International Journal of advances in health sciences (IJHS) ISSN 2349-7033 Vol2, Issue1, 2015, pp1-5 http://www.ijhsonline.com Research Article Effect of exposure to cleaning agents on pulmonary function tests in hospital cleaning workers in Jaipur Vipin Kumar Sharma *, Usha Singhal, Anshul Sharma and Vimlesh Kumar Sharma Department of Physiology, NIMS Medical College and Hospital, NIMS University Jaipur, India. *Corresponding Author: vipin2503@gmail.com [Received-12/09/2014, Accepted-01/11/2014] ABSTRACT Cleaning products are widely used both at work and in the home. These products have become an indispensable part of modern life, as they are used on daily basis in nearly all workplaces and homes Occupational exposure to cleaning workers leads to development of various pulmonary disorders, work related asthma being most the important of them. The aim of present study was to evaluate lung functions among Hospital cleaning workers and to compare with the control group. Thirty young Hospital cleaning workers and thirty controls that were similar in all respects to the study group were chosen. PFT were carried out on Hospital cleaning workers, and controls by using computerized Spirometry Spiroexcel. The data obtained was analyzed using Student t test.the study showed that PFT parameters FVC, FEV 1, FEF 25-75% and FEV1/FVC were all significantly less in Hospital cleaning workers. So it is concluded in the study that cleaning products produces changes in the lung functions and decreasing lung function parameters of Hospital cleaning workers. Key Words: PFT- FVC; FEV1; FEF 25-75%; FEV1/FVC; Hospital cleaning workers. INTRODUCTION The health conditions of workers all over the world vary widely, depending on the geographical location, the type of employment and the patterns of work including chemicals, biological agents, physical factors and adverse ergonomic conditions. The understanding of the relation and inter-actions between work and health is very fundamental in understanding and practicing of occupational health and safety (1). Cleaning products are widely used both at work and in the home (2). Cleaners are exposed to a large number of gaseous and particulate compounds. Professional cleaners work in diverse job tasks, ranging from domestic cleaning to cleaning
offices, industrial plants, kitchens and hospitals (3). Both professional and domestic cleaners are exposed to chemical components of cleaning products include disinfectants, detergents, alkaline agents (e.g., sodium hydroxide, ammonia),acids, complexing agents (water softeners), solvents, corrosion inhibitors (eg, monoethanolamine), film formers and polishes (eg, acryl polymers, polyethylene), preservatives (eg, benzalkonium chloride, isothiazolinones, formaldehyde), and perfumes or scents (4). There are a limited number of reports of new-onset work-related asthma occurring after a documented exposure to cleaning products (5-8), or exposure to common component of cleaning products (9-10). In recent years cleaning agents has been identified as potential risk factors responsible for increased incidence of asthma and asthma like symptoms among cleaning workers. The aim of present study was to evaluate lung functions among Hospital cleaning workers and to compare the results with the control group and also to determine the harmful effect of exposure to cleaning agents on lung function parameters. METHODS This study was conducted under the auspices of the Central Laboratory set up of the Department of Physiology, NIMS Medical College Jaipur. 30 Hospital cleaning workers and 30 age and sex matched controls were recruited from NIMS medical college and NIMS hospital Jaipur. Case and control were selected as per the criteria laid down and after satisfying these criteria they were subjected to pulmonary function tests. Inclusion criteria for control:-healthy young adults, both sexes, age group (18-35). For Hospital cleaning workers:--age group (18-35), both sexes, history of cleaning work, exposure to cleaning agents. Exclusion-criteria:-Subjects suffering from any respiratory Disorder, common cold and cough, allergy, Hay fever, pneumonia, asthma, COPD, tuberculosis, smokers, neuromuscular disorders. Hospital cleaning workers and controls were made to undergo pulmonary function tests using computerized Spirometry Spiroexcel. The Spiroexcel manufactured by Medicated system is PC based Pulmonary Function tests (PFT) System. The procedure of spirometry to be performed in the study for obtaining lung functions was explained to the subjects and controls in vernacular, and in detail. Subjects having understood the details of study and unconditionally consented to participate in the study The FVC, FEV1, FEF25-75% and FEV1/FVC% were recorded and the best of the three was taken into account. Tests were done in accordance to the official statement of the American Thoracic Society of Standardization of Spirometry (11). The tests were performed in the sitting position. The study and its conduct was cleared by the institutional ethical committee. Statistical Analysis Data are presented as mean + s.d. Student unpaired t tests with 95% confidence intervals were used wherever appropriate. p value (<0.05) was considered significant. The analysis was performed by using the statistical software. RESULTS Table1 shown the anthropometric data between the Hospital cleaning workers and their matched control subjects and data expressed as mean ±SD. There was no significant difference in respect of age, height and weight between the two groups Table -1: Anthropometric data between Controls and Hospital cleaning workers: Groups with Mean (± SD) Parameters Controls (N-30) Hospital cleaning workers (N-30) Age 25±1.41 29.63±3.11 NS Height 162.7±10.39 160.5±8.88 NS Weight 66.03±11.99 65.63±8.87 NS NS (P>0.05) represent no statistically significant difference between control and hospital cleaning workers Vipin Kumar Sharma, et al. 2
Pulmonary Function Data: The pulmonary function parameters mean SD values of the of Hospital cleaning workers and their matched controls are also shown in Table 2. Dynamic lung volumes and capacities (FEV 1 and FVC) were significantly reduced (P<0.05), FEF 25%-75% and FEV 1 /FVC ratio were also reduced (P<0.05) in Hospital cleaning workers when compare with control group. Table -2: Lung Function Parameters between Controls and Hospital cleaning workers Groups with Mean (± SD) Parameters Controls (N-30) Hospital cleaning workers (N-30) FVC 3.72±0.62 2.83±0.65* FEV1 3.21±0.54 2.31±0.56* FEV1/FVC 0.86±0.047 0.81±0.04* FEF25-75% 5.27±1.16 3.31±1.20* * (P<0.05) represent statistically significant difference between controls and hospital cleaning workers. Graphical presentation between Controls and Hospital cleaning workers. DISCUSSION: Most cleaning agents have an irritating effect on mucous membranes. They contain chemicals that may elicit new-onset asthma, exacerbation of asthma symptoms among individuals with preexisting asthma, asthma-like symptoms without asthma, or other respiratory conditions. Most of the cleaning agents associated with asthmalike symptoms have harmful irritative and/or sensitizing properties and may be involved in the development of chronic respiratory symptoms. This study was done to observe the effects of exposure t o cleaning agents on the pulmonary functions in hospital cleaning workers. Pulmonary function tests were carried out on age and sex matched controls, not exposed to cleaning agents professionally.comparison of the data of both groups was done, to arrive at the results described. FEV1 and FVC were significantly less in hospital cleaning workers as compared to Vipin Kumar Sharma, et al. 3
controls. This change in FEV1 and FVC was noticed in hospital cleaning workers exposed to cleaning agents. In a study conducted in United States of America by Arif et al [12] on occupation exposure among domestic cleaners and industrial cleaners found that domestic cleaners are more frequently exposed to respiratory irritants and respiratory sensitizers, consequently having more adverse respiratory symptoms as compared to industrial cleaners (12). Decline in PFTs among hospital cleaning workers as compare to controls proves the notion that hospital cleaning workers are having more chemical exposure than other industrial cleaners. Such disparity may be due to lack of job training, lack of competence and sparing use of protective gears. Arif et al (2009) has reported asthma was significantly greater among nursing professional involved in medical instrument cleaning and exposure to general cleaning products and disinfectants. Occupational exposures to vapors, gas, dust, or fumes have been shown to be a risk factor of airway obstruction [13]. In a crosssectional study among young subjects, chronic bronchitis symptoms were associated with occupational exposures assessed by using a job exposure matrix [14]. In another study which evaluates the relationship between specific occupations and occupational exposures during a 9 year follow-up period showed that occupational exposures to gases and fumes are associated with incidence of chronic bronchitis [15]. In our study decline in some of PFTs in hospital cleaning workers suggest that cleaning agents might be responsible for BHR-related symptoms. Baur et al (2012) has reported that irritant induced occupational asthma and especially occupational COPD are considerably underreported (16). It is imperative that in India also, irritant, cleaning agent induced occupational asthma may be underreported. In a study Medina-Ramon M et al (2005) reported that Women employed in domestic cleaning are at increased risk for symptoms of obstructive lung disease. Asthma symptoms in domestic cleaning women are associated with exposure to bleach and possibly other irritant agents. (17). In our study decline in PFT values among hospital cleaning workers, prove this notion. In a study done by Bauer Sevin et al (2007) evaluated the respiratory symptoms among cleaners working in hospital and compared the results of pulmonary function tests (PFTs) of cleaners with control group who were not exposed to cleaning products at work in Turkey. The mean % predicted of FEV 1 /FVC and FEF 25%-75% was found to be significantly lower than control group. In our study pulmonary function tests of hospital cleaning workers is FEV 1, FVC and FEV 1 /FVC and FEF 25%-75% was also found to be significantly lower than control group (18). Hence, our study substantiate the assumption that exposure to cleaning agents in hospital cleaning workers has detrimental effect on the lung function. In present study pulmonary function tests of Hospital cleaning workers were found to be significantly reduced when compared to control group. These findings are similar to previous studies. Hence, our study substantiate the assumption that exposure to cleaning agents in hospital cleaning workers has detrimental effect on the lung function. CONCLUSION: Thus it can be concluded that cleaning agents produces significant changes in the lung function parameters of Hospital cleaning workers and hence are potential risk factor for the development of respiratory diseases like asthma. The cleaning products have become an indispensable part of modern life, because without these products are essential for cleaning or disinfecting surfaces in general work environments. Further study is needed to identify the specific exposures responsible for altered lung functions in Hospital cleaning workers working in hospitals. Vipin Kumar Sharma, et al. 4
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