Poole
- ECETOC, Avenue Van Nieuwenhuyse 2, Box 8, B-1160 Bruxelles, Belgium
| | - Hidenori Suto
- Sumitomo Chemical Co. Ltd. Environmental Health Science Laboratory, 3-1-98 Kasugade-Naka, Konohana-Ku, Osaka 554-8558, Japan
| | - Ian Kimber
- University of Manchester, Faculty of Life Sciences, Michael Smith Building, Oxford Road, Manchester M13 9PT, UK
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Quinn MM, Henneberger PK, Braun B, Delclos GL, Fagan K, Huang V, Knaack JL, Kusek L, Lee SJ, Le Moual N, Maher KA, McCrone SH, Mitchell AH, Pechter E, Rosenman K, Sehulster L, Stephens AC, Wilburn S, Zock JP. Cleaning and disinfecting environmental surfaces in health care: Toward an integrated framework for infection and occupational illness prevention. Am J Infect Control 2015; 43:424-34. [PMID: 25792102 DOI: 10.1016/j.ajic.2015.01.029] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/25/2015] [Accepted: 01/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Cleaning and Disinfecting in Healthcare Working Group of the National Institute for Occupational Safety and Health, National Occupational Research Agenda, is a collaboration of infection prevention and occupational health researchers and practitioners with the objective of providing a more integrated approach to effective environmental surface cleaning and disinfection (C&D) while protecting the respiratory health of health care personnel. METHODS The Working Group, comprised of >40 members from 4 countries, reviewed current knowledge and identified knowledge gaps and future needs for research and practice. RESULTS An integrated framework was developed to guide more comprehensive efforts to minimize harmful C&D exposures without reducing the effectiveness of infection prevention. Gaps in basic knowledge and practice that are barriers to an integrated approach were grouped in 2 broad areas related to the need for improved understanding of the (1) effectiveness of environmental surface C&D to reduce the incidence of infectious diseases and colonization in health care workers and patients and (2) adverse health impacts of C&D on health care workers and patients. Specific needs identified within each area relate to basic knowledge, improved selection and use of products and practices, effective hazard communication and training, and safer alternatives. CONCLUSION A more integrated approach can support multidisciplinary teams with the capacity to maximize effective and safe C&D in health care.
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