Occupational exposure to disinfectants and asthma incidence in U.S. nurses: A prospective cohort study

Abstract

Background: Exposure to disinfectants among healthcare workers has been associated with respiratory health effects, in particular, asthma. However, most studies are cross-sectional and the role of disinfectant exposures in asthma development requires longitudinal studies. We investigated the association between occupational exposure to disinfectants and incident asthma in a large cohort of U.S. female nurses. Methods: The Nurses' Health Study II is a prospective cohort of 116 429 female nurses enrolled in 1989. Analyses included 61 539 participants who were still in a nursing job and with no history of asthma in 2009 (baseline; mean age: 55 years). During 277 744 person-years of follow-up (2009-2015), 370 nurses reported incident physician-diagnosed asthma. Occupational exposure was evaluated by questionnaire and a Job-Task-Exposure Matrix (JTEM). We examined the association between disinfectant exposure and subsequent asthma development, adjusted for age, race, ethnicity, smoking status, and body mass index.Results: Weekly use of disinfectants to clean surfaces only (23% exposed) or to clean medical instruments (19% exposed) was not associated with incident asthma (adjusted hazard ratio [95% confidence interval] for surfaces, 1.12 [0.87-1.43]; for instruments, 1.13 [0.87-1.48]). No association was observed between high-level exposure to specific disinfectants/cleaning products evaluated by the JTEM (formaldehyde, glutaraldehyde, bleach, hydrogen peroxide, alcohol quats, or enzymatic cleaners) and asthma incidence. Conclusions:In a population of late career nurses, we observed no significant association between exposure to disinfectants and asthma incidence. A potential role of disinfectant exposures in asthma development warrants further study among healthcare workers at earlier career stage to limit the healthy worker effect. K E Y W O R D Sasthma, cleaning products, disinfection, healthcare workers, occupational asthma

Causes and Phenotypes of Work-Related Asthma

“…A cross-sectional study that included housekeepers and medical instrument cleaners found that use of various combinations of alcohol, bleach, high level disinfectants, and enzymes were associated with questionnaire-based clusters of undiagnosed asthma and asthma exacerbations [19]. In contrast, a 6-year prospective cohort study of over 60,000 nurses at a late stage of their career found no significant association between exposure to disinfectants and observed asthma incidence, but questioned whether this may have resulted from a healthy worker effect [20]. However, from another grouping drawn from the same larger cohort of female nurses, the same group found an association between questionnaire reported doctor-diagnosed chronic obstructive pulmonary disease (COPD) incidence and more frequent use of disinfectants, once a week or more [21].…”

Reducing the Risk of COVID‐19 Transmission in Dental Offices: A Review

“…19,21 The CDC Guidelines provide good protocols for cleaning contaminated surfaces. [75][76][77] It is naturally advisable to Table 1 Different ways to reduce aerosols and droplets in dental offices 1. Abandoning and/or substituting techniques that produce droplets, if possible.…”

“…utilize disinfectants that work on both airborne and blood born viruses and microorganisms. 77 Fogging or "Aerosol disinfection" is also an option for disinfection of surfaces without touching between the patients. There are some chemicals which can be used as vapor disinfectant including hydrogen peroxide and hypochlorous acid.…”

“…Surfaces can be contaminated directly or indirectly by the deposition of droplet particles and the lifetime of the virus on surfaces varies depending on the materials and the presence of moisture 19,21 . The CDC Guidelines provide good protocols for cleaning contaminated surfaces 75–77 . It is naturally advisable to utilize disinfectants that work on both airborne and blood born viruses and microorganisms 77 …”

“…The CDC Guidelines provide good protocols for cleaning contaminated surfaces 75–77 . It is naturally advisable to utilize disinfectants that work on both airborne and blood born viruses and microorganisms 77 …”