Impact of Occupational Exposure to Disinfectant or Cleaning Agents on Asthma

Details

• Personal Author:
  Camargo CA ; Speizer F
• Description:
  Recent efforts to prevent healthcare-associated infections have led to increased use of disinfectants and cleaning agents. Studies suggest that occupational groups with regular exposure to these agents (e.g., health care workers) are at increased risk of asthma. However, the actual role of these common agents on the development and clinical course of asthma, and the specific agents and tasks involved, is largely unknown. The overall aim of the project was to address this knowledge gap in the Nurses' Health Study II, an ongoing prospective cohort study of 116,430 registered nurses, aged 24-44 years at baseline in 1989. Over the first 26 years, we observed approximately 14,000 incident cases of doctor-diagnosed asthma among approximately 22,000 nurses with a lifetime history of asthma. In 2009, 2011 and 2013, we asked all nurses about their job types and self-reported exposure to disinfectant or cleaning agents (approximately 35% of nurses were exposed weekly). In this project, we enhanced assessment of both the exposure and outcome through supplementary questionnaires during 2014- 2017. All nurses with asthma were sent questionnaires with validated questions on occupational exposures and asthma control (as defined by the 2007 NIH guidelines). The supplementary occupational questionnaire also was sent to a random sample of nurses without asthma (n=12,192); exposure data from this nonasthmatic group was used to create job exposure matrices (JEM) and task exposure matrices (TEM) that were applied to the entire cohort to better estimate exposure to specific agents. The enhanced data improved statistical power and permitted identification of specific agents that are most closely linked with asthma. The project had three specific aims. First, we used cohort data from 1989-2011 to determine the association between occupational exposure and incident asthma. We evaluated the "healthy worker effect" by examining job changes in relation to asthma status. Second, we performed a cross-sectional study (2014) to determine the association between occupational exposure and asthma control. Third, we conducted a prospective study to determine the association between occupational exposure and incident asthma (2009-2015, n approximately 370 cases). In the final year, we also performed preliminary work on the relation of occupational exposure to risk of incident COPD (2009-2015, n approximately 582 cases). Although occupational exposure to disinfectant or cleaning agents was not associated with incident asthma in late-career nurses, it was associated with worse asthma control. Moreover, preliminary work suggested, for the first time, that occupational exposure to disinfectant or cleaning agents was associated with incident chronic obstructive pulmonary disease (COPD). In summary, this innovative project determined the relation of a common occupational exposure among nurses to risk of adult-onset asthma and poor asthma control. The project provided a unique opportunity, in a large occupational cohort, to test several novel hypotheses about occupational exposures to disinfectant or cleaning agents and their impact on asthma - and to begin to study the role of occupational exposures on risk of developing COPD. The study results could have a major public health impact on the well-being of health care workers, cleaners, and others who are regularly exposed to disinfectant or cleaning agents. [Description provided by NIOSH]
• Subjects:
  Asthma, Occupational Cohort Studies Disinfectants Health Personnel Lung Occupational Exposure Occupational Health Respiratory System Safety
• Keywords:
  Cleaning Compounds Cohort Studies Health Care Workers JEM Job Exposure Matrix Nurses Occupational Asthma Occupational Exposure Pulmonary Disorders
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Final Grant Report
• Place as Subject:
  Massachusetts ; OSHA Region 1
• 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:
  1-128
• NIOSHTIC Number:
  nn:20055696
• NTIS Accession Number:
  PB2019-100849
• 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-010359, 2018 Sep; :1-128
• Email:
  ccamargo@partners.org
• Federal Fiscal Year:
  2018
• NORA Priority Area:
  Healthcare and Social Assistance
• Performing Organization:
  Brigham and Women's Hospital, Boston, Massachusetts
• Peer Reviewed:
  False
• Start Date:
  20130901
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20170831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:68c5c1665e23ed4f5b92abe41bebd50f156668e1fb29f6b91e2ce60fc89781a5a407c215879ba175751ba6c9272328597090027da839c7c618c1a3cbbd05b605
• Download URL:
  https://stacks.cdc.gov/view/cdc/218863/cdc_218863_DS1.pdf
• File Type:
  [PDF - 901.61 KB ]