美国护士消毒剂职业暴露于和其哮喘控制
2017/11/20
摘要
消毒剂的使用与卫生保健工作者的呼吸道不良反应有关。然而，并没有阐明其中特定的有害成分。我们在护士健康研究II中检测了消毒剂的职业暴露和哮喘控制的关系，这个研究包含了一大批女性护士。
在2014年，有哮喘的护士被邀请来完成关于目前的职业和哮喘的调查问卷（应答率80%）。哮喘控制由哮喘控制测试（ACT）来定义。用职业-工作-暴露矩阵（JTEM）来评估主要消毒剂的暴露。
这个分析包含了4102个有哮喘的护士（平均年龄58岁）。12%的护士哮喘控制差（ACT评分16-19），6%的护士控制的很差（ACT评分≤15）。使用消毒剂来清洁医疗器械（19%暴露）与哮喘控制差（OR 1.37; 95% CI 1.05–1.79）和非常差(OR 1.88, 95% CI 1.38–2.56)相关（P=0.004，对潜在混杂因素调整后）。使用JTEM评估，暴露于甲醛，戊二醛，次氯酸盐漂白剂，过氧化物和酶清洁剂与哮喘控制差有关（所有的P<0.05）；暴露于季胺盐混合物和酒精的与哮喘控制无关。
几种消毒剂的使用与哮喘控制差相关。我们的发现建议可以把预防医疗保健工作者哮喘恶化作为未来努力的目标。
Occupational exposure to disinfectants and asthma control in US nurses
Orianne Dumas, Aleta S. Wiley, Catherine Quinot, Raphaëlle Varraso, Jan-Paul Zock, Paul K. Henneberger, Frank E. Speizer, Nicole Le Moual, Carlos A. Camargo Jr
European Respiratory Journal 2017 50: 1700237;
Abstract
Disinfectant use has been associated with adverse respiratory effects among healthcare workers. However, the specific harmful agents have not been elucidated. We examined the association between occupational exposure to disinfectants and asthma control in the Nurses' Health Study II, a large cohort of female nurses.
Nurses with asthma were invited in 2014 to complete two questionnaires on their current occupation and asthma (response rate 80%). Asthma control was defined by the Asthma Control Test (ACT). Exposure to major disinfectants was evaluated by a job–task–exposure matrix (JTEM).
Analyses included 4102 nurses with asthma (mean age 58 years). Asthma control was poor (ACT score 16–19) in 12% of nurses and very poor (ACT score ≤15) in 6% of nurses. Use of disinfectants to clean medical instruments (19% exposed) was associated with poorly (OR 1.37; 95% CI 1.05–1.79) and very poorly (OR 1.88, 95% CI 1.38–2.56) controlled asthma (ptrend=0.004, after adjustment for potential confounders). Using JTEM estimates, exposure to formaldehyde, glutaraldehyde, hypochlorite bleach, hydrogen peroxide and enzymatic cleaners was associated with poor asthma control (all ptrend<0.05); exposure to quaternary ammonium compounds and alcohol was not.
Use of several disinfectants was associated with poor asthma control. Our findings suggest targets for future efforts to prevent worsening of asthma control in healthcare workers.
消毒剂的使用与卫生保健工作者的呼吸道不良反应有关。然而，并没有阐明其中特定的有害成分。我们在护士健康研究II中检测了消毒剂的职业暴露和哮喘控制的关系，这个研究包含了一大批女性护士。
在2014年，有哮喘的护士被邀请来完成关于目前的职业和哮喘的调查问卷（应答率80%）。哮喘控制由哮喘控制测试（ACT）来定义。用职业-工作-暴露矩阵（JTEM）来评估主要消毒剂的暴露。
这个分析包含了4102个有哮喘的护士（平均年龄58岁）。12%的护士哮喘控制差（ACT评分16-19），6%的护士控制的很差（ACT评分≤15）。使用消毒剂来清洁医疗器械（19%暴露）与哮喘控制差（OR 1.37; 95% CI 1.05–1.79）和非常差(OR 1.88, 95% CI 1.38–2.56)相关（P=0.004，对潜在混杂因素调整后）。使用JTEM评估，暴露于甲醛，戊二醛，次氯酸盐漂白剂，过氧化物和酶清洁剂与哮喘控制差有关（所有的P<0.05）；暴露于季胺盐混合物和酒精的与哮喘控制无关。
几种消毒剂的使用与哮喘控制差相关。我们的发现建议可以把预防医疗保健工作者哮喘恶化作为未来努力的目标。
（复旦大学附属中山医院呼吸内科 李蕾 摘译 杨 冬 审校）
（Camargo JrEuropean Respiratory Journal 2017 50: 1700237）
（Camargo JrEuropean Respiratory Journal 2017 50: 1700237）
Occupational exposure to disinfectants and asthma control in US nurses
Orianne Dumas, Aleta S. Wiley, Catherine Quinot, Raphaëlle Varraso, Jan-Paul Zock, Paul K. Henneberger, Frank E. Speizer, Nicole Le Moual, Carlos A. Camargo Jr
European Respiratory Journal 2017 50: 1700237;
Abstract
Disinfectant use has been associated with adverse respiratory effects among healthcare workers. However, the specific harmful agents have not been elucidated. We examined the association between occupational exposure to disinfectants and asthma control in the Nurses' Health Study II, a large cohort of female nurses.
Nurses with asthma were invited in 2014 to complete two questionnaires on their current occupation and asthma (response rate 80%). Asthma control was defined by the Asthma Control Test (ACT). Exposure to major disinfectants was evaluated by a job–task–exposure matrix (JTEM).
Analyses included 4102 nurses with asthma (mean age 58 years). Asthma control was poor (ACT score 16–19) in 12% of nurses and very poor (ACT score ≤15) in 6% of nurses. Use of disinfectants to clean medical instruments (19% exposed) was associated with poorly (OR 1.37; 95% CI 1.05–1.79) and very poorly (OR 1.88, 95% CI 1.38–2.56) controlled asthma (ptrend=0.004, after adjustment for potential confounders). Using JTEM estimates, exposure to formaldehyde, glutaraldehyde, hypochlorite bleach, hydrogen peroxide and enzymatic cleaners was associated with poor asthma control (all ptrend<0.05); exposure to quaternary ammonium compounds and alcohol was not.
Use of several disinfectants was associated with poor asthma control. Our findings suggest targets for future efforts to prevent worsening of asthma control in healthcare workers.
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