Occupational Health Risks Associated with Use of Environmental Surface Disinfectants in Health Care

Details

• Personal Author:
  Pechter E ; Rosenman, Kenneth D.
• Description:
  In their recent article, Weber et al concluded "scientific evidence does not support that the use of low-level disinfectant products on environmental surfaces by health care personnel is an important risk factor for the development of asthma or dermatitis." They reached this conclusion after reviewing the employee medical records at University of North Carolina hospitals (2003-2012) and conducting a literature review on disinfectants and health care workers. We take exception with the adequacy of the data for their study and the thoroughness of their literature review and do not find their conclusion to be supported by their data. Their conclusion diverts attention from the need for targeted cleaning and disinfection on surfaces and in situations where the risks are greatest and research has shown such intervention to be effective. The overuse of disinfectants causes health care workers to be unnecessarily exposed to substances that, we would hope the authors would agree, have at least the potential to cause or aggravate asthma or dermatitis in health care workers. The authors listed a number of limitations in their data, such as North Carolina's exclusion of workers' compensation for chemical sensitization, but did not appreciate the well-documented lack of recognition of work-related injuries and, especially, illnesses by employers. Weber asserts "no episodes of acute bronchospasm or persistent asthma were reported related to germicide exposure" and only 95 incidents of splashes, inflammation, exposures, or chemical burns in 10 years for 69,075 full-time work years. This flies in the face of national surveillance data of work-related injuries and illnesses and data on asthma. The Bureau of Labor Statistics' Survey of Occupational Injuries and Illnesses documents a rate of 5.3 cases involving days away from work per year caused by exposure to harmful substances or environments in the health care and social assistance industry-higher than the national average for all industries. The Centers for Disease Control and Prevention reported that the National Health Interview Survey showed the health care industry with a current asthma prevalence rate of 8.1% in hospitals and 9.5% in nursing and residential facilities, higher than in other industries. The National Institute for Occupational Safety and Health has documented elevated asthma and chronic obstructive pulmonary disease proportionate mortality rates in the health care industry.4 Over 40 articles have documented the association of cleaning products, and specifically disinfectants used in hospitals, with asthma. This includes antigen challenge testing with specific disinfectants, the gold standard for showing a causal relationship for chemical-induced asthma. Self-reported asthma in epidemiologic studies, which the authors characterize as weak evidence, has been validated to correlate with physician-diagnosed asthma. Six disinfectants used in hospitals meet the criteria of the Association of Occupational and Environmental Clinics for substances rated as causing asthma. Multistate surveillance has continued to document the contribution of cleaning products and disinfectants to work-related asthma (WRA) prevalence. In Massachusetts, nearly 16% of all confirmed WRA cases (2003-2013) were in the health care and social assistance industry, and the leading exposures were cleaning products. The cases of WRA among health care workers from disinfectants in state surveillance systems require a physician's diagnosis of asthma. In Michigan surveillance of work-related pesticide poisoning, disinfectants were the cause of over half the confirmed cases. In North Carolina, 7.8% of adults (estimated 592,279 persons) currently have asthma; however, the authors' analysis did not identify a single employee of UNC hospitals who sought medical care in employee health, or reported an episode of asthma exacerbation from their work with or near bleach, quats, or other chlorine-based products, ammonia, glutaraldehyde, hydrogen peroxide, and so forth. Workers in cleaning occupations frequently do not report their work-related illnesses because of discouragement by employers, job insecurity, and marginalization of this occupational category. Azaroff et al documented the obstacles to reporting work-related injuries and illnesses that prevent an accurate assessment of their true prevalence. In fact, even work-related amputations are undercounted. Failing to recognize the hazards of disinfectants along with blanket advice to continue to disinfect environmental surfaces leads to overuse and overexposure of hospital staff to these antimicrobial pesticides. Most hospital-associated infections are associated with venous or urinary catheters, ventilator use, antibiotic therapy, inadequate hand hygiene, length of hospital stay, surgical site infections, and antibiotic prescription. In fact, increased antimicrobial use has been associated with the emergence of resistance. Encouraging indiscriminate use of disinfectants on environmental surfaces may also lead to undertreatment of surfaces which do pose a real risk of microbe transfer and subsequent disease and which need targeted disinfectant application. For example, terminal room cleaning subsequent to occupancy by a patient with vancomycin-resistant Enterococcus, methicillin-resistant Staphylococcus aureus, or Clostridium difficile can prevent illness in the next occupant. The National Institute for Occupational Safety and Health's National Occupational Research Agenda Working Group concluded that there are gaps in our understanding and there is a need to evaluate the potential of environmental surfaces to contribute to hospital-associated infections in patients and occupationally acquired infections in health care workers. The need for nuanced antimicrobial stewardship and comprehensive surveillance and prevention of work-related illnesses remain important issues for hospitals. [Description provided by NIOSH]
• Subjects:
  Asthma Asthma, Occupational Disinfectants Environmental Exposure Health Personnel Hypersensitivity Occupational Health Safety Skin Skin Diseases
• Keywords:
  Allergic Dermatitis Cleaning Compounds Environmental Exposure Health Care Workers
• ISSN:
  0196-6553
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  Massachusetts ; Michigan ; OSHA Region 1 ; OSHA Region 5
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  44
• Issue:
  12
• NIOSHTIC Number:
  nn:20050868
• Citation:
  Am J Infect Control 2016 Dec; 44(12):1755-1756
• Contact Point Address:
  Elise Pechter, MAT, MPH, CIH, Occupational Health Surveillance Program, Massachusetts Department of Public Health, 250 Washington St, Boston, MA 02108
• Email:
  Elise.Pechter@state.ma.us
• Federal Fiscal Year:
  2017
• Performing Organization:
  Massachusetts State Department of Public Health
• Peer Reviewed:
  False
• Start Date:
  20050701
• Source Full Name:
  American Journal of Infection Control
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:c8895f6227d1d06a4c288a15249080832ca30d0e3fda7d57b35c318262264b0f91f8bef58fad6766f4b6485a073472ad79ed5f8e6546d4e2945b487ca0fe23db
• Download URL:
  https://stacks.cdc.gov/view/cdc/211062/cdc_211062_DS1.pdf
• File Type:
  [PDF - 194.07 KB ]