The Association of Current Asthma With and Without Exacerbation With Products Used and Tasks Performed by Healthcare Workers

Abstract

Background: Results from a 2014 survey of 2030 healthcare workers (76% female, mean age 48.6 years) in New York City included the association of current asthma and asthma exacerbation with the general activities of cleaning fixed surfaces and administering aerosolized medications. We extended that analysis to determine if specific products and tasks for these and other activities were associated with the same outcomes.

Methods: The survey instrument inquired about asthma-related outcomes, products used, and tasks performed. Polytomous logistic regression was used to model a three-category outcome for current asthma without and with exacerbation and no current asthma (referent). Inverse probability weights were applied in all regression models to adjust for selection and participation bias that may have resulted from a low response of 11.1% of invitees. A separate model was fit for each exposure variable and yielded adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

Results: For cleaning fixed surfaces, two products and eight tasks had increased odds of at least one adverse outcome. Enzymes had an OR = 3.01 (95% CI 1.50, 6.04) for current asthma with exacerbation, and bleach had an OR = 1.92 (95% CI 1.22, 3.01) for current asthma without exacerbation. The eight general cleaning tasks included three (cleanup blood/spills, wipe furniture, wipe equipment) associated with both adverse outcomes, and five tasks associated only with current asthma without exacerbation. For aerosolized medication tasks, the small-volume nebulizer was associated with current asthma with (OR = 1.89, 95% CI 1.06, 3.34) and without (OR = 1.66, 95% CI 1.01, 2.72) exacerbation, and two other tasks (continuous delivery system, metered dose inhaler) were associated only with current asthma without exacerbation.

Conclusions: Products and tasks in healthcare were associated with current asthma and asthma exacerbation. Future analyses will explore quantitative exposure-assessment strategies for specific chemicals and mixtures.

Keywords: asthma; cleaning; disinfecting; exacerbation; healthcare workers.