Characterization of Exposure to Cleaning Agents Among Health Workers in Two Southern African Tertiary Hospitals

Abstract

Background Whilst cleaning agents are commonly used in workplaces and homes, health workers (HWs) are at increased risk of exposure to significantly higher concentrations used to prevent healthcare-associated infections. Exposure assessment has been challenging partly because many are used simultaneously resulting in complex airborne exposures with various chemicals requiring different sampling techniques. The main objective of this study was to characterize exposures of HWs to various cleaning agents in two tertiary academic hospitals in Southern Africa. Methods A cross-sectional study of HWs was conducted in two tertiary hospitals in South Africa (SAH) and Tanzania (TAH). Exposure assessment involved systematic workplace observations, interviews with key personnel, passive personal environmental sampling for aldehydes (ortho-phthalaldehyde—OPA, glutaraldehyde and formaldehyde), and biomonitoring for chlorhexidine. Results Overall, 269 samples were collected from SAH, with 62 (23%) collected from HWs that used OPA on the day of monitoring. OPA was detectable in 6 (2%) of all samples analysed, all of which were collected in the gastrointestinal unit of the SAH. Overall, department, job title, individual HW use of OPA and duration of OPA use were the important predictors of OPA exposure. Formaldehyde was detectable in 103 (38%) samples (GM = 0.0025 ppm; range: <0.0030 to 0.0270). Formaldehyde levels were below the ACGIH TLV-TWA (0.1 ppm). While individual HW use and duration of formaldehyde use were not associated with formaldehyde exposure, working in an ear, nose, and throat ward was positively associated with detectable exposures (P-value = 0.002). Glutaraldehyde was not detected in samples from the SAH. In the preliminary sampling conducted in the TAH, glutaraldehyde was detectable in 8 (73%) of the 11 samples collected (GM = 0.003 ppm; range: <0.002 to 0.028). Glutaraldehyde levels were lower than the ACGIH’s TLV-Ceiling Limit of 0.05 ppm. p-chloroaniline was detectable in 13 (4%) of the 336 urine samples (GM = 0.02 ng/ml range: <1.00 to 25.80). Conclusion The study concluded that detectable exposures to OPA were isolated to certain departments and were dependent on the dedicated use of OPA by the HW being monitored. In contrast, low-level formaldehyde exposures were present throughout the hospital. There is a need for more sensitive exposure assessment techniques for chlorhexidine given its widespread use in the health sector.

Occupational risk factors and exposure–response relationships for airway disease among health workers exposed to cleaning agents in tertiary hospitals

“…Formaldehyde is a known asthmagen with both irritant and sensitising properties 4. Formalin (10%) solution was commonly used in both hospitals for specimen preparation (tissue fixation) 23. This was also evident in the exposure assessment study conducted in the SAH, which identified detectable levels of formaldehyde (GM=0.0025 ppm) in a considerable number (38%) of collected samples 23…”

“…A cross-sectional study of 699 HWs was conducted in two large tertiary academic hospitals (346 from a South Africa hospital (SAH) and 353 from Tanzanian hospital (TAH)) during the period July 2014–March 2015 for the SAH and between September 2017 and March 2018 for the TAH. All permanently employed HWs in selected departments that regularly used cleaning agents constituted the sampling frame of the study, as previously described 21–23. Study participants were selected from these departments using stratified random sampling according to job title, choosing up to five HWs from each department.…”

“…Information on occupational risk factors was obtained from the questionnaire, which had detailed information on the use of cleaning agents and related tasks in the past 12 months 24. More information regarding exposure assessment is provided in online supplemental table S1 and S2 and further details are contained in our recent article 23. Four major categories of cleaning-related tasks were considered, that is, medical instrument cleaning and disinfection, fixed surface cleaning and disinfection, specimen preparation and patients’ skin/wound cleaning and disinfection.…”

The impact of indoor pollution on asthma‐related outcomes: A systematic review for the EAACI guidelines on environmental science for allergic diseases and asthma

“…Cleaning agents and indoor pesticides cause mucous epithelial damage and may initiate or aggravate pre-existing asthma through different mechanisms, however their clinical relevance is still yet to be proven. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The aim of this systematic review (SR) and meta-analysis is to synthesize and update the current scientific evidence of the on the risk of developing asthma upon exposure to specific indoor pollutants and their impact on asthma-related outcomes. This SR was conducted in support of the recommendations enclosed in the clinical care guidelines developed by the European Society of Allergy and Clinical Immunology (EAACI) on the environmental science for allergic diseases and asthma.…”

“…tobacco smoke, furniture polish or cleaners and lack of proper ventilation). Cleaning agents and indoor pesticides cause mucous epithelial damage and may initiate or aggravate pre‐existing asthma through different mechanisms, however their clinical relevance is still yet to be proven 25–39 …”