Health Effects of Cleaning

Products

Dr. Susan Duty

Asst Professor

Simmons College, Nursing

Department

Objectives

• Identify occupational groups at risk

from exposure to cleaning products

• Identify 2 of the most frequent health

effects associated with cleaning
products

• Discuss strategies to reduce

exposure and minimize ill effects.

What is the problem?

• Many workers have job duties that include

the use of chemical cleaning materials

• Even more workers may be exposed as

by-standers

• Exposure may occur during prescribed

use or during a spill or other accident

• Illness can occur through the combination

of the Product selected and the Processes

used to apply the chemical

Cleaning
Product

• Carpet Cleaner

Floor wax

Stripper

• Disinfectant

• Toilet Cleaner

Glass Cleaner

• Janitor, Teacher,

Office Worker,

Health Care Worker,

Maid

• Nurse, Health Care

Workers and

Restaurant Workers

• Housekeeper, Hotel

Maintenance, Janitor

Type of
Worker

What Cleaners Have the Most

Risk?

Product Type

Hazardous Ingredients

How These Can Harm You

Oven Cleaner
Heavyduty degreaser

Glass Cleaner
General Purpose Cleaner
Carpet Spot Remover

Sodium Hydroxide

Oven cleaner in a spray can - very
convenient, but also very dangerous.
Sodium hydroxide can burn your eyes, and
the vapors can harm your lungs. Use it with
care - wear gloves & goggles, and provide
lots of fresh air.

Hydrochloric Acid
Phosphoric Acid

A solvent called "Butoxyethanol" Butoxyethanol absorbs through your skin

and can affect your blood, liver, & kidneys.
Wear gloves when you use cleaners with
this ingredient.

Toilet Cleaner

These acids are very good for removing
hard water rings, but they can burn your
eyes in seconds. Wear your gloves and
goggles, or better yet change to a milder
product (one with Citric Acid - strong lemon
juice).

Job Processes Associated with

Cleaning Chemicals

• Inadequate ventilation

– Reducing frequency and volume of air

exchanges or climate controls designed to

save energy can increase concentration of

chemicals in the indoor air

– Ventilation is often reduced at night to

save energy but night shift if often when

major cleaning processes take place to

minimize exposure to others

– With ‘tight’ building designs, windows and

doors don’t often open to allow fresh air

intake

Job Processes: Mixing

Chemicals

• Mixing Chemicals

– Many come in concentrated form and

have to be diluted

– Often times ill health is associated with

use of too concentrated product

– Incompatible chemicals combined

together can create a toxic gas (ie
bleach and quarternary ammonium can
create chloramine gas)

Job Processes: Application

• Use of spray bottles, aerosol cans, and

machines that may create a fine mist
(carpet washers, buffers etc) can increase
the amount of chemical suspended in the
air and cause breathing trouble

• Switch from aerosols and pumps to pour

and wipe applications

• Use enclosed systems to capture vapors

and dusts when using strippers, polishers
etc

Health Effects Associated with

Cleaning Products

• Work-Related Asthma [WRA])
• Contact Dermatitis
• Burns

– Skin
– Eyes

• Chemical pneumonitis
• Pulmonary edema

Work Related Asthma

New Onset

Work-Related

Asthma (NOA)

Work-Aggravated Asthma

(WAA)

Occupational

Asthma

Reactive Airways

Dysfunction Syndrome

(RADS)

With Latency

(Sensitizer)

Without Latency

(Irritant)

Workplace exposure to known asthma inducer?

Objective evidence of asthma present?

Am J Respir Crit Care Med vol
167 pp 787-797, 2003

Asthma

• Chronic inflammatory disorder of the

airways that results in

– Wheezing
– Coughing
– Chest tightness
– Dyspnea (trouble breathing)

• Inflammation makes the airways

sensitive to allergens, chemical

irritants, tobacco smoke, cold air and

exercise

Sensitizer-induced OA / WRA

(immunologically mediated)

• High molecular weight agents:

– Animal material: dander, excreta etc
– Plant material: flour, grain, wood dust etc

• Low molecular weight agents:

– Spray paints (toluene diisocyanate)
– Western red cedar wood dust
– Biocides:glutaraldehyde, chloramine T

• Irritants:

– chlorine, isocyanates, acetic acid

Sensitizer induced OA / WRA

• Prevalence:

– 2% among latex-exposed workers
– 50% among detergent enzyme workers
– Higher among people with atopy

(history of multiple allergies and
eczema)

– Higher with interaction between

smoking and atopy

Sensitizer Induced Asthma

Clinical presentation

• One or more symptoms of episodic cough,

wheeze, retrosternal chest tightness and

dyspnea

• Which began during work life

• Increased suspicion if symptoms are worse

at work and improve on weekends or

holidays

• Allergic rhinitis (runny nose) often predate

OA

• Need to address this early in disease

because once sensitized, the asthmatic

now reacts to all kinds of irritants and

other stimuli which can cloud the diagnosis

Case study: NOA with

Sensitization

• A 55 year old female worked as a housekeep in a

hospital for eight years. She had a 2 year history of

wheezing, cough, shortness of breath and chest

tightness that were worse at work. She particularly

noted symptoms when she used a floor cleaner that

contained quaternary ammonium salts, ethyl

alcohol, and sodium hydroxide.

• She had no history of asthma, bronchitis or allergic

rhinitis prior to the onset of symptoms at work and

had never smoked cigarettes. She quit her job

because of her illness. After six weeks away from

work her symptoms had markedly decreased.

Irritant-induced OA (RADS)

(without sensitization)

• Onset usually within 24 hours following exposure

to high level respiratory irritant (often go to ER)

• Symptoms persist more than 12 weeks
• Objective evidence of asthma
• No previously documented history of asthma or

other chronic lung disease

• Findings suggest RADS accounts for a minority of

OA cases (~10%)

• But of the RADS cases, cleaning products (23%)

and unspecified chemicals (16%) were most

frequently reported

Case Study Example: RADS

• 41 year old plumber who worked for 6 years

installing HVAC equipment. He frequently worked

with insulation in dusty areas. One day, while

spraying conductor coils with sodium hydroxide,

the wind shifted and he inhaled a large,

concentrated amount of the sodium hydroxide.

Within 24 hours he experienced wheezing,

coughing, chest tightness and shortness of breath.

He was treated in the ER and required inhalers and

steroids. He had no previous history of asthma and

had quit smoking 7 years before this accident. One

year later he still had symptoms which were

worsened by dust and other household chemicals.

He has been unable to return to work.

SENSOR Occupational Lung Disease Bulletin; November 2000

Work-aggravated Asthma

• Must have a history of asthma which worsens at

work AND improves when away from work AND is

exposed to potential respiratory irritants at work

• Even low levels of respiratory irritants can

aggravate pre-existing asthma

– ETS, cleaning agents, paints, fumes, dust

• Baseline control of asthma influences

susceptibility to WRA

• Relevant allergen exposure can increase airway

responsiveness for weeks so a non-work-related

cat exposure can leave the asthmatic more

susceptible to work-related irritants for several

weeks

Case Study:

Work Aggravated Asthma

• A 38 year old woman who worked as a lab

technician in a hospital developed wheezing,

cough, chest tightness and shortness of

breath within 10 minutes of exposure to a

floor cleaner which was applied to an

adjacent work area. She was seen in the

emergency room and admitted to the ICU

after this incident.

• The woman had a history of asthma and

allergies but reports that her symptoms have

become more severe since this incident

despite the fact that she is no longer

exposed to the floor cleaner

Surveillance of OA / WRA

• 4 states conduct surveillance

– California
– New Jersey
– Michigan
– Massachusetts

• From 1993-1997

– 1915 WRA cases were reported

• 22% of new onset WRA were RADS

– 235 (12%) were associated with cleaning

products

– Most frequent occupations were janitors/cleaners

and nurses/nurses aids

Massachusetts SENSOR

Data

• From 1993-2002, 873 cases were reported

• 55% (481) completed interviews

• 451 met OA criteria

– Most female (63%) and white (86%)

– 90% were new onset asthma (405)

• 10% of these (43) were RADS

– 10% (46) were work aggravated asthma

– 2.3% (10) were cleaning occupations while 39%

where teaches, nurses and office workers

– Specific agents identified as inducing asthma

included indoor air pollutants (21%), cleaning

products (17%), mold (12%) and dust (10%)

Public Health Consequences

• If someone is diagnosed with sensitizer

induced asthma, HCP should treat this as a

‘sentinel event’ and initiate investigation

for others in the workplace similarly

affected

• In MA report to ‘SENSOR’

–

http://www.mass.gov/dph/bhsre/ohsp/sensor/ast

bull_jan05.pdf

– 617-624-5632

• Most sensitizer-induced asthmatics fail to

recover even after removal from exposure

– Most often a result of delayed diagnosis with

longer duration of exposure

Advice to Prevent Breathing

Problems

• Read the MSDS (material safety data

sheet) for all the chemicals you work

with

• Read warning labels and follow

instructions

• Leave windows and doors open or use

fans to increase air exchange rate

• Keep cleaners in the original containers
• Take special precautions if working in

small rooms or confined spaces

Prevention of OA

• Primary

– Control exposure

• Substitution
• Ventilation
• Change process

– Education regarding hazards

• Use according to directions (ie don’t use full strength

if directions tell you to dilute first)

• Do not mix different products together (especially

bleach and ammonia or bleach and acids because the
combination can create poisonous fumes)

Recognize Warning Signs !

• Wheezing
• Chest tightness
• Cough
• Shortness of Breath

Other Health Effects of

Exposure to Cleaning

Chemicals

Eye and Skin Burns

• Disinfectants:

– Quaternary ammonium chlorides

– Alcohols

– Hydrogen peroxide

– Phenols

– Bleach (sodium hypochlorite)

– Iodine

• Metal and Glass Cleaners

– 2-Butoxyethanol

• Dry Cleaning Fluid

– Tetrachloroethlene; Perchloroethylene; "Perc";

• Floor cleaners strippers and Degreasers

– Ethanolamine

Contact Dermatitis

• Soaps/detergents, cleaning agents, and

solvents, are among the most frequent

causes of irritant contact

– Most detergents are alkaline, but even at neutral

pH (7); they de-fat the skin and interfere with

hydration causing cracks, fissures open lesions

– Many can cause sensitization (allergic contact

dermatitis)

• Primary Irritants
• Absolute Irritants
• Marginal Irritants

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Alkali Exposure (Sodium or
Potassium Hydroxide)

Advice to Prevent Skin

Problems

• Wear gloves and make sure they are

the appropriate glove for that
chemical

– Check the MSDS for recommended gloves

• If chemical gets on your skin rinse

thoroughly under running water for 15
minutes to minimize burn

• Seek medical attention

Eye Injuries: Alkali Burns

• Alkalis are chemicals that have a high pH.

• Alkali burns are the most dangerous type of

chemical burn. Alkalis penetrate the surface

of the eye and can cause severe injury.

• Common alkali substances contain the

hydroxides of ammonia, potassium, sodium,

calcium, and magnesium.

• Substances that contain alkali substances

include lye, drain cleaner, metal polishes,

oven cleaners, cement, lime, and ammonia.

Eye Injuries: Acid Burn

• Acid burns are caused by chemicals with a

low pH

• Acid burns tend to be less severe than alkali

burns.

• Acids usually damage the very front of the

eye.

• Common acids causing eye burns include

sulfuric acid, sulfurous acid, hydrochloric
acid, nitric acid, acetic acid, chromic acid,
muriatic acid, and hydrofluoric acid.

Symptoms of Eye Burns

• Eye pain
• Burning
• Tearing

www.eyecasualty.co.uk
/ maincontent1/burn.htm

Advice to Prevent Permanent

Eye Injury

• Wear Goggles
• Adhere to safe

working guidelines

• Flush IMMEDIATELY

with full-flow eye
wash station for 15
minutes