title: Occupational health risks associated with the use of germicides in health care.
abstract: Environmental surfaces have been clearly linked to transmission of key pathogens in health care facilities, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, Clostridium difficile, norovirus, and multidrug-resistant gram-negative bacilli. For this reason, routine disinfection of environmental surfaces in patient rooms is recommended. In addition, decontamination of shared medical devices between use by different patients is also recommended. Environmental surfaces and noncritical shared medical devices are decontaminated by low-level disinfectants, most commonly phenolics, quaternary ammonium compounds, improved hydrogen peroxides, and hypochlorites. Concern has been raised that the use of germicides by health care personnel may increase the risk of these persons for developing respiratory illnesses (principally asthma) and contact dermatitis. Our data demonstrate that dermatitis and respiratory symptoms (eg, asthma) as a result of chemical exposures, including low-level disinfectants, are exceedingly rare. Unprotected exposures to high-level disinfectants may cause dermatitis and respiratory symptoms. Engineering controls (eg, closed containers, adequate ventilation) and the use of personal protective equipment (eg, gloves) should be used to minimize exposure to high-level disinfectants. The scientific evidence does not support that the use of low-level disinfectants by health care personnel is an important risk for the development of asthma or contact dermatitis.
authors.affiliation: Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC; Department of Occupational Health, University of North Carolina Health Care, Chapel Hill, NC; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC. Electronic address: dweber@unch.unc.edu.
authors.forename: David J
authors.initials: DJ
authors.lastname: Weber
authors.affiliation: Department of Occupational Health, University of North Carolina Health Care, Chapel Hill, NC.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Consoli
authors.affiliation: Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC; Department of Occupational Health, University of North Carolina Health Care, Chapel Hill, NC; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: William A
authors.initials: WA
authors.lastname: Rutala
mesh_terms: D001249:Asthma / Q000139:chemically induced* / Q000453:epidemiology*; D003877:Dermatitis, Contact / Q000453:epidemiology*; D004202:Disinfectants / Q000009:adverse effects*; D004203:Disinfection / Q000379:methods*; D006268:Health Facilities; D006282:Health Personnel; D006801:Humans; D016273:Occupational Exposure; D018570:Risk Assessment
chemical_list: D004202:Disinfectants
keywords: Germicide; asthma; dermatitis; health care personnel; low-level disinfectants; occupational health; risk