Respiratory symptoms and airway inflammation associated with specific medical instrument cleaning and disinfection agents in tertiary hospital health workers
| n (%) | Asthma symptom score† | Asthma symptom score (≥2 vs 0–1) | WRONS | WRAS | FeNO, ppb‡ (n=654) | FeNO≥50 ppb (n=654) | |
| Prevalence (%) (n=697) | 91 (13) | 109 (16) | 48 (7) | 41 (6) | |||
| Medical instruments cleaning and disinfection | 301 (43) | 1.11 (0.83 to 1.48) | 1.04 (0.65 to 1.65) | 1.30 (0.85 to 1.97) | 0.76 (0.41 to 1.41) | 1.05 (0.95 to 1.15) | 1.42 (0.73 to 2.77) |
| Orthophthalaldehyde | |||||||
| Yes versus no | 113 (16) | 1.00 (0.68 to 1.47) | 0.81 (0.43 to 1.54) | 1.66 (0.98 to 2.81) | 0.82 (0.33 to 2.01) | 1.05 (0.93 to 1.20) | 2.60 (1.22 to 5.55)* |
| 0 min/week | 584 (86) | 1 | 1 | 1 | 1 | 1 | 1 |
| 1–99 min/week | 64 (10) | 1.16 (0.72 to 1.86) | 1.06 (0.50 to 2.26) | 1.12 (0.54 to 2.34) | 0.72 (0.21 to 2.47) | 1.12 (0.95 to 1.32) | 3.35 (1.42 to 7.92)** |
| ≥100 min/week | 30 (4) | 1.10 (0.56 to 2.16) | 0.73 (0.21 to 2.52) | 3.40 (1.46 to 7.48)** | 1.54 (0.44 to 5.45) | 0.97 (0.78 to 1.22) | 0.79 (0.10 to 6.15) |
| Glutaraldehyde | |||||||
| Yes versus no | 49 (7) | 1.33 (0.74 to 2.38) | 1.36 (0.55 to 3.35) | 1.20 (0.56 to 2.57) | 0.88 (0.29 to 2.66) | 1.00 (0.82 to 1.21) | 1.23 (0.34 to 4.48) |
| 0 min/week | 648 (94) | 1 | 1 | 1 | 1 | 1 | 1 |
| 1–99 min/week | 28 (4) | 1.47 (0.72 to 3.01) | 1.35 (0.43 to 4.25) | 0.57 (0.17 to 1.95) | 0.79 (0.18 to 3.57) | 1.03 (0.81 to 1.31) | 1.59 (0.34 to 7.50) |
| ≥100 min/week | 16 (2) | 1.05 (0.36 to 3.09) | 1.27 (0.27 to 6.03) | 3.69 (1.30 to 10.45)* | 1.45 (0.30 to 6.95) | 1.02 (0.73 to 1.41) | 1.12 (0.13 to 9.35) |
| Enzymatic cleaners | |||||||
| Yes versus no | 113 (16) | 1.10 (0.76 to 1.60) | 1.12 (0.62 to 2.03) | 1.27 (0.74 to 2.19) | 1.50 (0.71 to 3.17) | 1.09 (0.96 to 1.23) | 2.09 (0.98 to 4.48) |
| 0 min/week | 584 (87) | 1 | 1 | 1 | 1 | 1 | 1 |
| 1–99 min/week | 46 (7) | 1.46 (0.87 to 2.47) | 1.70 (0.76 to 3.78) | 0.72 (0.27 to 1.91) | 2.05 (0.74 to 5.71) | 1.09 (0.90 to 1.32) | 3.37 (1.30 to 8.71)* |
| ≥100 min/week | 43 (6) | 1.09 (0.60 to 1.98) | 0.92 (0.34 to 2.45) | 2.57 (1.27 to 5.18)** | 1.09 (0.31 to 3.76) | 1.02 (0.84 to 1.24) | 1.07 (0.24 to 4.80) |
| Chlorhexidine | |||||||
| Yes versus no | 84 (12) | 1.00 (0.64 to 1.54) | 0.65 (0.32 to 1.35) | 0.81 (0.38 to 1.73) | 0.76 (0.24 to 2.37) | 1.19 (1.02 to 1.38)* | 1.87 (0.73 to 4.80) |
| 0 min/week | 613 (91) | 1 | 1 | 1 | 1 | 1 | 1 |
| 1–99 min/week | 44 (7) | 1.10 (0.63 to 1.94) | 0.48 (0.16 to 1.45) | 0.79 (0.29 to 2.15) | NC | 1.24 (1.03 to 1.51)* | 2.47 (0.79 to 7.70) |
| ≥100 min/week | 13 (2) | 1.23 (0.48 to 3.15) | 0.71 (0.15 to 3.39) | 1.84 (0.48 to 7.12) | 1.16 (0.14 to 9.77) | 1.03 (0.74 to 1.43) | NC |
| Quaternary ammonium compounds | |||||||
| Yes versus no | 26 (4) | 0.88 (0.43 to 1.82) | 1.30 (0.45 to 3.72) | 1.04 (0.33 to 3.26) | 2.70 (0.71 to 10.23) | 1.11 (0.87 to 1.41) | 2.44 (0.64 to 9.34) |
| 0 min/week | 671 (97) | 1 | 1 | 1 | 1 | 1 | 1 |
| 1–99 min/week | 15 (2) | 0.69 (0.25 to 1.94) | 0.91 (0.19 to 4.36) | 0.40 (0.05 to 3.18) | NC | 1.15 (0.84 to 1.58) | 4.63 (1.11 to 19.26)* |
| ≥100 min/week | 3 (1) | NC | NC | NC | NC | NC | NC |
| Hydrogen peroxide | |||||||
| Yes versus no | 40 (6) | 1.30 (0.73 to 2.31) | 1.47 (0.61 to 3.55) | 1.77 (0.80 to 3.89) | 3.69 (1.49 to 9.18)** | 1.06 (0.87 to 1.30) | 2.19 (0.76 to 6.33) |
| 0 min/week | 657 (95) | 1 | 1 | 1 | 1 | 1 | 1 |
| 1–99 min/week | 27 (4) | 1.48 (0.76 to 2.89) | 1.92 (0.72 to 5.15) | 2.19 (0.87 to 5.50) | 3.64 (1.25 to 10.58)* | 1.06 (0.82 to 1.36) | 1.53 (0.40 to 5.87) |
| ≥100 min/week | 7 (1) | NC | NC | NC | NC | NC | NC |
| Alcohols | |||||||
| Yes versus no | 104 (15) | 0.86 (0.57 to 1.30) | 0.84 (0.43 to 1.63) | 1.09 (0.61 to 1.94) | 0.83 (0.34 to 2.02) | 0.99 (0.87 to 1.13) | 1.39 (0.60 to 3.18) |
| 0 min/week | 593 (88) | 1 | 1 | 1 | 1 | 1 | 1 |
| 1–99 min/week | 64 (10) | 0.99 (0.60 to 1.62) | 1.13 (0.52 to 2.43) | 0.56 (0.23 to 1.34) | 0.86 (0.29 to 2.53) | 1.00 (0.85 to 1.17) | 1.73 (0.67 to 4.48) |
| ≥100 min/week | 16 (2) | 1.01 (0.41 to 2.52) | 0.91 (0.20 to 4.17) | 4.56 (1.62 to 12.83)** | 0.87 (0.11 to 6.91) | 1.21 (0.89 to 1.63) | 1.27 (0.16 to 10.37) |
| Bleach | |||||||
| Yes versus no | 204 (29) | 1.01 (0.72 to 1.39) | 0.94 (0.55 to 1.62) | 1.12 (0.70 to 1.78) | 0.65 (0.32 to 1.33) | 0.94 (0.84 to 1.05) | 0.81 (0.37 to 1.75) |
| 0 min/week | 493 (75) | 1 | 1 | 1 | 1 | 1 | 1 |
| 1–99 min/week | 89 (14) | 1.00 (0.65 to 1.54) | 0.86 (0.41 to 1.79) | 0.69 (0.34 to 1.42) | 0.24 (0.06 to 1.03) | 0.97 (0.83 to 1.12) | 0.72 (0.24 to 2.17) |
| ≥100 min/week | 75 (11) | 1.05 (0.64 to 1.73) | 0.91 (0.39 to 2.11) | 2.37 (1.30 to 4.34)** | 1.16 (0.49 to 2.75) | 0.95 (0.81 to 1.11) | 0.88 (0.28 to 2.78) |
Data are presented as OR (95% CI), unless otherwise indicated.
Adjusted for atopy, gender, smoking, age, study site and allergic sensitisation to natural rubber latex.
Bold values denote statistical significance at p<0.05 level.
*p<0.05, **p<0.01.
†Mean ratio (95% CI).
‡Geometric mean ratio (95% CI).
FeNO, fractional exhaled nitric oxide; NC, not calculable; WRAS, work-related asthma symptoms; WRONS, work-related ocular-nasal symptoms.