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. 2020 Jan;63(1):44-50.
doi: 10.1002/ajim.23067. Epub 2019 Nov 6.

Occupational exposure to disinfectants and asthma incidence in U.S. nurses: A prospective cohort study

Orianne Dumas  1   2 , Krislyn M Boggs  3   4 , Catherine Quinot  1   2 , Raphaëlle Varraso  1   2 , Jan-Paul Zock  5   6   7 , Paul K Henneberger  8 , Frank E Speizer  3 , Nicole Le Moual  1   2 , Carlos A Camargo Jr  3   4
Affiliations

Occupational exposure to disinfectants and asthma incidence in U.S. nurses: A prospective cohort study

Orianne Dumas et al. Am J Ind Med. 2020 Jan.

Abstract

Background: Exposure to disinfectants among healthcare workers has been associated with respiratory health effects, in particular, asthma. However, most studies are cross-sectional and the role of disinfectant exposures in asthma development requires longitudinal studies. We investigated the association between occupational exposure to disinfectants and incident asthma in a large cohort of U.S. female nurses.

Methods: The Nurses' Health Study II is a prospective cohort of 116 429 female nurses enrolled in 1989. Analyses included 61 539 participants who were still in a nursing job and with no history of asthma in 2009 (baseline; mean age: 55 years). During 277 744 person-years of follow-up (2009-2015), 370 nurses reported incident physician-diagnosed asthma. Occupational exposure was evaluated by questionnaire and a Job-Task-Exposure Matrix (JTEM). We examined the association between disinfectant exposure and subsequent asthma development, adjusted for age, race, ethnicity, smoking status, and body mass index.

Results: Weekly use of disinfectants to clean surfaces only (23% exposed) or to clean medical instruments (19% exposed) was not associated with incident asthma (adjusted hazard ratio [95% confidence interval] for surfaces, 1.12 [0.87-1.43]; for instruments, 1.13 [0.87-1.48]). No association was observed between high-level exposure to specific disinfectants/cleaning products evaluated by the JTEM (formaldehyde, glutaraldehyde, bleach, hydrogen peroxide, alcohol quats, or enzymatic cleaners) and asthma incidence.

Conclusions: In a population of late career nurses, we observed no significant association between exposure to disinfectants and asthma incidence. A potential role of disinfectant exposures in asthma development warrants further study among healthcare workers at earlier career stage to limit the healthy worker effect.

Keywords: asthma; cleaning products; disinfection; healthcare workers; occupational asthma.

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Conflict of interest statement

Disclosure (Authors): The authors declare no conflicts of interest.

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