Nurses' use of disinfectants linked to higher risk for COPD

Nurses who regularly use disinfectants have a 22% higher risk of developing chronic obstructive pulmonary disease (COPD), according to research presented at the European Respiratory Society International Congress, held recently in Milan, Italy.

“To the best of our knowledge, we are the first to report a link between disinfectants and COPD among health care workers, and to investigate specific chemicals that may underlie this association,” said Orianne Dumas, PhD, postdoctoral researcher at the French National Institute of Health and Medical Research (INSERM), in Villejuif, France, who presented the research.

For their study, Dr. Dumas and colleagues examined data from 55,185 female registered nurses enrolled in the US Nurses’ Health Study II. The data showed that 663 nurses were diagnosed with COPD between 2009 and May 2017. Of these, the investigators questioned their exposure to disinfectants in relation to particular jobs or tasks. Finally, the researchers adjusted the results for confounding factors such as smoking, age, body mass index, and ethnicity.

“We found that nurses who use disinfectants to clean surfaces on a regular basis—at least once a week—had a 22% increased risk of developing COPD,” Dr. Dumas said.

When the researchers looked at exposure to specific disinfectants—including glutaraldehyde, bleach, hydrogen peroxide, alcohol, and quaternary ammonium (“quats”) compounds—they found that all were associated with 24% to 32% greater risk of COPD.

“In our study population, 37% of nurses used disinfectants to clean surfaces on a weekly basis and 19% used disinfectants to clean medical instruments on a weekly basis,” Dr. Dumas noted. “There was a suggestion of a link with the weekly use of disinfectants to clean instruments, but this was not statistically significant.”

Previous studies have linked health care workers’ use of disinfectants—notably low molecular weight agents such as glutaraldehyde—with breathing problems, including occupational asthma.

However, “the potential adverse effects of exposure to disinfectants on COPD have received much less attention, although two recent studies in European populations showed that working as a cleaner was associated with a higher risk of COPD,” Dr. Dumas said.

“Our findings provide further evidence of the effects of exposure to disinfectants on respiratory problems, and highlight the urgency of integrating occupational health considerations into guidelines for cleaning and disinfection in health care settings such as hospitals,” she added.

Dr. Dumas cautioned that this study offers only preliminary findings and that more research is needed. “In particular, we need to investigate the impact on COPD of lifetime occupational exposure to chemicals and clarify the role of each specific disinfectant,” she said. “We hope to receive funding from the US Centers for Disease Control and Prevention to continue this important work.”

The research has implications not just for hospitals and health care clinics, but for everyday settings.

“Some of these disinfectants, such as bleach and quats, are frequently used in ordinary households, and the potential impact of domestic use of disinfectants on COPD development is unknown,” Dr. Dumas said. “Earlier studies have found a link between asthma and exposure to cleaning products and disinfectants at home, such as bleach and sprays, so it is important to investigate this further.”