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

Protecting Patients, Harming Workers?

By Gary Evans, AHC Media Senior Staff Writer

Preliminary results of an ongoing public health investigation indicate that a powerful sporicidal cleaning agent used in some 500 hospitals is being linked to wheezing, watery eyes and asthma-like symptoms in healthcare workers, the National Institute for Occupational Safety and Health (NIOSH) reports.

The situation is emblematic of an ongoing dilemma in healthcare. Strong products needed to protect patients from an epidemic of Clostridium difficile -- a spore-former difficult to remove from the hospital environment – may trigger a panoply of symptoms in housekeeping and other health care workers exposed to the chemicals during cleaning.

“There really has to be a balance between patient safety and worker safety,” says Megan Casey, RN, MPH, a NIOSH nurse epidemiologist who is investigating the case. “We need to make sure that worker safety is not compromised as we continue this battle against healthcare-associated infections.”

NIOSH conducted a hazard evaluation report at Magee-Womens Hospital in Pittsburgh, concluding in an April 12, 2016 interim report that “these findings support the conclusion that exposure to OxyCide is associated with adverse health effects and indicate the need to minimize employee exposures.”1

[Employee health professionals should] encourage workers to report any symptoms that might be related to this product or any product containing acetic acid, proxy acidic acid, or hydrogen peroxide,” Casey tells Hospital Employee Health. “One of our main findings was that we found that product users reported more work-related symptoms than non-product users. These are symptoms that improved for the employee on days off or on vacation.”

A branch of the CDC, NIOSH recently published a summary of the findings in the MMWR that included the following key points:

• Researchers interviewed 79 (78%) of 101 current environmental services staff about their health.

• Among the 68 employees who worked with the product, the most commonly reported health outcomes were watery eyes (46%), nasal problems (41%), asthma-like symptoms (28%), use of allergy medicine (16%), and shortness of breath (16%).

• A total of 30 (44%) reported at least one work-related health outcome. Most commonly reported work-related symptoms were watery eyes (29%) and nasal problems (22%).

• Among 10 respondents with self-reported physician-diagnosed asthma, six reported that something at work brought on or worsened their asthma, and three mentioned the cleaning product specifically by name.

Hospital: ‘No comment’

OxyCide is an EPA-registered non-bleach sporicide and virucide manufactured by Ecolab in St. Paul, MN. The product safety indications say it requires no personal protective equipment when it is diluted with water by an automated dispenser before use.

“OxyCide is proven effective against several harmful bacteria and viruses that are known to cause healthcare-associated infections, including Clostridium difficile bacteria spores,” Roman Blahoski, director of Global Communications at Ecolab, told HEH via email. “C. diff infections are linked to 29,000 deaths each year. Hospitals across the country are finding that OxyCide is a key component of their programs to battle healthcare-acquired infections.”

McGee Womens Hospital spokesperson Gloria Kreps told HEH the hospital had no comment on the NIOSH report.

Though recommending several measures be taken by the hospital to protect workers, NIOSH has decided for now that that the evidence is not conclusive enough to recommend stronger action regarding use of the cleaner. The investigation is ongoing.

“Do the limitations of our study we can’t definitively determine the exact timing or the causality of these [worker] symptoms to the product,” Casey says.


1. NIOSH. HETA 2015-0053. Interim Report 3. April 12, 2016

For more on this story see the August 2016 issue of Hospital Employee Health.