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

Abstract

Background and Aims: Several studies from multiple work settings have reported an increase in asthma and asthma-like respiratory symptoms in workers exposed to cleaning or disinfecting agents. Hospital workers perform many cleaning and disinfecting activities and may be vulnerable to respiratory and skin symptoms caused by these agents. This systematic review and meta-analysis aim to quantify the risk of asthma and asthma-like symptoms in hospital workers exposed to cleaning/disinfecting agents. A secondary aim is to assess associated risks of skin symptoms in those studies.Methods: MEDLINE, EMBASE, CDSR, CENTRAL, CINAHL databases, and references of relevant review articles were searched. NHLBI quality assessment tools were used to assess the quality of the included studies. A total of 2550 articles were retrieved and 34 studies met criteria to be included. The software R version 4.0.5 was used to perform the meta-analysis. The random-effects model was used to pool the results due to within-studies heterogeneity.Results: Meta-analysis of 10 studies evaluating the association between occupational cleaning exposures and asthma demonstrated a 35% increased risk in exposed hospital workers (meta-RR = 1.35, 95% CI: 1.09-1.68). The risk of asthma increased when workers were exposed to bleach compared with nonexposed workers (meta-RR = 1.51, 95% CI: 0.54-4.18), but was not statistically significant. Two studies investigated the relationship between respiratory and skin symptoms and produced mixed results. Conclusions:The results suggest a need for preventive practices to reduce the risk of asthma and asthma-like symptoms in hospital workers exposed to occupational cleaning/disinfecting agents. Trial registration number: CRD42020137804.

Prevalence of work‐related skin symptoms and associated factors among tertiary hospital workers exposed to cleaning agents in Southern Africa

“…Furthermore, detailed information on glove usage practices could have provided better insights into their impact on adverse skin outcomes. Finally, while this study did not explore the relationship between work‐related skin and respiratory symptoms associated with cleaning agents, a recent systematic review reported that there was limited evidence for such a relationship and suggested further research in this regard 38 …”

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

“…In a cross-sectional analysis of a population-based European cohort, domestic use of hypochlorite bleach was associated with lower rates of atopy, hay fever and allergic symptoms but higher rates of lower respiratory symptoms and non-specific bronchial hyperresponsiveness (NSBH) 36. A recent meta-analysis also reported that the risk of asthma increased when workers were exposed to bleach compared with nonexposed workers (metaRR 1.51, 95% CI 0.54 to 4.18), but this was not found to be statistically significant 1. The lack of consistent association between bleach and eosinophilic airway inflammation (FeNO) could be due to the irritant nature of bleach-related pathophysiological changes.…”

“…Previous studies have demonstrated an association between asthma or respiratory symptoms and exposure to broad categories of cleaning-related exposures in healthcare settings 1. However, few studies have identified the specific cleaning agents responsible for asthma and other health outcomes 2–4.…”

“…Several studies have reported an association between asthma and fixed surface cleaning products such as ammonia and bleach 1–4 7 13 14. A Spanish study of cleaning workers employed in various settings including hospitals, reported an increased risk of asthma symptoms in workers that used hydrochloric acid, degreasers, air fresheners or ammonia in the last year 13.…”

A Novel Application of Risk–Risk Tradeoffs in Occupational Health: Nurses’ Occupational Asthma and Infection Risk Perceptions Related to Cleaning and Disinfection during COVID-19

“…Within health contexts, risk perceptions and acceptance thresholds are complicated by decisions that trade off risks of different outcomes. For example, cleaning and disinfection (C&D) of surfaces likely lowers infection risk, while some C&D products increase asthma-related risks in occupational contexts [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. Arif and Delclos (2012) reported that 0.8% of 3650 nurse respondents had occupational asthma (OA) [ 3 ].…”