Healthcare workers have a higher risk of work-related asthma, partly attributed to exposure to disinfectants used for surfaces and medical instrument cleaning. Hand hygiene practices also involve exposure to disinfectants. However, the potential respiratory risks associated with hand hygiene among healthcare workers are unknown. We investigated this issue in the Nurses’ Health Study II, a large prospective cohort study of U.S. female nurses enrolled in 1989.
Nurses with asthma were invited in 2014 to complete two supplemental questionnaires on their current occupation and asthma (response rate: 84%). Among 3,548 nurses (mean age: 59 years) with physician-diagnosed asthma and asthma medication use in the past year, we examined asthma control, as defined by the Asthma Control Test (ACT; last 4 weeks). Nurses were asked about the daily frequency of hand hygiene tasks: “wash/scrub hands with disinfectants/hand sanitizers” and “wash/scrub arms with disinfecting products”. Other disinfectant exposures (surfaces/instruments) were evaluated by questionnaire and a job-task-exposure matrix. Analyses were adjusted for age, race, ethnicity, smoking status, and body mass index.
Nurses with partly controlled (ACT: 20–24, 50%) and poorly controlled asthma (ACT ≤ 19, 18%) were compared to nurses with controlled asthma (ACT = 25, 32%). Hand washing/scrubbing > 10 times/day (46%) vs. never (15%) was associated with partly and poorly controlled asthma (OR, 95% CI: 1.30, 1.04–1.62 and 1.38, 1.02–1.88; p-trend: 0.01). Arms washing/scrubbing ≥ 1 time(s)/day (21%) vs. never (62%) was associated with partly and poorly controlled asthma (1.23, 1.01–1.51 and 1.74, 1.36–2.23; p-trend<0.001). We observed a consistent dose-response relationship between arm washing/scrubbing frequency (never to >10 times/day) and asthma control. Similar associations persisted after further adjustment for other disinfection tasks, specific disinfectants or type of nursing job.
In this large study of nurses, frequency of hand hygiene tasks was associated with poor asthma control. This potential new risk factor for work-related asthma warrants further study.
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