Estimated dermal exposure to nebulized pharmaceuticals for a simulated home healthcare worker scenario

J Occup Environ Hyg. 2020 Apr;17(4):193-205. doi: 10.1080/15459624.2020.1724297. Epub 2020 Mar 5.


The duties of home healthcare workers are extensive. One important task that is frequently performed by home healthcare workers is administration of nebulized medications, which may lead to significant dermal exposure. In this simulation study conducted in an aerosol exposure chamber, we administered a surrogate of nebulizer-delivered medications (dispersed sodium chloride, NaCl) to a patient mannequin. We measured the amount of NaCl deposited on the exposed surface of the home healthcare worker mannequin, which represented the exposed skin of a home healthcare worker. Factors such as distance and position of the home healthcare worker, room airflow rate and patient's inspiratory rate were varied to determine their effects on dermal exposure. There was a 2.78% reduction in dermal deposition for every centimeter the home healthcare worker moved away from the patient. Increasing the room's air exchange rate by one air change per hour increased dermal deposition by about 2.93%, possibly due to a decrease in near field particle settling. For every 10-degrees of arc the home healthcare worker is positioned from the left side of the patient toward the right and thus moving into the ventilation airflow direction, dermal deposition increased by about 4.61%. An increase in the patient's inspiratory rate from 15-30 L/min resulted in an average of 14.06% reduction in dermal deposition for the home healthcare worker, reflecting a relative increase in the aerosol fraction inhaled by the patient. The findings of this study elucidate the interactions among factors that contribute to dermal exposure to aerosolized pharmaceuticals administered by home healthcare workers. The results presented in this paper will help develop recommendations on mitigating the health risks related to dermal exposure of home healthcare workers.

Keywords: Dermal exposure; exposure assessment; healthcare workers; inhaled drugs; medication administration; patient care.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Drug-Related Side Effects and Adverse Reactions / etiology*
  • Home Care Services*
  • Humans
  • Nebulizers and Vaporizers
  • Occupational Exposure / analysis*
  • Skin / drug effects*