By Gary Evans, Medical Writer

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

“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 found.

Exposure to disinfectants in healthcare workers previously has been associated with respiratory health outcomes, including asthma. Moreover, pathogens like spore-forming Clostridioides difficile and emerging Candida auris require strong disinfectants to remove from surfaces. According to the Centers for Disease Control and Prevention, chronic lower respiratory disease — primarily COPD — was the third leading cause of death among U.S. women in 2017.

The new study investigators found that the highest risks of COPD incidence was among nurses exposed to hypochlorite bleach and hydrogen peroxide and in those chemicals combined with exposures to aldehydes.

“Glutaraldehyde and hydrogen peroxide are high-level disinfectants mainly used for medical instruments,” says lead author Orianne Dumas, PhD, a respiratory disease researcher at the University de Versailles in Bretonneux, France. “Bleach has a variety of uses in healthcare settings, including disinfection of surfaces such as floors and furniture.”

Further studies are needed to determine adequate prevention strategies to protect the workers’ respiratory health. Potential safer alternatives include non-chemical technologies for disinfection such as steam and UV light, she says.

“Whether the methods of product application — wiping vs. spraying — [and] environmental characteristics, such as ventilation, room size, or use of masks, may modulate respiratory risk should also be investigated,” she says.

For more on this study see the December 2019 issue of Hospital Employee Health.