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Fontana L, Stabile L, Caracci E, Chaillon A, Ait-Ikhlef K, Buonanno G. Filovirus outbreak responses and occupational health effects of chlorine spraying in healthcare workers: a systematic review and meta-analysis of alternative disinfectants and application methods. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.09.18.24313940. [PMID: 39371180 PMCID: PMC11451664 DOI: 10.1101/2024.09.18.24313940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
Objective In the context of filovirus outbreaks, chlorine spraying has been the standard for infection prevention and control. Due to potential occupational health risks, public health institutions now recommend wiping, which is labor-intensive and may increase the risk of heat stress for healthcare workers wearing personal protective equipment. This systematic review and meta-analysis quantified the health effects of occupational exposure to chlorine-based products compared to other disinfectants, and the effects of spraying compared to general disinfection tasks (GDTs) like wiping and mopping, in healthcare settings. Data sources design and eligibility criteria MEDLINE, Scopus, and ScienceDirect were searched for studies addressing the association between exposure to disinfectants applied by different application methods and occupational diseases in healthcare settings. Risk of bias was assessed by two independent reviewers using a validated tool. Data extraction and synthesis Two reviewers independently screened and performed data extraction and synthesis. A third reviewer resolved disagreements. Meta-analyses were conducted using fixed- and random-effects models based on the Higgins I² statistic. Results 30 studies investigating chlorine-based products (7,123 participants), glutaraldehyde (6,256 participants), peracetic acid, acetic acid and hydrogen peroxide (4,728 participants), quaternary ammonium compounds (QACs) (9,270 participants), use of spray (4,568 participants) and GDTs (3,480 participants) were included. Most had a cross-sectional design and high risk of bias. Meta-analysis indicates a significant association between respiratory conditions and exposure to chlorine-based products (OR 1.71, 95%CI 1.41- 2.08), glutaraldehyde (OR 1.44, 95%CI 1.14-1.81), QACs (OR 1.30, 95%CI 1.06-1.60), use of spray (OR 25, 95%CI 1.61-3.14) and GDTs (OR 2.20, 95%CI 1.66-2.90). The relative odds ratio (ROR) of respiratory conditions for chlorine-based products compared to QACs was 0.76 (95%CI 0.62-0.94). The ROR for the use of spray compared to GDTs was 0.98 (95%CI 0.74-1.29). Strengths include evaluating respiratory health risks of disinfectants, applying a validated tool, using both fixed- and random-effects models, and comparing pooled effect sizes. Limitations include high risk of bias for the majority of included articles, varying confounder adjustments, underreported non-respiratory outcomes, and unspecified disinfectants and PPE use for spray and GDTs articles. Conclusion Chlorine-based disinfectants significantly increase respiratory risk compared to QACs. Sprays and general disinfection tasks present similar risks. Our findings advocate for using less hazardous products like QACs, rather than banning sprays in filovirus outbreak responses to enhance disinfection safety. Prospero registration number CRD42023479363. Article summary Strengths and limitations of this studyThe systematic review and meta-analysis provide a comprehensive comparison of the health effects of occupational exposure to various disinfectants and application methods in healthcare settings.The study includes a broad range of disinfectants and application methods, offering a detailed assessment that extends beyond filovirus treatment centers.The inclusion of both fixed- and random-effects models in the meta-analysis ensures a robust evaluation of the data, accounting for potential variability among studies.While this study focused on respiratory conditions, other outcomes such as skin and ocular conditions were underreported, limiting the comprehensiveness of the assessment.Variations in exposure assessment methods and the lack of information on specific disinfectant products, PPE use, and ventilation further complicate comparisons and limit the ability to attribute health effects to specific factors.
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Hygiene requirements for cleaning and disinfection of surfaces: recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. GMS HYGIENE AND INFECTION CONTROL 2024; 19:Doc13. [PMID: 38655122 PMCID: PMC11035912 DOI: 10.3205/dgkh000468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
This recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) addresses not only hospitals, but also outpatient health care facilities and compiles current evidence. The following criteria are the basis for the indications for cleaning and disinfection: Infectious bioburden and tenacity of potential pathogens on surfaces and their transmission routes, influence of disinfecting surface cleaning on the rate of nosocomial infections, interruption of cross infections due to multidrug-resistant organisms, and outbreak control by disinfecting cleaning within bundles. The criteria for the selection of disinfectants are determined by the requirements for effectiveness, the efficacy spectrum, the compatibility for humans and the environment, as well as the risk potential for the development of tolerance and resistance. Detailed instructions on the organization and implementation of cleaning and disinfection measures, including structural and equipment requirements, serve as the basis for their implementation. Since the agents for surface disinfection and disinfecting surface cleaning have been classified as biocides in Europe since 2013, the regulatory consequences are explained. As possible addition to surface disinfection, probiotic cleaning, is pointed out. In an informative appendix (only in German), the pathogen characteristics for their acquisition of surfaces, such as tenacity, infectious dose and biofilm formation, and the toxicological and ecotoxicological characteristics of microbicidal agents as the basis for their selection are explained, and methods for the evaluation of the resulting quality of cleaning or disinfecting surface cleaning are presented.
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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: 3] [Impact Index Per Article: 3.0] [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.
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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
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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.
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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
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Anforderungen an die Hygiene bei der Reinigung und Desinfektion von Flächen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:1074-1115. [PMID: 36173419 PMCID: PMC9521013 DOI: 10.1007/s00103-022-03576-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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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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Jia Y, Wang J, Zhao L, Yan B. Eu 3+-β-diketone functionalized covalent organic framework hybrid material as a sensitive and rapid response fluorescent sensor for glutaraldehyde. Talanta 2022; 236:122877. [PMID: 34635257 DOI: 10.1016/j.talanta.2021.122877] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/01/2021] [Accepted: 09/09/2021] [Indexed: 11/22/2022]
Abstract
A covalent organic framework (named as TpDq) linked by β-ketoamine was prepared by imine condensation reaction with 1,3,5-triformylphloroglucinol (TFP) and 2,6-diaminoanthraquinone (DAAQ) as building blocks. Via employing a functionalized modification strategy, a new lanthanide complex Eu3+-β-diketone functionalized covalent organic framework hybrid material, Eu-TTA@TpDq (TTA = 2-thenoyltrifluoroacetone), has been synthesized. After post-synthetic modification (PSM), the shape and structure of the parent framework is well preserved and the modified material shows remarkable luminescence properties. Based on this, we designed it as a fluorescent probe and tried to use it to sense common aldehydes. The results indicate that Eu-TTA@TpDq exhibits a turn-off response toward glutaraldehyde which can distinguish from other common aldehydes. The fluorescent probe has the advantages of reusability, pH stability (4.50-8.52), fast luminescence response (<1 min) and low detection limit. The linear range of this method was 0-100 μM; the detection limit was 4.55 μM; the relative standard deviation was 2.16%. Furthermore, it has broad application prospect in both practical sensing of glutaraldehyde in water environment and simple detection of glutaraldehyde vapor. In addition, we preliminarily discussed the possible sensing mechanism.
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Affiliation(s)
- Yinghua Jia
- School of Chem. Science and Engineering, Tongji University, Siping Road 1239, Shanghai, 200092, China
| | - Jinmin Wang
- School of Chem. Science and Engineering, Tongji University, Siping Road 1239, Shanghai, 200092, China
| | - Limin Zhao
- School of Materials Science and Engineering, Liaocheng University, Liaocheng, 252000, China
| | - Bing Yan
- School of Chem. Science and Engineering, Tongji University, Siping Road 1239, Shanghai, 200092, China; School of Materials Science and Engineering, Liaocheng University, Liaocheng, 252000, China.
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Pearlman O. Reviewing the Use of Glutaraldehyde for High-level Disinfection by Sonographers. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318813361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A review of recent literature has demonstrated that ultrasound transducers may harbor bacteria and viruses that could cause cross-contamination for patients. Reducing the risk of cross-contamination is achieved by high-level disinfection of ultrasound transducers. One of the main types of high-level disinfectants (HLD) used in performing sonography is glutaraldehyde (GA). While GA-based HLDs are cleared in abundance by the FDA and compatible with most transducers, GA has been reported to cause extensive adverse effects and has limited efficacy as a disinfectant. This literature review provides a current set of studies that discuss high-level disinfection of ultrasound transducers, GA use, exposure, and alternatives. This information could be used by practitioners to carefully consider how to effectively clean ultrasound transducers and supporting equipment. Additional guidance is provided on how to potentially minimize GA exposure and suggestions for protecting patients during their imaging examination.
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Yu L, O'Sullivan D. Immobilization of whole cells of Lactococcus lactis containing high levels of a hyperthermostable β-galactosidase enzyme in chitosan beads for efficient galacto-oligosaccharide production. J Dairy Sci 2018; 101:2974-2983. [DOI: 10.3168/jds.2017-13770] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/06/2017] [Indexed: 12/22/2022]
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Burnett CL. Glutaral. Int J Toxicol 2017; 36:28S-30S. [PMID: 29025344 DOI: 10.1177/1091581817716646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christina L Burnett
- 1 Senior Scientific Writer/Analyst, Cosmetic Ingredient Review, Washington, DC, USA
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El-Helaly M, Balkhy HH, Waseem K, Khawaja S. Respiratory symptoms and ventilatory function among health-care workers exposed to cleaning and disinfectant chemicals, a 2-year follow-up study. Toxicol Ind Health 2015; 32:2002-2008. [PMID: 26525910 DOI: 10.1177/0748233715610043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previous cross-sectional studies have shown that exposure to cleaning chemicals among health-care workers (HCWs) is associated with respiratory disorders and ventilatory function changes. This study aimed to further explore this association using a longitudinal approach. A prospective 2-year follow-up study was carried out at a tertiary care hospital in Saudi Arabia from June 2012 to June 2014 among 56 nurses who were responsible for disinfection and sterilization of medical instruments and equipment. The workplaces of the participants were assessed for engineering, environmental, and safety control measures. Self-administered questionnaires were distributed to all participants to assess their exposure to cleaning chemicals and their medical history. Spirometric parameters were measured for all nurses in 2012 (baseline) and again in 2014 (follow-up). The prevalence of work-related respiratory symptoms did not increase significantly over this time. Among all the spirometric parameters, only forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio decreased significantly, and only 10.7% of participants who were exposed to cleaning chemicals for more than 10 years had FEV1 and FVC less than their longitudinal normal limits at the end of the study. Smoking and gender were associated with statistically significant decreases in some of the spirometric parameters. Our 2-year follow-up study did not demonstrate significant association between exposure to cleaning chemicals among HCWs and changes in the prevalence of work-related respiratory symptoms, but indicated early effects on ventilatory function among them. The study highlights the importance of periodic spirometry, proper work practices, and effective control measures to protect HCWs against potentially harmful workplace chemicals for disinfection and sterilization.
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Affiliation(s)
- Mohamed El-Helaly
- Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia .,Department of Community Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hanan H Balkhy
- Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdulla International Medical Research Center, King Saud University for Health Sciences, Riyadh, Saudi Arabia
| | - Khan Waseem
- Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sahdia Khawaja
- Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Precautionary practices of healthcare workers who disinfect medical and dental devices using high-level disinfectants. Infect Control Hosp Epidemiol 2015; 36:180-5. [PMID: 25633000 DOI: 10.1017/ice.2014.37] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND High-level disinfectants (HLDs) are used throughout the healthcare industry to chemically disinfect reusable, semicritical medical and dental devices to control and prevent healthcare-associated infections among patient populations. Workers who use HLDs are at risk of exposure to these chemicals, some of which are respiratory and skin irritants and sensitizers. OBJECTIVE To evaluate exposure controls used and to better understand impediments to healthcare workers using personal protective equipment while handling HLDs. DESIGN Web-based survey. PARTICIPANTS A targeted sample of members of professional practice organizations representing nurses, technologists/technicians, dental professionals, respiratory therapists, and others who reported handling HLDs in the previous 7 calendar days. Participating organizations invited either all or a random sample of members via email, which included a hyperlink to the survey. METHODS Descriptive analyses were conducted including simple frequencies and prevalences. RESULTS A total of 4,657 respondents completed the survey. The HLDs used most often were glutaraldehyde (59%), peracetic acid (16%), and ortho-phthalaldehyde (15%). Examples of work practices or events that could increase exposure risk included failure to wear water-resistant gowns (44%); absence of standard procedures for minimizing exposure (19%); lack of safe handling training (17%); failure to wear protective gloves (9%); and a spill/leak of HLD during handling (5%). Among all respondents, 12% reported skin contact with HLDs, and 33% of these respondents reported that they did not always wear gloves. CONCLUSION Findings indicated that precautionary practices were not always used, underscoring the importance of improved employer and worker training and education regarding HLD hazards.
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González Jara MA, Mora Hidalgo A, Avalos Gulin JC, López Albiach M, Muñoz Ortiz L, Torán Monserrat P, Esteva Ollé X. Exposure of health workers in primary health care to glutaraldehyde. J Occup Med Toxicol 2013; 8:31. [PMID: 24180250 PMCID: PMC4177389 DOI: 10.1186/1745-6673-8-31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 10/25/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In order to avoid proliferation of microorganisms, cleaning, disinfection and sterilisation in health centres is of utmost importance hence reducing exposure of workers to biological agents and of clients that attend these health centres to potential infections. One of the most commonly-used chemical is glutaraldehyde. The effects of its exposure are well known in the hospital setting; however there is very little information available with regards to the primary health care domain. OBJECTIVE To determine and measure the exposure of health workers in Primary Health Care Centres. Environmental to glutaraldehyde and staff concentration will be measured and compared with regulated Occupational Exposure Limits. METHODS/DESIGN Observational, cross-sectional and multi-centre study. The study population will be composed of any health professionals in contact with the chemical substance that work in the Primary Health Care Centres in the areas of Barcelonès Nord, Maresme, and Barcelona city belonging to the Catalan Institute of Health.Data will be collected from 1) Glutaraldhyde consumption from the previous 4 years in the health centres under study. 2) Semi-structured interviews and key informants to gather information related to glutaraldehyde exposure. 3) Sampling of the substance in the processes considered to be high exposure. DISCUSSION Although glutaraldehyde is extensively used in health centres, scientific literature only deals with certain occupational hazards in the hospital setting.This study attempts to take an in-depth look into the risk factors and environmental conditions that exist in the primary care workplace with exposure to glutaraldehyde.
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Affiliation(s)
- M Angel González Jara
- Basic Unit of Prevention Metropolitana Nord, Catalan Health Institute, Carrer Torrent de Can Gaio 17, 08320 El Masnou, Spain.
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