Cleaning, disinfection, and hygiene practices : occupational exposures and health hazards

<p dir="ltr">Occupational exposure to water, cleaning and disinfection products, and hygiene practices is widespread across multiple sectors, often involving a diverse range of products and tasks. Workers can be exposed through various routes which may lead adverse health effects, such as respiratory and skin symptoms. However, the extent of total exposure, including cumulative and combined effects of water and product use, remains insufficiently understood, posing challenges for effective risk assessment and implementation of appropriate management in the workplace.</p><p dir="ltr">This doctoral thesis aimed to investigate occupational exposures and health hazards associated with cleaning and disinfection products and hygiene practices in six different occupations. The overall aim was to generate knowledge and understanding that supports improved workplace prevention and protection strategies.</p><p dir="ltr">In Study I, workplace observations, airborne exposure assessment and questionnaire-based approach was used to characterize the work environment of cleaning personnel. Although the developed measuring methodology estimated airborne levels to cleaning products to be low, in relation to applicable Swedish OELs, a broad variety of cleaning substances/chemicals, including asthmagens and skin sensitizers, were found.</p><p dir="ltr">Study II and III used a questionnaire-based approach to study six different occupations, including frontline workers, to assess hand hygiene practices, exposure frequency and skin symptoms during the COVID-19 pandemic. These studies revealed higher exposure frequency to water, hand soap, and hand disinfection during the pandemic compared to before, alongside a high prevalence and newly debuting hand eczema 20.7% and 7.4%, respectively. Notably, 25.4% of the 434 ingredients found in these products were identified as skin sensitizers.</p><p dir="ltr">In Study IV, an in vitro experimental model evaluated how intense hand hygiene practices would affect the skin barrier integrity and the retention of common contact allergens in the skin. The findings showed that such practices impair the skin barrier evaluated by TEWL and higher metal (i.e. nickel, cobalt and chromium) amounts were generally measured in SLS-treated skin than untreated. These findings suggest that intense hand hygiene practices may enhance the retention/uptake of allergenic metals.</p><p dir="ltr">In Study V, the assessment of the hazard information provided in SDS of a selected professional cleaning and disinfection market products was done. A non-negligible fraction of SDSs were found to contain insufficient, inconsistent and not easily accessible hazard and precautionary information. Moreover, discrepancies in hazard identification between SDSs and other sources of information may undermine their role in occupational risk communication and management.</p><p dir="ltr">Overall, this thesis shows that exposure to cleaning and disinfection products and hygiene practices occurs across multiple occupations and involves a broad variety of substances/ingredients, many of which were identified as skin and respiratory irritants and sensitizers. The frequent and intense hand hygiene practices in the workplace suggest that there are major skin health implications, potentially enhancing uptake of allergens into the skin. Additionally, the thesis indicates the importance of the implementation skin care guidelines, procurement of products with safer formulations and policy changes to improve hazard identification/classification and enhance hazard communication to protect workers' health.</p><h3>List of scientific papers</h3><p dir="ltr">This thesis is based on the following studies and will be referred to in the text by their Roman numerals:</p><p dir="ltr">I. <b>Vilela, L.</b>, Blom, A., Runström Eden, G., Tinnerberg, H., Farbrot, A., Julander, A., & Schenk, L. (2025). Characterising cleaners' exposures to chemicals in cleaning products using gas chromatography mass spectrometry fingerprinting: A feasibility study. ACS Chemical Health & Safety. <a href="https://doi.org/10.1021/acs.chas.5c00088" target="_blank">https://doi.org/10.1021/acs.chas.5c00088</a></p><p dir="ltr">II. <b>Vilela, L.</b>, Lagrelius, M., Berglind, I. A., Midander, K., Schenk, L., & Julander, A. (2024). Water, soap, and hand-disinfectant exposure during the COVID-19 pandemic and self-reported hand eczema in frontline workers: A cross-sectional study. Contact dermatitis, 91(1), 22-29. <a href="https://doi.org/10.1111/cod.14540">https://doi.org/10.1111/cod.14540<br></a><br></p><p dir="ltr">III. <b>Vilela, L.</b>, Schenk, L., Midander, K., Berglind, I. A., Lagrelius, M., & Julander, A. Skin hazards associated with hygiene and hand care practices in six occupations during the COVID-19 pandemic. [Manuscript]</p><p dir="ltr">IV. <b>Vilela, L.</b>, Schenk, L., Julander, A., & Midander, K. (2024). Retention of nickel, cobalt and chromium in skin at conditions mimicking intense hand hygiene practices using water, soap, and hand-disinfectant in vitro. Journal of occupational medicine and toxicology (London, England), 19(1), 44. <a href="https://doi.org/10.1186/s12995-024-00442-5">https://doi.org/10.1186/s12995-024-00442-5<br></a><br></p><p dir="ltr">V. Erfani, B., <b>Vilela, L.</b>, Julander, A., & Schenk, L. (2023). Safety data sheets as an information pathway on hazards of occupationally used cleaning agents. Regulatory toxicology and pharmacology : RTP, 142, 105447. <a href="https://doi.org/10.1016/j.yrtph.2023.105447" rel="noreferrer" target="_blank">https://doi.org/10.1016/j.yrtph.2023.105447</a></p>