Abstract
Several reviews have reported an increased risk of obstructive respiratory diseases in workers exposed to cleaning or disinfection agents, but they have focused mainly on professional cleaners. Cleaning and disinfecting are frequently performed activities by healthcare workers. We conducted a systematic review with meta-analysis to quantify the risk of obstructive respiratory diseases in healthcare workers exposed to cleaning and disinfection agents. We searched the Medline and Embase databases until 4 February 2021 to find adequate primary studies. Two independent reviewers screened the titles/abstracts and the full texts of the studies, as well as performing data extraction and quality assessment. The literature search yielded 9432 records, and 8 studies were found through a hand search. After screening, 14 studies were included in the review. All had a high risk of bias, and most studies dealt with nurses, asthma, and hyperresponsiveness (BHR)-related symptoms. Only one study investigated COPD. The meta-analysis estimated an increased risk of new-onset asthma for nurses (Effect size (ES) = 1.67; 95% CI 1.11–2.50) compared with other occupations and found an increase in the risk of new-onset asthma for nurses exposed to cleaning and disinfecting surfaces (ES = 1.43; 95% CI 1.09–1.89) and instruments (ES = 1.34; 95% CI 1.09–1.65). Exposure to specific chemicals such as bleach and glutaraldehyde (GA) increased the risk of asthma in nurses (bleach ES = 2.44; 95% CI 1.56–3.82; GA ES = 1.91, 95% CI 1.35–2.70). A higher risk for BHR-related symptoms was observed for nurses exposed to cleaning surfaces (ES = 1.44; 95% CI 1.18–1.78). Although the overall evidence was rated as low, the limitations found in this review hint at a potential underestimation of the real risk. These findings highlight the need for reinforced prevention practices with regard to healthcare workers. Similar research investigating these associations among other healthcare workers such as rescue service and nursing home personnel is needed.
Highlights
MethodsThe ideal study would evaluate only nurses or other healthcare workers such as rescue service personnel with known exposure to cleaning or disinfection agents and compare them with otherwise similar workers in other occupational groups without any elevated risk for respiratory diseases due to other exposures (i.e., dusts, chemical irritants, allergenic substances)
Nursing and caring professionals constitute a large part of the working population
We found a total of 13,029 records in the electronic databases
Summary
The ideal study would evaluate only nurses or other healthcare workers such as rescue service personnel with known exposure to cleaning or disinfection agents and compare them with otherwise similar workers in other occupational groups without any elevated risk for respiratory diseases due to other exposures (i.e., dusts, chemical irritants, allergenic substances). We considered other study designs, such as studies using an internal comparison group (i.e., comparing nurses with and without exposure to cleaning or disinfectant agents). If adequate statistical models were used to reduce bias and control for confounding, this domain was considered as having a low risk of bias. If incident diseases were included or if a temporal relation could be established, this domain was considered low risk.
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