Selections from a recent NIOSH report described below detail convincing cases of exposure to environmental surface cleaning agents and disinfectants triggering work-related asthma in healthcare workers.
The first example was identified in the Michigan Work-Related Asthma Surveillance Program and describes an environmental services worker at a hospital in Michigan. A non-smoker in his 20s, the man worked in the environmental services department for two years with no reported health problems, but following the hospital’s use of a new cleaning product he quickly developed asthmatic symptoms. The product in question contained didecyl dimethyl ammonium chloride and alkyl dimethyl benzyl ammonium chloride, two quaternary ammonium compounds commonly used in antimicrobials and disinfectants.
The man was treated after his initial reaction at the hospital’s emergency department but required four more medical visits including a hospitalization before the cleaning product was no longer used. Currently, he requires regular medical use to manage his asthma that he developed seemingly as a result of the exposure.
The second compelling case is of California medical records clerk. The non-asthmatic lifetime non-smoker, 57, worked as a records clerk and receptionist. A coworker in her medical clinic wiped down her office supplies, including her phones, computer and desktop with alkyl dimethyl benzyl ammonium chloride, and dimethyl ethyl benzyl ammonium chloride — again, quaternary ammonium compounds.
Upon contact with the coated materials, the receptionist felt a burning before losing vision in her left eye and developing dyspnea. The clinic medical staff treated her with oxygen on the site, but unaware of the reaction’s cause, simply urged for her to wash her hands before having her meet with the compensation physician, who diagnosed her with work-related asthma. Continued use of the wipes in the office over the following six months caused the woman’s symptoms to become more severe. Eventually, the clinic offices stopped use of the wipes, and in cases where wipes were used elsewhere in the building the receptionist was advised to leave the building. After two years and an occupational relocation, the woman was again exposed to the quaternary ammonium compounds that initiated her asthmatic symptoms. On the advice of her physician, the woman stopped working a year later and currently continues to experience dyspnea. Her condition has worsened to the point of needing multiple medications to properly deal with her asthma. As her respiratory sensitization has generalized, she now must avoid contact with more chemicals than solely the initial quaternary ammonium compounds.