Workers Health & Safety Centre

Cleaning products damaging worker respiratory health, study confirms

The pandemic has seen calls for enhanced cleaning and disinfecting of surfaces, but now researchers are calling for enhanced protections for workers administering these products.
 
Now too, researchers and some public health authorities are even questioning overly zealous cleaning and disinfecting, or what one journalist has called “hygiene theatre.”

Asthma and COPD common

“In the last decade, consistent and growing evidence of an epidemic of ‘asthma-like’ respiratory symptoms among occupational cleaners has been reported worldwide,” wrote the authors of a systematic review, published in the journal Occupational and Environmental Medicine in November 2020.
 
The review of a broad collection of research evidence found workers using cleaning and disinfecting products face an estimated 50 per cent increased risk of suffering asthma. The findings, however, suggest much broader respiratory health impacts, including an estimated 43 per cent excess risk for chronic obstructive pulmonary disease (COPD). COPD is a group of lung diseases including chronic bronchitis and emphysema that together are the fifth leading cause of death in Canada between 2016 and 2019.  
 
Also of note, the researchers found:
  • cleaning products that are sprayed are found to be more strongly associated with asthma or worsening symptoms compared with liquid and powder products,
  • chronic exposure to relatively moderate doses of airborne irritant chemicals could cause inflammation and subsequent restriction of air passing into and out of the lungs
  • ongoing exposure can cause reversible airway obstruction to become irreversible
  • chlorine-based cleaning products (i.e., bleach), ammonia, quaternary ammonium compounds (quats) disinfectants and sterilizing agents including glutaraldehyde and ethanolamide were examples of agents linked to excess risk (ammonia and bleach showed the highest association with asthma risk).

Cleaning products, disinfectants and sterilizing agents often contain harmful chemical ingredients (including those mentioned above). Some are more toxic than others. In addition to respiratory health impacts discussed here, research evidence also links these exposures to skin irritation and disease, possible reproductive harm and even cancer.

Spread of COVID by surfaces not common

Of course, exposure to harmful ingredients is particularly relevant as some public health authorities continue to promote enhanced cleaning and disinfecting as a key measure to limit the spread of the COVID-19 virus at work and in the community.
 
This advice however is changing. The U.S. CDC for instance, have altered their advice stating transmission through contaminated surfaces is “not thought to be a common way that COVID-19 spreads.”
 
As early as last July, the Lancet published an article concluding claims for COVID transmission by contaminated surfaces were exaggerated and “assumed on the basis of studies that have little resemblance to real-life scenarios.” The equally respected scientific journal, Nature, published an article this past January which came to similar conclusions.
 
This isn’t to say cleaning and disinfecting surfaces is no longer important, it just means in terms of priorities this route of transmission falls behind others. Many experts have pointed to airborne transmission as a primary route of COVID transmission and one in need of urgent precautionary action.

Safer substitution key

In light of growing evidence about the hazards of cleaning and disinfecting products and their use, a review of current practices and products also needs urgent action. Occupational health and safety law recognizes the precautionary principle in employer general duty provisions to take every reasonable precaution for the protection of workers. All serious health and safety practitioners also subscribe to the hierarchy of controls, including Ontario’s Ministry of Labour, where substitution of a hazard should be considered first.
 
Fortunately, there are many sources available to help with this critical task. For instance, the University of Washington’s Department of Environmental & Occupational Health Sciences recommends looking for disinfectants approved for use by the U.S. EPA with active ingredients such as ethanol, isopropanol, hydrogen peroxide, lactic acid, or citric acid. San Francisco Environment Department also offers an up-to-date list of safer disinfectants that are approved for use on COVID-19 by the U.S. EPA.
 
The globally-recognized University of Massachusetts Lowell’s Toxics Use Reduction Institute (TURI) has also done important work too developing a list of EPA-approved disinfecting products with safer active ingredients. According to TURI, “Many of the disinfecting product choices available on the market use chemicals such as bleach, phenols or quaternary ammonium compounds, often referred to as quats that can adversely impact human and environmental health.”
 
Further still, many products recommended by TURI and others as safer, are at least as effective as the harmful ones in eliminating the COVID virus from surfaces. In many cases, like hydrogen peroxide, they are much more effective. Hydrogen peroxide-based products often deactivate the virus within a minute, whereas quats-based products take upwards of 10 minutes.

Safer food prep sanitizers

For those involved in food preparation, safer alternatives are also contemplated when considering required disinfectants to meet Ontario’s Regulation 493, a regulation for food premises under the Health Promotion and Protection Act. Amended in 2018, the regulation now includes “other sanitizing agents” beyond the more toxic options of products containing iodine or quats. Ontario’s Ministry of Health and Long-term Care explains this regulation “has been modernized to allow for the use of alternative sanitizers.”
 
In doing so, the province caught up to U.S. food safety laws and a position taken by the Toxics Use Reduction Institute in 2013. They wrote, “Many kitchens use bleach to sanitize food contact surfaces, but chlorine is one of the worst offenders in terms of health impact. Food safety codes require that food contact surfaces be sanitized after cleaning but do NOT specifically require the use of chlorine or quaternary ammonium (Quats). Hydrogen peroxide solutions and other greener alternatives CAN provide a safe, code-compliant level of sanitization when used in the proper dilutions and with proper dwell times (Capitols for emphasis are those of TURI.).”

Worker participation and training

In addition to employer duties, joint health and safety committees (JHSCs) and worker health and safety representatives in smaller workplaces also have a legal right to participate in the development of COVID-19 precautions like cleaning and disinfecting and their evaluation through workplace inspections. To ensure JHSCs can effectively carry out their powers, employers must also provide JHSCs in Ontario-regulated and federal-regulated workplaces with training.
 
Employers must also ensure workers exposed to or who may be exposed to a hazardous product, participate in general and workplace-specific GHS WHMIS training. This training must result in the workers being able to use WHMIS information to protect their health and safety.
 
WHSC remains a leading provider of such training including COVID-19GHS WHMISChemical HazardsJHSC Certificationhealth and safety representatives in small workplacesfederal committees and prevention programs and supervisors. Many of these programs are currently offered through our virtual classroom, allowing for the safety of participants and instructors during this COVID-19 crisis.
 
Don’t see what you need? Beyond scheduled classes, and where participant numbers warrant, we can work with you to coordinate almost any of our training courses in a virtual classroom for all workers, workplace representatives and supervisors.
 
To learn more:
Contact a WHSC training services representative near you.
Email: contactus@whsc.on.ca
Call: 1-888-869-7950
Visit: www.whsc.on.ca
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Related WHSC resources
Lung disease in nurses linked to disinfectant use at work
Cleaners and janitors: Confronting COVID-19
All COVID resources