Exposure to Disinfectants, Cleaning Products Linked to COPD Risk

November 04, 2019
Regular use of chemical disinfectants among female nurses was found to be a potential risk factor for the development of chronic obstructive pulmonary disease (COPD), according to a study published in JAMA Network Open
COPD is the third leading cause of mortality worldwide and among the diseases contributing the most to disability-adjusted life-years, noted the study authors. While tobacco smoke is the leading risk factor for COPD, occupational exposures have been found to additionally contribute to incidence rates. Most occupational studies on COPD-related risk have focused on broad exposure categories, such as vapor, gases, or fumes, as opposed to industry-specific studies, which generally provide more attributable data on specific causal agents.
Exposure to chemical disinfectants has been linked with respiratory health outcomes such as asthma and COPD in a few European studies, but data on the association of specific chemicals and occupational exposure with COPD risk have yet to be studied. As cleaning products and disinfectant use is most prominent among women and those part of the healthcare industry, researchers sought to examine the correlating risk factor for this demographic.
Researchers investigated the relation of disinfectant and cleaning product exposure with COPD incidence by analyzing 73,262 female registered nurses in the United States part of the Nurses’ Health Study II. In the study, nurses were followed up through questionnaires every 2 years since its inception in 1989. The present study includes women who were still in a nursing job and had no history of COPD in 2009. Data included responses from questionnaires conducted between 2009 and 2015, and primary measurement of incident physician-diagnosed COPD was determined by occupational exposure to disinfectants, as evaluated by a questionnaire and a job-task exposure matrix (JTEM).
Among the study cohort, mean age at baseline was 54.7 years; 96% were white, 1.7% were black, 1.8% were Hispanic, and 2.3% were another race/ethnicity. After analyzing 368,145 person-years of follow up, 582 nurses reported incident physician-diagnosed COPD. Of the 73,262 nurses in the study cohort, correlations to COPD incidence were attributed to 16,786 (22.9%) of nurses reporting weekly use of disinfectants to clean surfaces and 13,899 (19%) of nurses exposed to weekly use of disinfectants to clean medical instruments, with adjusted hazard ratios (AHRs) of 1.38 (95% CI, 1.13-1.68) for cleaning surfaces only and 1.31 (95% CI, 1.07-1.61) for cleaning medical instruments.
High-level exposure, determined by JTEM, to several specific disinfectants such as glutaraldehyde (AHR, 1.25; 95% CI, 1.04-1.51), bleach (AHR, 1.36; 95% CI, 1.13-1.64), hydrogen peroxide (AHR, 1.29; 95% CI, 1.08-1.54), alcohol (AHR, 1.32; 95% CI, 1.10-1.59), and quaternary ammonium compounds (AHR, 1.33; 95% CI, 1.11-1.60) all exhibited significant associations with COPD incidence.
“These longitudinal results suggest that regular use of chemical disinfectants among nurses may be a risk factor for developing COPD,” wrote the authors. As exposure to these chemical irritants is heightened among workers in the healthcare industry, which is among the largest employment sectors in the United States and Europe, further analysis and exposure-reduction strategies compatible with infection control in healthcare settings should be developed, they noted.
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Protect Workers if the Air Quality Is Unhealthy Due to Wildfire Smoke
Cal/OSHA advised employers that steps must be taken to protect workers from harmful exposure if the air quality is unhealthy due to wildfire smoke. California’s protection from wildfire smoke standard applies to workplaces where the Air Quality Index (AQI) for fine particles in the air is 151 or greater and where workers may be exposed to wildfire smoke.
When wildfire smoke affects a worksite, employers must monitor the AQI for particulate matter in the air, known as PM2.5. Employers can monitor the AQI using the following websites:
If the AQI for PM2.5 is 151 or greater, employers must take the following steps to protect employees:
  • Communication – Inform employees of the AQI for PM2.5 and the protective measures available to them.
  • Training – Train all employees on the information contained in section 5141.1 Appendix B.
  • Modifications – Implement modifications to the workplace, if feasible, to reduce exposure. Examples include providing enclosed structures or vehicles for employees to work in, where the air is filtered.
  • Changes – Implement practicable changes to work procedures or schedules. Examples include changing the location where employees work or reducing the amount of time they work outdoors or exposed to unfiltered outdoor air.
  • Respiratory protection – Provide proper respiratory protection equipment, such as disposable respirators, for voluntary use.
  • To filter out fine particles, respirators must be labeled N-95, N-99, N-100, R-95, P-95, P-99, or P-100, and must be labeled as approved by the US National Institute for Occupational Safety and Health (NIOSH).
If the AQI for PM2.5 exceeds 500, respirator use is required. Employers must ensure employees uses respirators and implement a respiratory protection program as required in California’s respiratory standard. For information or help on developing a respiratory protection program, see Cal/OSHA’s Respiratory Protection Fact Sheet.
Smoke from wildfires contains chemicals, gases and fine particles that can harm health. The greatest hazard comes from breathing fine particles in the air (called PM2.5), which can reduce lung function, worsen asthma and other existing heart and lung conditions, and cause coughing, wheezing and difficulty breathing.
Guidance for employers and workers on working safely in conditions with smoke caused by the wildfires is available on Cal/OSHA’s web page, including information for protecting outdoor workers, details on how to protect indoor workers from outdoor air pollution, and frequently asked questions about N95 masks.
Information on current wildfires is available from CalFire and the Incident Information System website.
Chemical Safety Board Releases Factual Update and New Animation Detailing the Events of the Massive Explosion and Fire at the PES Refinery in Philadelphia, PA
The US Chemical Safety Board (CSB) released a factual update into the June 21, 2019, explosion and fire at the Philadelphia Energy Solutions (PES) Refinery in Philadelphia. The factual update notes that a pipe elbow, which had corroded to about half the thickness of a credit card, appears to have ruptured in the refinery’s alkylation unit, releasing process fluid that included over 5,000 pounds of hydrofluoric acid, or HF. The leaking process fluid formed a large ground-hugging vapor cloud. Two minutes later, the cloud ignited, causing a massive fire and explosions.
Interim Executive Dr. Kristen Kulinowski said, “Since 2015, the CSB has investigated three major incidents at refineries that utilize HF for alkylation. Incidents in Superior, WI, and Torrance, CA, fortunately did not result in an HF release. That was not the case here in Philadelphia. Though the main tank holding HF was not breached, HF was a component of the process fluid released from the alkylation unit. We are lucky there were no serious injuries or fatalities.”
While the CSB’s investigation is still ongoing, the factual update notes important details of the incident collected through interviewing witnesses, gathering evidence and ultimately, piecing together the events that led to the explosion:
  • The piping was susceptible to corrosion from the hydrofluoric acid that was in the process fluid. The elbow that ruptured corroded faster than the rest of the piping in this part of the process. 
  • While pipe thickness in this section of the unit was periodically measured to monitor corrosion rates, the thickness of the elbow that failed had not been monitored for corrosion. The piece of piping that failed had a high nickel and copper content. Various industry publications have found that carbon steel with a higher percentage of nickel and copper corrodes at a faster rate than carbon steel with a lower percentage when used in a process with hydrofluoric acid.
  • A secondary event at the PES refinery occurred when the V-1 Treater Feed Surge Drum ruptured, which launched a fragment of the vessel weighing 38,000 pounds across the Schuylkill River. Two other large fragments landed within the PES Refinery.
CSB Supervisory Investigator Lauren Grim said, “Corrosion is not a new issue for the CSB. In its prior investigation of a 2012 Chevron Refinery fire we determined that corrosion caused the rupture of a piping component.  Similarly, the 2009 Silver Eagle refinery fire was also caused by the failure of piping that had thinned due to corrosion.”
The CSB’s interim animation details the events which occurred at the PES refinery on June 21st. During the news conference Interim Executive Kulinowski noted that moving forward the CSB is examining the need for more robust reviews of corrosion mechanisms as well as looking more closely at the use of HF in the refining process. 
Carrier Recalls Carrier- and Bryant-Branded Heat Pumps Due to Fire Hazard
This recall involves Carrier and Bryant-branded 1.5-ton multi-zone, 4-ton multi-zone and 4-ton single-zone ductless heat pump outdoor units. The units are used for cooling and heating homes and light commercial facilities. The model number and product number can be found on the nameplate/rating plate on the side of the units. The recalled models and product numbers are:
Model Number
Product Number
1.5-ton multi-zone
4-ton multi-zone
4-ton single-zone
1.5-ton multi-zone
4-ton multi-zone
4-ton single-zone
Central New York Roofing Contractor Cited for Fall Protection Violations
OSHA has cited Proctor Enterprises Inc. – based in Stanley, New York, and doing business as Proctor Roofing and Contracting – for exposing employees to falls at a Stanley, New York, worksite. The roofing contractor faces a total of $116,686 in penalties for two willful violations of OSHA standards.
OSHA cited the company for failing to provide employees with fall protection while they installed roofing materials, and for using ladders that did not extend at least 3 feet above upper landings for required stability. OSHA previously cited Proctor for fall-related violations in 2015 and 2016 at worksites in Geneva and Newark, New York.
“Falls are the leading cause of work-related injuries and fatalities in construction,” said OSHA Syracuse Area Director Jeffrey Prebish. “This company’s failure to provide legally required fall protection places workers at risk for serious injuries.”
OSHA’s Protecting Roofing Workers booklet describes the types of fall protection employers can use, including fall restraint and guardrail systems, and requirements for using extension ladders and stepladders. OSHA offers additional compliance assistance resources on preventing falls from ladders, scaffolds, and roofs on the OSHA Fall Protection webpage.
The company has 15 business days from receipt of the citations and penalties to comply, request an informal conference with OSHA’s area director, or contest the findings before the independent Occupational Safety and Health Review Commission.
Contempt Petition Filed Against Massachusetts Roofing Company for Not Complying with Court-Ordered Safety Settlement
The U.S. Department of Labor has asked the U.S. Court of Appeals for the First Circuit to hold The Roof Kings LLC and its owner, Craig Galligan, in civil contempt for not fulfilling the terms of an order issued by the First Circuit in 2018. The order enforces a settlement agreement between the company and OSHA.
OSHA cited the Massachusetts roofing contractor for fall and other hazards at four eastern Massachusetts worksites between 2013 and 2016. OSHA and The Roof Kings reached a settlement as part of a consent order – issued on September 25, 2017 – that was approved by the Occupational Safety and Health Review Commission (OSHRC). The order required that the company provide OSHA with abatement certification for 32 cited safety hazards, written notice of upcoming roofing jobs, and pay $72,000 in penalties in 60 monthly installments. 
The Roof Kings LLC made three initial payments of $1,200 each, but failed to pay more or fulfill other obligations under the settlement. In October 2018, the First Circuit granted the Department's petition for an order requiring the company to comply with the settlement agreement. The Department's petition asks the court to find the defendants in civil contempt, order them to provide written certification that they have abated the violations affirmed in the settlement agreement, and pay overdue penalties of $206,090 plus interest, within 20 days. If the defendants refuse or fail to do so, the Department requests the court to subject The Roof Kings and Galligan to coercive sanctions, including incarceration.
"The U.S. Department of Labor will use all available legal tools to ensure that employers comply with their obligations under the Occupational Safety and Health Act," said Solicitor of Labor Kate S. O'Scannlain.
"Employers must adhere to their legal obligation to provide workplaces free of hazardous conditions," said OSHA Regional Administrator Galen Blanton. "Worker safety can be achieved when employers comply with the law." 
OSHA's Andover and Braintree Area Offices conducted the inspections. The Office of the Solicitor is litigating the case for the Department.
Liquid Nicotine Can Be Deadly for Children and Pets
The U.S. Consumer Product Safety Commission (CPSC) warns consumers that even small amounts of liquid nicotine can be extremely hazardous to children and pets who swallow it or come into contact with it through their skin. Parents and caregivers should always store liquid nicotine in its child-resistant packaging, tightly seal the container after each use, and keep it locked up and away from children and pets. When handling solutions containing liquid nicotine, adults should also be careful to minimize direct skin contact. Liquid nicotine is commonly used in e-cigarettes and is available to consumers in a variety of stores and online.
Consumers should treat liquid nicotine like any other potentially toxic substance. If a child or pet swallows liquid nicotine, or gets any amount on their skin or eyes, immediately call the Poison Control Center Hotline at: 1-800-222-1222.
Consumers who may have purchased liquid nicotine in bottles that lack child-resistant packaging features should contact CPSC at www.SaferProducts.gov so that the agency can take appropriate steps with the manufacturer or retailer.
Alabama Framing Contractor Cited for Exposing Employees to Falls
OSHA has cited Diaz Professional Construction LLC for exposing employees to falls at a Montgomery, Alabama, residential worksite. The framing contractor faces $31,879 in penalties.
OSHA initiated the inspection as part of its Regional Emphasis Program for Falls in Construction after inspectors observed employees performing framing activities without fall protection. OSHA cited the company for failing to use a fall protection system, allowing employees to operate pneumatic nail guns without eye protection and failing to train workers on the fall hazards.  
“Falls are the leading cause of fatalities in construction,” said OSHA Mobile Area Director Jose Gonzalez. “Employers can protect workers from falls by ensuring that they wear required personal fall arrest or restraint systems, and by installing guardrail systems around roof openings.”
OSHA’s Fall Prevention/Protection webpage provides a list of resources on protecting construction workers from falls, including Protecting Roofing Workers, and Fall Protection in Construction.
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