Development of a Job-Task-Exposure Matrix for disinfecting and cleaning chemicals in French healthcare workers
Résumé
Objective: Occupational exposure to disinfectants and cleaning products in healthcare workers raise health concerns. The improvement of exposure assessment methods for specific chemicals is still needed, as there is only one Job-Task-Exposure Matrix (JTEM) among nurses. In the French population-based cohort CONSTANCES, we investigated exposures to specific chemicals by healthcare workers with the aim of creating a JTEM. Methods: Participants from the French cohort CONSTANCES identified as healthcare or laboratory workers at inclusion (2012-2020) were invited in 2022 to respond to a questionnaire about the frequency of cleaning tasks and chemicals used at work (current/last held job). Weekly use of 10 chemicals was described across combinations of 12 jobs and 8 tasks. Results: Among 5037 healthcare/laboratory worker respondents, nursing (43%) was the most common job, followed by nursing assistants (17%) and physicians (16%). Cleaning surfaces (64%), medical instruments (56%) and other medical equipment (52%) were the most commonly reported tasks. Quaternary ammonium compounds (QAC), alcohol and glutaraldehyde were the most commonly reported chemicals used weekly, by 71, 42 and 20% of participants respectively. QAC and alcohol were reported in every job-task category involving at least one task. Overall, cleaning endoscopes and operating rooms were tasks for which, across jobs, chemical use most differed, especially with a weekly use of ortho-phthalaldehyde, peracetic and acetic acids by 10-28% of participants (chemicals otherwise rarely used). Conclusion: Using data from this broad population of healthcare workers, including nurses, with a diversity of cleaning tasks, we were able to identify chemicals commonly used in a combination of jobs/tasks. The JTEM will aim to minimize exposure misclassification in order to provide a more accurate assessment of health effects of specific chemicals.