title: Under-estimation of self-reported occupational exposure by questionnaire in hospital workers.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Universite´ Paris Descartes, AP-HP, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Donnay
authors.forename: M-A
authors.initials: MA
authors.lastname: Denis
authors.forename: R
authors.initials: R
authors.lastname: Magis
authors.forename: J
authors.initials: J
authors.lastname: Fevotte
authors.forename: N
authors.initials: N
authors.lastname: Massin
authors.forename: O
authors.initials: O
authors.lastname: Dumas
authors.forename: I
authors.initials: I
authors.lastname: Pin
authors.forename: D
authors.initials: D
authors.lastname: Choudat
authors.forename: F
authors.initials: F
authors.lastname: Kauffmann
authors.forename: N
authors.initials: N
authors.lastname: Le Moual
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001249:Asthma / Q000139:chemically induced / Q000523:psychology; D016022:Case-Control Studies; D003902:Detergents / Q000032:analysis* / Q000633:toxicity; D004202:Disinfectants / Q000032:analysis* / Q000633:toxicity; D004784:Environmental Monitoring / Q000379:methods / Q000592:standards; D006801:Humans; D008875:Middle Aged; D009784:Occupational Diseases / Q000139:chemically induced / Q000523:psychology; D016273:Occupational Exposure / Q000009:adverse effects / Q000032:analysis* / Q000706:statistics & numerical data; D010564:Personnel, Hospital / Q000706:statistics & numerical data*; D012650:Self Disclosure; D055815:Young Adult
chemical_list: D003902:Detergents; D004202:Disinfectants