Powerful cleaning and disinfectant products are being deployed in hospitals to eradicate dangerous pathogens on environmental surfaces.

Both spore-forming Clostridioides difficile and an emerging fungal strain of Candida auris require strong sporicidals to be eradicated from the hospital environment. Yet the price of protecting the patient is being exacted on healthcare workers who may have serious complications after repeated exposure to these chemicals in disinfectants.

Exposure to disinfectants and cleaning products in the hospitals over time puts nurses at increased risk of developing chronic obstructive pulmonary disease (COPD), investigators reported.1

“In a cohort study of 73,262 U.S. female nurses participating in the Nurses’ Health Study II who were followed up from 2009 to 2015, occupational exposure to cleaning products and disinfectants was significantly associated with a 25% to 38% increased risk of developing chronic obstructive pulmonary disease independent of asthma and smoking,” the authors noted.

Previously, exposure to disinfectants in healthcare workers has been associated with respiratory health outcomes, including asthma. Moreover, pathogens like spore-forming C. diff and emerging C. auris require strong disinfectants to be removed from surfaces.

Given the implications of the COPD findings, Hospital Infection Control & Prevention reached out to lead author Orianne Dumas, PhD, a respiratory disease researcher at the Université de Versailles in Bretonneux, France.

HIC: You found that use of several specific disinfectants was associated with higher risk of COPD development, with many used concurrently. Did you find evidence of a dose-response effect; that is, the greater the frequency and/or duration of exposure, the higher the risk of COPD?

Dumas: We found a dose-response effect according to the frequency of cleaning/disinfection tasks. We did not examine dose-response effect according to duration of exposure. Indeed, in our study we could only investigate the impact of recent exposure (the follow-up duration was about six years), as we did not have detailed information on the duration of exposure over the lifetime.

HIC: This study included nurses, but is it reasonable to extrapolate that housekeeping and environmental service workers also would be at higher risk of COPD?

Dumas: Other epidemiological studies have reported increased risk of COPD in other professions regularly exposed to disinfectants and cleaning products, such as cleaning workers. In addition, some of these disinfectants, such as bleach and quat, are frequently used in ordinary households. The potential impact of domestic use of disinfectants on COPD development should be investigated.

HIC: You found that “the highest risks of COPD incidence among nurses exposed to hypochlorite bleach or hydrogen peroxide and in those combining these exposures with exposure to aldehydes.” How commonly are these used in healthcare?

Dumas: Glutaraldehyde and hydrogen peroxide are high-level disinfectants mainly used for medical instruments. Bleach has a of variety of uses in healthcare settings, including disinfection of surfaces such as floors and furniture.

HIC: What are some possible interventions and alternatives to reduce the risk of these chemicals? Would wearing a mask and/or respirator be partially protective?

Dumas: Prevention issues are particularly sensitive in healthcare settings. Indeed, adequate levels of disinfection must be maintained to protect patients and workers from healthcare-associated infections. Further studies are needed to determine adequate prevention strategies to protect the workers’ respiratory health. Potential safer alternatives include emerging nonchemical technologies for disinfection (for example, steam, UV light) or green cleaning. Whether the methods of product application (wiping vs. spraying), the environment characteristics (ventilation, room size), or use of masks may modulate respiratory risk also should be investigated.

REFERENCE

  1. Dumas O, Varraso R, Boggs KM, et al. Association of occupational exposure to disinfectants with incidence of chronic obstructive pulmonary disease among US female nurses. JAMA Netw Open 2019;2:e1913563.