Association of hand and arm disinfection with asthma control in US nurses

Abstract

Objectives: To investigate the association between occupational exposure to disinfectants/antiseptics used for hand hygiene and asthma control in nurses.

Methods: In 2014, we invited female nurses with asthma drawn from the Nurses' Health Study II to complete two supplemental questionnaires on their occupation and asthma (cross-sectional study, response rate: 80%). Among 4055 nurses (mean age: 59 years) with physician-diagnosed asthma and asthma medication use in the past year, we examined asthma control, as defined by the Asthma Control Test (ACT). Nurses were asked about the daily frequency of hand hygiene tasks: 'wash/scrub hands with disinfectants/hand sanitizers' (hand hygiene) and 'wash/scrub arms with disinfecting products' (surrogate of surgical hand/arm antisepsis). Analyses were adjusted for age, race, ethnicity, smoking status and body mass index.

Results: Nurses with partly controlled asthma (ACT: 20-24, 50%) and poorly controlled asthma (ACT ≤19, 18%) were compared with nurses with controlled asthma (ACT=25, 32%). In separate models, both hand and arm hygiene were associated with poorly controlled asthma. After mutual adjustment, only arm hygiene was associated with poorly controlled asthma: OR (95% CI) for <1 time/day, 1.38 (1.06 to 1.80); ≥1 time/day, 1.96 (1.52 to 2.51), versus never. We observed a consistent dose-response relationship between frequency of arm hygiene tasks (never to >10 times/day) and poor asthma control. Associations persisted after further adjustment for surfaces/instruments disinfection tasks.

Conclusions: Frequency of hand/arm hygiene tasks in nurses was associated with poor asthma control. The results suggest an adverse effect of products used for surgical hand/arm antisepsis. This potential new occupational risk factor for asthma warrants further study.

Keywords: asthma; epidemiology; health care workers; occupational asthma; women.

Figure 1

Associations of hand and arm hygiene with asthma control: (A) separate models for hand and arm hygiene; (B) separate models for hand and arm hygiene, with adjustment for self-reported weekly use of disinfectants to clean surfaces/instruments (no, surfaces only, instruments); and (C) hand and arm hygiene entered in the same model for mutual adjustment. Multinomial logistic regressions, adjusted for age, smoking status in 2013, body mass index in 2013, race and ethnicity. Results are presented as odds ratio and 95% confidence intervals (lines). Reference category was “never” for hand/arm hygiene and “controlled asthma” for asthma control.