Health Effects Associated With Humidifier Disinfectant Use: A Systematic Review for Exploration

Abstract

Background It has been 10 years since the outbreak of lung disease caused by humidifier disinfectants in Korea, but the health effects have not yet been summarized. Therefore, this study aims to systematically examine the health effects of humidifier disinfectants that have been discovered so far. Methods All literature with humidifier disinfectants and their representative components as the main words were collected based on the web, including PubMed, Research Information Sharing Service, and government publication reports. A total of 902 studies were searched, of which 196 were selected. They were divided into four groups: published human studies (group 1), published animal and cytotoxicology studies (group 2), technical reports (group 3), and gray literature (group 4). Results Out of the 196 studies, 97 (49.5%) were published in peer-reviewed journals as original research. Group 1 consisted of 49 articles (50.5%), while group 2 consisted of 48 articles (49.5%). Overall, respiratory diseases such as humidifier disinfectant associated lung injury, interstitial lung disease, and asthma have a clear correlation, but other effects such as liver, heart, thymus, thyroid, fetal growth, metabolic abnormalities, and eyes are observed in toxicological experimental studies, but have not yet been identified in epidemiologic studies. Conclusion The current level of evidence does not completely rule out the effects of humidifier disinfectants on extrapulmonary disease. Based on the toxicological evidence so far, it is required to monitor the population of humidifier disinfectant exposure continuously to see if similar damage occurs.

Characterizing Subjects Exposed to Humidifier Disinfectants Using Computed-Tomography-Based Latent Traits: A Deep Learning Approach

“…The most common HD chemical ingredient was polyhexamethylene guanidine (PHMG). Other major ingredients were oligo (2-)ethoxyethoxyethyl guanidine chloride (PGH), chloromethylisothiazolinone (CMIT), and methylisothiazolinone (MIT) [15]. The exposure type and duration were defined based upon the questionnaire.…”

Knowledge, attitudes and practice regarding environmental friendly disinfectants for household use among residents of China in the post-pandemic period

“…The significant increase of public consumption for household disinfectant products triggered by COVID-19 pandemic greatly contributes to the tremendous environmental burden of disinfectant emissions in the post-pandemic period ( 2 ). Growing evidences have demonstrated various health, environmental, and ecological hazards associated with the residue and by-product of various common disinfectants, being typically represented by chlorine-based disinfectants ( 6 ) and quaternary ammonium compounds ( 7 , 8 ), at the environmentally relevant concentrations. For example, exposure to humidifier disinfectants, such as polyhexamethylene guanidine and benzalkonium chlorides, has been identified as the cause of a social disaster in Korea, 2011, which led to more than hundreds of deaths among pregnant women and infants from pulmonary diseases ( 8 ).…”

“…Growing evidences have demonstrated various health, environmental, and ecological hazards associated with the residue and by-product of various common disinfectants, being typically represented by chlorine-based disinfectants ( 6 ) and quaternary ammonium compounds ( 7 , 8 ), at the environmentally relevant concentrations. For example, exposure to humidifier disinfectants, such as polyhexamethylene guanidine and benzalkonium chlorides, has been identified as the cause of a social disaster in Korea, 2011, which led to more than hundreds of deaths among pregnant women and infants from pulmonary diseases ( 8 ). Ecotoxicity data for disinfectant quaternary ammonium compounds suggested their persistent, bioaccumulative and toxic (PBT) potentials at various trophic levels, including algae, fish, invertebrates, and aquatic plants ( 7 ).…”