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.

Background: Prior analyses of data from a questionnaire survey of healthcare workers identified associations of current asthma and exacerbation of asthma with housekeeping and nursing occupations and cleaning and patient care tasks. These findings are augmented with new evaluations of the association of the same outcomes with using products and combinations of products represented by exposure clusters (ECs). Methods: The 2,030 participants were cleaners, nurses, and technicians working in hospitals and nursing homes in New York City. Health outcomes were all current asthma (n=173) and a variable with three subsets of these cases: no exacerbation, n=99; moderate exacerbation, n=41; and severe exacerbation, n=33. The two metrics of occupational exposure were self-reported use of 14 cleaning, disinfecting, and medical products, and 5 ECs with a No Products EC reference. Logistic regression models yielded odds ratios (ORs) and 95% confidence intervals (95% CIs) adjusted for age, gender, race, smoking, and allergy history. Results: Products with elevated ORs were: Chlorine Bleach for all current asthma OR=1.60 (95% CI 1.11, 2.31), no exacerbation OR=1.84 (1.16, 2.90); Aerosolized Medications for all current asthma OR=1.66 (1.14, 2.42), moderate exacerbation OR=2.35 (1.18, 4.66); and Skin Wipes for moderate exacerbation OR=2.17 (1.09, 4.35). The Housekeeping/Chlorine EC had elevated ORs for all current asthma OR=2.01 (1.22, 3.30), no exacerbation OR=1.91 (1.01, 3.60), moderate exacerbation OR=3.11 (1.11, 8.68). Conclusion: The results confirm previous findings showing associations of asthma outcomes with performing cleaning and patient care tasks in healthcare.

Introduction Healthcare workers are exposed to a complex mixture of chemicals from using cleaning and disinfection products. Cleaning tasks and products are associated with elevated prevalence of asthma and respiratory symptoms, however quantitative exposure estimates are lacking which hinders prevention. The objectives of this study were to create a quantitative task exposure matrix (TEM) for cleaning and disinfection product-use for a set of 14 volatile organic compounds (VOCs) and compare exposure estimates by job, unit, and products used. Material and Methods Quantitative VOC exposure estimates were obtained using data collected at four U.S. hospitals. Personal time-integrated VOC samples were collected and analyzed for 14 specific VOCs. All measurements included detailed information on tasks, products used, job, unit, and other workplace characteristics. Bayesian multiple linear regression models accounting for measurements below the limit of detection (LOD) were used to assess exposures by job, unit, product, and the interaction of product with job and unit. Geometric mean (GM) exposure estimates in parts per billion generated from the multiple regression models were used to create a TEM and compared to identify differences between jobs, units, and products. Notable differences were identified using non-overlapping 95% credible intervals. Results Total 14-VOC exposures (TVOC14) were highest among dental occupations (GM=1680) and lowest among laboratory technicians (GM=399). Nurses (GM=1541) had higher exposures than laboratory technicians. Similarly, laboratory settings (GM= 389) had lower TVOC14 exposures than operating rooms (GM=1440). Of products studied, exposures were highest for high-level disinfectants (GM= 2000) and lowest for enzyme products (GM=322). Conclusion A TEM was successfully created using the GM for product-job, product-unit and product, and assigned to participants in an epidemiologic study. The quantitative estimates for the 14 VOCs will be used in multi-pollutant models to explore respiratory health outcomes associated with mixed VOC exposures.

Introduction Cleaning products are complex mixtures of chemicals, and their use is associated with elevated prevalence of asthma symptoms among healthcare workers. In this study, we evaluate the effects of cleaning and disinfecting tasks, products used, and quantitative volatile organic compound (VOC) exposures on asthma outcome clusters of cough/phlegm, mild asthma, undiagnosed asthma and uncontrolled asthma. Materials and Methods Healthcare workers from nine select occupations working in New York City hospitals and nursing homes completed a questionnaire with modules on cleaning and disinfecting tasks and product use. Frequency of cleaning tasks and products were calculated and quantitative exposure to total and 12 specific or composite VOCs were assigned to participants based on predictive statistical models. Exposure-response relationships for asthma outcome clusters were explored using polytomous logistic regression adjusted for age, gender, race, smoking and allergic status. Results Various cleaning and disinfecting tasks were significantly associated with at least one of four asthma clusters including tasks involved in cleaning fixed surfaces, disinfecting medical instruments, administration of aerosolized medications and dental tasks. Products significantly associated with asthma clusters included use of orthophthaldehyde, alcohol, bleach, acids, ammonia, enzymatic cleaners, detergents, glass cleaners and phenolics on surfaces or instruments. Most VOC exposures were significantly associated with at least one of four asthma clusters. Specifically, chloroform, methylene chloride and VOC 11 (sum of 11 specific VOCs) were significantly associated with mild asthma, undiagnosed asthma and uncontrolled asthma. Notably, VOC exposures were highly correlated and specific VOCs with the greatest influence on the asthma clusters remain unclear. Conclusion These results confirm previous findings of the association between cleaning and disinfecting products and asthma outcomes and highlight the need for prudent actions to mitigate exposures. However, these single predictor models do not represent workplace conditions; multipollutant models are needed to investigate mixed exposures and their interactions.

IntroductionCertain cleaning and disinfecting products are used extensively in healthcare and associated with asthma and respiratory symptoms. However, quantitative exposures to these products are not well-characterized. The objective of this study was to characterize exposures to cleaning and disinfecting chemicals in healthcare occupations.MethodsExposure assessments were conducted at five hospitals targeted 14 healthcare occupations. Mobile-area and personal real-time and time-integrated air monitoring was conducted for volatile organic compounds (VOCs), and 14 specific VOCs were quantified, including total VOCs (TVOCs). Quaternary ammonium compounds (QACs) were quantified at one hospital. Exposure data were summarized by occupation and geometric means (GMs) and geometric standard deviations (GSDs) were calculated. GM exposure estimates for product-application tasks were obtained from linear regression models.ResultsThe GMs for TVOCs were highest among nursing assistants, licensed practical nurses, and medical equipment preparers (range: 4367–2142 ppb), followed by respiratory therapists, pharmacy technicians, registered nurses, housekeepers, floor strippers/waxers, and dental assistants (range: 2120–1565 ppb); GSDs varied from 1.06 to 9.01. GMs for selected VOCs were: ethanol (1.54–2594 ppb), acetone (18.5–70.6 ppb), chloroform (0.09–0.57 ppb), α-pinene (0.04–0.19 ppb), and d-limonene (0.12–4.23 ppb). Real-time TVOC GMs were the highest for the product-application tasks of using skin wipes containing QACs, using enzymatic cleaners, using glass-cleaning products, cleaning instruments with high-level disinfectants, and using detergents to clean surfaces (2091–1049 ppb). Specific VOC levels were strongly associated with product-application tasks; using products containing bleach or QACs predicted levels of chloroform and d-limonene, respectively. Concentrations of QACs were low in short-duration (0.23–1.5 µg/m3) and full-shift (0.006–0.028 µg/m3) area air samples.ConclusionsExposure levels of total and specific VOCs varied by occupations and tasks. These estimates can be used to generate a job-task exposure matrix for use in epidemiologic studies.

RATIONALE: We conducted a cross-sectional questionnaire survey of 2,030 healthcare workers (cleaners and different types of nurses and technicians) who worked in hospitals and nursing homes in New York City. The 173 participants with physician-diagnosed current asthma included those with and without evidence of exacerbation in the last 12 months. Previous analyses found the workplace tasks of cleaning fixed surfaces and administering aerosolized medications to be associated with current asthma and moderate exacerbation of asthma in separate models. Workplace conditions can potentially impact asthma cases by worsening their symptoms and increasing the need for care and medication, even if the cases do not experience exacerbation episodes. We conducted analyses to investigate whether current asthma without exacerbation was associated with selected healthcare tasks. METHODS: We divided the 173 workers with physician-diagnosed current asthma into three exclusive groups based on self-reported care and medication usage for asthma in the last 12 months: 33 severe exacerbation (hospitalization overnight for asthma or increased oral steroid usage), 41 moderate exacerbation (no severe exacerbation, and urgent treatment or short-term increased usage of inhaled steroids or rescue bronchodilators), and 99 without exacerbation but at least some symptoms, medication usage, or care related to asthma. We created a single outcome variable with four categories, including three for current asthma (asthma+no exacerbation, asthma+moderate exacerbation, asthma+severe exacerbation) and a common reference category for participants with no current asthma, and fit a multinomial logistic regression model for each occupational risk factor that also included covariates to adjust for potential confounding. RESULTS: Among current asthma cases, those without exacerbation were less likely to have experienced asthma-related absenteeism and presenteeism and had a lower mean asthma symptom score than those with exacerbation. From the regression models, moderate exacerbation (but not severe exacerbation) was associated with both cleaning fixed surfaces (odds ratio (OR) 3.20, 95% confidence interval (CI) 1.29-7.94) and administering aerosolized medications (OR 2.37, 95% CI 1.19-4.72). Current asthma without exacerbation had a statistically significant association with administering aerosolized medications (OR 1.61, 95% CI 1.00-2.60) but not with cleaning fixed surfaces (OR 1.52, 95% CI 0.95-2.43). CONCLUSIONS: Results from this study of urban healthcare workers indicate that current asthma cases without exacerbation do not have the same extent of adverse outcomes as their counterparts with exacerbation, but still represent a disease group that could potentially be less common if certain workplace exposures were better controlled.

Background: Prior studies indicate that asthma-related symptoms in healthcare workers are associated with workplace mold odor (MO) and the combination of painting with floor and wall renovations (P/FR/WR). We used data from a questionnaire survey of healthcare workers to study whether self-reports of MO and P/FR/WR in the past year were risk factors for current asthma with and without exacerbation. Methods: The 2,030 survey participants were cleaners, nurses, and technicians in over 250 hospitals and nursing homes in New York City. We divided the 173 participants with physician-diagnosed current asthma into three categories based on self-reported asthma-related symptoms and care in the past year: 33 severe exacerbation (hospitalized overnight or increased oral steroids); 41 moderate exacerbation (no severe exacerbation, but urgent care or short-term increase in inhaled steroids or rescue bronchodilators); and 99 current asthma/no exacerbation (but symptoms or care). Multinomial logistic regression models of the asthma categories yielded adjusted odds ratios (ORs) for MO and P/FR/WR. Results: More participants reported all three renovation activities P/FR/WR (n=542, 27%) than MO (n=147, 7.2%) at work. Current asthma outcomes were not associated with MO. Moderate exacerbation (OR 3.08, 95% CI 1.11, 8.56, p=0.03) and current asthma/no exacerbation (OR 1.90, 95% CI 0.98, 3.70, p=0.06) were associated with P/FR/WR. Conclusion: The renovation combination P/FR/WR in healthcare was a risk factor for moderate, but not severe, exacerbation of asthma. Minimizing exposure to dusts and gases during renovations might reduce exacerbation of asthma among workers and other occupants of healthcare facilities.

BACKGROUND:Asthma-related health outcomes are known to be associated with indoor moisture and renovations. The objective of this study was to estimate the frequency of these indoor environmental quality (IEQ) factors in healthcare facilities and their association with asthma-related outcomes among workers. METHODS:New York City healthcare workers (n = 2030) were surveyed regarding asthma-related symptoms, and moisture and renovation factors at work and at home during the last 12 months. Questions for workplace moisture addressed water damage (WD), mold growth (MG), and mold odor (MO), while for renovations they addressed painting (P), floor renovations (FR), and wall renovations (WR). Regression models were fit to examine associations between work and home IEQ factors and multiple asthma-related outcomes. RESULTS:Reports of any moisture (n = 728, 36%) and renovations (n = 1412, 70%) at work were common. Workplace risk factors for asthma-related outcomes included the moisture categories of WD by itself, WD with MO (without MG), and WD with MG and MO, and the renovation category with the three factors P, FR, and WR. Reports of home IEQ factors were less frequent and less likely to be associated with health outcomes. Data analyses suggested that MG and/or MO at work and at home had a synergistic effect on the additive scale with a symptom-based algorithm for bronchial hyperresponsiveness. CONCLUSIONS:The current study determined that moisture and renovation factors are common in healthcare facilities, potentially putting workers at risk for asthma-related outcomes. More research is needed to confirm these results, especially prospective studies.

Cleaning and disinfecting tasks and product use are associated with elevated prevalence of asthma and respiratory symptoms among healthcare workers; however, the levels of exposure that pose a health risk remain unclear. The objective of this study was to estimate the peak, average, and determinants of real-time total volatile organic compound (TVOC) exposure associated with cleaning tasks and product-use. TVOC exposures were measured using monitors equipped with a photoionization detector (PID). A simple correction factor was applied to the real-time measurements, calculated as a ratio of the full-shift average TVOC concentrations from a time-integrated canister and the PID sample, for each sample pair. During sampling, auxiliary information, e.g. tasks, products used, engineering controls, was recorded on standardized data collection forms at 5-min intervals. Five-minute averaged air measurements (n = 10 276) from 129 time-series comprising 92 workers and four hospitals were used to model the determinants of exposures. The statistical model simultaneously accounted for censored data and non-stationary autocorrelation and was fit using Markov-Chain Monte Carlo within a Bayesian context. Log-transformed corrected concentrations (cTVOC) were modeled, with the fixed-effects of tasks and covariates, that were systematically gathered during sampling, and random effect of person-day. The model-predicted geometric mean (GM) cTVOC concentrations ranged from 387 parts per billion (ppb) for the task of using a product containing formaldehyde in laboratories to 2091 ppb for the task of using skin wipes containing quaternary ammonium compounds, with a GM of 925 ppb when no products were used. Peak exposures quantified as the 95th percentile of 15-min averages for these tasks ranged from 3172 to 17 360 ppb. Peak and GM task exposures varied by occupation and hospital unit. In the multiple regression model, use of sprays was associated with increasing exposures, while presence of local exhaust ventilation, large room volume, and automatic sterilizer use were associated with decreasing exposures. A detailed understanding of factors affecting TVOC exposure can inform targeted interventions to reduce exposures and can be used in epidemiologic studies as metrics of short-duration peak exposures.

Abstract Little is known about emissions and exposure potential from vat polymerization additive manufacturing, a process that uses light-activated polymerization of a resin to build an object. Five vat polymerization printers (three stereolithography (SLA) and two digital light processing (DLP) were evaluated individually in a 12.85 m3 chamber. Aerosols (number, size) and total volatile organic compounds (TVOC) were measured using real-time monitors. Carbonyl vapors and particulate matter were collected for offline analysis using impingers and filters, respectively. During printing, particle emission yields (#/g printed) ranged from 1.3 ± 0.3 to 2.8 ± 2.6 x 108 (SLA printers) and from 3.3 ± 1.5 to 9.2 ± 3.0 x 108 (DLP printers). Yields for number of particles with sizes 5.6 to 560 nm (#/g printed) were 0.8 ± 0.1 to 2.1 ± 0.9 x 1010 and from 1.1 ± 0.3 to 4.0 ± 1.2 x 1010 for SLA and DLP printers, respectively. TVOC yield values (µg/g printed) ranged from 161 ± 47 to 322 ± 229 (SLA printers) and from 1281 ± 313 to 1931 ± 234 (DLP printers). Geometric mean mobility particle sizes were 41.1–45.1 nm for SLA printers and 15.3–28.8 nm for DLP printers. Mean particle and TVOC yields were statistically significantly higher and mean particle sizes were significantly smaller for DLP printers compared with SLA printers (p < 0.05). Energy dispersive X-ray analysis of individual particles qualitatively identified potential occupational carcinogens (chromium, nickel) as well as reactive metals implicated in generation of reactive oxygen species (iron, zinc). Lung deposition modeling indicates that about 15–37% of emitted particles would deposit in the pulmonary region (alveoli). Benzaldehyde (1.0–2.3 ppb) and acetone (0.7–18.0 ppb) were quantified in emissions from four of the printers and 4-oxopentanal (0.07 ppb) was detectable in the emissions from one printer. Vat polymerization printers emitted nanoscale particles that contained potential carcinogens, sensitizers, and reactive metals as well as carbonyl compound vapors. Differences in emissions between SLA and DLP printers indicate that the underlying technology is an important factor when considering exposure reduction strategies such as engineering controls.

Background: Poor indoor air quality (IAQ) related to building sources and characteristics can potentially affect the respiratory health of workers. The objective of this study was to evaluate the association of asthma-related outcomes with workplace moisture/mold and renovations in a sample of urban healthcare workers in the United States. Methods: We invited housekeepers, nurses, and technicians employed at hospitals and nursing homes in New York City to complete a questionnaire that inquired about moisture/mold and renovations at work and home, and asthma-related outcomes. We used responses to questions about respiratory symptoms to generate an asthma symptom score for each participant. Regression models of outcomes included covariates for confounders and IAQ at work and home. Results: The 2,030 participants were predominantly female (76%) and African American (62%), with mean age 48.6 years. Many participants reported workplace moisture/mold (11.2% mold growth/odor, 24.7% just water damage) and renovations (47.9% wall/floor renovation, 21.7% just painting). After controlling for similar exposures at home, workplace IAQ exposures were associated with several asthma-related outcomes. The ratio mean asthma symptom score (and 95% confidence interval) was 1.80 (1.36, 2.37) for mold growth/odor, 1.39 (1.12, 1.73) for just water damage, 1.89 (1.48, 2.41) for wall/floor renovation, and 1.39 (1.05, 1.85) for just painting. Conclusions: These findings add to existing evidence for the association of workplace moisture/mold and renovations with asthma-related outcomes in healthcare workers, and suggest the need for further efforts to control these exposures in healthcare facilities.

There is a paucity of data on additive manufacturing process emissions and personal exposures in real-world workplaces. Hence, we evaluated atmospheres in four workplaces utilizing desktop "3-dimensional" (3-d) printers [fused filament fabrication (FFF) and sheer] for production, prototyping, or research. Airborne particle diameter and number concentration and total volatile organic compound concentrations were measured using real-time instruments. Airborne particles and volatile organic compounds were collected using time-integrated sampling techniques for off-line analysis. Personal exposures for metals and volatile organic compounds were measured in the breathing zone of operators. All 3-d printers that were monitored released ultrafine and fine particles and organic vapors into workplace air. Particle number-based emission rates (#/min) ranged from 9.4 × 109 to 4.4 × 1011 (n = 9samples) for FFF3-d printers and from 1.9 to 3.8 × 109 (n = 2 samples) for a sheer 3-d printer. The large variability in emission rate values reflected variability from the printers as well as differences in printer design, operating conditions, and feedstock materials among printers. A custom-built ventilated enclosure evaluated at one facility was capable of reducing particle number and total organic chemical concentrations by 99.7% and 53.2%, respectively. Carbonyl compounds were detected in room air; however, none were specifically attributed to the 3-d printing process. Personal exposure to metals (aluminum, iron) and 12 different organic chemicals were all below applicable NIOSH Recommended Exposure Limit values, but results are not reflective of all possible exposure scenarios. More research is needed to understand 3-d printer emissions, exposures, and efficacy of engineering controls in occupational settings.

Asthma is a heterogeneous disease with varying severity and subtypes. Recent reviews of epidemiologic studies have identified cleaning and disinfecting activities (CDAs) as important risk factors for asthma-related outcomes among healthcare workers. However, the complexity of CDAs in healthcare settings has rarely been examined. This study utilized a complex survey dataset and data reduction approaches to identify and group healthcare workers with similar patterns of asthma symptoms, and then explored their associations with groups of participants with similar patterns of CDAs. Self-reported information on asthma symptoms/care, CDAs, demographics, smoking status, allergic status, and other characteristics were collected from 2030 healthcare workers within nine selected occupations in New York City. Hierarchical clustering was conducted to systematically group participants based on similarity of patterns of the 27 asthma symptom/care variables, and 14 product applications during CDAs, separately. Word clouds were used to visualize the complex information on the resulting clusters. The associations of asthma health clusters (HCs) with exposure clusters (ECs) were evaluated using multinomial logistic regression. Five HCs were identified (HC-1 to HC-5), labelled based on predominant features as: "no symptoms", "winter cough/phlegm", "mild asthma symptoms", "undiagnosed/untreated asthma", and "asthma attacks/exacerbations". For CDAs, five ECs were identified (EC-1 to EC-5), labelled as: "no products", "housekeeping/chlorine", "patient care", "general cleaning/laboratory", and "disinfection products". Using HC-1 and EC-1 as the reference groups, EC-2 was associated with HC-4 (odds ratio (OR) = 3.11, 95% confidence interval (95% CI) = 1.46-6.63) and HC-5 (OR = 2.71, 95% CI = 1.25-5.86). EC-3 was associated with HC-5 (OR = 2.34, 95% CI = 1.16-4.72). EC-4 was associated with HC-5 (OR = 2.35, 95% CI = 1.07-5.13). EC-5 was associated with HC-3 (OR = 1.81, 95% CI = 1.09-2.99) and HC-4 (OR = 3.42, 95% CI = 1.24-9.39). Various combinations of product applications like using alcohols, bleach, high-level disinfectants, and enzymes to disinfect instruments and clean surfaces captured by the ECs were identified as risk factors for the different asthma symptoms clusters, indicating that prevention efforts may require targeting multiple products. The associations of HCs with EC can be used to better inform prevention strategies and treatment options to avoid disease progression. This study demonstrated hierarchical clustering and word clouds were useful techniques for analyzing and visualizing a complex dataset with a large number of potentially correlated variables to generate practical information that can inform prevention activities.

Background: Previous studies have suggested an association of asthma onset and exacerbation with cleaning and disinfecting activities in a number of industries, including healthcare. The objective of the current study was to investigate the association of asthma and related outcomes with occupations and tasks in urban healthcare workers in the United States. Methods: A questionnaire was implemented in a sample of workers from nine healthcare occupations in New York City. We used regression models to examine the association of post-hire asthma, current asthma, exacerbation of asthma, a symptom algorithm for bronchial hyper-responsiveness (BHR-related symptoms), a symptom-based asthma score, and the symptom wheeze with occupation and four healthcare tasks, while adjusting for other risk factors and potential confounders. Results: A total of 2030 participants completed the questionnaire. The task of cleaning fixed surfaces was significantly associated with most outcome variables, including current asthma (odds ratio (OR) = 1.84, 95% confidence interval (CI) 1.26-2.68), moderate exacerbation (OR = 3.10, 95% CI 1.25-7.67), and BHR-related symptoms (OR = 1.38, 95% CI 1.08-1.77). In comparison to nursing assistants, the occupations environmental service workers and registered nurses were at higher risk for current asthma, and licensed practical nurses were at higher risk for moderate exacerbation. Other tasks associated with outcomes were administering aerosolized medications with current asthma and moderate exacerbation, and sterilizing medical equipment with BHR-related symptoms. Conclusions: These findings add to the growing body of evidence for the association of asthma with cleaning and other activities in healthcare. Further research is especially needed to investigate the association of asthma-related outcomes with exposure metrics based on tasks, products, and chemical exposures in healthcare.

ObjectivesUse of cleaning and disinfecting products is associated with work-related asthma among healthcare workers, but the specific levels and factors that affect exposures remain unclear. The objective of this study was to evaluate the determinants of selected volatile organic compound (VOC) exposures in healthcare settings.MethodsPersonal and mobile-area air measurements (n = 143) from 100 healthcare workers at four hospitals were used to model the determinants of ethanol, acetone, 2-propanol, d-limonene, α-pinene, and chloroform exposures. Hierarchical cluster analysis was conducted to partition workers into groups with similar cleaning task/product-use profiles. Linear mixed-effect regression models using log-transformed VOC measurements were applied to evaluate the association of individual VOCs with clusters of task/product use, industrial hygienists' grouping (IH) of tasks, grouping of product application, chemical ingredients of the cleaning products used, amount of product use, and ventilation.ResultsCluster analysis identified eight task/product-use clusters that were distributed across multiple occupations and hospital units, with the exception of clusters consisting of housekeepers and floor strippers/waxers. Results of the mixed-effect models showed significant associations between selected VOC exposures and several clusters, combinations of IH-generated task groups and chemical ingredients, and product application groups. The patient/personal cleaning task using products containing chlorine was associated with elevated levels of personal chloroform and α-pinene exposures. Tasks associated with instrument sterilizing and disinfecting were significantly associated with personal d-limonene and 2-propanol exposures. Surface and floor cleaning and stripping tasks were predominated by housekeepers and floor strippers/waxers, and use of chlorine-, alcohol-, ethanolamine-, and quaternary ammonium compounds-based products was associated with exposures to chloroform, α-pinene, acetone, 2-propanol, or d-limonene.ConclusionsHealthcare workers are exposed to a variety of chemicals that vary with tasks and ingredients of products used during cleaning and disinfecting. The combination of product ingredients with cleaning and disinfecting tasks were associated with specific VOCs. Exposure modules for questionnaires used in epidemiologic studies might benefit from seeking information on products used within a task context.

Background: Prior studies have reported increased asthma risk in healthcare workers. The objective of this study was to evaluate the association of asthma-related outcomes with work tasks and occupations in a sample of urban healthcare workers in the United States. Methods: We invited workers from nine occupations–environmental service workers (ESWs, or housekeepers) and various nursing and technical occupations–to complete a questionnaire. The four work tasks evaluated were clean fixed surfaces (CLEAN), sterilize medical equipment (STERILIZE), administer aerosolized medications (AEROMED), and use chemicals on patients. The asthma outcomes included current asthma (CurAsthma), asthma exacerbation, and a symptom algorithm for bronchial hyper-responsiveness (BHR status). Regression models of outcomes had covariates for exposure and confounders, and weights to adjust for potential participation bias. Results: The 2,030 participants were 76% female, 62% African American, and a mean age of 48 years. The task CLEAN stood out because it had an elevated odds ratio (OR) for several outcomes, including CurAsthma, OR=1.84 (95% confidence interval (CI) 1.26-2.68), moderate exacerbation, OR=3.07 (95% CI 1.25-7.59), and BHR status, OR=1.38 (95% CI 1.08-1.77). The task AEROMED was associated with CurAsthma and moderate exacerbation, and STERILIZE with BHR status. Among occupations, ESWs and registered nurses were associated with CurAsthma, and licensed practical nurses with moderate exacerbation. Conclusion: This study adds to the growing body of evidence for the association of asthma and related symptoms with cleaning and other activities in healthcare, and helps to inform strategies for prevention.

Exposure to volatile organic compounds (VOCs) has been an indoor environmental quality (IEQ) concern in schools and other buildings for many years. Newer designs, construction practices and building materials for “green” buildings and the use of “environmentally friendly” products have the promise of lowering chemical exposure. This study examines VOCs and IEQ parameters in 144 classrooms in 37 conventional and high performance elementary schools in the U.S. with the objectives of providing a comprehensive analysis and updating the literature. Tested schools were built or renovated in the past 15 years, and included comparable numbers of conventional, Energy Star, and Leadership in Energy and Environmental Design (LEED)-certified buildings. Indoor and outdoor VOC samples were collected and analyzed by thermal desorption, gas chromatography and mass spectroscopy for 94 compounds. Aromatics, alkanes and terpenes were the major compound groups detected. Most VOCs had mean concentrations below 5 µg/m3, and most indoor/outdoor concentration ratios ranged from one to 10. For 16 VOCs, the within-school variance of concentrations exceeded that between schools and, overall, no major differences in VOC concentrations were found between conventional and high performance buildings. While VOC concentrations have declined from levels measured in earlier decades, opportunities remain to improve indoor air quality (IAQ) by limiting emissions from building-related sources and by increasing ventilation rates.

Low ventilation rates (VRs) in schools have been associated with absenteeism, poorer academic performance, and teacher dissatisfaction. We measured VRs in 37 recently constructed or renovated and mechanically ventilated U.S. schools, including LEED and EnergyStar-certified buildings, using CO2 and the steady-state, build-up, decay, and transient mass balance methods. The transient mass balance method better matched conditions (specifically, changes in occupancy) and minimized biases seen in the other methods. During the school day, air change rates (ACRs) averaged 2.0±1.3 hour-1 , and only 22% of classrooms met recommended minimum ventilation rates. HVAC systems were shut off at the school day close, and ACRs dropped to 0.21±0.19 hour-1 . VRs did not differ by building type, although cost-cutting and comfort measures resulted in low VRs and potentially impaired IAQ. VRs were lower in schools that used unit ventilators or radiant heating, in smaller schools and in larger classrooms. The steady-state, build-up, and decay methods had significant limitations and biases, showing the need to confirm that these methods are appropriate. Findings highlight the need to increase VRs and to ensure that energy saving and comfort measures do not compromise ventilation and IAQ.

The preferred sampling medium for measuring human exposures of persistent organic compounds (POPs) is blood, and relevant sample types include whole blood, plasma, and dried blood spots (DBS). Because information regarding the performance and comparability of measurements across these sample types is limited, it is difficult to compare across studies. This study evaluates the performance of POP measurements in plasma, whole blood and DBS, and presents the distribution coefficients needed to convert concentrations among the three sample types. Blood samples were collected from adult volunteers, along with demographic and smoking information, and analyzed by GC/MS for organochlorine pesticides (OCPs), chlorinated hydrocarbons (CHCs), polychlorinated biphenyls (PCBs), and brominated diphenyl ethers (PBDEs). Regression models were used to evaluate the relationships between the sample types and possible effects of personal covariates. Distribution coefficients also were calculated using physically-based models. Across all compounds, concentrations in plasma were consistently the highest; concentrations in whole blood and DBS samples were comparable. Distribution coefficients for plasma to whole blood concentrations ranged from 1.74 to 2.26 for pesticides/CHCs, averaged 1.69 ± 0.06 for the PCBs, and averaged 1.65 ± 0.03 for the PBDEs. Regression models closely fit most chemicals (R2 > 0.80), and whole blood and DBS samples generally showed very good agreement. Distribution coefficients estimated using biologically-based models were near one and did not explain the observed distribution. Among the study population, median concentrations of several pesticides/CHCs and PBDEs exceeded levels reported in the 2007-2008 National Health and Nutrition Examination Survey, while levels of other OCPs and PBDEs were comparable or lower. Race and smoking status appeared to slightly affect plasma/blood concentration ratios for several POPs. The experimentally-determined distribution coefficients can be used to compare POP exposures across studies using different types of blood-based matrices.