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An increased incidence of asthma was reported among healthcare workers and cleaners. However the role of the quaternary ammonium compounds (quats), commonly used in disinfection products, is not yet clear. The aims were to analyze asthma prevalence among healthcare professionals, and the influence of quats and other exposures (Chlorinated products /bleach, latex, glutaraldehyde).
Methods
All workers with more than 6 months of seniority working in 7 healthcare settings were requested. The study included: detailed questionnaire, physical exam, spirometry and specific IgE measurements. Occupational exposure assessment was done through a detailed professional questionnaire, workplace studies and a cleaning /disinfection products ingredients review. Data were analyzed using Poisson regression analysis.
Results
543 workers (89% female) participated; 37.1 % were registered nurses (RN), 16.4 % nursing aides (NA), 17.3% cleaners. 32.8 % had atopy. 335 participants mainly nursing professionals and cleaners were exposed to quats. RN and NA reported a significantly higher prevalence of asthma symptoms especially for physician diagnosed asthma (16.1 % among RN and 16.7 % among NA, 7.7 % among cleaners, less than 4 % among others, p = 0.004). Concerning new-onset asthma, the same tendency was observed. No significant association was found between IgE concentrations to quats and occupation, exposures or symptoms. Significant adjusted RR of 5.7 for diagnosed asthma and 11.8 for new-onset asthma were found when participants were exposed to quats. Disinfection tasks were more at risk than simple cleaning tasks. Manual dilution of products remained the tasks with the highest risk.
Discussion
Nursing professionals had a greater risk of developing new-onset asthma or exacerbated-asthma. This risk was particularly marked during disinfection tasks, our results highlighted the major role of quats exposure. Whatever pathogenic underlying mechanisms (immunological or irritative), preventive measures should be conducted in order to warn about risks, and to better control quats exposure.