Are Healthcare Workers at an Increased Risk for Obstructive Respiratory Diseases Due to Cleaning and Disinfection Agents? A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
Aims and Objectives
2. Methods
2.1. Protocol and Registration
2.2. Eligibility Criteria
2.3. Information Sources and Search
2.4. Study Selection and Data Collection
- study design
- study region
- study population size
- population sampling information (time and type of recruitment, response, and follow-up)
- exposure and exposure assessment
- population characteristics of the exposure and comparison group (sex, age, duration of employment)
- outcome and outcome assessment
- prevalence or incidence of outcome
- relevant study results, including adjustment for confounders
2.5. Risk of Bias Assessment
2.5.1. Recruitment Procedure and Follow-Up
2.5.2. Exposure Definition and Measurement
2.5.3. Outcome Source and Validation
2.5.4. Confounding
2.5.5. Analysis Methods
2.5.6. Chronology
2.5.7. Blinding of Assessors
2.5.8. Funding
2.5.9. Conflicts of Interest
2.5.10. Overall Assessment of Risk of Bias
2.6. Statistical Analysis
2.7. Quality of Evidence Assessment
- study limitations (risk of bias)
- indirectness
- imprecision (range of the confidence intervals of studies greater than 2.0 relative risk)
- publication bias
- if the study findings had a large effect size (Relative Risk > 2.0)
- if a positive dose-response relationship was found
- if there is presence of residual confounding
3. Results
3.1. Study Selection
3.2. Asthma
3.2.1. Risk of Bias
3.2.2. Synthesis of Results
3.3. Bronchial Hyperresponsiveness (BHR)-Related Symptoms
3.3.1. Risk of Bias
3.3.2. Synthesis of Results
3.4. Work-Related and Respiratory Symptoms
3.5. Chronic Obstructive Pulmonary Disease (COPD)
3.6. Quality of Evidence Assessment
4. Discussion
4.1. Strengths and Limitations
4.2. Agreement with Other Studies and Reviews
4.3. Implications for Practice
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Category | Inclusion | Exclusion |
---|---|---|
Population (P) | Employable population of both sexes, between 16 and 70 years old | Non-employable population (for instance, with disabilities or illnesses that render them not being able to work, adolescents and children (under 16 years of age), and elderly people (over 70 years of age) |
Exposure (E) | Type A: Employment as a nurse or in rescue service with an occupational exposure to cleaning or disinfection agents Type B: Exposure to cleaning or disinfection agents, in which nurses or rescue workers were an important part of the exposed population | Type A: Employment in settings with no occupational exposure to cleaning or disinfection agents Type B: Exposure to agents other than cleaning or disinfection |
Control/Comparator (C) | Type A: Population employed in other occupational groups where an average risk can be presumed (external comparison group) Type B: Working population not exposed to cleaning or disinfection agents (internal or external comparison group) | Type A and B: Groups with an elevated risk for respiratory diseases, due to exposure to inorganic/organic dusts, chemical irritants, and allergenic substances |
Outcome (O) | Obstructive diseases such as COPD and asthma: medical diagnosis such as in doctors’ records, hospital records, health insurance records; self-report Lung function abnormalities: changes in the objective markers FEV1, PEF, VC, and other outcomes of pulmonary function tests (spirometry, body plethysmography) | Rhinitis, skin allergies, and other non-respiratory, non-obstructive diseases |
Study design (S) | Cohort, case-control, cross-sectional | Qualitative studies, studies with only abstracts, conference papers/posters, reviews, letters, editorials; studies using a convenience sample, not reporting response, or with a response less than 10% |
Study ID | Major Domains | Minor Domains | Overall | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Recruitment Procedure and Follow-Up | Exposure Definition and Measurement | Outcome Source and Validation | Confounding | Analysis Method | Chronology | Assessor Blinding | Funding | Conflict of Interest | ||
Type A (Risk in nurses exposed to cleaning/disinfection agents) | ||||||||||
Arif et al. 2009 * [36] | | | | | | | | | | |
Delclos et al. 2007 * [38] | | | | | | | | | | |
Delclos et al. 2009 * [37] | | | | | | | | | | |
Arif and Delclos 2012 * [35] | | | | | | | | | | |
Gonzalez et al. 2014 [39] | | | | | | | | | | |
Mirabelli et al. 2007 [40] | | | | | | | | | | |
Type B (Risk of exposure to cleaning and disinfectants in nurses) | ||||||||||
Arif et al. 2009 * [36] | | | | | | | | | | |
Delclos et al. 2007 * [38] | | | | | | | | | | |
Delclos et al. 2009 * [37] | | | | | | | | | | |
Arif and Delclos 2012 * [35] | | | | | | | | | | |
Gonzalez et al. 2014 [39] | | | | | | | | | | |
Mirabelli et al. 2007 [40] | | | | | | | | | | |
Caridi et al. 2019 [41] | | | | | | | | | | |
Dimich-Ward et al. 2004 [42] | | | | | | | | | | |
Ellett et al. 1996 [43] | | | | | | | | | | |
Dumas et al. 2021 [46] | | | | | | | | | | |
Patel et al. 2020 [48] | | | | | | | | | | |
Dumas et al. 2020 † [45] | | | | | | | | | | |
Study ID | Major Domains | Minor Domains | Overall | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Recruitment Procedure and Follow-Up | Exposure Definition and Measurement | Outcome Source and Validation | Confounding | Analysis Method | Chronology | Assessor Blinding | Funding | Conflict of Interest | ||
Type A (Risk in nurses exposed to cleaning/disinfection agents) | ||||||||||
Arif et al. 2009 * [36] | | | | | | | | | | |
Delclos et al. 2007 * [38] | | | | | | | | | | |
Type B (Risk of exposure to cleaning and disinfectants in nurses) | ||||||||||
Arif et al. 2009 * [36] | | | | | | | | | | |
Delclos et al. 2007 * [38] | | | | | | | | | | |
Caridi et al. 2019 [41] | | | | | | | | | | |
Patel et al. 2020 [48] | | | | | | | | | | |
Risk | Quality of Study Limitations: ↓ | Indirectness of Evidence: ↓ | Inconsistency: ↓ | Imprecision, Range Confidence Interval Effect Size > 2.0: ↓ | Publication Bias, Yes or Unclear: ↓ | Effect Estimate >2.0: ↑ >5.0: ↑↑ | Dose–Response Effect: ↑ | Residual Confounding: ↑ | Overall Certainty (High, Moderate, Low) |
---|---|---|---|---|---|---|---|---|---|
New-onset asthma in nurses | yes ↓ 1 | no (-) | no (-) | no (-) | unclear ↓ | no (-) | no (-) | yes ↑ 2 | low |
New-onset asthma by cleaning/disinfecting surfaces in nurses | yes ↓ 1 | yes ↓ 3 | no (-) | no (-) | unclear ↓ | no (-) | no (-) | no (-) | low |
New-onset asthma by instrument cleaning/disinfecting/sterilization | yes ↓ 1 | yes ↓ 4 | no (-) | no (-) | unclear ↓ | no (-) | no (-) | no (-) | low |
New-onset asthma by exposure to bleach | yes ↓ 1 | yes ↓ 5 | no (-) | yes (-)↓ 6 | unclear ↓ | yes ↑ 7 | no (-) | no (-) | low |
New-onset asthma by exposure to glutaraldehyde | yes ↓ 1 | no (-) | no (-) | no (-) | unclear ↓ | no (-) | no (-) | no (-) | low |
Bronchial hyperresponsiveness (BHR)-related symptoms by cleaning surfaces | yes ↓ 1 | yes ↓ 8 | no (-) | no (-) | unclear ↓ | no (-) | no (-) | no (-) | low |
BHR-related symptoms by instrument cleaning/disinfecting/sterilization | yes ↓ 1 | yes ↓ 8 | no (-) | no (-) | unclear ↓ | no (-) | no (-) | no (-) | low |
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Romero Starke, K.; Friedrich, S.; Schubert, M.; Kämpf, D.; Girbig, M.; Pretzsch, A.; Nienhaus, A.; Seidler, A. Are Healthcare Workers at an Increased Risk for Obstructive Respiratory Diseases Due to Cleaning and Disinfection Agents? A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2021, 18, 5159. https://doi.org/10.3390/ijerph18105159
Romero Starke K, Friedrich S, Schubert M, Kämpf D, Girbig M, Pretzsch A, Nienhaus A, Seidler A. Are Healthcare Workers at an Increased Risk for Obstructive Respiratory Diseases Due to Cleaning and Disinfection Agents? A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2021; 18(10):5159. https://doi.org/10.3390/ijerph18105159
Chicago/Turabian StyleRomero Starke, Karla, Sophie Friedrich, Melanie Schubert, Daniel Kämpf, Maria Girbig, Anna Pretzsch, Albert Nienhaus, and Andreas Seidler. 2021. "Are Healthcare Workers at an Increased Risk for Obstructive Respiratory Diseases Due to Cleaning and Disinfection Agents? A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 18, no. 10: 5159. https://doi.org/10.3390/ijerph18105159