Keeping germs at bay is an ongoing battle in healthcare settings, but it’s a battle that may come at an unexpected cost. In a recent study in JAMA Network Open, researchers found that cleaning products and disinfectants were associated with a 25% to 38% increased risk of developing chronic obstructive pulmonary disease (COPD) in healthcare workers. Clinicians should be aware of this new risk factor in patients with COPD, the researchers advised. “If future studies confirm these results, exposure-reduction strategies that are compatible with infection control in healthcare settings should be developed,” wrote lead author Orianne Dumas, PhD, a researcher at Inserm, Villejuif, France, and coauthors. A persistent problem Previous research has indicated that 15% to 20% of COPD cases are due to occupational exposures. Martie van Tongeren, PhD, professor, Occupational & Environmental Health, University of Manchester, Manchester, UK, who was not affiliated with this study, noted: “Respiratory health effects due to exposure to cleaning agents and disinfectants is a persistent and known problem, in particular in the healthcare sector, where there is a strong focus on prevention of hospital-acquired infection.” But no one knows exactly which cleaning agents or disinfectants may be responsible for the link to respiratory effects. To that end, Dr. Dumas and colleagues sought to investigate the association between exposure to disinfectants and the incidence of COPD in a large-scale cohort of healthcare workers. They used data from more than 73,000 women in the ongoing, prospective Nurses’ Health Study II (average age: 54.7 years; 96% white). The researchers followed up with questionnaires every 2 years from 2009 to 2015. They looked at participants’ frequency of cleaning or disinfection tasks and spray use for seven of the most commonly used products: formaldehyde, glutaraldehyde, bleach, hydrogen peroxide, alcohol, quaternary ammonium compounds, and enzymatic cleaners. Airway irritants During 6 years of follow-up, 582 nurses reported incident, physician-diagnosed COPD. Results showed that using any disinfectant on a weekly basis was associated with greater COPD incidence (AHR: 1.35, 95% CI: 1.14-1.59), even after adjusting for age, smoking, race, ethnicity, and body mass index. While no single type of nursing job was associated with increased COPD incidence, the risk of COPD was highest among nurses who used cleaners and disinfectants most frequently (4-7 days per week). Incidence of COPD was greater among participants who used disinfectants to clean surfaces only (AHR: 1.38, 95% CI: 1.13-1.68) and to clean medical instruments (AHR 1.31, 95% CI: 1.07-1.61). Among the seven most commonly used products, researchers found that high-level exposure to five of them—glutaraldehyde, bleach, hydrogen peroxide, alcohol, and quaternary ammonium compounds—was significantly associated with increased risks of COPD incidence ranging from 25% to 36%. “When studying combinations of exposure to specific disinfectants, we found the highest risks of COPD incidence among nurses exposed to hypochlorite bleach or hydrogen peroxide and in those combining these exposures with exposure to aldehydes. Both the chemical properties of specific products and the greater number of products used could explain these elevated risks,” Dr. Dumas and coauthors wrote. “Moreover, all of the agents that were associated with COPD incidence when evaluated separately have been described as airway irritants.” A new risk factor The authors concluded: “Although the associations between exposure to specific disinfectants and COPD incidence must be replicated in independent cohorts and underlying pathophysiological mechanisms must be clarified, there is a biological plausibility that long-term exposure to irritant disinfectants and cleaning agents could contribute to persistent airway damage and COPD pathogenesis.” Dr. Dumas and colleagues did acknowledge some limitations of their study, noting that the population of mainly white, female nurses may limit the generalizability of their results. They also called for additional studies in different populations, including other healthcare-related professions as well as male participants and more diverse racial and ethnic groups. “Nonetheless, clinicians should be aware of this new risk factor and systematically look for sources of exposure to cleaning products and disinfectants in addition to other occupational exposures in patients with COPD,” Dr. Dumas and coauthors advised. Source
