Home many cleaning agents used today are liquids sprayed

health care (HHC) is a fast-growing industry, with almost 50% job growth
expected between 2012 and 2022.1 However, occupational injury rates
in home health care are higher than the national average.2 Each
patient’s home can expose HHC workers to a wide range of biological, chemical,
and physical hazards. (REF) One of those hazards, use of cleaning and disinfecting
agents, has been shown to have associations with occupational asthma incidence in
healthcare settings and with professional cleaners.(REF) Cleaning agents may
contain irritants such as ammonia, chlorine (bleach), or acetic acid, while
others may contain sensitizers such as quaternary ammonium compounds, all of
which may be chemicals of concern.(REF) Many of the studies looking at
cleaning agent exposure in healthcare settings use hospital settings,(REF)
but there are significant differences between a hospital setting and a
patient’s home, with differences in ventilation, frequency, and type of cleaner
used as potential variables that make air concentrations of chemicals difficult
to predict. While some data indicate that high air concentrations of chemicals
are possible with area monitoring,(REF) actual personal breathing
zone (PBZ) exposure data during typical residential cleaning activities is
lacking. Some research has investigated the role that environmental factors (i.e.
room size, product concentration, ventilation) have on resulting air
concentrations in hospital bathrooms,(REF) but this may not produce
a realistic picture of actual exposures in residential workplaces.

exact nature of the cleaning product sprays used may need additional
characterization as well. One assumption is that when these chemical mixtures
are used, volatile compounds in the liquid convert rapidly to the vapor phase and
constitute all of the inhalation dose. However, this assumption may not be
valid if aerosol particles are generated in high concentrations before complete
vaporization. Past work has shown that consumer products using aerosol cans and
propellants do generate aerosol particles that are respirable,(REF) but
many cleaning agents used today are liquids sprayed via hand triggers. While it
is assumed that most particles produced by liquid sprays are larger than the
particles produced by propellant cans, there is limited data on the exact size
and concentration of the particles produced by cleaning product sprays
currently on the market. Measuring both aerosol and vapor concentrations produced
by consumer cleaning product sprays would help determine whether the previous
assumption on exposure levels is valid. Additionally, if aerosol contributions
are significant, it would indicate that more accurate measurement methods for
personal exposures may be needed since current measurement methods only measure
vapor concentration. The proposed study will test the overall hypothesis
that using common cleaning products to
perform cleaning tasks according to manufacturers’ instructions can result in
significant exposures to volatile cleaning product ingredients by the user.
We will accomplish the following specific aims:

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Specific Aim 1 (SA 1): To survey HHC workers to determine the
types and frequencies of exposure. We hypothesize that home health nurses (HHN) will perform
more tasks involving disinfecting chemicals, and home health aides (HHA) will
perform more tasks involving general cleaning chemicals.  

Specific Aim 2 (SA 2): To determine if aerosol exposure from cleaning product
spray ingredients contribute more than 10% of total exposure mass. We
hypothesize that aerosols will contribute more than 10% of the exposure mass
and may require alternative analytical methods to those currently used to
measure the combined contribution.

Specific Aim 3 (SA 3): To quantify the effects that
ventilation, level of dirtiness, amounts applied, and individual variation may
have on exposures. We hypothesize that increased ventilation will decrease
exposures, dirtier surfaces and higher applied amounts will increase exposures,
and individuals will apply significantly different amounts compared to other

Specific Aim 4 (SA 4): To characterize exposures to cleaning
product ingredients (acetic acid and ammonia) during typical cleaning
activities in actual houses and compare to occupational exposure limits. We
hypothesize that the average exposure from typical cleaning activities will
exceed 10% of the occupational exposure limit for each chemical.

The work
proposed here is expected to characterize the range of cleaning
ingredient exposures possible under real-world conditions in residential
workplaces such as home healthcare, but may also be extrapolated to other
occupations who use cleaning chemicals such as healthcare workers and
professional cleaners. These results will produce a positive impact by
prioritizing factors influencing exposures and guiding risk reduction efforts.


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