When I was young (high school, college) I had a variety of jobs, including golf caddy (cured me of golf for the rest of my life; there were no carts, just an 11 year old lugging two bags with 16 clubs over 18 holes) and paper boy (4 am on Sundays hauling 80 huge Sunday papers in a wagon; took about 2 hours. Weekdays were smaller papers but the same wagon, and after school. I know, I know. Soon you’ll expect me to talk about how I had to walk 5 miles to school, barefoot in the winter, but it wouldn’t be true. It was only 4 miles). Then I started working in hospitals and basically I’ve been working in hospitals or medical centers ever since. My first job was as a summer job as a “houseman.” About all I did was sweep stairwells and corridors and wipe handrails with disinfectant. All day, from morning until the end of the workday (shift change was about 3 pm). It was a lousy job and I was glad to switch over to transport of patients to and from the x-ray department, a summer job I did until almost entering medical school. Much more interesting. I read the charts, chatted with the patients and watched them read x-rays. But I thought about the houseman job yesterday when reading CDC’s Morbidity and Mortality Weekly Reports (MMWR), where there was a report, “Acute Antimicrobial Pesticide-Related Illnesses Among Workers in Health-Care Facilities — California, Louisiana, Michigan, and Texas, 2002–2007.” I found the use of the term “pesticide” here somewhat unusual, since the “pests” aren’t insects or rodents but bacteria and viruses and the worker exposure was in doing just the kind of job (and some others) I did as a houseman:
Antimicrobial pesticides (e.g., sterilizers, disinfectants, and sanitizers) are chemicals used to destroy or suppress the growth of harmful microorganisms on inanimate objects and surfaces. Health-care facilities use antimicrobial pesticides to prevent pathogen transmission from contaminated environmental surfaces. Occupational exposures to antimicrobial pesticides are known to cause adverse health effects. (CDC, MMWR [cites omitted])
This is apparently the first ever attempt to count injury from using these santizers. They are mainly quarternary ammonium compounds (QACS), glutaraldehyde and bleach solutions. QACs are used to wipe down surfaces and it’s likely that’s what I used mainly as a houseman in the hospital. They are also used for things like blood pressure cuffs that come in contact with a patient’s skin. Glutaraldehyde is used by immersing heat sensitive medical instruments in it, things like cystoscopes. Bleach is used to decontaminate blood spills and for environmental sanitation. Wiping everything with bleach solution is likely what was done in many schools closed in the early days of the flu pandemic. It wouldn’t have done much good but it’s reassuring to parents. Any of these chemicals can cause irritation and if splashed in the eye can cause ocular injury. CDC estimates there are about 5000 different products on the market and over half are marketed specifically to health care institutions. They come in all forms: formulated into sprays, liquids, concentrated powders, and gases and we know very little about occupational hazards entailed by their use. Only the four states in the title of the report require reporting of adverse events from these products by health care institutions and even these reports are almost certainly produce underestimates. In the five year period 2002 – 2007 there were only 401 acute events related to work in health care facilities and involved the demographic of the user workforce: mainly female (82%) and in the 25 – 54 age range (73%). Note that when I worked as a houseman I wasn’t in either demographic group. Job titles were mostly janitor/housekeepers, nursing/medical assistants and technicians. Almost all (85%) were low severity, most commonly eye irritation or conjunctivitis, then headache or dizziness and respiratory symptoms. It was in these latter cases that the serious effects occurred, one of them fatal:
The fatal case occurred in a woman aged 52 years employed as a laundry worker at a Michigan nursing home who had a 2-year history of non–steroid-dependent asthma and chronic bronchitis. She smoked two packs of cigarettes and some marijuana daily. In February 2007, she was exposed to nondiluted bleach fumes from an open pail near a running clothes dryer for 10–15 minutes. She complained of shortness of breath, used her albuterol inhaler, but collapsed. 9-1-1 was called, and cardiopulmonary resuscitation and intubation were performed at the scene. She never regained consciousness and died 5 days later in the hospital.
The most obvious intervention would be use of eye protection whenever splashing is possible or there is spraying. Probably not going to happen. This is a low paid workforce, although many are now unionized, which might help. The data we have here is fragmentary and incomplete. It shows that these agents, familiar as they are to those of us who spend a lot of time in hospitals, are not benign. Like many things they can cause harm. While this is true of many things, these are agents whose use is to kill living cells, unwanted bacteria. But they are very non-specific so it isn’t too surprising that human cells that get in the way might also be harmed.
It’s a commonplace that hospitals are dangerous places for patients. They are also dangerous places for workers. We are familiar with the pathogen problem and the ergonomics issues of raising and lifting. Now we can add disinfectants to the list. They aren’t at the top, that’s for sure.
But they are there.