Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town, 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, United Republic of.
Occup Environ Med. 2023 Jul;80(7):361-371. doi: 10.1136/oemed-2022-108763. Epub 2023 May 3.
This study investigated occupational risk factors and exposure-response relationships for airway disease among health workers (HWs) exposed to cleaning agents in two tertiary hospitals in South Africa and Tanzania.
In this cross-sectional study, 697 participants completed questionnaire interviews while 654 underwent fractional exhaled nitric oxide (FeNO) testing. Asthma Symptom Score (ASS) was computed based on the sum of answers to five questions on asthma-related symptoms in the past 12 months. For exposure-response analyses, cleaning agent-related self-reported exposure variables were categorised into three levels (cleaning product not used; use of a cleaning product for up to 99 min per week and use of a cleaning product for ≥100 min per week).
Asthma-related outcomes (ASS and FeNO) demonstrated positive associations with medical instrument cleaning agents (orthophthalaldehyde and enzymatic cleaners) and tasks (instruments precleaning and changing sterilisation solutions) as well as patient care activities (disinfection prior to procedures and disinfecting wounds). A particularly pronounced dose-response relationship was observed between work-related ocular-nasal symptoms and medical instrument cleaning agents (orthophthalaldehyde, glutaraldehyde, enzymatic cleaners, alcohols and bleach) (OR range: 2.37-4.56) and tasks (OR range: 2.92-4.44). A strong association was also observed between ASS and use of sprays for fixed surface cleaning (mean ratio 2.81; 95% CI 1.41 to 5.59).
Specific agents for medical instrument disinfection for example, orthophthalaldehyde and enzymatic cleaners, patient care activities and use of sprays are important occupational risk factors for airway disease among HWs.
本研究旨在调查南非和坦桑尼亚两家三级医院中接触清洁剂的卫生工作者（HWs）的职业风险因素和暴露-反应关系，与气道疾病有关。
在这项横断面研究中，697 名参与者完成了问卷调查访谈，而 654 名参与者接受了呼出气一氧化氮（FeNO）测试。哮喘症状评分（ASS）是根据过去 12 个月中与哮喘相关症状的五个问题的答案总和计算得出的。对于暴露-反应分析，清洁剂相关的自我报告暴露变量被分为三个水平（未使用清洁产品；每周使用清洁产品不超过 99 分钟和每周使用清洁产品超过 100 分钟）。
哮喘相关结局（ASS 和 FeNO）与医疗仪器清洁剂（邻苯二甲醛和酶清洁剂）和任务（仪器预清洁和更换消毒溶液）以及患者护理活动（程序前消毒和消毒伤口）呈正相关。工作相关眼-鼻症状与医疗仪器清洁剂（邻苯二甲醛、戊二醛、酶清洁剂、醇类和漂白剂）和任务（范围：2.37-4.56）之间观察到特别明显的剂量-反应关系。还观察到 ASS 与固定表面清洁用喷雾的使用之间存在强烈关联（平均比值 2.81；95%CI 1.41 至 5.59）。
例如，用于医疗仪器消毒的特定制剂，例如邻苯二甲醛和酶清洁剂、患者护理活动和喷雾的使用，是 HWs 气道疾病的重要职业风险因素。
