title: Asthma among workers in healthcare settings: role of disinfection with quaternary ammonium compounds.
abstract: BACKGROUND
  An increased incidence of asthma has been reported among healthcare workers. The role of quaternary ammonium compounds (QACs), commonly used in cleaning/disinfection products, has not been clearly defined. The aim of this study was to analyse associations between asthma and occupational exposure to disinfectants, especially QACs.
  
  
  METHODS
  The study was performed on a stratified random sample of the various healthcare departments of 7 healthcare settings. The study included: questionnaire, physical examination and specific IgE assays. Occupational exposure assessment was performed by means of a work questionnaire, workplace studies and a review of products ingredients. Data were analysed by logistic regression.
  
  
  RESULTS
  Response rate was 77%; 543 workers (89% female) participated; 37.1% were registered nurses (RNs), 16.4% auxiliary nurses (ANs), 17.3% cleaners; 32.8% were atopic. 335 participants were exposed to QACs. Nursing professionals reported a significantly higher risk of reported physician-diagnosed asthma and, for RNs, of nasal symptoms at work than administrative staff working in healthcare sector. This risk was particularly marked during disinfection tasks and when exposure to QACs. Exposure to QACs increased significantly the risk of reported physician-diagnosed asthma and nasal symptoms at work (adjusted OR = 7.5 and 3.2, respectively). No significant association was found with other exposures such as latex glove use, chlorinated products/bleach or glutaraldehyde.
  
  
  CONCLUSIONS
  RNs and ANs presented a higher risk of reported asthma than administrative staff. The highest risk was associated with tasks involving dilution of disinfection products by manual mixing, suggesting possible exposure to repeated peaks of concentrated products known to be strong respiratory irritants. Workplace interventions should be conducted to more clearly determine QAC exposure and improve disinfection procedures.
authors.affiliation: Occupational Diseases Department, University Hospitals, Strasbourg, France; Department of Occupational Medicine, Faculty of Medicine, University of Strasbourg, Strasbourg, France.
authors.forename: M
authors.initials: M
authors.lastname: Gonzalez
authors.forename: J
authors.initials: J
authors.lastname: Jégu
authors.forename: M-C
authors.initials: MC
authors.lastname: Kopferschmitt
authors.forename: C
authors.initials: C
authors.lastname: Donnay
authors.forename: G
authors.initials: G
authors.lastname: Hedelin
authors.forename: F
authors.initials: F
authors.lastname: Matzinger
authors.forename: M
authors.initials: M
authors.lastname: Velten
authors.forename: L
authors.initials: L
authors.lastname: Guilloux
authors.forename: A
authors.initials: A
authors.lastname: Cantineau
authors.forename: F
authors.initials: F
authors.lastname: de Blay
mesh_terms: D000328:Adult; D064751:Ammonium Compounds / Q000009:adverse effects; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D003430:Cross-Sectional Studies; D004202:Disinfectants / Q000009:adverse effects; D004203:Disinfection; D005260:Female; D005602:France; D006282:Health Personnel; D006801:Humans; D007073:Immunoglobulin E; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D015995:Prevalence; D062486:Public Health Surveillance; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D064751:Ammonium Compounds; D004202:Disinfectants; D007073:Immunoglobulin E
keywords: cleaners; disinfection; healthcare workers; nurses; occupational exposure; quaternary ammonium compounds; work-related asthma