"The National Institute for Occupational Safety and Health received a confidential employee request to conduct a health hazard evaluation at a hospital. The request cited concerns about exposure of hospital employees to a sporicidal cleaning and disinfection product containing hydrogen peroxide, peracetic acid, and acetic acid, and listed symptoms experienced by employees, including respiratory distress, skin problems, headaches, chest tightness, burning eyes, sore throat, and nausea. We performed a walk-through assessment of cleaning products used at the hospital on August 15, 2017, and informally interviewed hospital employees about cleaning products they used and any related health concerns. We observed the sporicidal product containing hydrogen peroxide, peracetic acid, and acetic acid was the main cleaning product used by environmental services staff for surface cleaning tasks. We returned on July 31 and August 1, 2018, to perform air-sampling and administer a postshift health questionnaire. We collected 56 full-shift air samples for hydrogen peroxide, peracetic acid, and acetic acid on or near environmental services staff performing cleaning activities. We also collected full-shift area samples in locations throughout the hospital. We observed environmental services staff while they performed their regular cleaning duties and noted task duration, cleaning product use and duration, and use of any personal protective equipment. Environmental services staff were observed occasionally using, or reported occasionally using, other sensitizer or irritant containing products including products containing quaternary ammonium compounds, bleach, phosphoric acid, sodium xylenesulfonate, or ethanolamines when cleaning general surfaces or bathroom surfaces. We also administered a voluntary post-shift health and work history questionnaire to patient-care and ancillary staff recruited from the same areas and departments of the hospital where area air samples were collected. All full-shift time-weighted average air samples for hydrogen peroxide and acetic acid were below established U.S. occupational exposure limits. Nasal, throat, and eye irritation, as well as shortness of breath were the most frequently reported work-related symptoms in the postshift survey of acute, cross-shift work-related symptoms. Similarly, nasal, throat, and eye irritation, as well as sneeze were the most frequently reported work-related symptoms in the post-shift survey of symptoms occurring in the previous four weeks. We observed statistically significant positive associations between work-related acute, crossshift eye, upper airway, and lower airway symptoms in relation to exposure to hydrogen peroxide, peracetic acid, and acetic acid vapors after adjusting for age, gender, smoking status, use of other cleaning products containing sensitizers and irritants, allergic status, and stress. Work-related acute nasal and eye irritation, and shortness of breath were significantly associated with increased exposure to hydrogen peroxide, peracetic acid, and acetic acid, indicating an increase in symptoms with increasing exposure to the mixture of vapors from the sporicidal product. Work-related acute, cross-shift wheeze was significantly associated with increases in exposure to hydrogen peroxide, one of the constituents in the sporicidal product. We also observed positive associations between work-related eye and upper airway symptoms in the previous four weeks in relation to exposure to hydrogen peroxide, peracetic acid, and acetic acid vapors after adjusting for age, gender, smoking status, frequency of use of other cleaning products containing sensitizers and irritants, allergic status, and stress. Work-related nasal and eye irritation in the previous four weeks were significantly associated with increases in departmental concentrations to hydrogen peroxide, peracetic acid, and acetic acid. Work-related sneeze in the previous four weeks was significantly associated with increases in departmental concentrations of peracetic acid. We identify several ways to reduce employee exposure to the sporicidal product containing hydrogen peroxide, peracetic acid, and acetic acid. We recommend that management restrict the use of sporicidal products containing hydrogen peroxide, peracetic acid, and acetic acid to areas of high risk for healthcare-acquired infections and minimize the use of sporicidal products containing hydrogen peroxide, peracetic acid, and acetic acid on non-critical surfaces and in non-patient areas. We also recommend that management provide workplace accommodations for employees who develop symptoms related to the use of sporicidal and high-level disinfectants. Management should also ensure that all heating, ventilation, and air-conditioning systems are functioning well and meet all applicable American Society of Heating, Refrigeration, and Air Conditioning Engineers standards.." - NIOSHTIC-2

NIOSH no. 20057074

Recommended citation for this report: NIOSH [2019]. Evaluation of exposure to a hydrogen peroxide, peracetic acid, and acetic acid containing cleaning and disinfection product and symptoms in hospital employees. By Blackley BH, Virji M, Harvey R, Cox-Ganser J, Nett R. Morgantown, WV: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, NIOSH HHE Report No. 2017-0114-3357.

2017-0114-3357.pdf