April 29th, 2016 8:51 am ET - Brie M. Hawley, PhD
Workers’ health and safety is an important consideration when choosing cleaning and disinfectant products. In health care settings, disinfection products help minimize healthcare-acquired infections. In January 2015, the National Institute for Occupational Health (NIOSH), received a request to conduct a health hazard evaluation at a Pennsylvania hospital using a new surface cleaning product consisting of hydrogen peroxide (HP), peroxyacetic acid (PAA), and acetic acid (AA). The request cited concerns about exposure of hospital environmental services staff to the cleaning product and reported symptoms including burning eyes, nose, and throat; cough; headache; asthma exacerbations; and skin burns. A summary of the NIOSH evaluation was recently published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.
The cleaning product is an EPA-registered non-bleach sporicide (kills spores) advertised as a one-step disinfectant cleaner, virucide (destroys viruses), and deodorizer. According to the manufacturer’s safety data sheet, the product requires no personal protective equipment when it is diluted with water by an automated dispenser before use.
As part of the NIOSH response, researchers interviewed 79 (78%) of 101 current environmental services staff about their health. Full-shift, time-weighted average personal air samples were also collected from a convenience sample of 50 workers for measurement of HP, AA, and PAA. Of the 79 interviewees, 68 (86%) reported using the cleaning product. 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. All air sampling measurements for HP (ranging from 6 parts per billion (ppb) to 511 ppb) and AA (7 ppb–530 ppb) were below their respective occupational exposure limits of 1,000 ppb and 10,000 ppb (2). No exposure limit is established for PAA.
To date, few cross-sectional assessments of worker exposure to HP, AA, and PAA in healthcare settings have been performed, despite the use of this product in more than 500 hospitals nationwide. This evaluation found that hospital cleaning staff using a product containing HP, AA, and PAA frequently reported work-related symptoms despite measured exposures that were below established limits for two of the three chemicals for which full-shift exposure limits are established. However, because both HP and PAA are strong oxidants, it is plausible that the mixture of HP and PAA contributed to the symptoms reported by workers, despite low documented levels of exposure. Furthermore, existing exposure limits might not be protective against asthma-like symptoms. The Association of Occupational and Environmental Clinics recently listed this product as an asthmagen in its Exposure Database (4).
How do we protect workers?
Hospitals should be alert for respiratory, skin, and eye symptoms in environmental services staff. Hospital management can implement a reporting system that would permit employees to report work-related symptoms, with the option for employees who do not wish to be identified to remain anonymous. If environmental services staff do report respiratory, skin, and/or eye symptoms, a combination of engineering and administrative controls might be needed to reduce employee exposures. Additionally, although a one-step disinfectant, virucide, and deodorizer might be considered for widespread use in a hospital, the decision to use disinfectants in specific areas of a health care facility should reflect the level of risk of a health care acquired infection. Finally, physicians should be aware of the potential adverse health effects of occupational exposure to cleaning products and disinfectants when evaluating patients with respiratory and skin complaints.
Have you experienced health effects related to the cleaning products you use at work? Tell us how your workplace addressed the situation in the comment section below.
If you or others in your workplace have experienced symptoms related to use of cleaning products or disinfectants and are interested in a NIOSH evaluation you can request information at the HHE website. A health hazard evaluation can help workers and employers learn whether health hazards are present at their workplace.
Brie M. Hawley, PhD
Dr. Hawley is an industrial hygienist in the NIOSH Respiratory Health Division.