Showing papers by "Frank E. Speizer published in 2017"

Occupational exposure to disinfectants and asthma control in US nurses.

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.

Development of a job-task-exposure matrix to assess occupational exposure to disinfectants among US nurses.

Abstract: Objectives Occupational exposure to disinfectants is associated with work-related asthma, especially in healthcare workers. However, little is known about the specific products involved. To evaluate disinfectant exposures, we designed job-exposure (JEM) and job-task-exposure (JTEM) matrices, which are thought to be less prone to differential misclassification bias than self-reported exposure. We then compared the three assessment methods: self-reported exposure, JEM and JTEM. Methods Disinfectant use was assessed by an occupational questionnaire in 9073 US female registered nurses without asthma, aged 49–68 years, drawn from the Nurses9 Health Study II. A JEM was created based on self-reported frequency of use (1–3, 4–7 days/week) of 7 disinfectants and sprays in 8 nursing jobs. We then created a JTEM combining jobs and disinfection tasks to further reduce misclassification. Exposure was evaluated in 3 classes (low, medium, high) using product-specific cut-offs (eg, Results The most frequently reported disinfectants were alcohol (weekly use: 39%), bleach (22%) and sprays (20%). More nurses were classified as highly exposed by JTEM (alcohol 41%, sprays 41%, bleach 34%) than by JEM (21%, 30%, 26%, respectively). Agreement between JEM and JTEM was fair-to-moderate (κ 0.3–0.5) for most disinfectants. JEM and JTEM exposure estimates were heterogeneous in most nursing jobs, except in emergency room and education/administration. Conclusions The JTEM may provide more accurate estimates than the JEM, especially for nursing jobs with heterogeneous tasks. Use of the JTEM is likely to reduce exposure misclassification.

Determinants of disinfectant use among nurses in U.S. healthcare facilities

Abstract: Background Disinfectant use among healthcare workers has been associated with respiratory disorders, especially asthma. We aimed to describe disinfectants used by U.S. nurses, and to investigate qualitative and quantitative differences according to workplace characteristics and region. Methods Disinfectant use was assessed by questionnaire in 8,851 nurses. Hospital characteristics were obtained from the American Hospital Association database. Results Working in a hospital was associated with higher disinfectant use (OR: 2.06 [95%CI: 1.89–2.24]), but lower spray use (0.74 [0.66–0.82]). Nurses working in smaller hospitals (<50 beds vs. ≥200 beds) were more likely to use disinfectants (1.69 [1.23–2.32]) and sprays (1.69 [1.20–2.38]). Spray use was lower in the West than in the Northeast (0.75 [0.58–0.97]). Conclusion Disinfectant use was more common among nurses working in smaller hospitals, possibly because they perform more diverse tasks. Variations in spray use by hospital size and region suggest additional targets for future efforts to prevent occupational asthma. Am. J. Ind. Med. 60:131–140, 2017. © 2016 Wiley Periodicals, Inc.

Tubal Ligation, Hysterectomy, and Risk of Ovarian Cancer

Abstract: OBJECTIVE To assess whether tubal ligation and hysterectomy affect subsequent risk of ovarian cancer. DESIGN Prospective cohort study with 12 years of follow-up. SETTING United States, multistate. PARTICIPANTS A total of 121,700 female registered nurses who were 30 to 55 years of age in 1976; the follow-up rate was 90% as of 1988. MAIN OUTCOME MEASURE Ovarian cancer of epithelial origin confirmed by medical record review. RESULTS We observed a strong inverse association between tubal ligation and ovarian cancer, which persisted after adjustment for age, oral contraceptive use, parity, and other ovarian cancer risk factors (multivariate relative risk [RR], 0.33; 95% confidence interval [CI], 0.16 to 0.64). The association was similar when we assessed tubal ligation status at the baseline questionnaire and excluded cases in the first 4 years to eliminate any possible short-term decrease in risk due to screening of the ovaries during ligation surgery. We noted a weaker inverse association between simple hysterectomy and ovarian cancer (RR, 0.67; 95% CI, 0.45 to 1.00). Neither vasectomy nor condom use by a partner was associated with risk of ovarian cancer. CONCLUSIONS These data indicate that tubal ligation, and perhaps hysterectomy, may substantially reduce risk of epithelial ovarian cancer.

Late Breaking Abstract - Occupational exposure to disinfectants and COPD incidence in US nurses: a prospective cohort study

Abstract: Background: Exposure to disinfectants in healthcare workers has been associated with respiratory health effects, including asthma. Despite biological plausibility for an association between disinfectants (irritant chemicals) and COPD, available data are sparse. Aims: To investigate the association between exposure to disinfectants and incident COPD in a large cohort of US female nurses. Methods: The Nurses’ Health Study II is a prospective cohort of 116,430 female registered nurses enrolled in 1989. Analyses included 55,185 participants who were still in a nursing job and with no history of COPD in 2009 (baseline; mean age: 54 years). During ~8 years of follow-up (until May 2017), 663 nurses reported incident physician-diagnosed COPD. Occupational exposure was evaluated by questionnaire and a Job-Task-Exposure Matrix (JTEM). We examined the association between disinfectant exposure and subsequent COPD development, adjusted for age, smoking (pack-years), body mass index, race and ethnicity. Results: Using disinfectants to clean surfaces on a weekly basis (37% exposed) was associated with incident COPD (adjusted odds ratio [aOR], 95% CI: 1.22, 1.04-1.43). An association was suggested for weekly use of disinfectants to clean instruments (19% exposed; aOR: 1.18, 0.98-1.43). High level exposure to several specific disinfectants evaluated by the JTEM (glutaraldehyde, bleach, hydrogen peroxide, alcohol and quats) were significantly (p Conclusions: Results support a prospective association between exposure to disinfectants and higher COPD incidence in nurses. This novel hypothesis merits further investigation.