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Under-estimation of self-reported occupational exposure by questionnaire in hospital workers
  1. C Donnay1,
  2. M-A Denis2,3,
  3. R Magis4,
  4. J Fevotte3,5,
  5. N Massin6,
  6. O Dumas7,8,
  7. I Pin9,
  8. D Choudat1,4,
  9. F Kauffmann7,8,
  10. N Le Moual7,8
  1. 1Université Paris Descartes, AP-HP, Paris, France
  2. 2Hospices Civils de Lyon, Groupement Hospitalier Est, Médecine du Personnel, Bron, France
  3. 3UMRESTTE UMR T9405 (INRETS; Université de Lyon; Université Lyon 1; Institut de Veille Sanitaire), Bron, France
  4. 4Service Central de Médecine du Travail, AP-HP, Paris, France
  5. 5Institut de Veille Sanitaire, Département Santé Travail (DST/InVS), Saint Maurice, France
  6. 6Département Epidémiologie en Entreprise, INRS, Vandœuvre-lès-Nancy, France
  7. 7Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Respiratory and Environmental Epidemiology Team, Villejuif, France
  8. 8Université Paris Sud 11, UMRS 1018, Villejuif, France
  9. 9Inserm, U823, Centre de Recherche Albert Bonniot, La Tronche, France
  1. Correspondence to Nicole Le Moual, Inserm U 1018/CESP, Centre for Research in Epidemiology and Population Health, Respiratory and Environmental Epidemiology, 16, avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France; nicole.lemoual{at}


Objectives The aim of the study was to determine whether self-reported occupational exposure to cleaning/disinfecting agents in hospital workers is accurate, in comparison to expert assessment, taken to be the gold standard.

Methods In the Epidemiological Study of the Genetics and Environment of Asthma (EGEA), participants were interviewed on occupation with a specific questionnaire for hospital workers regarding tasks and cleaning/disinfecting agents. Two estimates of exposure were available: self-report and expert assessment. The expert assessment involved a standardised procedure to estimate intensity, frequency and probability of exposure for each job. The present analysis focused on eight exposures: formaldehyde, glutaraldehyde, bleach/chlorine, alcohol, quaternary ammonium components, ammonia, sprays and latex gloves. Agreement and differences between self-reported and expert estimates were studied by kappa and phi coefficients and McNemar tests, respectively.

Results In the survey of 1571 adults, 176 ever hospital workers (327 occupations) with both self-reported and expert exposure assessments were studied. An underestimation of self-reported exposure was observed especially for formaldehyde (26.5% vs 32.7%, p=0.01), ammonia (7.4% vs 18.8%, p<0.0001), alcohol (64.9% vs 93.0%, p<0.0001) and quaternary ammonium components (16.6% vs 70.9%, p<0.0001), compared to expert assessment.

Conclusion Occupational exposure to disinfecting/cleaning agents is common and high in hospitals. A large underestimation of self-reported exposure and a lack of knowledge of product components was observed. Our results show the relevance of expert assessment in epidemiological studies to limit measurement bias. This work underlines the need for health education programmes on the occupational risks induced by these types of products.

  • Healthcare worker
  • epidemiology
  • exposure assessment
  • disinfectant

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  • EGEA Cooperative Group: Coordination: F Kauffmann, F Demenais (genetics), I Pin (clinical aspects); Respiratory epidemiology: Inserm U 700, Paris: M Korobaeff (EGEA1), F Neukirch (EGEA1); Inserm 707, Paris: I Annesi-Maesano; Inserm CESP/U 1018, Villejuif: F Kauffmann, N Le Moual, R Nadif, MP Oryszczyn; Inserm U 823, Grenoble: V Siroux; Genetics: Inserm U 393, Paris: J Feingold; Inserm U 946, Paris: E Bouzigon, F Demenais, MH Dizier; CNG, Evry: I Gut, M Lathrop; Clinical centres: Grenoble: I Pin, C Pison; Lyon: D Ecochard (EGEA1), F Gormand, Y Pacheco; Marseille: D Charpin (EGEA1), D Vervloet; Montpellier: J Bousquet; Paris Cochin: A Lockhart (EGEA1), R Matran (now in Lille); Paris Necker: E Paty, P Scheinmann; Paris-Trousseau: A Grimfeld, J Just; Data and quality management: Inserm ex-U155 (EGEA1): J Hochez; Inserm CESP/U 1018, Villejuif: N Le Moual; Inserm ex-U780: C Ravault; Inserm ex-U794: N Chateigner; Grenoble: J Ferran.

  • Funding This study was funded by Merck Sharp & Dohme, the Hospital Program of Clinical Research (PHRC)-Paris, the National Research Agency (Health Environment, Health-Work Program) and the French Agency of Health Safety, Environment and Work (AFSSET, EST-09-15).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Cochin Port-Royal Hospital, Paris, for the initial survey and by Necker-Enfants Malades Hospital, Paris for the follow-up.

  • Provenance and peer review Not commissioned; externally peer reviewed.