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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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Rosenman KD, Reilly MJ, Wang L. Calls to a State Poison Center Concerning Cleaners and Disinfectants From the Onset of the COVID-19 Pandemic Through April 2020. Public Health Rep 2020; 136:27-31. [PMID: 33059533 PMCID: PMC7856373 DOI: 10.1177/0033354920962437] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
An increased use of disinfectants during the coronavirus disease 2019 (COVID-19) pandemic may increase the number of adverse health effects among people who apply them or among those who are in the area being disinfected. For the 3-month period from January 1 to March 30, 2020, the number of calls about exposure to cleaners and disinfectants made to US poison centers in all states increased 20.4%, and the number of calls about exposure to disinfectants increased 16.4%. We examined calls about cleaners and disinfectants to the Michigan Poison Center (MiPC) since the onset of the COVID-19 pandemic. We compared all calls related to exposure to cleaners or disinfectants, calls with symptoms, and calls in which a health care provider was seen during the first quarters of 2019 and 2020 and in relationship to key COVID-19 dates. From 2019 to 2020, the number of all disinfectant calls increased by 42.8%, the number of calls with symptoms increased by 57.3%, the average number of calls per day doubled after the first Michigan COVID-19 case, from 4.8 to 9.0, and the proportion of calls about disinfectants among all exposure calls to the MiPC increased from 3.5% to 5.0% (P < .001). Calls for exposure to cleaners did not increase significantly. Exposure occurred at home for 94.8%97.1% of calls, and ingestion was the exposure route for 59.7% of calls. Information about the adverse health effects of disinfectants and ways to minimize exposure should be included in COVID-19 pandemic educational materials.
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Affiliation(s)
- Kenneth D. Rosenman
- Division of Occupational and Environmental Medicine, Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA,Kenneth D. Rosenman, MD, Michigan State University, Division of Occupational and Environmental Medicine, 909 Wilson Rd, Room 117 West Fee, East Lansing, MI 48824, USA;
| | - Mary Jo Reilly
- Division of Occupational and Environmental Medicine, Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Ling Wang
- Division of Occupational and Environmental Medicine, Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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Causes and Phenotypes of Work-Related Asthma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134713. [PMID: 32627764 PMCID: PMC7369698 DOI: 10.3390/ijerph17134713] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 12/23/2022]
Abstract
Work-related asthma (WRA) includes heterogeneous conditions, which have in common (i) symptoms and signs compatible with asthma and (ii) a relationship with exposures in the workplace. The types of WRA described in this review are distinguished by their etiology, comprising of work-exacerbated asthma (WEA), irritant-induced asthma (IIA), and immunologic occupational asthma (OA). There have been significant advances in the definition and characterization of the different forms of WRA by international panels of experts. The present review provides a comprehensive and updated view of the current knowledge on causes and phenotypes of WRA. Health care practitioners should consider WRA in any case of adult asthma, given that one fifth of workers with asthma report symptoms of WEA and it has been estimated that OA represents 10% to 25% of asthma in adulthood. The information provided in this review will facilitate the physician in the recognition of the different forms of WRA, since it has been established that five categories of agents are responsible for at least 60% of WEA cases and seven groups of agents are the cause of 70% of immunologic OA. In addition, there is agreement that IIA can be elicited not only by a single massive irritant exposure, but also by low/moderate repeated irritant exposures.
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Rosenman K, Reilly MJ, Pechter E, Fitzsimmons K, Flattery J, Weinberg J, Cummings K, Borjan M, Lumia M, Harrison R, Dodd K, Schleiff P. Cleaning Products and Work-Related Asthma, 10 Year Update. J Occup Environ Med 2020; 62:130-137. [PMID: 31895737 PMCID: PMC7839059 DOI: 10.1097/jom.0000000000001771] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the frequency of work-related asthma (WRA) and characteristics of individuals with exposure to cleaning products 1998 to 2012, compared with 1993 to 1997. METHODS Cases of WRA from products used for cleaning or disinfecting surfaces were identified from California, Massachusetts, Michigan (1998 to 2012), New Jersey (1998 to 2011), and New York (2009 to 2012). RESULTS There were 1199 (12.4%) cleaning product cases among all 9667 WRA cases; 77.8% women, 62.1% white non-Hispanic, and average age of 43 years. The highest percentages worked in healthcare (41.1%), and were building cleaners (20.3%), or registered nurses (14.1%). CONCLUSIONS The percentage of WRA cases from exposure to cleaning products from 1998 to 2012 was unchanged from 1993 to 1997 indicating that continued and additional prevention efforts are needed to reduce unnecessary use, identify safer products, and implement safer work processes.
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Affiliation(s)
- Kenneth Rosenman
- Michigan State University, Michigan (Dr Rosenman, Ms Reilly); Massachusetts Department of Public Health, Massachusetts (Ms Pechter, Ms Fitzsimmons); California Department of Public Health (Ms Flattery, Dr Harrison); Public Health Institute, Contractor to California Department of Public Health (Ms Weinberg), California; New York State Department of Health (Ms Cummings), New York; New Jersey Department of Health (Dr Borjan, Dr Lumia), New Jersey; and National Institute for Occupational Safety and Health, Cincinnati, Ohio (Ms Dodd, Ms Schleiff)
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Dumas O, Boggs KM, Quinot C, Varraso R, Zock J, Henneberger PK, Speizer FE, Le Moual N, Camargo CA. Occupational exposure to disinfectants and asthma incidence in U.S. nurses: A prospective cohort study. Am J Ind Med 2020; 63:44-50. [PMID: 31692020 DOI: 10.1002/ajim.23067] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/24/2019] [Accepted: 10/18/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Exposure to disinfectants among healthcare workers has been associated with respiratory health effects, in particular, asthma. However, most studies are cross-sectional and the role of disinfectant exposures in asthma development requires longitudinal studies. We investigated the association between occupational exposure to disinfectants and incident asthma in a large cohort of U.S. female nurses. METHODS The Nurses' Health Study II is a prospective cohort of 116 429 female nurses enrolled in 1989. Analyses included 61 539 participants who were still in a nursing job and with no history of asthma in 2009 (baseline; mean age: 55 years). During 277 744 person-years of follow-up (2009-2015), 370 nurses reported incident physician-diagnosed asthma. Occupational exposure was evaluated by questionnaire and a Job-Task-Exposure Matrix (JTEM). We examined the association between disinfectant exposure and subsequent asthma development, adjusted for age, race, ethnicity, smoking status, and body mass index. RESULTS Weekly use of disinfectants to clean surfaces only (23% exposed) or to clean medical instruments (19% exposed) was not associated with incident asthma (adjusted hazard ratio [95% confidence interval] for surfaces, 1.12 [0.87-1.43]; for instruments, 1.13 [0.87-1.48]). No association was observed between high-level exposure to specific disinfectants/cleaning products evaluated by the JTEM (formaldehyde, glutaraldehyde, bleach, hydrogen peroxide, alcohol quats, or enzymatic cleaners) and asthma incidence. CONCLUSIONS In a population of late career nurses, we observed no significant association between exposure to disinfectants and asthma incidence. A potential role of disinfectant exposures in asthma development warrants further study among healthcare workers at earlier career stage to limit the healthy worker effect.
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Affiliation(s)
- Orianne Dumas
- INSERM, U1168, VIMA‐Aging and Chronic DiseasesEpidemiological and Public Health ApproachesVillejuif France
- UMR‐S 1168Univ Versailles St‐Quentin‐en‐YvelinesMontigny le Bretonneux France
| | - Krislyn M. Boggs
- Channing Division of Network Medicine, Department of MedicineBrigham & Women's Hospital and Harvard Medical SchoolBoston Massachusetts
- Department of Emergency MedicineMassachusetts General Hospital and Harvard Medical SchoolBoston Massachusetts
| | - Catherine Quinot
- INSERM, U1168, VIMA‐Aging and Chronic DiseasesEpidemiological and Public Health ApproachesVillejuif France
- UMR‐S 1168Univ Versailles St‐Quentin‐en‐YvelinesMontigny le Bretonneux France
| | - Raphaëlle Varraso
- INSERM, U1168, VIMA‐Aging and Chronic DiseasesEpidemiological and Public Health ApproachesVillejuif France
- UMR‐S 1168Univ Versailles St‐Quentin‐en‐YvelinesMontigny le Bretonneux France
| | - Jan‐Paul Zock
- Barcelona Institute for Global Health (ISGlobal)Barcelona Spain
- Universitat Pompeu Fabra (UPF)Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP)Madrid Spain
| | - Paul K. Henneberger
- Respiratory Health DivisionNational Institute for Occupational Safety and HealthMorgantown West Virginia
| | - Frank E. Speizer
- Channing Division of Network Medicine, Department of MedicineBrigham & Women's Hospital and Harvard Medical SchoolBoston Massachusetts
| | - Nicole Le Moual
- INSERM, U1168, VIMA‐Aging and Chronic DiseasesEpidemiological and Public Health ApproachesVillejuif France
- UMR‐S 1168Univ Versailles St‐Quentin‐en‐YvelinesMontigny le Bretonneux France
| | - Carlos A. Camargo
- Channing Division of Network Medicine, Department of MedicineBrigham & Women's Hospital and Harvard Medical SchoolBoston Massachusetts
- Department of Emergency MedicineMassachusetts General Hospital and Harvard Medical SchoolBoston Massachusetts
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Walters GI, Burge PS, Moore VC, Robertson AS. Cleaning agent occupational asthma in the West Midlands, UK: 2000-16. Occup Med (Lond) 2019; 68:530-536. [PMID: 30184236 DOI: 10.1093/occmed/kqy113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Cleaning agents are now a common cause of occupational asthma (OA) worldwide. Irritant airway and sensitization mechanisms are implicated for a variety of old and new agents. Aims To describe the exposures responsible for cleaning agent OA diagnosed within a UK specialist occupational lung disease service between 2000 and 2016. Methods The Birmingham NHS Occupational Lung Disease Service clinical database was searched for cases of OA caused by cleaning agents, and data were gathered on age, gender, atopic status, smoking history, symptom onset, diagnostic investigations (including Occupational Asthma SYStem analysis of workplace serial peak expiratory flow measurements and specific inhalational challenge), proposed mechanism, industry, occupation and causative agent. Results Eighty patients with cleaning agent OA (77% female, 76% arising de novo) were identified. The median annual number of cases was 4 (interquartile range = 2-7). The commonest cleaning agents causing OA were chloramines (31%), glutaraldehyde (26%) and quaternary ammonium compounds (11%) and frequently implicated industries were healthcare (55%), education (18%) and leisure (8%). Conclusions Certain cleaning agents in common usage, such as chlorine-releasing agents, quaternary ammonium compounds and aldehydes, are associated with sensitization and asthma. Their use alters over time, and this is particularly evident in UK healthcare where cleaning and decontamination practice and policy have changed. Vigilance for OA in workplaces such as hospitals, nursing homes, leisure centres and swimming pools, where these cleaning agents are regularly used, is therefore essential.
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Affiliation(s)
- G I Walters
- Birmingham Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, Queensway, Birmingham, UK.,Occupational and Environmental Medicine, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - P S Burge
- Birmingham Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, Queensway, Birmingham, UK.,Occupational and Environmental Medicine, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - V C Moore
- Birmingham Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, Queensway, Birmingham, UK
| | - A S Robertson
- Birmingham Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, Queensway, Birmingham, UK
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Carder M, Seed MJ, Money A, Agius RM, van Tongeren M. Occupational and work-related respiratory disease attributed to cleaning products. Occup Environ Med 2019; 76:530-536. [PMID: 31167951 DOI: 10.1136/oemed-2018-105646] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/29/2019] [Accepted: 05/13/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Exposure to cleaning products has been associated with adverse respiratory outcomes. This study aimed to investigate the medically reported incidence, trends in incidence and occupational determinants of work-related respiratory disorders attributed to cleaning agents and to explore the role of 'Quantitative Structure Activity Relationships' (QSAR) in corroborating the identification of chemical respiratory sensitisers. METHODS Respiratory diagnoses attributed to cleaning agents were extracted from The Health and Occupation Research (THOR) surveillance network, 1989-2017. Incidence, trends in incidence and incidence rate ratios by occupation were investigated. Agents were classified by chemical type and QSAR hazard indices were determined for specific organic chemicals. RESULTS Approximately 6% (779 cases) of the (non-asbestos) THOR respiratory cases were attributed to cleaning agents. Diagnoses were predominantly asthma (58%) and inhalation accidents (27%) with frequently reported chemical categories being aldehydes (30%) and chlorine/its releasers (26%). No significant trend in asthma incidence (1999-2017) was observed (annual average change of -1.1% (95% CI -4.4 to 2.4)). This contrasted with a statistically significant annual decline in asthma incidence (-6.8% (95% CI -8.0 to -5.6)) for non-cleaning agents. There was a large variation in risk between occupations. 7 of the 15 organic chemicals specifically identified had a QSAR generated hazard index consistent with being a respiratory sensitiser. CONCLUSION Specific occupations appear to be at increased risk of adverse respiratory outcomes attributed to cleaning agents. While exposure to agents such as glutaraldehyde have been addressed, other exposures, such as to chlorine, remain important. Chemical features of the cleaning agents helped distinguish between sensitising and irritant agents.
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Affiliation(s)
- Melanie Carder
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | | | - Annemarie Money
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Raymond M Agius
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
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Abstract
Background: Cleaning and disinfecting agents are widely used in modern life, in homes, schools, public places, and workplaces as well as in recreational facilities such as swimming pools. Use has been for sanitizing purposes and to assist in reduction of infection as well as for deodorizing purposes. However, adverse respiratory effects have been associated with use of cleaning products ranging from effects in infancy and early childhood up to adults at home and work. Methods: This review summarizes recent published literature on the effects of cleaning agents used pre-natally, in childhood and adult life, at home, work, and in swimming pools. Results: Several studies have indicated that there is an increased risk of developing asthma among adults with frequent exposure to cleaning products at work and in the home. Potential mechanisms include sensitization and respiratory irritant effects. Exposure to irritant chlorine by-products from swimming pools have also been associated with respiratory effects and increased risk of asthma. Potential effects from maternal exposures to cleaning products on infants, and effects on early childhood atopy are less clear. Conclusions: Exposure to cleaning agents increases relative risks of asthma among workers, and adults using these agents in the home. Risks are also increased with exposure to chlorinated by-products from swimming pools, both in adults and children. Further studies are needed to understand the mechanisms of these associations.
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Freedman D, Woods GW. The developing significance of context and function: Neuroscience and law. BEHAVIORAL SCIENCES & THE LAW 2018; 36:411-425. [PMID: 30033592 DOI: 10.1002/bsl.2351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/21/2017] [Accepted: 11/27/2017] [Indexed: 06/08/2023]
Abstract
Neuroscience has already changed the understanding of how intent forms and is acted upon, how an individual's cognitive processes shape behavior, and how bio-psychosocial history and neurodevelopmental approaches provide information that has been largely missing from the assessment of intent. In this paper, we first review the state of forensic assessment of mental condition and intent, focused primarily on the weaknesses of the current approach. In Section 2, we discuss neurobehavioral forensic assessment, which is a neuroscience-based approach. Section 3 focuses on the changing understanding of mental illness and how neuroscience is pushing law towards a functional capacity-and-ability model and away from a diagnostic cut-off model. Finally, in Sections 4 and 5, we turn to the role of social and environmental context in shaping behavior and propose a model of behavioral intent in line with the scientific evidence.
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