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职业健康丨护士患COPD？或许与消毒剂的使用不无关系！

原创 2017-10-25 翻译：赵博 SIFIC感染官微

检索：刘金淑
翻译：赵博

审核：刘金淑、陈志锦

研究表明，护士患COPD与经常使用消毒剂不无关系

根据在美国超过5.5万名护士中发现该疾病的新研究，经常使用消毒剂与诱发慢性阻塞性肺疾病（COPD）的较高风险相关。

法国维勒瑞夫岛国家健康与医学研究院的奥里安·杜马斯博士，欲将在欧洲呼吸学会的国际会议上阐述，由于消毒剂中存在的特殊化学物质，某些涉及到经常暴露于消毒剂的工作，如表面清洁消毒，与COPD发生风险增加22％-32％有关。

杜马和她的同事们分析了在1989年开始的美国护士健康研究II登记的55185名注册护士的数据。他们研究那些2009年未患COPD且一直从事护理工作的护士，对她们进行为期8年的追踪研究，直到2017年5月。在此期间，663名护士被诊断患有COPD。护士暴露于消毒剂的评估是通过问卷形式和工作或任务分配所建立的暴露模型进行。结果调整考虑了可能影响评估结果的因素，如吸烟、年龄、体重指数和种族等。

杜马斯说：“我们发现，经常使用消毒剂清洁表面的护士（至少每周使用一次）患COPD的风险增加了22%。但是建议每周使用消毒剂来清洁仪器在统计学上并没有意义。”

研究人员还研究了特定消毒剂的暴露：戊二醛(一种用于医疗器械的高效消毒剂)、漂白剂、过氧化氢、酒精和季铵盐类化合物(亦称为“季铵盐”，主要用于地板和家具等表面的低水平消毒)。所有这些都与患COPD的风险增加24%—32%有关。

杜马斯补充说：“在我们的研究中，37%的护士每周使用消毒剂清洁物表，19%的护士每周使用消毒剂清洁医疗器械。”

以往的研究已经将消毒剂与卫生保健工作者中的哮喘等呼吸问题联系起来。她接着说：“接触消毒剂对COPD的潜在不利影响受到的关注较少，尽管最近在欧洲的两项研究表明，保洁工作者患COPD的风险更高。但据我们所知，我们是首个报道医务工作者患COPD和使用消毒剂之间的联系，同时也对可能导致两者关联性的特定化学成分进行研究。我们的研究结果进一步证明了接触消毒剂对呼吸系统疾病的影响，并强调了将职业健康因素纳入医院等卫生保健机构清洁和消毒指导方案的紧迫性。这些都是初步的发现，还需要进行更多的研究。特别是，我们需要调查终身职业接触化合物对COPD的影响，并阐明每种特定消毒剂的作用。我们希望得到疾病和预防控制中心(CDC)的资助，以继续这项重要工作。其中一些消毒剂，如漂白剂和季铵盐，常用于普通家庭，而家用消毒剂对COPD发展的潜在影响尚不清楚。早期研究发现，哮喘和接触家用清洁产品和消毒剂有关系，例如漂白剂和喷雾剂，因此进一步的研究是非常重要的。”

杜马斯强调，因为这是一项观察性研究，研究结果并不能说明消毒剂引致COPD，只是有些消毒剂和该疾病的发展有关。

来源：欧洲肺基金会

原文

Study Says Nurses' Regular Use ofDisinfectants is Associated With Developing COPD

Regular use of disinfectants islinked to a higher risk of developing chronic obstructive pulmonary disease(COPD), according to new research looking at incidence of the disease in morethan 55,000 nurses in the U.S.

Orianne Dumas, PhD, from INSERM,Villejuif, France, will tell the European Respiratory Society InternationalCongress being held today that certain tasks involving frequent exposure todisinfectants, such as cleaning surfaces, and specific chemicals indisinfectants, were associated with a 22 percent to 32percent increased risk of developing COPD.

Dumas and her colleagues analyzed datafrom 55,185 female registered nurses enrolled in the U.S. Nurses' Health StudyII, which started in 1989. They looked at those nurses who were still in anursing job and with no history of COPD in 2009, and then followed them forapproximately eight years until May 2017. During that time 663 nurses werediagnosed with COPD. The nurses' exposure to disinfectants was evaluated via aquestionnaire and a matrix that assigns exposure to disinfectants by job ortask. The results were adjusted for factors that might affect the outcome, suchas smoking, age, body mass index and ethnicity.

"We found that nurses who usedisinfectants to clean surfaces on a regular basis - at least once a week - hada 22% increased risk of developing COPD," says Dumas. "There was asuggestion of a link with the weekly use of disinfectants to clean instrumentsbut this was not statistically significant."

The researchers also looked at exposureto specific disinfectants: glutaraldehyde (a strong disinfectant used formedical instruments), bleach, hydrogen peroxide, alcohol and quaternaryammonium compounds (known as "quats," mainly used for low-leveldisinfection of surfaces such as floors and furniture). All of these wereassociated with an increased risk of COPD of between 24 percent to 32percent.

"In our study population, 37percent of nurses used disinfectants to clean surfaces on a weekly basis and 19percent used disinfectants to clean medical instruments on a weeklybasis," Dumas says.

Previous studies have linked exposure todisinfectants with breathing problems such as asthma among healthcare workers."The potential adverse effects of exposure to disinfectants on COPD havereceived much less attention, although two recent studies in Europeanpopulations showed that working as a cleaner was associated with a higher riskof COPD. To the best of our knowledge, we are the first to report a linkbetween disinfectants and COPD among healthcare workers, and to investigatespecific chemicals that may underlie this association," she says."Our findings provide further evidence of the effects of exposure todisinfectants on respiratory problems, and highlight the urgency of integratingoccupational health considerations into guidelines for cleaning anddisinfection in healthcare settings such as hospitals. These are preliminaryfindings and more research needs to be carried out. In particular, we need toinvestigate the impact on COPD of lifetime occupational exposure to chemicalsand clarify the role of each specific disinfectant. We hope to receive fundingfrom the Centers for Disease Control and Prevention (CDC) to continue thisimportant work. Some of these disinfectants, such as bleach and quats, arefrequently used in ordinary households, and the potential impact of domesticuse of disinfectants on COPD development is unknown. Earlier studies have founda link between asthma and exposure to cleaning products and disinfectants athome, such as bleach and sprays, so it is important to investigate thisfurther."

Dumas emphasizes that, as this is anobservational study, the findings cannot show that disinfectants cause COPD, onlythat there is an association between some disinfectants and the development ofthe disease.

The Nurses' Health Study II iscoordinated at the Channing Division of Network Medicine, Brigham and Women'sHospital and Harvard Medical School, Boston.

Source: European Lung Foundation

图文编辑：小小牧童

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