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Are Healthcare Workers at an Increased Risk for Obstructive Respiratory Diseases Due to Cleaning and Disinfection Agents? A Systematic Review and Meta-Analysis

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  • Karla Romero Starke

    (Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
    Institute of Sociology, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, Thüringer Weg 9, 09126 Chemnitz, Germany)

  • Sophie Friedrich

    (Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany)

  • Melanie Schubert

    (Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany)

  • Daniel Kämpf

    (Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany)

  • Maria Girbig

    (Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany)

  • Anna Pretzsch

    (Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany)

  • Albert Nienhaus

    (Department of Occupational Medicine, Toxic Substances and Health Research, Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW), 22089 Hamburg, Germany
    Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany)

  • Andreas Seidler

    (Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany)

Abstract

Several reviews have reported an increased risk of obstructive respiratory diseases in workers exposed to cleaning or disinfection agents, but they have focused mainly on professional cleaners. Cleaning and disinfecting are frequently performed activities by healthcare workers. We conducted a systematic review with meta-analysis to quantify the risk of obstructive respiratory diseases in healthcare workers exposed to cleaning and disinfection agents. We searched the Medline and Embase databases until 4 February 2021 to find adequate primary studies. Two independent reviewers screened the titles/abstracts and the full texts of the studies, as well as performing data extraction and quality assessment. The literature search yielded 9432 records, and 8 studies were found through a hand search. After screening, 14 studies were included in the review. All had a high risk of bias, and most studies dealt with nurses, asthma, and hyperresponsiveness (BHR)-related symptoms. Only one study investigated COPD. The meta-analysis estimated an increased risk of new-onset asthma for nurses (Effect size (ES) = 1.67; 95% CI 1.11–2.50) compared with other occupations and found an increase in the risk of new-onset asthma for nurses exposed to cleaning and disinfecting surfaces (ES = 1.43; 95% CI 1.09–1.89) and instruments (ES = 1.34; 95% CI 1.09–1.65). Exposure to specific chemicals such as bleach and glutaraldehyde (GA) increased the risk of asthma in nurses (bleach ES = 2.44; 95% CI 1.56–3.82; GA ES = 1.91, 95% CI 1.35–2.70). A higher risk for BHR-related symptoms was observed for nurses exposed to cleaning surfaces (ES = 1.44; 95% CI 1.18–1.78). Although the overall evidence was rated as low, the limitations found in this review hint at a potential underestimation of the real risk. These findings highlight the need for reinforced prevention practices with regard to healthcare workers. Similar research investigating these associations among other healthcare workers such as rescue service and nursing home personnel is needed.

Suggested Citation

  • Karla Romero Starke & Sophie Friedrich & Melanie Schubert & Daniel Kämpf & Maria Girbig & Anna Pretzsch & Albert Nienhaus & Andreas Seidler, 2021. "Are Healthcare Workers at an Increased Risk for Obstructive Respiratory Diseases Due to Cleaning and Disinfection Agents? A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 18(10), pages 1-24, May.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:10:p:5159-:d:553588
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    References listed on IDEAS

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    1. Karla Romero Starke & Marlen Kofahl & Alice Freiberg & Melanie Schubert & Mascha Luisa Groß & Stefanie Schmauder & Janice Hegewald & Daniel Kämpf & Johanna Stranzinger & Albert Nienhaus & Andreas Seid, 2019. "Are Daycare Workers at a Higher Risk of Parvovirus B19 Infection? A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 16(8), pages 1-16, April.
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    3. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    4. Jim Giles, 2005. "Start your engines," Nature, Nature, vol. 438(7068), pages 554-555, December.
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