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Original article
Development of a job-task-exposure matrix to assess occupational exposure to disinfectants among US nurses
  1. C Quinot1,2,
  2. O Dumas1,2,3,4,
  3. PK Henneberger5,
  4. R Varraso1,2,
  5. AS Wiley3,
  6. FE Speizer3,
  7. M Goldberg1,2,6,
  8. JP Zock7,8,9,10,
  9. CA Camargo Jr3,4,
  10. N Le Moual1,2
  1. 1INSERM, U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, F-94807, Villejuif, France
  2. 2Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
  3. 3Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
  4. 4Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  5. 5Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
  6. 6INSERM-UVSQ, UMS 011, Villejuif, France
  7. 7Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
  8. 8ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
  9. 9Universitat Pompeu Fabra (UPF), Barcelona, Spain
  10. 10CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
  1. Correspondence to Catherine Quinot, Inserm UMRS 1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, 16, avenue Paul Vaillant Couturier, Villejuif cedex 94807, France; catherine.quinot{at}


Objectives Occupational exposure to disinfectants is associated with work-related asthma, especially in healthcare workers. However, little is known about the specific products involved. To evaluate disinfectant exposures, we designed job-exposure (JEM) and job-task-exposure (JTEM) matrices, which are thought to be less prone to differential misclassification bias than self-reported exposure. We then compared the three assessment methods: self-reported exposure, JEM and JTEM.

Methods Disinfectant use was assessed by an occupational questionnaire in 9073 US female registered nurses without asthma, aged 49–68 years, drawn from the Nurses' Health Study II. A JEM was created based on self-reported frequency of use (1–3, 4–7 days/week) of 7 disinfectants and sprays in 8 nursing jobs. We then created a JTEM combining jobs and disinfection tasks to further reduce misclassification. Exposure was evaluated in 3 classes (low, medium, high) using product-specific cut-offs (eg, <30%, 30–49.9%, ≥50%, respectively, for alcohol); the cut-offs were defined from the distribution of self-reported exposure per job/task.

Results The most frequently reported disinfectants were alcohol (weekly use: 39%), bleach (22%) and sprays (20%). More nurses were classified as highly exposed by JTEM (alcohol 41%, sprays 41%, bleach 34%) than by JEM (21%, 30%, 26%, respectively). Agreement between JEM and JTEM was fair-to-moderate (κ 0.3–0.5) for most disinfectants. JEM and JTEM exposure estimates were heterogeneous in most nursing jobs, except in emergency room and education/administration.

Conclusions The JTEM may provide more accurate estimates than the JEM, especially for nursing jobs with heterogeneous tasks. Use of the JTEM is likely to reduce exposure misclassification.

  • Job-Exposure Matrix
  • Job-Task-Exposure Matrix
  • occupational exposure
  • nurses
  • disinfectants

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