NIOSH Evaluates Hospital Workers’ Exposure to New Disinfection Product

Published May 4, 2016

​A summary of a recent NIOSH health hazard evaluation of a Pennsylvania hospital focuses on respiratory symptoms and skin irritation reported by workers using a new surface-cleaning disinfection product. The summary, which was recently published in CDC’s Morbidity and Mortality Weekly Report (MMWR), describes the cleaning product as an EPA-registered non-bleach sporicide that is advertised as a one-step cleaner, virucide, and deodorizer. The product consists of hydrogen peroxide, peroxyacetic acid, and acetic acid, and, according to the manufacturer’s safety data sheet, it requires no personal protective equipment when diluted with water by an automated dispenser before use. The confidential employee request for NIOSH to conduct a health hazard evaluation contained reports of symptoms among hospital environmental services staff who had used the product that included burning eyes, nose, and throat; cough; headache; asthma exacerbations; and skin burns.

During the evaluation, NIOSH interviewed 78 percent of current environmental services staff members regarding their health and collected a total of 50 full-shift personal air samples for measurement of hydrogen peroxide, acetic acid, and peroxyacetic acid. According to the MMWR report, the most commonly reported health outcomes were watery eyes, nasal problems, asthma-like symptoms, use of allergy medicine, and shortness of breath. The air sample results for hydrogen peroxide ranged from 6 parts per billion (ppb) to 511 ppb, with all measurements below the occupational exposure limit (OEL) of 1,000 ppb. Full-shift air sample results for acetic acid ranged from 7 to 530 ppb for acetic acid, and from 1 to 48 ppb for peroxyacetic acid. All measurements for acetic acid also fell below the chemical’s OEL of 10,000 ppb. Researchers noted that no full-shift exposure limit has been established for peroxyacetic acid.

Even though the workers’ measured exposures were below the established full-shift exposure limits for hydrogen peroxide and acetic acid, NIOSH researchers state that because both chemicals are strong oxidants, “it is possible that the mixture of hydrogen peroxide and peroxyacetic acid contributed to the symptoms reported by workers.” Further, the authors write that existing exposure limits might not be protective against asthma-like symptoms.

“These results are preliminary and further investigation is needed to fully understand the relationship between exposure to disinfection products in healthcare settings and worker health,” the report reads. “In the interim, consideration of the health and safety of workers is prudent when choosing disinfection products, and hospitals should be alert for respiratory, skin, and eye symptoms in environmental services staff members.”

See the full report on CDC’s website.