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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Kill the Bug, Spare the Nurse: Pressure to Stop Infections Means Harsher Chemical Cleaners

A 57-year-old medical records clerk – non-asthmatic, lifetime nonsmoker -- worked as a receptionist and records clerk in a medical clinic in California. One day 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.

In the fierce battle against healthcare-associated infections (HAIs), healthcare workers have unwittingly become collateral damage, developing skin irritation, headaches and even asthma from cleaners and disinfectants. To address those health hazards, infection preventionists and occupational health professionals have come together in an unprecedented collaboration. The National Institute for Occupational Safety and Health (NIOSH) gathered more than 40 experts from various fields to review what is known about cleaning and disinfection of hospital surfaces and to identify knowledge gaps and research needs. Their conclusion: Hospitals should engage interdisciplinary teams to evaluate the hazards of their cleaning and disinfecting products.1

“The [multidisciplinary] model we used in our working group can also be used in healthcare settings,” says Paul Henneberger, MPH, ScD, NIOSH research health scientist in Morgantown, WV, and co-chair of the Cleaning and Disinfecting in Healthcare Working Group. “The difference would be that the professions involved would go beyond infection prevention and occupational health,” he says. “It should also include the people who are actually doing the work – the environmental services workers, nurses, and technicians who would be impacted by any policies and practices.”

By their nature, cleaning and disinfecting products must be toxic enough to kill a wide range of microbes, including Clostridium difficile spores. Almost a half-million people develop C. difficile infection annually year, and about two-thirds of the cases are associated with an inpatient stay, according to the Centers for Disease Control and Prevention. Hospitals are under intense pressure to reduce those and other infections. But studies show that hospital workers exposed to cleaning and disinfecting products have an increased risk of asthma and other respiratory problems.2

For more on this important story see the September 2015 issue of Hospital Employee Health.


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.

3. 2. Folletti I, Zock JP, Moscato G, et al. Asthma and rhinitis in cleaning workers: a systematic review of epidemiological studies. J Asthma 2014;51:18-28.