Reference List: Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education

BACKGROUND: Respiratory irritants represent a major cause of occupational obstructive airway diseases. We provide an overview of the evidence related to irritative agents causing occupational asthma or occupational COPD. METHODS: We searched MEDLINE via PubMed. Reference lists of relevant reviews were also screened. The SIGN grading system was used to rate the quality of each study. The modified RCGP three-star system was used to grade the body of evidence for each irritant agent regarding its causative role in either occupational asthma or occupational COPD. RESULTS: A total of 474 relevant papers were identified, covering 188 individual agents, professions or work-sites. The focus of most of the studies and the predominant diagnosis was occupational asthma, whereas occupational COPD arose only incidentally.The highest level assigned using the SIGN grading was 2+ (well-conducted systematic review, cohort or case--control study with a low risk of confounding or bias). According to the modified RCGP three-star grading, the strongest evidence of association with an individual agent, profession or work-site ("**") was found for 17 agents or work-sites, including benzene-1,2,4-tricarboxylicacid-1,2-anhydride, chlorine, platinum salt, isocyanates, cement dust, grain dust, animal farming, environmental tobacco smoke, welding fumes or construction work. Phthalic anhydride, glutaraldehyde, sulphur dioxide, cotton dust, cleaning agents, potrooms, farming (various), foundries were found to be moderately associated with occupational asthma or occupational COPD ("*[+]"). CONCLUSION: This study let us assume that irritant-induced occupational asthma and especially occupational COPD are considerably underreported. Defining the evidence of the many additional occupational irritants for causing airway disorders will be the subject of continued studies with implications for diagnostics and preventive measures. 19. Dodson, R.E., et al., Endocrine Disruptors and Asthma-Associated Chemicals in Consumer Products. Environ Health Perspect, 2012. BACKGROUND: Laboratory and human studies raise concerns about endocrine disruption and asthma from exposure to chemicals in consumer products. Limited labeling or testing information is available to evaluate products as exposure sources. OBJECTIVES: We analytically quantified endocrine disruptors and asthma-related chemicals in a range of cosmetics, personal care products, cleaners, sunscreens, and vinyl products. We evaluated whether labels can be used to select products without these chemicals. METHODS: We selected 213 commercial products representing 50 product types. We tested 42 composited samples of high market-share products. We also tested 43 alternative products identified using criteria expected to minimize target compounds. Analytes included parabens, phthalates, bisphenol A, triclosan, ethanolamines, alkylphenols, fragrances, glycol ethers, cyclosiloxanes and UV filters. RESULTS: We detected 55 compounds, indicating a wide range of exposures from common products. Vinyl products contained >10% DEHP and could be an important source of DEHP in homes. In other products, the highest concentrations and numbers of detects were in the fragranced products perfume, air fresheners, and dryer sheets, and in sunscreens. Some products that did not contain the well-known EDC phthalates contained other less-studied phthalates (also EDCs), suggesting a substitution. Many detected chemicals were not listed on labels. CONCLUSIONS: Common products contain complex mixtures of EDCs and asthma-related compounds. Toxicological studies of these mixtures are needed to understand their biological activity. For epidemiology, findings raise cautions about potential confounding from co-occurring chemicals and misclassification due to variability in product composition. It appears that consumers can avoid some target chemicals—synthetic fragrances, BPA, and regulated active ingredients—using purchasing criteria. More complete labeling would enable consumers to avoid the rest. 20. Ghosh, R.E., et al., Asthma and occupation in the 1958 birth cohort. Thorax, 2013. 68(4): p. 365-71. OBJECTIVE: To examine the association of adult onset asthma with lifetime exposure to occupations and occupational exposures. METHODS: We generated lifetime occupational histories for 9488 members of the British 1958 birth cohort up to age 42 years. Blind to asthma status, jobs were coded to the International Standard Classification of Occupations 1988 and an Asthma Specific Job Exposure Matrix (ASJEM) with an expert re-evaluation step. Associations of jobs and ASJEM exposures with adult onset asthma were assessed in logistic regression models adjusting for sex, smoking, social class at birth and childhood hay fever. RESULTS: Of the 7406 cohort members with no asthma or wheezy bronchitis in childhood, 639 (9%) reported asthma by age 42 years. Adult onset asthma was associated with 18 occupations, many previously identified as risks for asthma (eg, farmers: OR 4.26, 95% CI 2.06 to 8.80; hairdressers: OR 1.88, 95% CI 1.24 to 2.85; printing workers: OR 3.04, 95% CI 1.49 to 6.18). Four were cleaning occupations and a further three occupations were likely to use cleaning agents. Adult onset asthma was associated with five of the 18 high-risk specific ASJEM exposures (flour exposure: OR 2.12, 95% CI 1.17 to 3.85; enzyme exposure: OR 2.32, 95% CI 1.22 to 4.42; cleaning/disinfecting products: OR 1.67, 95% CI 1.26 to 2.22; metal and metal fumes: OR 1.45, 95% CI 1.02 to 2.07; textile production: OR 1.71, 95% CI 1.12 to 2.61). Approximately 16% (95% CI 3.8% to 27.1%) of adult onset asthma was associated with known asthmagenic occupational exposures. CONCLUSIONS: This study suggests that about 16% of adult onset asthma in British adults born in the late 1950s could be due to occupational exposures, mainly recognised highrisk exposures. 21. Gonzalez, M., et al., Asthma among workers in healthcare settings: role of disinfection with quaternary ammonium compounds. Clin Exp Allergy, 2013. INTRODUCTION: An increased incidence of asthma has been reported among healthcare workers. The role of quaternary ammonium compounds (QACs), commonly used in cleaning/disinfection products, has not been clearly defined. The aim of this study was to analyze associations between asthma and occupational exposure to disinfectants, especially QACs. METHODS: The study was performed on a stratified random sample of the various healthcare departments of 7 healthcare settings. The study included: questionnaire, physical examination and specific IgE assays. Occupational exposure assessment was performed by means of a work questionnaire, workplace studies and a review of products ingredients. Data were analyzed by logistic regression. RESULTS: response rate was 77%; 543 workers (89% female) participated; 37.1% were registered nurses (RNs), 16.4% auxiliary nurses (ANs), 17.3% cleaners; 32.8% were atopic. 335 participants were exposed to QACs. Nursing professionals reported a significantly higher risk of reported physician-diagnosed asthma and, for RNs, of nasal symptoms at work than administrative staff working in healthcare sector. This risk was particularly marked during disinfection tasks and when exposure to QACs. Exposure to QACs increased significantly the risk of reported physician diagnosed asthma and nasal symptoms at work (adjusted OR = 7.5 and 3.2 respectively). No significant association was found with other exposures such as latex glove use, chlorinated products / bleach or glutaraldehyde. CONCLUSION: RNs and ANs presented a higher risk of reported asthma than administrative staff. The highest risk was associated with tasks involving dilution of disinfection products by manual mixing, suggesting possible exposure to repeated peaks of concentrated products known to be strong respiratory irritants. Workplace interventions should be conducted in order to more clearly determine QAC exposure and improve disinfection procedures. This article is protected by copyright. All rights reserved. 22. Vandenplas, O., et al., Asthma related to cleaning agents: a clinical insight. BMJ Open, 2013. 3(9): p.