Asthma in Texas Healthcare Workers II

Details

• Personal Author:
  Carson A ; Conway S ; De Los Reyes J ; Delclos GL ; Gimeno D ; Han I ; Patel J ; Pompeii L ; Whitehead L
• Description:
  Healthcare professionals (HCPs) are at risk for work-related asthma (WRA). The 2003 Texas Asthma Study (TAS) found higher odds of new-onset asthma (NOA) associated with medical instrument and building surface cleaning, aerosolized medication administration, and powdered latex glove use in 1992-2000. Subsequent changes in cleaning practices over this time may have affected asthma risk. We assessed changes in WRA prevalence and its risk factors, and examined asthma burden in Texas HCPs about 15 years after the 2003 study. The project involved two major activities: exposure assessment and administration of a statewide survey. In the exposure assessment phase, the 2003 asthma-specific job-exposure matrix (JEM) was updated, using literature review, focus groups with Houston area HCPs and expert input. Exposures centered on cleaning/disinfection products, procedures and tasks, and latex glove use. JEM coding was conducted by a group of experts and followed the same coding scale used in 2003, to allow comparisons. In the field phase, the 2003 questionnaire was first revised and updated to include new self-reported exposures, components related to occupational history to better characterize WRA in terms of work-exacerbated asthma (WEA) or occupational asthma (OA) and to assess the socioeconomic impact of asthma. It was then administered to a population-based sample of selected groups of healthcare workers in Texas: physicians, nurses, respiratory therapists, occupational therapists, and certified nurse aides (n=9,914). We examined two asthma outcomes: NOA, i.e. asthma with onset after entering the healthcare field, and bronchial hyperresponsiveness symptoms (BHR), using a previously validated 8-item predictor from the TAS. We used unconditional logistic regression, taking into account survey weights, to estimate associations between exposures and outcomes. Asthma burden was measured by missed workdays and the Work Role Function Questionnaire (WRFQ), a surrogate for presenteeism (i.e., working while ill). Overall response rate was 34.8% (n=3,444); the final analytical sample was 2,427 participants. The weighted prevalence of NOA was 7.1%, highest among nurses; for BHR, it was 31.0%, highest for occupational therapists. NOA was associated with building surface cleaning (OR 2.03, 95%CI 1.26-3.28), ortho-phthalaldehyde (OR 1.93, 95%CI 1.29-2.88), bleach/quaternary ammonium compounds (OR 1.83, 95%CI 1.14-2.93) and sprays (OR 2.03, 95%CI 1.26-3.28), but not with other exposures. For BHR, there were no statistically significant adverse associations. Mean missed work days due to health problems among asthmatics and non-asthmatics in the past 12 months were 9.9 and 13.5, respectively (p>0.05); however, 76% of these missed work days among asthmatics were due to asthma or breathing problems. Mean WRFQ scores were statistically significantly lower for asthmatics, indicating greater presenteeism. Compared to the 2003 TAS, NOA and BHR prevalence were unchanged; medical instrument cleaning/disinfection, powdered latex glove use and exposure to a workplace spill were no longer statistically significant risk factors. Cleaning of building surfaces, ortho-phthalaldehyde, bleach, quaternary ammonium compounds, and using sprays to apply cleaners remain a problem. Consequently, HCPs remain at risk for WRA, although there are encouraging trends. Exposure controls, together with optimum clinical management of asthma, would likely result in a decrease in asthma burden in healthcare occupations. In terms of work functioning, asthmatics are more likely than non-asthmatics to work while ill, even though they trend towards missing fewer days of work. [Description provided by NIOSH]
• Subjects:
  Aerosols Asthma, Occupational Health Care Facilities Workforce And Services Health Personnel Occupational Health Personal Protective Equipment Risk Assessment Risk Factors Safety Surface-Active Agents
• Keywords:
  Cleaning Compounds Exposure Assessment Gloves Health Care Workers JEM Job Exposure Matrix Medical Equipment Occupational Asthma Risk Factors Surfactants
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Final Grant Report
• Place as Subject:
  OSHA Region 6 ; Texas
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-63
• NIOSHTIC Number:
  nn:20055653
• NTIS Accession Number:
  PB2019-100845
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R01-OH-010648, 2018 Oct; :1-63
• Contact Point Address:
  George L. Delclos, MD, MPH, PhD, The University of Texas Health Science Center at Houston (UTHealth), PO Box 20036, Houston, Texas 77225-0036
• Email:
  George.Delclos@uth.tmc.edu
• Federal Fiscal Year:
  2019
• NORA Priority Area:
  Healthcare and Social Assistance
• Performing Organization:
  University of Texas Health Science Center at Houston
• Peer Reviewed:
  False
• Start Date:
  20140801
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20180731
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:94fe589c82fece173377ee5d018008cbe6165d367c690efc064277ef9a9f7f016cf26dbe29398c8912df927f51f566599d07f0d3c1cada9ceac0dcab63530588
• Download URL:
  https://stacks.cdc.gov/view/cdc/218859/cdc_218859_DS1.pdf
• File Type:
  [PDF - 2.99 MB ]