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Original research
Occupational risk factors and exposure–response relationships for airway disease among health workers exposed to cleaning agents in tertiary hospitals
  1. Hussein H Mwanga1,2,
  2. Roslynn Baatjies1,3,
  3. Mohamed Fareed Jeebhay1
  1. 1 Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa
  2. 2 Department of Environmental and Occupational Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
  3. 3 Department of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, Western Cape, South Africa
  1. Correspondence to Professor Mohamed Fareed Jeebhay, Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, Western Cape, South Africa; mohamed.jeebhay{at}uct.ac.za

Abstract

Objectives This study investigated occupational risk factors and exposure–response relationships for airway disease among health workers (HWs) exposed to cleaning agents in two tertiary hospitals in South Africa and Tanzania.

Methods In this cross-sectional study, 697 participants completed questionnaire interviews while 654 underwent fractional exhaled nitric oxide (FeNO) testing. Asthma Symptom Score (ASS) was computed based on the sum of answers to five questions on asthma-related symptoms in the past 12 months. For exposure–response analyses, cleaning agent-related self-reported exposure variables were categorised into three levels (cleaning product not used; use of a cleaning product for up to 99 min per week and use of a cleaning product for ≥100 min per week).

Results Asthma-related outcomes (ASS and FeNO) demonstrated positive associations with medical instrument cleaning agents (orthophthalaldehyde and enzymatic cleaners) and tasks (instruments precleaning and changing sterilisation solutions) as well as patient care activities (disinfection prior to procedures and disinfecting wounds). A particularly pronounced dose–response relationship was observed between work-related ocular-nasal symptoms and medical instrument cleaning agents (orthophthalaldehyde, glutaraldehyde, enzymatic cleaners, alcohols and bleach) (OR range: 2.37–4.56) and tasks (OR range: 2.92–4.44). A strong association was also observed between ASS and use of sprays for fixed surface cleaning (mean ratio 2.81; 95% CI 1.41 to 5.59).

Conclusions Specific agents for medical instrument disinfection for example, orthophthalaldehyde and enzymatic cleaners, patient care activities and use of sprays are important occupational risk factors for airway disease among HWs.

  • Allergy and Immunology
  • Asthma
  • Health Personnel
  • Chemical Hazard Release
  • Toxicology

Data availability statement

Data are available on reasonable request.

http://dx.doi.org/10.1136/oemed-2022-108763

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Contributors HHM and MFJ were responsible for the conceptualisation of the study. HHM and RB were responsible for the fieldwork. HHM was responsible for data collection, data management, analysis and write up under the supervision of RB and MFJ. HHM was responsible for preparation of the first draft of the manuscript. All authors contributed to and reviewed the manuscript before submission. MFJ is responsible for the overall content as the guarantor.

    • Funding South African Medical Research Council, Millennium Promise Programme NIH Grant 1D43ES018744-01 (University of Michigan/Fogarty International Center), Allergy Society of South Africa & National Research Foundation of South Africa.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.