Exposure to Disinfectants, Cleaning Products Linked to COPD Risk Among Female Nurses

Regular use of chemical disinfectants among female nurses was found to be a potential risk factor for the development of chronic obstructive pulmonary disease (COPD), according to a study published last week in JAMA Network Open.

COPD is the third leading cause of mortality worldwide and among the diseases contributing the most to disability-adjusted life-years, noted the study authors. While tobacco smoke is the leading risk factor for COPD, occupational exposures have been found to additionally contribute to incidence rates. Most occupational studies on COPD-related risk have focused on broad exposure categories, such as vapor, gases, or fumes, as opposed to industry-specific studies, which generally provide more attributable data on specific causal agents.

Exposure to chemical disinfectants has been linked with respiratory health outcomes such as asthma and COPD in a few European studies, but data on the association of specific chemicals and occupational exposure with COPD risk have yet to be studied. As cleaning products and disinfectant use is most prominent among women and those part of the healthcare industry, researchers sought to examine the correlating risk factor for this demographic.

Researchers investigated the relation of disinfectant and cleaning product exposure with COPD incidence by analyzing 73,262 female registered nurses in the United States part of the Nurses’ Health Study II. In the study, nurses were followed up through questionnaires every 2 years since its inception in 1989. The present study includes women who were still in a nursing job and had no history of COPD in 2009. Data included responses from questionnaires conducted between 2009 and 2015, and primary measurement of incident physician-diagnosed COPD was determined by occupational exposure to disinfectants, as evaluated by a questionnaire and a job-task exposure matrix (JTEM).

Among the study cohort, mean age at baseline was 54.7 years; 96% were white, 1.7% were black, 1.8% were Hispanic, and 2.3% were another race/ethnicity. After analyzing 368,145 person-years of follow up, 582 nurses reported incident physician-diagnosed COPD. Of the 73,262 nurses in the study cohort, correlations to COPD incidence were attributed to 16,786 (22.9%) of nurses reporting weekly use of disinfectants to clean surfaces and 13,899 (19%) of nurses exposed to weekly use of disinfectants to clean medical instruments, with adjusted hazard ratios (AHRs) of 1.38 (95% CI, 1.13-1.68) for cleaning surfaces only and 1.31 (95% CI, 1.07-1.61) for cleaning medical instruments.

High-level exposure, determined by JTEM, to several specific disinfectants such as glutaraldehyde (AHR, 1.25; 95% CI, 1.04-1.51), bleach (AHR, 1.36; 95% CI, 1.13-1.64), hydrogen peroxide (AHR, 1.29; 95% CI, 1.08-1.54), alcohol (AHR, 1.32; 95% CI, 1.10-1.59), and quaternary ammonium compounds (AHR, 1.33; 95% CI, 1.11-1.60) all exhibited significant associations with COPD incidence.

“These longitudinal results suggest that regular use of chemical disinfectants among nurses may be a risk factor for developing COPD,” wrote the authors. As exposure to these chemical irritants is heightened among workers in the healthcare industry, which is among the largest employment sectors in the United States and Europe, further analysis and exposure-reduction strategies compatible with infection control in healthcare settings should be developed, they noted.

Reference

Dumas O, Varraso R, Boggs KM, et al. Association of occupational exposure to disinfectants with incidence of chronic obstructive pulmonary disease among US female nurses. JAMA Netw Open. 2019;2(10):e1913563.