Occupational risk factors and exposure-response relationships for airway disease among health workers exposed to cleaning agents in tertiary hospitals

Occup Environ Med. 2023 Jul;80(7):361-371. doi: 10.1136/oemed-2022-108763. Epub 2023 May 3.


Objectives: 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.

Methods: 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).

Results: 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).

Conclusions: 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.

Keywords: Allergy and Immunology; Asthma; Chemical Hazard Release; Health Personnel; Toxicology.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Asthma* / diagnosis
  • Cross-Sectional Studies
  • Detergents / adverse effects
  • Humans
  • Occupational Diseases* / chemically induced
  • Occupational Diseases* / complications
  • Occupational Exposure* / adverse effects
  • Occupational Exposure* / analysis
  • Respiration Disorders*
  • Risk Factors
  • Tertiary Care Centers


  • Detergents