S-95 Changes in respiratory symptoms, spirometry, and exhaled nitric oxide among home care aides performing cleaning and disinfecting using different products: a longitudinal repeated measures study

• Published in: Occupational and environmental medicine (London, England) Vol. 78; no. Suppl 1; p. A149
• Main Authors: Quinn, Margaret, Sama, Susan, Sheikh, Noor, Kriebel, David, Gore, Rebecca, Lindberg, John, Galligan, Catherine, Markkanen, Pia, Karlsson, Nicole, Virji, Abbas, LeBouf, Ryan
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.10.2021; BMJ Publishing Group LTD
• Subjects: Ammonium; Ammonium compounds; Bathrooms; Biomarkers; Bleaches; Chlorides; Cleaning; Construction industry; Construction specifications; Cough; Disinfection; Distilled water; Environmental assessment; Fixtures; Irritation; Nitric oxide; Population studies; Population-based studies; Quaternary ammonium compounds; Quaternary ammonium salts; Residential areas; Sodium hypochlorite; Spirometry; Symposia; Thymol; Within-subjects design
• ISSN: 1351-0711; 1470-7926
• DOI: 10.1136/OEM-2021-EPI.407

ObjectivesOccupational and population-based studies show that cleaning and disinfecting (C&D) tasks can increase the risk of adverse respiratory symptoms. However, quantitative evaluation of specific C&D products and practices and their impacts on respiratory health are limited. Previously, we found that 80% of home care (HC) aide visits to clients’ homes involve C&D. Increasingly, C&D ingredients are combined in single products that often contain bleach, quaternary ammonium compounds (QACs) or other respiratory irritants. So-called ‘green’ C&D products might be better alternatives but have not been evaluated for respiratory health. This study evaluated the relationship between the use of conventional and ‘green’ C&D products on respiratory outcomes.MethodsA longitudinal repeated measures study design was used. Twenty HC aides each participated in four sessions in an environmental assessment laboratory where a simulated bathroom with fixtures (toilet, tub/shower, sink) was built according to residential construction specifications. During each 40-minute session, aides performed typical C&D tasks. Three multi-purpose spray C&D products - one bleach-based (1–5% by weight sodium hypochlorite), one QACs-based (including benzyldimethyldodecylammonium chloride, benzyldimethyltetradecylammonium chloride, and benzyldimethylhexadecylammonium chloride) and one ‘green’ (plant-based thymol, active disinfecting ingredient) - and distilled water in a spray bottle were randomized among the aides’ sessions. Respiratory symptoms, spirometry, and exhaled nitric oxide (eNO, a biomarker of airway response) were measured pre-and post-session.ResultsAides reported more respiratory symptoms following use of the bleach-based product (eye, nose, throat irritation, cough, and difficulty breathing) and experienced a reduction in FEV1 (-4.3%, 95%CI: -7.4 to -1.1), compared to the other products and to distilled water. Mean eNO decreased by 10 ppb (95% CI: -8 to -13ppb) following bleach-based product use compared to the other products and to distilled water.ConclusionsBleach-based C&D products may cause acute adverse respiratory changes after a relatively short exposure representative of C&D in HC.