1
|
Mwanga HH, Dumas O, Migueres N, Le Moual N, Jeebhay MF. Airway Diseases Related to the Use of Cleaning Agents in Occupational Settings. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1974-1986. [PMID: 38432401 DOI: 10.1016/j.jaip.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
Exposure to disinfectants and cleaning products (DCPs) is now a well-established risk factor for work-related asthma (WRA). However, questions remain on the specific causal agents and pathophysiological mechanisms. Few studies have also reported an association between DCPs and rhinitis or chronic obstructive pulmonary disease. This review discusses the recent evidence pertaining to airway diseases attributable to occupational exposure to DCPs. In contrast to other agents, the incidence of WRA due to DCPs has increased over time. The use of DCPs in spray form has clearly been identified as an added risk factor. The mechanisms for WRA associated with DCPs remain poorly studied; however, both allergic and nonallergic responses have been described, with irritant mechanisms thought to play a major role. An early diagnostic workup based on clinical assessment accompanied by evaluation of lung function and immunological and airway inflammatory markers is important to guide optimal care and exposure avoidance to the implicated agent. Future research should focus on the effects of "green" products, pathophysiological mechanisms, and quantitative exposure assessment including the use of barcode-based methods to identify specific agents. There is an urgent need to strengthen preventive measures and interventions to reduce the burden of airway diseases associated with DCPs.
Collapse
Affiliation(s)
- Hussein H Mwanga
- Department of Environmental and Occupational Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - Nicolas Migueres
- Division of Pulmonology, Department of Chest Diseases, University Hospital of Strasbourg and Fédération de Médecine translationnelle, Strasbourg University, Strasbourg, France; UMR 7357 Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie ICUBE, Strasbourg, France
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, Villejuif, France.
| | - Mohamed F Jeebhay
- Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa.
| |
Collapse
|
2
|
Hussain MS, Gupta G, Mishra R, Patel N, Gupta S, Alzarea SI, Kazmi I, Kumbhar P, Disouza J, Dureja H, Kukreti N, Singh SK, Dua K. Unlocking the secrets: Volatile Organic Compounds (VOCs) and their devastating effects on lung cancer. Pathol Res Pract 2024; 255:155157. [PMID: 38320440 DOI: 10.1016/j.prp.2024.155157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/08/2024]
Abstract
Lung cancer (LCs) is still a serious health problem globally, with many incidences attributed to environmental triggers such as Volatile Organic Compounds (VOCs). VOCs are a broad class of compounds that can be released via various sources, including industrial operations, automobile emissions, and indoor air pollution. VOC exposure has been linked to an elevated risk of lung cancer via multiple routes. These chemicals can be chemically converted into hazardous intermediate molecules, resulting in DNA damage and genetic alterations. VOCs can also cause oxidative stress, inflammation, and a breakdown in the cellular protective antioxidant framework, all of which contribute to the growth of lung cancer. Moreover, VOCs have been reported to alter critical biological reactions such as cell growth, apoptosis, and angiogenesis, leading to tumor development and metastasis. Epidemiological investigations have found a link between certain VOCs and a higher probability of LCs. Benzene, formaldehyde, and polycyclic aromatic hydrocarbons (PAHs) are some of the most well-researched VOCs, with comprehensive data confirming their cancer-causing potential. Nevertheless, the possible health concerns linked with many more VOCs and their combined use remain unknown, necessitating further research. Identifying the toxicological consequences of VOCs in LCs is critical for establishing focused preventative tactics and therapeutic strategies. Better legislation and monitoring mechanisms can limit VOC contamination in occupational and environmental contexts, possibly reducing the prevalence of LCs. Developing VOC exposure indicators and analyzing their associations with genetic susceptibility characteristics may also aid in early identification and targeted therapies.
Collapse
Affiliation(s)
- Md Sadique Hussain
- School of Pharmaceutical Sciences, Jaipur National University, Jagatpura, Jaipur, Rajasthan 302017, India
| | - Gaurav Gupta
- Centre for Global Health Research, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, India; Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, 346, United Arab Emirates; School of Pharmacy, Suresh Gyan Vihar University, Mahal Road, Jagatpura, Jaipur, India
| | - Riya Mishra
- School of Pharmacy, Suresh Gyan Vihar University, Mahal Road, Jagatpura, Jaipur, India
| | - Neeraj Patel
- School of Pharmacy, Suresh Gyan Vihar University, Mahal Road, Jagatpura, Jaipur, India
| | - Saurabh Gupta
- Chameli Devi Institute of Pharmacy, Department of Pharmacology, Khandwa Road, Village Umrikheda, Near Toll booth, Indore, Madhya Pradesh 452020, India
| | - Sami I Alzarea
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakaka, 72341, Al-Jouf, Saudi Arabia
| | - Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, 21589, Jeddah, Saudi Arabia.
| | - Popat Kumbhar
- Tatyasaheb Kore College of Pharmacy, Warananagar, Tal: Panhala Dist: Kolhapur, Maharashtra 416113, India
| | - John Disouza
- Tatyasaheb Kore College of Pharmacy, Warananagar, Tal: Panhala Dist: Kolhapur, Maharashtra 416113, India
| | - Harish Dureja
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak 124001, India
| | - Neelima Kukreti
- School of Pharmacy, Graphic Era Hill University, Dehradun 248007, India
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India; Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Kamal Dua
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia; Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, NSW 2007, Australia.
| |
Collapse
|
3
|
Ayala CE, Vaughan SR, Pérez RL, Leonard BS, King B, Jorgensen K, Warner IM. Influence of humidity on accuracy of QCM - IR780-based GUMBOS sensor arrays. Anal Chim Acta 2023; 1278:341677. [PMID: 37709438 DOI: 10.1016/j.aca.2023.341677] [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: 06/04/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 09/16/2023]
Abstract
Herein, hydrophobic coating materials are reported for QCM detection of VOCs under dry and humid conditions. In this study, IR780-based GUMBOS ([IR780][OTf] and [IR780][NTf2]) were synthesized using an ion exchange reaction and the anions trifluoromethanesulfonimide ([OTf]) and bisperfluoromethanesulfonimide ([NTf2]). The parent iodide salts and GUMBOS ([IR780][I]), [IR780][OTf], and [IR780][NTf2]) were characterized using several analytical techniques. These salts were then employed as sensor coatings on quartz crystal resonators using an electrospray coating method. These sensors were exposed to four flow ratios of five common VOCs in the absence and presence of 10 vol% water. Fundamental frequency responses were recorded and further employed as input variables to develop highly accurate multi-sensor arrays (MSAs). Accuracy was better than 78.3% without water, and better than 91.7% in the presence of water. When multi-harmonic responses were evaluated as input variables to assess discrimination ability for each sensor, highly accurate virtual sensor arrays (VSAs) were developed using each GUMBOS coating. In the case of [IR780][NTf2], a slight improvement in discrimination was achieved in the presence of water (95%) versus the absence of water. Moreover, this study highlights development of readily synthesized hydrophobic coatings of IR780-based GUMBOS for potential detection and discrimination of VOCs in aqueous systems.
Collapse
Affiliation(s)
- Caitlan E Ayala
- Department of Chemistry, Louisiana State University, Baton Rouge, LA, 70803, USA
| | - Stephanie R Vaughan
- Department of Chemistry, Louisiana State University, Baton Rouge, LA, 70803, USA
| | - Rocío L Pérez
- Department of Chemistry, Louisiana State University, Baton Rouge, LA, 70803, USA; Department of Chemistry and Biochemistry, Georgia Southern University, Statesboro, GA, 30458, USA.
| | - Breona S Leonard
- Department of Chemistry, Louisiana State University, Baton Rouge, LA, 70803, USA
| | - Baleigh King
- Department of Chemistry and Biochemistry, Georgia Southern University, Statesboro, GA, 30458, USA
| | - Kyle Jorgensen
- Department of Chemistry and Biochemistry, Georgia Southern University, Statesboro, GA, 30458, USA
| | - Isiah M Warner
- Department of Chemistry, Louisiana State University, Baton Rouge, LA, 70803, USA.
| |
Collapse
|
4
|
Wilson AM, Ogunseye OO, Fingesi T, McClelland DJ, Gerald LB, Harber P, Beamer PI, Jones RM. Exposure frequency, intensity, and duration: What we know about work-related asthma risks for healthcare workers from cleaning and disinfection. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2023; 20:350-363. [PMID: 37279493 PMCID: PMC10696642 DOI: 10.1080/15459624.2023.2221712] [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: 06/08/2023]
Abstract
The objective of this review was to scope the current evidence base related to three exposure assessment concepts: frequency, intensity, and duration (latency) for cleaning and disinfection exposures in healthcare and subsequent work-related asthma risks. A search strategy was developed addressing intersections of four main concepts: (1) work-related asthma; (2) occupation (healthcare workers/nurses); (3) cleaning and disinfection; and (4) exposure. Three databases were searched: Embase, PubMed, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database. Data were extracted related to three main components of risk assessment: (1) exposure frequency, (2) exposure intensity, and (3) exposure duration. Latency data were analyzed using an exponential distribution fit, and extracted concentration data were compared to occupational exposure limits. The final number of included sources from which data were extracted was 133. Latency periods for occupational asthma were exponentially distributed, with a mean waiting time (1/λ) of 4.55 years. No extracted concentration data were above OELs except for some formaldehyde and glutaraldehyde concentrations. Data from included sources also indicated some evidence for a dose-response relationship regarding increased frequency yielding increased risk, but this relationship is unclear due to potential confounders (differences in role/task and associated exposure) and the healthy worker effect. Data priority needs to include linking concentration data to health outcomes, as most current literature does not include both types of measurements in a single study, leading to uncertainty in dose-response relationships.
Collapse
Affiliation(s)
- Amanda M. Wilson
- Department of Community, Environment, & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Olusola O. Ogunseye
- Department of Community, Environment, & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Tina Fingesi
- Department of Community, Environment, & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | | | - Lynn B. Gerald
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Philip Harber
- Department of Community, Environment, & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Paloma I. Beamer
- Department of Community, Environment, & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Rachael M. Jones
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
5
|
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.
Collapse
|
6
|
Wahlang B, Gao H, Rai SN, Keith RJ, McClain CJ, Srivastava S, Cave MC, Bhatnagar A. Associations between residential volatile organic compound exposures and liver injury markers: The role of biological sex and race. ENVIRONMENTAL RESEARCH 2023; 221:115228. [PMID: 36610539 PMCID: PMC9957966 DOI: 10.1016/j.envres.2023.115228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/27/2022] [Accepted: 01/03/2023] [Indexed: 05/28/2023]
Abstract
While occupational exposures to volatile organic compounds (VOCs) have been linked to steatohepatitis and liver cancer in industrial workers, recent findings have also positively correlated low-dose, residential VOC exposures with liver injury markers. VOC sources are numerous; factors including biological make up (sex), socio-cultural constructs (gender, race) and lifestyle (smoking) can influence both VOC exposure levels and disease outcomes. Therefore, the current study's objective is to investigate how sex and race influence associations between residential VOC exposures and liver injury markers particularly in smokers vs. nonsmokers. Subjects (n = 663) were recruited from residential neighborhoods; informed consent was obtained. Exposure biomarkers included 16 urinary VOC metabolites. Serological disease biomarkers included liver enzymes, direct bilirubin, and hepatocyte death markers (cytokeratin K18). Pearson correlations and generalized linear models were conducted. Models were adjusted for common liver-related confounders and interaction terms. The study population constituted approximately 60% females (n = 401) and 40% males (n = 262), and a higher percent of males were smokers and/or frequent drinkers. Both sexes had a higher percent of White (75% females, 82% males) vs. Black individuals. Positive associations were identified for metabolites of acrolein, acrylamide, acrylonitrile, butadiene, crotonaldehyde, and styrene with alkaline phosphatase (ALP), a biomarker for cholestatic injury; and for the benzene metabolite with bilirubin; only in females. These associations were retained in female smokers. Similar associations were also observed between these metabolites and ALP only in White individuals (n = 514). In Black individuals (n = 114), the styrene metabolite was positively associated with aspartate transaminase. Interaction models indicated that positive associations for acrylamide/crotonaldehyde metabolites with ALP in females were dose-dependent. Most VOC associations with K18 markers were negative in this residential population. Overall, the findings demonstrated that biological sex, race, and smoking status influence VOC effects on liver injury and underscored the role of biological-social-lifestyle factor(s) interactions when addressing air pollution-related health disparities.
Collapse
Affiliation(s)
- Banrida Wahlang
- Superfund Research Center, University of Louisville, Louisville, KY, 40202, USA; Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, 40202, USA; The Center for Integrative Environmental Health Sciences, University of Louisville, Louisville, KY, 40202, USA; The Hepatobiology and Toxicology Center, University of Louisville, Louisville, KY, 40202, USA.
| | - Hong Gao
- Superfund Research Center, University of Louisville, Louisville, KY, 40202, USA; Envirome Institute, University of Louisville, Louisville, KY, 40202, USA; Division of Environmental Medicine, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, 40202, USA
| | - Shesh N Rai
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, 45267, USA; Cancer Data Science Center, Biostatistics and Informatics Shared Resource, College of Medicine, University of Cincinnati, Cincinnati, OH, 45267, USA
| | - Rachel J Keith
- Superfund Research Center, University of Louisville, Louisville, KY, 40202, USA; Envirome Institute, University of Louisville, Louisville, KY, 40202, USA; Division of Environmental Medicine, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, 40202, USA
| | - Craig J McClain
- Superfund Research Center, University of Louisville, Louisville, KY, 40202, USA; Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, 40202, USA; The Center for Integrative Environmental Health Sciences, University of Louisville, Louisville, KY, 40202, USA; Department of Pharmacology & Toxicology, School of Medicine, University of Louisville, Louisville, KY, 40202, USA; The Hepatobiology and Toxicology Center, University of Louisville, Louisville, KY, 40202, USA; Alcohol Research Center, University of Louisville, Louisville, KY, 40202, USA
| | - Sanjay Srivastava
- Superfund Research Center, University of Louisville, Louisville, KY, 40202, USA; Envirome Institute, University of Louisville, Louisville, KY, 40202, USA; Division of Environmental Medicine, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, 40202, USA; Department of Pharmacology & Toxicology, School of Medicine, University of Louisville, Louisville, KY, 40202, USA; Department of Biochemistry and Molecular Genetics, School of Medicine, University of Louisville, Louisville, KY, 40202, USA
| | - Mathew C Cave
- Superfund Research Center, University of Louisville, Louisville, KY, 40202, USA; Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, 40202, USA; The Center for Integrative Environmental Health Sciences, University of Louisville, Louisville, KY, 40202, USA; Department of Pharmacology & Toxicology, School of Medicine, University of Louisville, Louisville, KY, 40202, USA; The Hepatobiology and Toxicology Center, University of Louisville, Louisville, KY, 40202, USA; Alcohol Research Center, University of Louisville, Louisville, KY, 40202, USA; Department of Biochemistry and Molecular Genetics, School of Medicine, University of Louisville, Louisville, KY, 40202, USA
| | - Aruni Bhatnagar
- Superfund Research Center, University of Louisville, Louisville, KY, 40202, USA; The Center for Integrative Environmental Health Sciences, University of Louisville, Louisville, KY, 40202, USA; Envirome Institute, University of Louisville, Louisville, KY, 40202, USA; Division of Environmental Medicine, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, 40202, USA; Department of Pharmacology & Toxicology, School of Medicine, University of Louisville, Louisville, KY, 40202, USA; Department of Biochemistry and Molecular Genetics, School of Medicine, University of Louisville, Louisville, KY, 40202, USA
| |
Collapse
|
7
|
Kobos L, Anderson K, Kurth L, Liang X, Groth CP, England L, Laney AS, Virji MA. Characterization of Cleaning and Disinfection Product Use, Glove Use, and Skin Disorders by Healthcare Occupations in a Midwestern Healthcare Facility. BUILDINGS (BASEL, SWITZERLAND) 2022; 12:10.3390/buildings12122216. [PMID: 38650891 PMCID: PMC11034745 DOI: 10.3390/buildings12122216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Healthcare facility staff use a wide variety of cleaning and disinfecting products during their daily operations, many of which are associated with respiratory or skin irritation or sensitization with repeated exposure. The objective of this study was to characterize the prevalence of cleaning and disinfection product use, glove use during cleaning and disinfection, and skin/allergy symptoms by occupation and identify the factors influencing glove use among the healthcare facility staff. A questionnaire was administered to the current employees at a midwestern Veterans Affairs healthcare facility that elicited information on cleaning and disinfection product use, glove use during cleaning and disinfection, skin/allergy symptoms, and other demographic characteristics, which were summarized by occupation. The central supply/environmental service workers (2% of the total survey population), nurses (26%,), nurse assistants (3%), and laboratory technicians (5%) had the highest prevalence of using cleaning or disinfecting products, specifically quaternary ammonium compounds, bleach, and alcohol. Glove use while using products was common in both patient care and non-patient care occupations. The factors associated with glove use included using bleach or quaternary ammonium compounds and using cleaning products 2-3 or 4-5 days per week. A high frequency of glove use (≥75%) was reported by workers in most occupations when using quaternary ammonium compounds or bleach. The use of alcohol, bleach, and quaternary ammonium compounds was associated with skin disorders (p < 0.05). These research findings indicate that although the workers from most occupations report a high frequency of glove use when using cleaning and disinfection products, there is room for improvement, especially among administrative, maintenance, and nursing workers. These groups may represent populations which could benefit from the implementation of workplace interventions and further training regarding the use of personal protective equipment and the potential health hazards of exposure to cleaning and disinfecting chemicals.
Collapse
Affiliation(s)
- Lisa Kobos
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
| | - Kim Anderson
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
| | - Laura Kurth
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
| | - Xiaoming Liang
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
| | - Caroline P. Groth
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV 26505, USA
| | - Lucy England
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
| | - A. Scott Laney
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
| | - M. Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
| |
Collapse
|
8
|
Mwanga HH, Baatjies R, Jeebhay MF. Characterization of Exposure to Cleaning Agents Among Health Workers in Two Southern African Tertiary Hospitals. Ann Work Expo Health 2022; 66:998-1009. [PMID: 35674666 PMCID: PMC9551323 DOI: 10.1093/annweh/wxac034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Whilst cleaning agents are commonly used in workplaces and homes, health workers (HWs) are at increased risk of exposure to significantly higher concentrations used to prevent healthcare-associated infections. Exposure assessment has been challenging partly because many are used simultaneously resulting in complex airborne exposures with various chemicals requiring different sampling techniques. The main objective of this study was to characterize exposures of HWs to various cleaning agents in two tertiary academic hospitals in Southern Africa. METHODS A cross-sectional study of HWs was conducted in two tertiary hospitals in South Africa (SAH) and Tanzania (TAH). Exposure assessment involved systematic workplace observations, interviews with key personnel, passive personal environmental sampling for aldehydes (ortho-phthalaldehyde-OPA, glutaraldehyde and formaldehyde), and biomonitoring for chlorhexidine. RESULTS Overall, 269 samples were collected from SAH, with 62 (23%) collected from HWs that used OPA on the day of monitoring. OPA was detectable in 6 (2%) of all samples analysed, all of which were collected in the gastrointestinal unit of the SAH. Overall, department, job title, individual HW use of OPA and duration of OPA use were the important predictors of OPA exposure. Formaldehyde was detectable in 103 (38%) samples (GM = 0.0025 ppm; range: <0.0030 to 0.0270). Formaldehyde levels were below the ACGIH TLV-TWA (0.1 ppm). While individual HW use and duration of formaldehyde use were not associated with formaldehyde exposure, working in an ear, nose, and throat ward was positively associated with detectable exposures (P-value = 0.002). Glutaraldehyde was not detected in samples from the SAH. In the preliminary sampling conducted in the TAH, glutaraldehyde was detectable in 8 (73%) of the 11 samples collected (GM = 0.003 ppm; range: <0.002 to 0.028). Glutaraldehyde levels were lower than the ACGIH's TLV-Ceiling Limit of 0.05 ppm. p-chloroaniline was detectable in 13 (4%) of the 336 urine samples (GM = 0.02 ng/ml range: <1.00 to 25.80). CONCLUSION The study concluded that detectable exposures to OPA were isolated to certain departments and were dependent on the dedicated use of OPA by the HW being monitored. In contrast, low-level formaldehyde exposures were present throughout the hospital. There is a need for more sensitive exposure assessment techniques for chlorhexidine given its widespread use in the health sector.
Collapse
Affiliation(s)
- H H Mwanga
- Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Room 4. 45, Fourth Level, Falmouth Building Anzio Road, Observatory, 7925, 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
| | - R Baatjies
- Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Room 4. 45, Fourth Level, Falmouth Building Anzio Road, Observatory, 7925, Cape Town, South Africa
- Department of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - M F Jeebhay
- Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Room 4. 45, Fourth Level, Falmouth Building Anzio Road, Observatory, 7925, Cape Town, South Africa
| |
Collapse
|
9
|
van den Berg RB, de Poot S, Swart EL, Crul M. Assessment of occupational exposure to nebulized isopropyl alcohol as disinfectant during aseptic compounding of parenteral cytotoxic drugs in cleanrooms. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:361-368. [PMID: 34185621 DOI: 10.1080/15459624.2021.1933505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pharmacy technicians are exposed to volatile organic compounds, like the disinfectant isopropyl alcohol (IPA), during the process of aseptic compounding of parenteral cytotoxic drugs. The occupational exposure to nebulized IPA during aseptic compounding has not been investigated. The aim of this study was to investigate the exposure to IPA during aseptic compounding of parenteral cytotoxic drugs and to assess compliance with legal and regulatory limits. As a secondary endpoint, the difference between two disinfection methods was compared regarding the exposure to IPA. The exposure to IPA was measured during five working shifts of 8 hr and one shift of 4 hr. The concentration IPA was measured by using a six-gas monitor. Total daily exposure was calculated as 8-hr Time Weighted Average (TWA) air concentration in mg/m3 and compared with an Occupational Exposure Limit (OEL) value of 500 mg/m3 and incidental peak exposure of 5,000 mg/m3. To assess whether the 8-hr TWA air concentration meets the legal and regulatory limits the Similar Exposure Groups (SEG) compliance test was used. A paired sample t-test was conducted to assess difference in exposure between two disinfection methods. The average 8-hr TWA exposure to IPA during the six measurements varied from 2.6 mg/m3 to 43.9 mg/m3 and the highest momentary concentration measured was 860 mg/m3. The result of the SEG compliance test was 3.392 (Ur value) and was greater than the Ut value of 2.187 which means the exposure to IPA is in compliance with the OEL value. No significant difference in exposure was shown between two disinfection methods (p = 0.49). In conclusion, exposure to IPA during aseptic compounding of parenteral cytotoxic drugs showed compliance to the OEL values with no significant difference in exposure between two disinfection methods.
Collapse
Affiliation(s)
- Roland B van den Berg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Stan de Poot
- Department of Occupational Health & Safety, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Eleonora L Swart
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mirjam Crul
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
10
|
Yeoman AM, Shaw M, Lewis AC. Estimating person-to-person variability in VOC emissions from personal care products used during showering. INDOOR AIR 2021; 31:1281-1291. [PMID: 33615569 DOI: 10.1111/ina.12811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
An increasing fraction of volatile organic compounds (VOC) emissions come from the domestic use of solvents, contained within myriad commonplace consumer products. Emission rates are often poorly characterized and depend significantly on individual behavior and specific product formulation and usage. Time-concentration profiles of volatile organic compounds (VOCs) arising from the use of a representative selection of personal care products (PCPs) during showering are generated, and person-to-person variability in emissions calculated. A panel of 18 participants used a standardized set of products, dosages, and application times during showering in a controlled indoor bathroom setting. Proton transfer mass spectrometry was used to measure the in-room VOC evolution of limonene (representing the sum of monoterpenes), benzyl alcohol, and ethanol. The release of VOCs had reproducible patterns between users, but noticeable variations in absolute peak concentrations, despite identical amounts of material being used. The amounts of VOC emitted to air for one showering activity were as follows: limonene (1.77 mg ± 42%), benzyl alcohol (1.07 mg ± 41%), and ethanol (0.33 mg ± 78%). Real-world emissions to air were between 1.3 and 11 times lower than bottom-up estimates based on dynamic headspace measurements of product emissions rates, likely a result of PCPs being washed away before VOC evaporation could occur.
Collapse
Affiliation(s)
- Amber M Yeoman
- Wolfson Atmospheric Chemistry Laboratories, University of York, York, UK
| | - Marvin Shaw
- National Centre for Atmospheric Science, University of York, York, UK
| | - Alastair C Lewis
- National Centre for Atmospheric Science, University of York, York, UK
| |
Collapse
|
11
|
Lindberg JE, Quinn MM, Gore RJ, Galligan CJ, Sama SR, Sheikh NN, Markkanen PK, Parker-Vega A, Karlsson ND, LeBouf RF, Virji MA. Assessment of home care aides' respiratory exposure to total volatile organic compounds and chlorine during simulated bathroom cleaning: An experimental design with conventional and "green" products. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:276-287. [PMID: 34004120 PMCID: PMC8898565 DOI: 10.1080/15459624.2021.1910280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Home care (HC) aide visits to clients' homes often involve cleaning and disinfecting (C&D) bathrooms. Some ingredients in C&D household products are associated with respiratory illness, including sodium hypochlorite (bleach) and quaternary ammonium compounds (quats). "Green" products may be safer for the environment, however there are limited quantitative evaluations of their respiratory risks. This study assessed airborne concentrations and time profiles of total volatile organic compounds (TVOC) and chlorine generated during typical bathroom cleaning performed by aides using conventional and green products. Aides performed cleaning tasks in a simulated residential bathroom constructed in an environmental air sampling laboratory. A balanced experimental design involved each aide coming to the lab for four visits during which she performed two 20-min cleaning sessions using one of three C&D products (bleach-based, 1-5% sodium hypochlorite by weight; quats-based, 0.1-1% by weight quaternary ammonium compounds; and "green," 0.05% by weight thymol, a component of botanical thyme oil) or distilled water as a control. TVOC and chlorine direct reading instruments were attached to aides with sample inlets located in the breathing zone. Ten-second averages of TVOC and chlorine gas concentrations and instantaneous peak concentrations were recorded for the sessions' duration. TVOC concentrations by methods of C&D application (spraying, streaming, wiping) also were evaluated. The study completed 169 air sampling sessions with 22 aides. The quats-based product generated more than twice the average TVOC concentrations (mean = 1,210 ppb) than the bleach-based (mean = 593 ppb) or green (mean = 498 ppb) products. Each product generated TVOC concentrations that rose rapidly within the first few minutes of application. Spraying produced the highest TVOC exposures, wiping the lowest. Thirteen aides (65%) experienced peak chlorine exposures above the OSHA PEL ceiling limit (1 ppm) when using the bleach-based product. HC aides may experience respiratory hazards from use of conventional or green C&D products formulated with bleach or other respiratory irritants and sprayed in small, poorly ventilated spaces typical of bathrooms. Spraying should be avoided.
Collapse
Affiliation(s)
- J. E. Lindberg
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - M. M. Quinn
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - R. J. Gore
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, Massachusetts
| | - C. J. Galligan
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - S. R. Sama
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - N. N. Sheikh
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - P. K. Markkanen
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - A. Parker-Vega
- Office of Environment, Health and Safety, University of California, San Francisco, San Francisco, California
| | - N. D. Karlsson
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - R. F. LeBouf
- Division of Respiratory Health, National Institute for Occupational Safety and Health (NIOSH), Morgantown, West Virginia
| | - M. A. Virji
- Division of Respiratory Health, National Institute for Occupational Safety and Health (NIOSH), Morgantown, West Virginia
| |
Collapse
|
12
|
Aillón García P, Parga-Landa B. An improved proposal for using laminar copper as a biocidal material in touch surfaces in a hospital Intensive Care Unit (ICU). ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:16314-16322. [PMID: 33387326 DOI: 10.1007/s11356-020-11678-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 11/15/2020] [Indexed: 06/12/2023]
Abstract
The use of copper for reducing nosocomial infections or healthcare-acquired infections (HAI) has been carried out in intensive care units (ICU) by replacing some objects generally made of stainless steel or other materials with solid pieces of copper. The authors' proposal for a sustainable use of copper consists of introducing it in a "lamina + adhesive" format. This proposal has been tested in an ICU at the Ceuta Hospital in Spain. It has been found to provide an equally efficient solution as antibacterial material than the usual "solid" format, but with only a layer of 50 microns of copper, which is a high-cost and limited resource. After that intervention, some improvements are also proposed: a standardization of the pieces chosen to cover with a lamina of copper for saving material; and another method of replacement aiming to lower the time that the ICU cannot be used. To ensure that the proposed bonding method is harmless to human health and the adhesive does not interfere with the indoor environment by releasing toxic chemicals, the "lamina + adhesive" sheet has been further tested. The results and proposals are briefly shown.
Collapse
Affiliation(s)
- Paula Aillón García
- Metropolitan Thechnological University UTEM, Sargento Aldea, 355, Santiago, Chile.
| | - Blanca Parga-Landa
- Polytechnic University of Madrid, Av. de la Memoria, 4, 28040, Madrid, Spain
| |
Collapse
|
13
|
Lin N, Rosemberg MA, Li W, Meza-Wilson E, Godwin C, Batterman S. Occupational exposure and health risks of volatile organic compounds of hotel housekeepers: Field measurements of exposure and health risks. INDOOR AIR 2021; 31:26-39. [PMID: 32609907 PMCID: PMC8020495 DOI: 10.1111/ina.12709] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 05/08/2023]
Abstract
Hotel housekeepers represent a large, low-income, predominantly minority, and high-risk workforce. Little is known about their exposure to chemicals, including volatile organic compounds (VOCs). This study evaluates VOC exposures of housekeepers, sources and factors affecting VOC levels, and provides preliminary estimates of VOC-related health risks. We utilized indoor and personal sampling at two hotels, assessed ventilation, and characterized the VOC composition of cleaning agents. Personal sampling of hotel staff showed a total target VOC concentration of 57 ± 36 µg/m3 (mean ± SD), about twice that of indoor samples. VOCs of greatest health significance included chloroform and formaldehyde. Several workers had exposure to alkanes that could cause non-cancer effects. VOC levels were negatively correlated with estimated air change rates. The composition and concentrations of the tested products and air samples helped identify possible emission sources, which included building sources (for formaldehyde), disinfection by-products in the laundry room, and cleaning products. VOC levels and the derived health risks in this study were at the lower range found in the US buildings. The excess lifetime cancer risk (average of 4.1 × 10-5 ) still indicates a need to lower exposure by reducing or removing toxic constituents, especially formaldehyde, or by increasing ventilation rates.
Collapse
Affiliation(s)
- Nan Lin
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA 48109
| | - Marie-Anne Rosemberg
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA 48109
| | - Wei Li
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA 48109
| | - Emily Meza-Wilson
- College of Literature, Science and the Arts, University of Michigan, Ann Arbor, Michigan, USA 48109
| | - Christopher Godwin
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA 48109
| | - Stuart Batterman
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA 48109
| |
Collapse
|
14
|
Benjamin ML, Arnold S, Rao M, Davis K, Maier A, Virkutyte J. Ventilation and posture effects on inhalation exposures to volatile cleaning ingredients in a simulated domestic worker cleaning environment. INDOOR AIR 2021; 31:128-140. [PMID: 32648981 DOI: 10.1111/ina.12715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 05/13/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
Associations between cleaning chemical exposures and asthma have previously been identified in professional cleaners and healthcare workers. Domestic workers, including housecleaners and caregivers, may receive similar exposures but in residential environments with lower ventilation rates. Study objectives were to compare exposures to occupational exposure limits (OELs), to determine relative contributions from individual cleaning tasks to overall exposure, and to evaluate the effects of ventilation and posture on exposure. Airborne chemical concentrations of sprayed cleaning chemicals (acetic acid or ammonia) were measured during typical cleaning tasks in a simulated residential work environment. Whole-house cleaning exposures (18 cleaning tasks) were measured using integrated personal sampling methods. Individual task exposures were measured with a sampling line attached to subjects' breathing zones, with readings recorded by a ppbRAE monitor, equipped with a photoionization detector calibrated for ammonia and acetic acid measurements. Integrated sampling results indicated no exposures above OELs occurred, but 95th percentile air concentrations would require risk management decisions. Exposure reductions were observed with increased source distance, with lower exposures from mopping floors compared to kneeling. Exposure reductions were also observed for most but not all tasks when ventilation was used, with implications that alternative exposure reduction methods may be needed.
Collapse
Affiliation(s)
- Michael L Benjamin
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Susan Arnold
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Marepalli Rao
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kermit Davis
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Jurate Virkutyte
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW Evidence for adverse respiratory effects of occupational exposure to disinfectants and cleaning products (DCPs) has grown in the last two decades. The relationship between DCPs and asthma is well documented but questions remain regarding specific causal agents. Beyond asthma, associations between DCPs and COPD or chronic rhinitis are plausible and have been examined recently. The purpose of this review is to summarize recent advances on the effect of occupational exposure to DCP and chronic airway diseases. RECENT FINDINGS Recent epidemiological studies have often focused on healthcare workers and are characterized by efforts to improve assessment of exposure to specific DCPs. Despite increasing knowledge on the effect of DCPs on asthma, the burden of work-related asthma caused by DCPs has not decreased in the past decade, emphasizing the need to strengthen prevention efforts. Novel data suggest an association between occupational exposure to DCPs and other chronic airway diseases, such as rhinitis, COPD, and poor lung function. SUMMARY Epidemiological and experimental data showed that many chemicals contained in DCPs are likely to cause airway damage, indicating that prevention strategies should target multiple products. Further research is needed to evaluate the impact of DCP exposure on occupational airway diseases beyond asthma.
Collapse
|
16
|
Chemicals inhaled from spray cleaning and disinfection products and their respiratory effects. A comprehensive review. Int J Hyg Environ Health 2020; 229:113592. [PMID: 32810683 DOI: 10.1016/j.ijheh.2020.113592] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/20/2020] [Accepted: 07/03/2020] [Indexed: 12/13/2022]
Abstract
Spray cleaning and disinfection products have been associated with adverse respiratory effects in professional cleaners and among residents doing domestic cleaning. This review combines information about use of spray products from epidemiological and clinical studies, in vivo and in vitro toxicological studies of cleaning chemicals, as well as human and field exposure studies. The most frequent chemicals in spray cleaning and disinfection products were compiled, based on registrations in the Danish Product Registry. The chemicals were divided into acids, bases, disinfectants, fragrances, organic solvents, propellants, and tensides. In addition, an assessment of selected cleaning and disinfectant chemicals in spray products was carried out. Chemicals of concern regarding respiratory effects (e.g. asthma) are corrosive chemicals such as strong acids and bases (including ammonia and hypochlorite) and quaternary ammonium compounds (QACs). However, the evidence for respiratory effects after inhalation of QACs is ambiguous. Common fragrances are generally not considered to be of concern following inhalation. Solvents including glycols and glycol ethers as well as propellants are generally weak airway irritants and not expected to induce sensitization in the airways. Mixing of certain cleaning products can produce corrosive airborne chemicals. We discuss different hypotheses for the mechanisms behind the development of respiratory effects of inhalation of chemicals in cleaning agents. An integrative assessment is needed to understand how these chemicals can cause the various respiratory effects.
Collapse
|
17
|
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.
Collapse
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
| | | |
Collapse
|
18
|
Yeoman AM, Shaw M, Carslaw N, Murrells T, Passant N, Lewis AC. Simplified speciation and atmospheric volatile organic compound emission rates from non-aerosol personal care products. INDOOR AIR 2020; 30:459-472. [PMID: 32034823 PMCID: PMC7217173 DOI: 10.1111/ina.12652] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/09/2020] [Accepted: 02/05/2020] [Indexed: 05/22/2023]
Abstract
Volatile organic compounds (VOCs) emitted from personal care products (PCPs) can affect indoor air quality and outdoor air quality when ventilated. In this paper, we determine a set of simplified VOC species profiles and emission rates for a range of non-aerosol PCPs. These have been constructed from individual vapor analysis from 36 products available in the UK, using equilibrium headspace analysis with selected-ion flow-tube mass spectrometry (SIFT-MS). A simplified speciation profile is created based on the observations, comprising four alcohols, two cyclic volatile siloxanes, and monoterpenes (grouped as limonene). Estimates are made for individual unit-of-activity VOC emissions for dose-usage of shampoos, shower gel, conditioner, liquid foundation, and moisturizer. We use these values as inputs to the INdoor air Detailed Chemical Model (INDCM) and compare results against real-world case-study experimental data. Activity-based emissions are then scaled based on plausible usage patterns to estimate the potential scale of annual per-person emissions for each product type (eg, 2 g limonene person-1 yr-1 from shower gels). Annual emissions from non-aerosol PCPs for the UK are then calculated (decamethylcyclopentasiloxane 0.25 ktonne yr-1 and limonene 0.15 ktonne yr-1 ) and these compared with the UK National Atmospheric Emissions Inventory estimates for non-aerosol cosmetics and toiletries.
Collapse
Affiliation(s)
- Amber M. Yeoman
- Wolfson Atmospheric Chemistry LaboratoriesUniversity of YorkYorkUK
| | - Marvin Shaw
- Wolfson Atmospheric Chemistry LaboratoriesUniversity of YorkYorkUK
- National Centre for Atmospheric ScienceUniversity of YorkYorkUK
| | - Nicola Carslaw
- Department of Environment and GeographyUniversity of YorkYorkUK
| | - Tim Murrells
- Ricardo Energy & Environment Gemini BuildingHarwellUK
| | - Neil Passant
- Ricardo Energy & Environment Gemini BuildingHarwellUK
| | - Alastair C. Lewis
- Wolfson Atmospheric Chemistry LaboratoriesUniversity of YorkYorkUK
- National Centre for Atmospheric ScienceUniversity of YorkYorkUK
| |
Collapse
|
19
|
A Proposal: Nurse-Sensitive Environmental Indicators. ANNUAL REVIEW OF NURSING RESEARCH 2019; 38:265-274. [PMID: 32102966 DOI: 10.1891/0739-6686.38.265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Healthcare contributes significant pollution to the natural environment. Nurses are obligated by professional commitment, to avoid causing harm in their care processes and decisions, including environmental harm. Nurse awareness of healthcare-generated pollution is growing but nurses may lack an understanding of how nursing contributes specifically to this pollution and what nurses can do within their scope and span to address it. This chapter introduces the concept "Nurse-Sensitive Environmental Indicators" as a proposal to identify, measure, and reduce the unintended harm of nursing practice that contributes to healthcare-generated pollution. It discusses the environmental problem, environmental health, and healthcare. The chapter explains what environmental stewardship has to do with nursing and describes nurse sensitive indicators. As has been the case with other quality outcomes measures, identifying agreed-upon environmental outcomes measures may give the nursing profession tools to measure and then address environmental impacts arising from nursing practice.
Collapse
|
20
|
Sauvé JF, Friesen MC. Using Decision Rules to Assess Occupational Exposure in Population-Based Studies. Curr Environ Health Rep 2019; 6:148-159. [PMID: 31297745 PMCID: PMC6698417 DOI: 10.1007/s40572-019-00240-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Population-based studies increasingly link task-based occupational questionnaire responses collected from subjects to exposure estimates via transparent, programmable decision rules. We reviewed recent applications and methodological developments of rule-based approaches. RECENT FINDINGS Agent-specific decision rules require interviews incorporating work-task-based questions. Some studies have developed rules before the interviews took place, while others developed rules after the interviews were completed. Agreement between rule-based estimates and exposures assigned using job-by-job expert review were generally moderate to good (Kappa = 0.4-0.8). Rules providing quantitative intensity levels using measurement data or that integrate multiple independent exposure sources for the same job represent further advances to improve the characterization of occupational exposures in population studies. Decision rules have provided transparent and reproducible assessments, reduce job-by-job review, and facilitate sensitivity analyses in epidemiologic studies. Future studies should consider the development of decision rules concurrent with the questionnaire design to facilitate occupational exposure assessment efforts.
Collapse
Affiliation(s)
- Jean-François Sauvé
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Melissa C Friesen
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
| |
Collapse
|
21
|
Su FC, Friesen MC, Humann M, Stefaniak AB, Stanton ML, Liang X, LeBouf RF, Henneberger PK, Virji MA. Clustering asthma symptoms and cleaning and disinfecting activities and evaluating their associations among healthcare workers. Int J Hyg Environ Health 2019; 222:873-883. [PMID: 31010790 DOI: 10.1016/j.ijheh.2019.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/28/2019] [Accepted: 04/11/2019] [Indexed: 01/09/2023]
Abstract
Asthma is a heterogeneous disease with varying severity and subtypes. Recent reviews of epidemiologic studies have identified cleaning and disinfecting activities (CDAs) as important risk factors for asthma-related outcomes among healthcare workers. However, the complexity of CDAs in healthcare settings has rarely been examined. This study utilized a complex survey dataset and data reduction approaches to identify and group healthcare workers with similar patterns of asthma symptoms, and then explored their associations with groups of participants with similar patterns of CDAs. Self-reported information on asthma symptoms/care, CDAs, demographics, smoking status, allergic status, and other characteristics were collected from 2030 healthcare workers within nine selected occupations in New York City. Hierarchical clustering was conducted to systematically group participants based on similarity of patterns of the 27 asthma symptom/care variables, and 14 product applications during CDAs, separately. Word clouds were used to visualize the complex information on the resulting clusters. The associations of asthma health clusters (HCs) with exposure clusters (ECs) were evaluated using multinomial logistic regression. Five HCs were identified (HC-1 to HC-5), labelled based on predominant features as: "no symptoms", "winter cough/phlegm", "mild asthma symptoms", "undiagnosed/untreated asthma", and "asthma attacks/exacerbations". For CDAs, five ECs were identified (EC-1 to EC-5), labelled as: "no products", "housekeeping/chlorine", "patient care", "general cleaning/laboratory", and "disinfection products". Using HC-1 and EC-1 as the reference groups, EC-2 was associated with HC-4 (odds ratio (OR) = 3.11, 95% confidence interval (95% CI) = 1.46-6.63) and HC-5 (OR = 2.71, 95% CI = 1.25-5.86). EC-3 was associated with HC-5 (OR = 2.34, 95% CI = 1.16-4.72). EC-4 was associated with HC-5 (OR = 2.35, 95% CI = 1.07-5.13). EC-5 was associated with HC-3 (OR = 1.81, 95% CI = 1.09-2.99) and HC-4 (OR = 3.42, 95% CI = 1.24-9.39). Various combinations of product applications like using alcohols, bleach, high-level disinfectants, and enzymes to disinfect instruments and clean surfaces captured by the ECs were identified as risk factors for the different asthma symptoms clusters, indicating that prevention efforts may require targeting multiple products. The associations of HCs with EC can be used to better inform prevention strategies and treatment options to avoid disease progression. This study demonstrated hierarchical clustering and word clouds were useful techniques for analyzing and visualizing a complex dataset with a large number of potentially correlated variables to generate practical information that can inform prevention activities.
Collapse
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, Bethesda, MD, USA
| | - Michael Humann
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, 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
| | - 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
| | - Ryan F LeBouf
- 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
| | - M Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA.
| |
Collapse
|