Asthma among workers in healthcare settings: role of disinfection with quaternary ammonium compounds

Clin Exp Allergy. 2014 Mar;44(3):393-406. doi: 10.1111/cea.12215.


Introduction: An increased incidence of asthma has been reported among healthcare workers. The role of quaternary ammonium compounds (QACs), commonly used in cleaning/disinfection products, has not been clearly defined. The aim of this study was to analyse associations between asthma and occupational exposure to disinfectants, especially QACs.

Methods: The study was performed on a stratified random sample of the various healthcare departments of 7 healthcare settings. The study included: questionnaire, physical examination and specific IgE assays. Occupational exposure assessment was performed by means of a work questionnaire, workplace studies and a review of products ingredients. Data were analysed by logistic regression.

Results: Response rate was 77%; 543 workers (89% female) participated; 37.1% were registered nurses (RNs), 16.4% auxiliary nurses (ANs), 17.3% cleaners; 32.8% were atopic. 335 participants were exposed to QACs. Nursing professionals reported a significantly higher risk of reported physician-diagnosed asthma and, for RNs, of nasal symptoms at work than administrative staff working in healthcare sector. This risk was particularly marked during disinfection tasks and when exposure to QACs. Exposure to QACs increased significantly the risk of reported physician-diagnosed asthma and nasal symptoms at work (adjusted OR = 7.5 and 3.2, respectively). No significant association was found with other exposures such as latex glove use, chlorinated products/bleach or glutaraldehyde.

Conclusion: RNs and ANs presented a higher risk of reported asthma than administrative staff. The highest risk was associated with tasks involving dilution of disinfection products by manual mixing, suggesting possible exposure to repeated peaks of concentrated products known to be strong respiratory irritants. Workplace interventions should be conducted to more clearly determine QAC exposure and improve disinfection procedures.

Keywords: cleaners; disinfection; healthcare workers; nurses; occupational exposure; quaternary ammonium compounds; work-related asthma.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Ammonium Compounds / adverse effects
  • Asthma / diagnosis
  • Asthma / epidemiology*
  • Asthma / etiology*
  • Cross-Sectional Studies
  • Disinfectants / adverse effects
  • Disinfection
  • Female
  • France
  • Health Personnel*
  • Humans
  • Immunoglobulin E
  • Incidence
  • Male
  • Middle Aged
  • Occupational Exposure*
  • Prevalence
  • Public Health Surveillance
  • Risk Factors
  • Surveys and Questionnaires
  • Young Adult


  • Ammonium Compounds
  • Disinfectants
  • Immunoglobulin E