Are Healthcare Workers at an Increased Risk for Obstructive Respiratory Diseases Due to Cleaning and Disinfection Agents? A Systematic Review and Meta-Analysis

Abstract

Several reviews have reported an increased risk of obstructive respiratory diseases in workers exposed to cleaning or disinfection agents, but they have focused mainly on professional cleaners. Cleaning and disinfecting are frequently performed activities by healthcare workers. We conducted a systematic review with meta-analysis to quantify the risk of obstructive respiratory diseases in healthcare workers exposed to cleaning and disinfection agents. We searched the Medline and Embase databases until 4 February 2021 to find adequate primary studies. Two independent reviewers screened the titles/abstracts and the full texts of the studies, as well as performing data extraction and quality assessment. The literature search yielded 9432 records, and 8 studies were found through a hand search. After screening, 14 studies were included in the review. All had a high risk of bias, and most studies dealt with nurses, asthma, and hyperresponsiveness (BHR)-related symptoms. Only one study investigated COPD. The meta-analysis estimated an increased risk of new-onset asthma for nurses (Effect size (ES) = 1.67; 95% CI 1.11–2.50) compared with other occupations and found an increase in the risk of new-onset asthma for nurses exposed to cleaning and disinfecting surfaces (ES = 1.43; 95% CI 1.09–1.89) and instruments (ES = 1.34; 95% CI 1.09–1.65). Exposure to specific chemicals such as bleach and glutaraldehyde (GA) increased the risk of asthma in nurses (bleach ES = 2.44; 95% CI 1.56–3.82; GA ES = 1.91, 95% CI 1.35–2.70). A higher risk for BHR-related symptoms was observed for nurses exposed to cleaning surfaces (ES = 1.44; 95% CI 1.18–1.78). Although the overall evidence was rated as low, the limitations found in this review hint at a potential underestimation of the real risk. These findings highlight the need for reinforced prevention practices with regard to healthcare workers. Similar research investigating these associations among other healthcare workers such as rescue service and nursing home personnel is needed.

The relationship between cleaning product exposure and respiratory and skin symptoms among healthcare workers in a hospital setting: A systematic review and meta‐analysis

“…In conclusion, this review found a higher risk of asthma among healthcare workers exposed to cleaning or disinfecting tasks or agents. These findings are consistent with the results of previously conducted systematic reviews 8,43 . Compared with this review, both previous reviews determined a greater increase in asthma risk associated with cleaning or disinfecting tasks 8,43 .…”

“…These findings are consistent with the results of previously conducted systematic reviews. 8,43 Compared with this review, both previous reviews determined a greater increase in asthma risk associated with cleaning or disinfecting tasks. 8,43 The limitations found in this review may contribute to a potential underestimation of the risk.…”

“…8,43 Compared with this review, both previous reviews determined a greater increase in asthma risk associated with cleaning or disinfecting tasks. 8,43 The limitations found in this review may contribute to a potential underestimation of the risk. The findings highlight the importance of implementing safe work practices and control measures that protect healthcare workers from potentially harmful occupational cleaning and disinfecting exposures.…”

An Overview of Cleaning Agents’ Health Hazards and Occupational Injuries and Diseases Attributed to Them in Sweden

“…Epidemiological research on health effects from cleaning and disinfection agents generally focus on cleaning and nursing occupations ( Quirce and Barranco, 2010 ; Van den Borre and Deboosere, 2018 ; Carder et al , 2019 ; De Matteis et al , 2020 ; Dumas and Le Moual, 2020 ; Archangelidi et al , 2021 ; Romero Starke et al , 2021 ). To some extent the SWEA data confirm expected patterns regarding in which sectors and occupations diseases and injuries occur, however, the full range of sectors and occupations covered by the ISA data show the wide-spread use of this product group.…”

“…Observational studies point towards links between use of cleaning agents and lung disease ( Quirce and Barranco, 2010 ; Van den Borre and Deboosere, 2018 ; Carder et al , 2019 ; De Matteis et al , 2020 ; Dumas and Le Moual, 2020 ; Archangelidi et al , 2021 ; Romero Starke et al , 2021 ). A Belgian registry study found increased mortality in respiratory and cardiovascular diseases among cleaners ( Van den Borre and Deboosere, 2018 ).…”