Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Room 4. 45, Fourth Level, Falmouth Building Anzio Road, Observatory, 7925, Cape Town, South Africa.
Department of Environmental and Occupational Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Ann Work Expo Health. 2022 Oct 11;66(8):998-1009. doi: 10.1093/annweh/wxac034.
Whilst cleaning agents are commonly used in workplaces and homes, health workers (HWs) are at increased risk of exposure to significantly higher concentrations used to prevent healthcare-associated infections. Exposure assessment has been challenging partly because many are used simultaneously resulting in complex airborne exposures with various chemicals requiring different sampling techniques. The main objective of this study was to characterize exposures of HWs to various cleaning agents in two tertiary academic hospitals in Southern Africa.
A cross-sectional study of HWs was conducted in two tertiary hospitals in South Africa (SAH) and Tanzania (TAH). Exposure assessment involved systematic workplace observations, interviews with key personnel, passive personal environmental sampling for aldehydes (ortho-phthalaldehyde-OPA, glutaraldehyde and formaldehyde), and biomonitoring for chlorhexidine.
Overall, 269 samples were collected from SAH, with 62 (23%) collected from HWs that used OPA on the day of monitoring. OPA was detectable in 6 (2%) of all samples analysed, all of which were collected in the gastrointestinal unit of the SAH. Overall, department, job title, individual HW use of OPA and duration of OPA use were the important predictors of OPA exposure. Formaldehyde was detectable in 103 (38%) samples (GM = 0.0025 ppm; range: <0.0030 to 0.0270). Formaldehyde levels were below the ACGIH TLV-TWA (0.1 ppm). While individual HW use and duration of formaldehyde use were not associated with formaldehyde exposure, working in an ear, nose, and throat ward was positively associated with detectable exposures (P-value = 0.002). Glutaraldehyde was not detected in samples from the SAH. In the preliminary sampling conducted in the TAH, glutaraldehyde was detectable in 8 (73%) of the 11 samples collected (GM = 0.003 ppm; range: <0.002 to 0.028). Glutaraldehyde levels were lower than the ACGIH's TLV-Ceiling Limit of 0.05 ppm. p-chloroaniline was detectable in 13 (4%) of the 336 urine samples (GM = 0.02 ng/ml range: <1.00 to 25.80).
The study concluded that detectable exposures to OPA were isolated to certain departments and were dependent on the dedicated use of OPA by the HW being monitored. In contrast, low-level formaldehyde exposures were present throughout the hospital. There is a need for more sensitive exposure assessment techniques for chlorhexidine given its widespread use in the health sector.
清洁剂在工作场所和家庭中被广泛使用，而卫生工作者（HWs）面临着更高浓度清洁剂的暴露风险，这些清洁剂用于预防医疗机构相关感染。暴露评估具有挑战性，部分原因是许多清洁剂同时使用，导致具有各种化学物质的复杂空气传播暴露，需要不同的采样技术。本研究的主要目的是在南非的两家三级学术医院中描述 HWs 接触各种清洁剂的情况。
在南非（SAH）和坦桑尼亚（TAH）的两家三级医院进行了 HWs 的横断面研究。暴露评估包括系统的工作场所观察、与关键人员的访谈、醛（邻苯二醛-OPA、戊二醛和甲醛）的被动个人环境采样以及氯己定的生物监测。
总体而言，从 SAH 共采集了 269 个样本，其中 62 个（23%）来自于监测当天使用 OPA 的 HWs。在所有分析的样本中，有 6 个（2%）可检测到 OPA，均采集于 SAH 的胃肠道科。总体而言，科室、职称、个人使用 OPA 情况和 OPA 使用时间是 OPA 暴露的重要预测因素。在 103 个（38%）样本中可检测到甲醛（GM = 0.0025ppm；范围：<0.0030 至 0.0270）。甲醛水平低于 ACGIH TLV-TWA（0.1ppm）。虽然个人使用甲醛和使用甲醛的时间与甲醛暴露无关，但在耳鼻喉科工作与可检测暴露呈正相关（P 值=0.002）。在 SAH 采集的样本中未检测到戊二醛。在 TAH 的初步采样中，在采集的 11 个样本中，有 8 个（73%）可检测到戊二醛（GM = 0.003ppm；范围：<0.002 至 0.028）。戊二醛水平低于 ACGIH 的 TLV-Ceiling Limit（0.05ppm）。在 336 个尿样中，有 13 个（4%）可检测到对氯苯胺（GM = 0.02ng/ml；范围：<1.00 至 25.80）。
研究表明，OPA 的可检测暴露仅限于某些科室，且依赖于正在监测的 HW 对 OPA 的专用使用。相比之下，医院内普遍存在低水平的甲醛暴露。鉴于氯己定在卫生部门的广泛使用，需要更敏感的暴露评估技术。
