Cleaning and disinfection of environmental surfaces and patient care items serve as foundational elements of infection prevention, but they may also compromise the health of workers frequently exposed to these often harsh disinfectants and cleaning agents. In June, members of the Cleaning and Disinfecting in Healthcare Working Group of the National Institute for Occupational Safety and Health National Occupational Research Agenda recommended that infection prevention and occupational health groups work together to integrate efforts to prevent healthcare-associated infections (HAIs) and protect healthcare workers.1
To kick off joint research efforts, the Working Group, which included more than 40 infection prevention and occupational health professionals from four countries, published a summary document in the American Journal of Infection Control that outlined the advantages and disadvantages of cleaning and disinfection for the prevention and control of healthcare-associated infections and identified gaps in knowledge. The document also presented information on the growing evidence that cleaning and disinfecting can cause both acute and chronic health problems, especially respiratory issues, in healthcare workers.
Balancing the need for infection prevention with protecting healthcare workers has proven quite challenging. From 2002-2007, more than 400 healthcare workers in four states reported an illness or injury related to exposure to a disinfectant. Environmental services workers accounted for nearly a quarter of these cases, followed by nursing and medical assistants (16%), technicians (15%), and nurses (11%).
Overall, U.S. healthcare workers account for one out of seven cases of work-related asthma, according to the Working Group. These workers are exposed to a variety of volatile organic compounds known to cause or exacerbate asthma such as chlorine, ammonia, ethanolamine, quaternary ammonium compounds, and 2 butoxyethanol. These substances may be dispensed as aerosols or liquids in a wide range of built environments and ventilation conditions.
To minimize the threat of side effects, hospitals that have adopted “green,” more environmentally-friendly cleaners and disinfectants have been constrained by a lack of a clear definition for this classification. Little systematic research has been completed, and a lack of oversight by the Food and Drug Administration for many green alternatives (copper surfaces, steam cleaning, ultraviolet light) can hamper adoption in facilities that require use of FDA-approved methods.
The Working Group identified two substantial gaps in knowledge:
A need for better understanding of the effectiveness of products and procedures used in cleaning and disinfecting to reduce the incidence of infectious diseases and colonization in both patients and healthcare workers.
A need for greater understanding of the impact of cleaning and disinfecting products and procedures on the health of healthcare workers and patients, with particular attention to their respiratory health effects.
Specifically, the Working Group noted that relatively little research has been conducted in actual healthcare settings on the extent to which contact with contaminated surfaces contributes to HAIs or occupational acquired infections in healthcare workers.
In addition, hospitals have little guidance on the best chemicals to use on specific equipment or surfaces or the appropriate use and effectiveness of newer chemical disinfectants or non-chemical disinfection methods. Hospitals also lack research on the hazards of cleaning and disinfecting agents and procedures, duration of exposure risk and safe exposure levels.
The authors called on infection prevention and occupational health professionals to improve communication regarding cleaning and disinfecting, including training in appropriate use of agents for various environments and surfaces, proper labeling of products and comprehensive safety sheets that include respiratory and dermatological risk assessments, creation of a forum for clinicians to share resources and information on integrating infection and occupational illness prevention, and methods that raise awareness of the potential health effects of cleaning and disinfecting.
How has your hospital integrated infection prevention and occupational health?
Quinn MM, Henneberger PK, Braun B, Delclos GL, Fagan K, Huang V, Knaack JLS, Kusek L, Lee SJ, Le Moual N, Maher KAE, McCrone SH, Mitchell AH, Pechter E, Rosenman K, Sehulster L, Stephens AC, Wilburn S, Zock JP. Cleaning and disinfecting environmental surfaces in health care: Toward an integrated framework for infection and occupational illness prevention. Am J. Infect Control, 2015. (43)424-434.