Whether we’re talking politics, religious beliefs, vaccination, science or the use of disinfectants as part of an infection prevention program, there will always be differing opinions and there will always be that polarizing personality that you either love or hate. As a wise woman (or man) once said “there are two sides to every story and the truth lies somewhere in the middle”.
A great example of this is the use of disinfectants and their role in occupational or worked-related asthma. According to sources I have read, more than 300 workplace substances have been identified as possible causes of occupational asthma. These substances can be broken down into the following categories: animal substances, chemicals, enzymes, metals, plant substances and respiratory irritants. If you’re luckier than me, I hope you’ve never experienced an asthma attack. If you’re not familiar with asthma, symptoms start when your lungs become irritated which leads to inflammation. This inflammation causes a restriction of the airways which makes breathing difficult. With occupational asthma, lung inflammation may be triggered by either an allergic response to a substance or irritation of the lungs caused by an inhalation of a substance, such as chlorine.
Enter the differing opinions. A study published in May 2016 in AJIC titled “Occupational healthrisks associated with the use of germicides in health care” concluded that the data reviewed in the study demonstrate that occupational asthma as a result of chemical exposures, including low-level disinfectants, are exceedingly rare. However, unprotected exposures to high-level disinfectants may cause respiratory symptoms.
On the other side of the story, a study by Rosenman et al. reported that a cleaning product was at least 1 of the 3 suspected agents identified in 12% of confirmed work related asthma cases that they reviewed. The fact that bleach was the most frequently identified product should not be all that surprising considering that bleach was recently designated an asthma-causing agent by the Association of Occupational and Environmental Clinics (Sastre 2011). Furthermore, Quaternary ammonium compounds (Quats or QACs) also tend to be frequently identified as potential asthma causing agents due to their prevalence in numerous cleaning and disinfectant products. Michigan’s SENSOR program published a detailed report on the link between asthma and Quats in their 2008-2009 newsletter. The newsletter includes several case reports and a review of several peer reviewed studies completed on the subject.
This leads me to try to figure out what the “truth” is. I think there is enough evidence to support the fact that the use of some chemicals (including some disinfectants) can lead to occupational asthma particularly with our increased reliance on disinfectants as part of our infection prevention program. However, I also believe that we cannot with broad strokes state that all disinfectants will cause occupational asthma. I think there are products available on the market that meet the criteria of non-asthma inducing agents that can be used safety and effectively.
As a person with asthma, I know I can state categorically that some disinfectant actives irritate my airways more than others. I can also state without a doubt that the method of application can also dramatically increase or decrease the level of irritation. Perhaps the next investigation should be to look at the method of application – spray and wipe versus wiping with a cloth or pre-moistened wipe to see which method reduces the likelihood of inducing respiratory irritation. Not to say I already know the answer, but I do know which method bugs me the least! Wiping! I also happen to believe that wiping is the best method of application for disinfectants to ensure even distribution of the disinfectant solution and physical friction to help lift and remove soils and bugs from the surface you are wiping. But, I’ll let you decide for yourself!