Characterization of cleaning and disinfecting tasks and product use among hospital occupations

Saito, Rena; Virji, M. Abbas; Henneberger, Paul K.; Humann, Michael; LeBouf, Ryan F.; Stanton, Marcia L.; Liang, Xiaoming; Stefaniak, Aleksandr B.

doi:10.1002/ajim.22393

Cited by 60 publications

(65 citation statements)

References 40 publications

(52 reference statements)

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“…In a study conducted in 5 U.S. hospitals, cleaning and disinfecting tasks (at least once per shift), were frequent among registered nurses (66%),[9] consistent with our results. Among U.S. hospital workers[6], self-reported exposures to cleaning and disinfecting products during instrument cleaning (42%) and building surface cleaning (78%) were higher than in the present study.…”

Section: Discussionsupporting

confidence: 91%

“…[1,4,6] Several studies have shown associations with onset or symptoms of asthma but little is known about specific agents involved,[2,3,7] which limits the development of disease prevention strategies. [8] Indeed, identifying which specific agents might affect the respiratory health of healthcare workers is challenging,[4,9] partly due to the lack of suitable exposure assessment methods.…”

Section: Introductionmentioning

confidence: 99%

“…[12] Occupational exposure may be heterogeneous for a given occupation according to tasks performed. Several authors underlined the importance of taking into account the tasks to reduce exposure misclassification,[9,13] leading to the emergence of the task-exposure matrix (TEM) and job-task-exposure matrix (JTEM), mainly in cancer epidemiology. [9,12,14,15] To the best of our knowledge, no JEM, TEM or JTEM are available to evaluate exposure to the specific agents or compounds of cleaning products and disinfectants.…”

Section: Introductionmentioning

confidence: 99%

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Development of a job-task-exposure matrix to assess occupational exposure to disinfectants among US nurses

Quinot

Dumas

et al. 2016

Occup Environ Med

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Objectives Occupational exposure to disinfectants is associated with work-related asthma, especially in healthcare workers. However, little is known about the specific products involved. To evaluate disinfectant exposures, we designed job-exposure (JEM) and job-task-exposure (JTEM) matrices, which are thought to be less prone to differential misclassification bias than self-reported exposure. We then compared the three assessment methods: self-reported exposure, JEM, and JTEM. Methods Disinfectant use was assessed by an occupational questionnaire in 9,073 U.S. female registered nurses without asthma, aged 49–68 years, drawn from the Nurses’ Health Study II. A JEM was created based on self-reported frequency of use (1–3, 4–7 days/week) of 7 disinfectants and sprays in 8 nursing jobs. We then created a JTEM combining jobs and disinfection tasks to further reduce misclassification. Exposure was evaluated in 3 classes (low, medium, high) using product-specific cut-offs (e.g., <30%, 30–49.9%, ≥50%, respectively, for alcohol); the cut-offs were defined from the distribution of self-reported exposure per job/task. Results The most frequently reported disinfectants were alcohol (weekly use: 39%), bleach (22%) and sprays (20%). More nurses were classified as highly exposed by JTEM (alcohol 41%, sprays 41%, bleach 34%) than by JEM (21%, 30%, 26%, respectively). Agreement between JEM and JTEM was fair-to-moderate (kappa: 0.3–0.5) for most disinfectants. JEM and JTEM exposure estimates were heterogeneous in most nursing jobs, except in emergency room and education/administration. Conclusion The JTEM may provide more accurate estimates than the JEM, especially for nursing jobs with heterogeneous tasks. Use of the JTEM is likely to reduce exposure misclassification.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Development of a job-task-exposure matrix to assess occupational exposure to disinfectants among US nurses

Quinot

Dumas

et al. 2016

Occup Environ Med

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“…The prevalence of respiratory illness in healthcare professionals is much higher than that of the general population (Liss et al, 2011;Bakerly et al, 2008), and exposure to multiple chemicals for prolonged periods of time is almost certainly a contributory factor (Saito et al, 2015;Wiszniewska and Walusiak-Skorupa, 2014). There are well-documented reports of occupational asthma attributable to glutaraldehyde, but the prevalence is low ( Vandenplas et al, 2011).…”

Section: Glutaraldehydementioning

confidence: 99%

Thresholds in chemical respiratory sensitisation

et al. 2015

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There is a continuing interest in determining whether it is possible to identify thresholds for chemical allergy. Here allergic sensitisation of the respiratory tract by chemicals is considered in this context. This is an important occupational health problem, being associated with rhinitis and asthma, and in addition provides toxicologists and risk assessors with a number of challenges. In common with all forms of allergic disease chemical respiratory allergy develops in two phases. In the first (induction) phase exposure to a chemical allergen (by an appropriate route of exposure) causes immunological priming and sensitisation of the respiratory tract. The second (elicitation) phase is triggered if a sensitised subject is exposed subsequently to the same chemical allergen via inhalation. A secondary immune response will be provoked in the respiratory tract resulting in inflammation and the signs and symptoms of a respiratory hypersensitivity reaction. In this article attention has focused on the identification of threshold values during the acquisition of sensitisation. Current mechanistic understanding of allergy is such that it can be assumed that the development of sensitisation (and also the elicitation of an allergic reaction) is a threshold phenomenon; there will be levels of exposure below which sensitisation will not be acquired. That is, all immune responses, including allergic sensitisation, have threshold requirement for the availability of antigen/allergen, below which a response will fail to develop. The issue addressed here is whether there are methods available or clinical/epidemiological data that permit the identification of such thresholds. This document reviews briefly relevant human studies of occupational asthma, and experimental models that have been developed (or are being developed) for the identification and characterisation of chemical respiratory allergens. The main conclusion drawn is that although there is evidence that the acquisition of sensitisation to chemical respiratory allergens is a dose-related phenomenon, and that thresholds exist, it is frequently difficult to define accurate numerical values for threshold exposure levels. Nevertheless, based on occupational exposure data it may sometimes be possible to derive levels of exposure in the workplace, which are safe. An additional observation is the lack currently of suitable experimental methods for both routine hazard characterisation and the measurement of thresholds, and that such methods are still some way off. Given the current trajectory of toxicology, and the move towards the use of non-animal in vitro and/or in silico) methods, there is a need to consider the development of alternative approaches for the identification and characterisation of respiratory sensitisation hazards, and for risk assessment.

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“…In another study conducted in French hospitals, Gonzalez et al 22 reported that around 75%, 50% and 20% of participants were exposed to quats, chlorinated products/bleach (mainly cleaners) and glutaraldehyde, respectively. In five US hospitals, Saito et al 26 observed that products containing alcohols were the most frequently used by clinical laboratory technicians, certified nursing assistants and registered nurses (58%, 75% and 68% of shifts) for a mean duration of 45 min. For housekeepers, products with alcohol and quats were the most frequently used (>90% of shifts) for a mean duration of 115 min 26…”

Section: Discussionmentioning

confidence: 99%

Development of a bar code-based exposure assessment method to evaluate occupational exposure to disinfectants and cleaning products: a pilot study

et al. 2018

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Characterization of cleaning and disinfecting tasks and product use among hospital occupations

Cited by 60 publications

References 40 publications

Development of a job-task-exposure matrix to assess occupational exposure to disinfectants among US nurses

Development of a job-task-exposure matrix to assess occupational exposure to disinfectants among US nurses

Thresholds in chemical respiratory sensitisation

Development of a bar code-based exposure assessment method to evaluate occupational exposure to disinfectants and cleaning products: a pilot study

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