Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Respiratory Health Division, Morgantown, WV, USA.
Independent Consultant, La Center, WA, USA.
Ann Work Expo Health. 2019 Aug 7;63(7):759-772. doi: 10.1093/annweh/wxz043.
Cleaning and disinfecting tasks and product use are associated with elevated prevalence of asthma and respiratory symptoms among healthcare workers; however, the levels of exposure that pose a health risk remain unclear. The objective of this study was to estimate the peak, average, and determinants of real-time total volatile organic compound (TVOC) exposure associated with cleaning tasks and product-use. TVOC exposures were measured using monitors equipped with a photoionization detector (PID). A simple correction factor was applied to the real-time measurements, calculated as a ratio of the full-shift average TVOC concentrations from a time-integrated canister and the PID sample, for each sample pair. During sampling, auxiliary information, e.g. tasks, products used, engineering controls, was recorded on standardized data collection forms at 5-min intervals. Five-minute averaged air measurements (n = 10 276) from 129 time-series comprising 92 workers and four hospitals were used to model the determinants of exposures. The statistical model simultaneously accounted for censored data and non-stationary autocorrelation and was fit using Markov-Chain Monte Carlo within a Bayesian context. Log-transformed corrected concentrations (cTVOC) were modeled, with the fixed-effects of tasks and covariates, that were systematically gathered during sampling, and random effect of person-day. The model-predicted geometric mean (GM) cTVOC concentrations ranged from 387 parts per billion (ppb) for the task of using a product containing formaldehyde in laboratories to 2091 ppb for the task of using skin wipes containing quaternary ammonium compounds, with a GM of 925 ppb when no products were used. Peak exposures quantified as the 95th percentile of 15-min averages for these tasks ranged from 3172 to 17 360 ppb. Peak and GM task exposures varied by occupation and hospital unit. In the multiple regression model, use of sprays was associated with increasing exposures, while presence of local exhaust ventilation, large room volume, and automatic sterilizer use were associated with decreasing exposures. A detailed understanding of factors affecting TVOC exposure can inform targeted interventions to reduce exposures and can be used in epidemiologic studies as metrics of short-duration peak exposures.
清洁和消毒任务以及产品使用与医护人员哮喘和呼吸道症状的高发率有关；然而，造成健康风险的接触水平仍不清楚。本研究的目的是估计与清洁任务和产品使用相关的总挥发性有机化合物 (TVOC) 暴露的峰值、平均值和决定因素。使用配备光电离检测器 (PID) 的监测仪测量 TVOC 暴露量。对于每对样本，应用一个简单的校正因子来校正实时测量值，该校正因子是通过将整个班次的平均 TVOC 浓度从积分罐和 PID 样品的比值计算得出。在采样过程中，以 5 分钟为间隔，在标准化数据收集表上记录辅助信息，例如任务、使用的产品、工程控制等。使用来自包含 92 名工人和 4 家医院的 129 个时间序列的 5 分钟平均空气测量值（n = 10276）来建立暴露决定因素的模型。该统计模型同时考虑了截尾数据和非平稳自相关，并在贝叶斯框架内使用马尔可夫链蒙特卡罗进行拟合。对经过对数转换的校正浓度 (cTVOC) 进行建模，固定效应包括任务和协变量，这些变量在采样过程中系统地收集，以及人员日的随机效应。模型预测的几何平均值 (GM) cTVOC 浓度范围从在实验室使用含甲醛的产品的任务中的 387 个十亿分之一 (ppb) 到使用含季铵化合物的皮肤擦拭剂的任务中的 2091 ppb，当不使用产品时，GM 为 925 ppb。这些任务中 15 分钟平均的第 95 百分位数量化的峰值暴露值范围为 3172 至 17360 ppb。峰值和 GM 任务暴露值因职业和医院科室而异。在多元回归模型中，喷雾的使用与暴露增加有关，而局部排气通风、大房间体积和自动消毒器的使用与暴露减少有关。详细了解影响 TVOC 暴露的因素可以为减少暴露的针对性干预措施提供信息，并可在流行病学研究中用作短期高峰暴露的指标。
