The Association of Cleaning Products and Practices with Asthma among Texas Healthcare Professionals

Jenil Patel, The University of Texas School of Public Health


Healthcare professionals (HCPs) are at risk for work-related asthma (WRA). The 2003 Texas Asthma Study (TAS) found higher odds of new-onset asthma (NOA) associated with medical instrument and building surface cleaning, and powdered latex glove use in 1992-2000. Subsequent changes in cleaning practices may have affected asthma risk. We assessed changes in WRA prevalence and its risk factors, and examined asthma burden in Texas HCPs. This was a statewide representative survey of 9,914 Texas physicians, nurses, respiratory therapists, occupational therapists, and certified nurse aides. Exposures to cleaning/disinfection products and tasks were measured using an updated asthma-specific job-exposure matrix (JEM). We examined two asthma outcomes: NOA, i.e. asthma with onset after entering healthcare, and bronchial hyperresponsiveness symptoms (BHR), using a validated 8-item predictor. We used logistic regression, taking into account survey weights, to estimate associations between exposures and outcomes. Asthma burden was measured by missed workdays and the Work Role Function Questionnaire (WRFQ), a surrogate for presenteeism (working while ill). Overall response rate was 34.8%; the final analytical sample was 2,427 participants. The weighted prevalence of NOA was 7.1%, highest among nurses; for BHR, it was 31.0%, highest for occupational therapists. NOA was associated with building surface cleaning (OR 2.03, 95%CI 1.26-3.28), orthophthalaldehyde (OR 1.93, 95%CI 1.29-2.88), bleach/quaternary ammonium compounds (OR 1.83, 95%CI 1.14-2.93) and sprays (OR 2.03, 95%CI 1.26-3.28), but not with other exposures. For BHR, there were no significant adverse associations. Mean missed work days due to health problems among asthmatics and non-asthmatics in past 12 months were 9.9 and 13.5, respectively (p>0.05); however, 76% of these missed work days among asthmatics were due to asthma or breathing problems. Mean WRFQ scores were significantly lower for asthmatics, indicating greater presenteeism. HCPs remain at risk for WRA, although there are encouraging trends. Compared to the TAS, NOA and BHR prevalence were unchanged; medical instrument cleaning/disinfection, powdered latex glove use and exposure to a workplace spill were no longer significant risk factors. Cleaning of building surfaces, orthophthalaldehyde, bleach, quaternary ammonium compounds, and using sprays to apply cleaners remain a problem. Exposure controls, together with optimum clinical management of asthma, would likely result in a decrease in asthma burden in healthcare occupations.

Subject Area

Occupational safety|Public health|Epidemiology

Recommended Citation

Patel, Jenil, "The Association of Cleaning Products and Practices with Asthma among Texas Healthcare Professionals" (2018). Texas Medical Center Dissertations (via ProQuest). AAI10930521.