Health problems and disinfectant product exposure among staff at a large multispecialty hospital

Casey, Megan; Hawley, Brie; Edwards, Nicole; Cox‐Ganser, Jean M.; Cummings, Kristin J.

doi:10.1016/j.ajic.2017.04.003

Cited by 54 publications

(61 citation statements)

References 23 publications

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“…Few studies have evaluated occupational exposure to HP, PAA, and AA and health outcomes in a health care setting (Cristofari-Marquand et al , 2007; Casey et al , 2017). In this study, work-related acute eye and nasal symptoms and chronic airway symptoms were reported by hospital workers using a sporicidal product containing HP, PAA, and AA.…”

Section: Discussionmentioning

confidence: 99%

Respiratory Symptoms in Hospital Cleaning Staff Exposed to a Product Containing Hydrogen Peroxide, Peracetic Acid, and Acetic Acid

Hawley

Casey

Virji

et al. 2017

Annals of Work Exposures and Health

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Cleaning and disinfecting products consisting of a mixture of hydrogen peroxide (HP), peracetic acid (PAA), and acetic acid (AA) are widely used as sporicidal agents in health care, childcare, agricultural, food service, and food production industries. HP and PAA are strong oxidants and their mixture is a recognized asthmagen. However, few exposure assessment studies to date have measured HP, PAA, and AA in a health care setting. In 2015, we performed a health and exposure assessment at a hospital where a new sporicidal product, consisting of HP, PAA, and AA was introduced 16 months prior. We collected 49 full-shift time-weighted average (TWA) air samples and analyzed samples for HP, AA, and PAA content. Study participants were observed while they performed cleaning duties, and duration and frequency of cleaning product use was recorded. Acute upper airway, eye, and lower airway symptoms were recorded in a post-shift survey (n = 50). A subset of 35 cleaning staff also completed an extended questionnaire that assessed symptoms reported by workers as regularly occurring or as having occurred in the previous 12 months. Air samples for HP (range: 5.5 to 511.4 ppb) and AA (range: 6.7 to 530.3 ppb) were all below established US occupational exposure limits (OEL). To date, no full-shift TWA OEL for PAA has been established in the United States, however an OEL of 0.2 ppm has been suggested by several research groups. Air samples for PAA ranged from 1.1 to 48.0 ppb and were well below the suggested OEL of 0.2 ppm. Hospital cleaning staff using a sporicidal product containing HP, PAA, and AA reported work-shift eye (44%), upper airway (58%), and lower airway (34%) symptoms. Acute nasal and eye irritation were significantly positively associated with increased exposure to the mixture of the two oxidants: HP and PAA, as well as the total mixture (TM) of HP, PAA, and AA. Shortness of breath when hurrying on level ground or walking up a slight hill was significantly associated with increased exposure to the oxidant mixture (P = 0.017), as well as the TM (P = 0.026). Our results suggest that exposure to a product containing HP, PAA, and AA contributed to eye and respiratory symptoms reported by hospital cleaning staff at low levels of measured exposure.

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Section: Discussionmentioning

confidence: 99%

Respiratory Symptoms in Hospital Cleaning Staff Exposed to a Product Containing Hydrogen Peroxide, Peracetic Acid, and Acetic Acid

Hawley

Casey

Virji

et al. 2017

Annals of Work Exposures and Health

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“…A range of discomfort was reported for workers exposed to between 1.0 ppm and 3.0 ppm of this mixed aerosol in this same report. Additional health effects, which have been recently documented, include a possible link to exacerbation of asthma in workers (Casey et al, 2017;Hawley et al, 2017). Given its current Figure 6.…”

Section: Discussionmentioning

confidence: 99%

Description and evaluation of a peracetic acid air sampling and analysis method

et al. 2017

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Peracetic acid (PAA) is a corrosive chemical with a pungent odor, which is extensively used in occupational settings and causes various health hazards in exposed workers. Currently, there is no US government agency recommended method that could be applied universally for the sampling and analysis of PAA. Legacy methods for determining airborne PAA vapor levels frequently suffered from cross-reactivity with other chemicals, particularly hydrogen peroxide (HO). Therefore, to remove the confounding factor of cross-reactivity, a new viable, sensitive method was developed for assessment of PAA exposure levels, based on the differential reaction kinetics of PAA with methyl p-tolylsulfide (MTS), relative to HO, to preferentially derive methyl p-tolysulfoxide (MTSO). By quantifying MTSO concentration produced in the liquid capture solution from an air sampler, using an internal standard, and utilizing the reaction stoichiometry of PAA and MTS, the original airborne concentration of PAA is determined. After refining this liquid trap high-performance liquid chromatography (HPLC) method in the laboratory, it was tested in five workplace settings where PAA products were used. PAA levels ranged from the detection limit of 0.013 parts per million (ppm) to 0.4 ppm. The results indicate a viable and potentially dependable method to assess the concentrations of PAA vapors under occupational exposure scenarios, though only a small number of field measurements were taken while field testing this method. However, the low limit of detection and precision offered by this method makes it a strong candidate for further testing and validation to expand the uses of this liquid trap HPLC method.

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“…Extensive research has been done previously at exposure to most frequently used disinfectant compound, that is, quats, sodium hypochlorite, hydrogen peroxide, alcohol, and glutaraldehyde. All of these were linked with an increased risk of chronic obstructive pulmonary disease (COPD), asthma, and eye irritation on health workers and individuals when used regularly (Casey et al 2017;Dumas et al 2019;Weinmann et al 2019). Chemical residues left on a surface can become airborne and inhaled, and often contribute to poor indoor air quality with consequences for the asthmatic, allergic, or sensitive people (IOM 2000).…”

Section: Toxic Effect Of Disinfectantsmentioning

confidence: 99%

Consequences of chemical impact of disinfectants: safe preventive measures against COVID-19

Kumar

Ashok

Akondi

2020

Critical Reviews in Toxicology

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Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has created a significant threat to global health. It originated in Wuhan, China and caused a total of 83,483 confirmed cases and 4634 deaths until June 2020. This novel virus spread primarily through respiratory droplets and close contact. The person-to-person transmission by direct transmittance through cough, sneeze, droplet inhalation, and contact spreading from dry surfaces contaminated with secretions of nose, mouth, and eyes of an infected person has been proven about SARS-CoV-2 transmission. As disease progressed, a series of complications tends to develop, especially in critically ill and immunocompromised patients. Pathological studies showed representative features of acute respiratory distress syndrome (ARDS) and implications on multiple organs as well. However, no specific antiviral drugs or vaccines are immediately available for the treatment of this lethal disease. The efficacy of some promising antivirals needs to be investigated by ongoing clinical trials. In current circumstances, supportive care, precautions, and social distancing are the only preventive options to ameliorate COVID-19. To disinfect the environment, mainly chemical disinfectants are being used robustly. However, due to panic state, fright, and unawareness, people are using it violently, which can have an adverse effect on human health and environment. This review discusses about the potential harmful effect of disinfectants, if used inappropriately. Here, we will also discuss safe preventive options as an alternative to robust use of disinfection methods to fight against COVID-19.

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Health problems and disinfectant product exposure among staff at a large multispecialty hospital

Cited by 54 publications

References 23 publications

Respiratory Symptoms in Hospital Cleaning Staff Exposed to a Product Containing Hydrogen Peroxide, Peracetic Acid, and Acetic Acid

Respiratory Symptoms in Hospital Cleaning Staff Exposed to a Product Containing Hydrogen Peroxide, Peracetic Acid, and Acetic Acid

Description and evaluation of a peracetic acid air sampling and analysis method

Consequences of chemical impact of disinfectants: safe preventive measures against COVID-19

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