Workers Health & Safety Centre

Lung disease in nurses linked to disinfectant use at work

Ontario nurse using disinfectant at work
Exposure reduction strategies needed now as regular use of disinfectants by female nurses linked to the development of chronic obstructive pulmonary disease (COPD), study finds.
Researchers from Harvard University and the French National Institute of Health and Medical Research (Inserm) analyzed data from more than 73,000 nurses employed in US hospitals between 2009 and 2015 and were part of the Nurses’ Health Study II. No participants had COPD—a group of lung diseases including chronic bronchitis and emphysema—at the outset of this study. By the end, 582 nurses were diagnosed with COPD.
Though this study was not designed to uncover an explicit causal link, the authors suggest the findings “Provide further evidence of an adverse association between disinfectants and cleaning products and respiratory health.”

Exposure common

This most recent study found almost 23 per cent of nurses used disinfectants at least once a week to clean work surfaces and 19 per cent to clean medical instruments. Overall, this use was found to increase risk of developing COPD by 35 per cent compared to those not exposed. Those using disinfectants more often—four to seven days per week—had an even greater risk.
The researchers also looked at specific disinfectants finding glutaraldehyde, hydrogen peroxide, hypochlorite bleach, alcohol and quaternary ammonium compounds were associated with excess risk for developing COPD ranging from 25 to 36 per cent. Further still, exposure to multiple products, such as hypochlorite bleach or hydrogen peroxide and aldehydes was found to significantly increase risk.

Evidence cries out for prevention

As noted by the researchers, these findings “confirmed older and smaller analyses of population-based studies reporting increased risk of COPD or chronic bronchitis among cleaners or health care-related professions.”
They also explained, “A large body of evidence already supports an association between these exposures and asthma; our additional findings of an association with COPD incidence urges the need for the development of exposure-reduction strategies that remain compatible with infection control in health care settings.”
To this end, the researchers cite potential safer alternatives including green cleaning and nonchemical technologies such as steam and UV light.

Of course, employers (and supervisors) have the most significant obligations to protect workers from these and other workplace hazards including seeking out and implementing safer alternatives. In fact, beginning in January, 2020, Ontario regulations governing control of exposure to biological or chemical agents will be amended placing substitution at the top of the hierarchy of controls employers must consider to protect workers from exposure [s. 3, O. Reg. 833].

WHMIS and other training obligations

Employers also have significant training obligations. Perhaps most relevant for nurses (and others) exposed to disinfectants and cleaning products is mandatory WHMIS training. Workplace Hazardous Materials Information System, commonly known as WHMIS, is designed to provide workers, supervisors and employers with health and safety information relating to hazardous products used, stored, handled or disposed of in the workplace.

WHSC can help

Workers Health and Safety Centre (WHSC) Globally-Harmonized WHMIS training is highly interactive and applies adult learning principles to ensure learning is engaging, relevant and achieved. Such is the difference between our program and other free WHMIS initiatives, which are not training at all, but merely online information. Employers in health care and other sectors must consider this when selecting a training partner and delivery model. After all, Ontario law requires that WHMIS training results in workers being able to use the information to protect their health and safety [s. 7(3), WHMIS Reg.].

WHSC offers additional training programs and resources to help workplace parties including supervisorsjoint health and safety committees and representatives understand their legal duties and responsibilities related to workplace hazards including harmful chemicals. Many of these same programs offer essential insight into the information and tools needed to reduce or eliminate exposure.
With some 900,000 Ontarians suffering with COPD and the fact it is the 5th leading cause of death in Ontario, the time to pursue prevention is now.
Unsure about your WHMIS or other training obligations or want to know more about the hazardous potential of disinfectants or cleaning products?

Visit:   WHSC WHMIS resources
Call:    1-888-869-7950 and ask to speak to a training services representative