Work‐related allergy and asthma associated with cleaning agents in health workers in Southern African tertiary hospitals

Abstract

Background: Health workers (HWs) are exposed to diverse cleaning agents in large hospitals. This study determined the prevalence of work-related symptoms, allergic sensitization, and lung function abnormalities in HWs of two tertiary hospitals in Southern Africa. Methods: A cross-sectional study of 699 HWs (South Africa: SAH, n = 346; Tanzania: TAH, n = 353) was conducted. Health outcomes were assessed using a standardized ECRHS questionnaire, immunological tests (specific IgE antibody to common aeroallergens and to occupational allergens: natural rubber latex [NRL] Hev b5 and Hev b6.02, chlorhexidine, and ortho-phthalaldehyde [OPA]), spirometry [pre-and postbronchodilator], methacholine challenge, and fractional exhaled nitric oxide (FeNO).Results: A large proportion of participants (78%) were women. Median age was 42 years, with 76% nurses, 12% cleaners, and 5% administrative workers. Current smoking was more common in SAHWs (12%) than TAHWs (1%). The overall prevalence of doctor-diagnosed asthma was 7%. Atopy was present in 43% of HWs, while 4% were sensitized to OPA, 2% to NRL, and 1% to chlorhexidine. Prevalence of work-related ocular-nasal symptoms (16%) was higher than skin (12%) and chest (7%) symptoms. TAHWs had significantly lower mean lung volumes, higher degrees of significant airflow obstruction and impaired lung function. The prevalence of bronchial hyperresponsiveness in SAHWs (14%) was high. Overall, 23% of HWs had abnormal FeNO; 6% having high (>50 ppb) levels. FeNO was positively associated with sensitization to occupational allergens, primarily OPA and NRL.Conclusions: HWs from both hospitals had similar prevalence of work-related respiratory symptoms. Sensitization to OPA and NRL appears to be contributing to allergic airway inflammation in these HWs.

Job and exposure intensity among hospital cleaning staff adversely affects respiratory health

“…The prevalence of symptoms (ranging from 8% to 22%) was similar to that reported by other studies, but current asthma (7.8%) in our sample was at the lower end of the ranges reported in the literature, with studies reporting prevalence from 11% (Spanish and Brazilian cleaners) through to 22.4% among New Zealand cleaners, but similar to reported findings among South African healthcare workers (6%) 8,10,14,22,27,28 . This lower asthma prevalence among three separate cohorts in Southern Africa, compared to the reporting of asthma‐like symptoms within our sample could be an indication of under‐diagnosis and lack of access to health services.…”

“…A retrospective case series analyses found that cleaning products that induce a reduced FEV1 response contained sensitising QACs 13 . Chloramines and orthophthalaldehydes are other sensitizers found in cleaning agents and with sensitisation reported among cleaners 14 …”

“…1 Cleaning tasks are associated with exposure to several chemical agents with potential harmful effects to the respiratory system. 2 Findings of epidemiological studies 3 have revealed that cleaners are among the highest risk occupations for developing occupational asthma 4 which is caused by exposure to various workplace agents. 5,6 However, the relationship of respiratory outcomes due to exposure to cleaning agents and cleaning job tasks varies across studies.…”

“…13 Chloramines and orthophthalaldehydes are other sensitizers found in cleaning agents and with sensitisation reported among cleaners. 14 Exposure to chemicals and cleaning products in health care facilities require more investigation due to the complexity of the products used in cleaning, ranging from detergents, abrasives or acids, each presenting with different risks to exposed workers.…”

“…7 The recent work by Mwanga addresses this gap in two cohorts from South Africa and Tanzania respectively. 14,19 The risk in workers from African countries is likely to be substantially different from those in the global North, particularly with regard to levels and duration of exposure, types of agents used, and work practices. Furthermore, the work environments themselves are likely to present increased risk of other adverse outcomes-for example in healthcare settings, African workers are at greater risk for tuberculosis, which may increase the risk for adverse respiratory outcomes from irritant exposures.…”