The following case reports from a recent comprehensive NIOSH report1 provide compelling examples of work-related asthma from environmental surface cleaning and disinfecting exposures in healthcare.

A hospital environmental services worker in Michigan: A man in his 20s, lifetime nonsmoker, worked in a hospital environmental services department for two years with no health problems. He developed asthma after the introduction of a new cleaning product that immediately caused him to wheeze and become short of breath. The cleaning product contained the quaternary ammonium compounds didecyl dimethyl ammonium chloride and alkyl dimethyl benzyl ammonium chloride.

He was treated at his hospital’s emergency department after his initial exposure, and he subsequently had one hospitalization and three additional emergency department visits until use of the cleaning product was discontinued after manufacture of the product ceased. He requires medication on an ongoing basis to manage his asthma symptoms. His case was identified in the Michigan Work-Related Asthma Surveillance Program.

A medical records clerk in a clinic in California: A 57-year-old woman, nonasthmatic, lifetime nonsmoker, worked as a receptionist and records clerk in a medical clinic. Her desktop, phones, and computer keyboard were wiped by a coworker with disinfectant wipes containing the quaternary ammonium compounds, alkyl dimethyl benzyl ammonium chloride, and dimethyl ethyl benzyl ammonium chloride.

Immediately on contact with the phone, the receptionist developed burning and vision loss in her left eye and then experienced difficulty breathing. Initially uncertain what caused the reaction, the clinic medical staff administered oxygen, advised her to wash her hands, and sent her to the workers’ compensation physician. She was diagnosed with work-related asthma. Over a six-month period, when the wipes were used on office surfaces, the receptionist’s respiratory symptoms worsened. Use of wipes was discontinued in the offices and when the wipes were used elsewhere in the clinic, the receptionist was instructed to leave the building.

Two years later, after changing buildings, she was sent to the emergency department when instruments were cleaned in a room next to her office and again after cleaning and disinfecting surfaces in the clinic waiting room with the same quaternary ammonium compounds. Based on medical advice, the receptionist stopped work three years after her initial incident. She continues to have difficulty breathing and requires multiple medications to manage her illness. Her respiratory sensitization has become more generalized and she now needs to restrict her contact with other chemicals, including some personal care products (J. Weinberg, Industrial Hygiene Research Scientist, California Department of Public Health, personal communication, 2014).


  1. Quinn MM, Henneberger PK, and members of the National Institute for Occupational Safety and Health National Occupational Research Agenda Cleaning and Disinfecting in Healthcare Working Group. Cleaning and disinfecting environmental surfaces in healthcare: Toward an integrated framework for infection and occupational illness prevention. Am J Infect Control 2015; 43:424-434.