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Issues Of The Environment: Living With Increased Levels Of Disinfectants Through COVID-19 Crisis

May 13, 2020

Dr. Kenneth Rosenman, Chief of the Michigan State University Division of Occupational and Environmental Medicine.
Credit Michigan State University Department of Medicine / medicine.chm.msu.edu

Slowly, the economy is beginning to reopen.  All businesses will be required to conduct more stringent cleaning and sanitizing protocols to protect works and the public from COVID-19.  And, we will continue to use more of these products in our homes.  That means far more chemical exposure for all.  That, too, is a threat to public health.  In this week's "Issues of the Environment," WEMU's David Fair speaks to Dr. Kenneth Rosenman, chief of Michigan State University's Division of Occupational and Environmental Medicine, about the dangers, and measures we can take to mitigate health impacts.


Overview

  • The majority of products used to disinfect against COVID-19 that meet EPA’s criteria for use against SARS-CoV-2, the cause of COVID-19, contain the active ingredient Quaternary ammonium.  Others contain mixtures of Hydrogen Peroxide; Peroxyacetic Acid, Isopropanol, Ethanol, Sodium hypochlorite, Octanoic acid, Phenolic, Triethylene glycol, L-Lactic Acid, Glycolic Acid, or Dischloroisocyanurate dihydrate.

 

  • Certain of these compounds, particularly the most common--Quaternary ammonium and Sodium hypochlorite (bleach)-- have been studied and shown to have negative health effects when used regularly. Longitudinal research has looked specifically at exposure to glutaraldehyde, bleach, hydrogen peroxide, alcohol and quaternary ammonium compounds (quats).  All of these were associated with an increased risk of COPD of between 24% and 32%.  They also contribute to poor indoor air quality that can aggravate asthma in children.  QUATs have also been shown to possibly cause fertility issues in men

 

  • According to EPA, fetuses and very young children are particularly sensitive to the effects of toxic chemicals.  During early development, growth is rapid and organs, especially the brain, are developing.  In the US, researchers estimate that 5% of childhood cancer and 30% of childhood asthma are related to chemical exposures.  Best practices for using chemical sanitizers when they are needed, include rinsing items with water and drying them after the chemicals are applied, according to the EPA. (https://www.epa.gov/sites/production/files/documents/ece_curriculumfinal.pdf)

 

  • Dr. Kenneth Rosenman, Chief, Division of Occupational and Environmental Medicine for Michigan State University, studies the effects of chemicals and their connection to health.  He will discuss the balance between using disinfectants with possible health consequences, and the importance of disinfecting during the global pandemic, COVID-19.  Dr. Rosenman is an expert in the field of occupational and environmental health.  He mentioned that some of the health disparities seen between African Americans and other races in terms of fatalities from COVID-19 might be confounded by the fact that this group already has a higher rate of exposure to chemical hazards in the workplace. 

Disinfectant Approved for COVID-19

List N includes products that meet EPA’s criteria for use against SARS-CoV-2, the cause of COVID-19.  When purchasing a product, check if its EPA registration number is included on this list.  If it is, you have a match and the product can be used against SARS-CoV-2.  You can find this number on the product label – just look for the EPA Reg. No.  These products may be marketed and sold under different brand names, but if they have the same EPA registration number, they are the same product.

This list includes products with emerging viral pathogen claims and those with human coronavirus claims. If a product with an emerging viral pathogen claim is not available, use a product with a coronavirus claim. If the product is listed as “N” under the Emerging Viral Pathogen Claim column, then it has a human coronavirus claim. (Source: *directly quoted* https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2)

Health Risks of Common Disinfectants

Regular Use of Disinfectants Linked to Lung Disease

A US longitudinal study has linked the regular use of disinfectants, such as bleach and glutaraldehyde, to a higher risk of developing progressive lung diseases.

The research by Harvard University and the French National Institute of Health and Medical Research (Inserm) analysed data from more than 55,000 nurses in US hospitals, which it followed for eight years, from 2009 until 2017.

During that time, 663 nurses were diagnosed with chronic obstructive pulmonary disease (COPD).  Those who used disinfectants to clean surfaces at least once a week had a 22% increased risk of developing the illness, the study found.

The researchers looked specifically at exposure to glutaraldehyde, bleach, hydrogen peroxide, alcohol and quaternary ammonium compounds (quats).  All of these were associated with an increased risk of COPD of between 24% and 32%.

"In our study population, 37% of nurses used disinfectants to clean surfaces on a weekly basis and 19% used disinfectants to clean medical instruments on a weekly basis," Orianne Dumas from Inserm told the European Respiratory Society International Congress, when presenting the study there on 10 September.

The findings, she said, "provide further evidence of the effects of exposure to disinfectants on respiratory problems, and highlight the urgency of integrating occupational health considerations into guidelines for cleaning and disinfection in healthcare settings, such as hospitals".

Industry reaction

In response to the study, the American Cleaning Institute said it agrees with Dr. Dumas' statement on the importance of occupational health considerations, in order to minimise exposures to healthcare workers and patients alike.  But the trade body emphasised that ingredients in disinfectant products are registered with the US EPA and safe when used as intended.

"Indeed, we cannot underestimate the importance of proper disinfection in healthcare settings to address the growing problem of hospital-acquired infections, and the critical role of nurses in delivering that service," said the ACI's Paul DeLeo.

Dr. DeLeo added that it is difficult to assess the findings in-depth because the research has not yet been published.  European soap and detergents trade body, Aise, also said it is too soon to comment on the study's results, but added that, while disinfectants play a critical role in healthcare, their safe use is essential and personnel should undergo formal training.

According to Dr. Dumas, this is the first study to report a link between disinfectants and COPD among healthcare workers.  Earlier studies have found a link between asthma and exposure to cleaning products and disinfectants in household settings.

More research is needed, she said, to clarify the role of each specific disinfectant.  Inserm is hoping for more funding from the US Centers for Disease Control and Prevention to continue this work. (Source: *directly quoted* https://chemicalwatch.com/biocideshub/58685/us-study-links-regular-disinfectant-use-to-lung-disease)

Fertility 

Common ingredients in the cleaning sprays for your kitchen and bathroom make mice less fertile, suggesting the compounds could do the same to humans, according to a new study.  Health researchers are concerned about specific chemicals used in cleaners—including popular brands like Lysol, Clorox, and Simple Green—called quaternary ammonium compounds, used to kill microorganisms. Recent laboratory work from Virginia Tech University scientists found that when mice are exposed, both males and females have some unsettling impacts, such as weaker sperm and decreased ovulation.  Industry representatives have pushed back on the research, saying federal agencies deem the chemicals safe and that mice were exposed to unrealistically high levels. (Source: *directly quoted* https://www.scientificamerican.com/article/germ-killing-bathroom-sprays-appear-to-weaken-fertility/)

Children are more sensitive to the health effects of toxic chemicals

Fetuses and very young children are particularly sensitive to the effects of toxic chemicals. During early development, growth is rapid and organs, especially the brain, are developing.  In the US, researchers estimate that 5% of childhood cancer and 30% of childhood asthma are related to chemical exposures. The President’s Cancer Panel noted in 2010, “the true burden of environmentally induced cancer has been grossly underestimated.”

Health effects from exposure to toxic chemicals may not show up for years or even decades.  Unlike adults, children have many years to develop illnesses caused by early exposures to toxic chemicals.  It is important to practice the “precautionary principle” and protect children from potential health effects, even if some cause and effect relationships are not yet fully proven.

Many new products are marketed with terms such as “green” to make the public think they are safer.  However, there is no legal definition of these terms, and when they are used on a product label, they do not assure that a product is safe.  Fortunately, there are independent organizations and government agencies working to review cleaning products in order to identify products that are effective and safer for human health, wildlife, and the environment. 

Best Practices for Sanitizing

Best practices for using chemical sanitizers when they are needed, include rinsing items with water and drying them after the chemicals are applied, according to the EPA.  For more information visit: (https://www.epa.gov/sites/production/files/documents/ece_curriculumfinal.pdf)

CDC Guidelines for Disinfectant Use Against COVID-19

There is much to learn about the novel coronavirus that causes coronavirus disease 2019 (COVID-19).  Based on what is currently known about the novel coronavirus and similar coronaviruses that cause SARS and MERS, spread from person-to-person with these viruses happens most frequently among close contacts (within about 6 feet).  This type of transmission occurs via respiratory droplets.  On the other hand, transmission of novel coronavirus to persons from surfaces contaminated with the virus has not been documented. Transmission of coronavirus occurs much more commonly through respiratory droplets than through fomites.  Current evidence suggests that novel coronavirus may remain viable for hours to days on surfaces made from a variety of materials.  Cleaning of visibly dirty surfaces followed by disinfection is a best practice measure for prevention of COVID-19 and other viral respiratory illnesses in households and community settings.

Purpose

This guidance provides recommendations on the cleaning and disinfection of households where persons under investigation (PUI) or those with confirmed COVID-19 reside or may be in self-isolation.  It is aimed at limiting the survival of the virus in the environments.  These recommendations will be updated if additional information becomes available.

These guidelines are focused on household settings and are meant for the general public.

  • Cleaning refers to the removal of germs, dirt, and impurities from surfaces.  Cleaning does not kill germs, but by removing them, it lowers their numbers and the risk of spreading infection.
  • Disinfecting refers to using chemicals to kill germs on surfaces.  This process does not necessarily clean dirty surfaces or remove germs, but by killing germs on a surface after cleaning, it can further lower the risk of spreading infection.

General Recommendations for Routine Cleaning and Disinfection of Households

Community members can practice routine cleaning of frequently touched surfaces (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks) with household cleaners and EPA-registered disinfectants that are appropriate for the surface, following label instructions.  Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves and making sure you have good ventilation during use of the product.

General Recommendations for Cleaning and Disinfection of Households with People Isolated in Home Care (e.g. Suspected/Confirmed to have COVID-19)

  • Household members should educate themselves about COVID-19 symptoms and preventing the spread of COVID-19 in homes.
  • Clean and disinfect high-touch surfaces daily in household common areas (e.g. tables, hard-backed chairs, doorknobs, light switches, remotes, handles, desks, toilets, sinks)
    • In the bedroom/bathroom dedicated for an ill person: consider reducing cleaning frequency to as-needed (e.g., soiled items and surfaces) to avoid unnecessary contact with the ill person.
      • As much as possible, an ill person should stay in a specific room and away from other people in their home, following home care guidance.
      • The caregiver can provide personal cleaning supplies for an ill person’s room and bathroom, unless the room is occupied by child or another person for whom such supplies would not be appropriate.  These supplies include tissues, paper towels, cleaners and EPA-registered disinfectants (examples at this link
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      • If a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person.  If this is not possible, the caregiver should wait as long as practical after use by an ill person to clean and disinfect the high-touch surfaces.
  • Household members should follow home care guidance when interacting with persons with suspected/confirmed COVID-19 and their isolation rooms/bathrooms.

How to clean and disinfect:

Surfaces

  • Wear disposable gloves when cleaning and disinfecting surfaces. Gloves should be discarded after each cleaning.  If reusable gloves are used, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be used for other purposes.  Consult the manufacturer’s instructions for cleaning and disinfection products used.  Clean hands immediately after gloves are removed.
  • If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection.
  • For disinfection, diluted household bleach solutions, alcohol solutions with at least 70% alcohol, and most common EPA-registered household disinfectants should be effective.
    • Diluted household bleach solutions can be used if appropriate for the surface. Follow manufacturer’s instructions for application and proper ventilation.  Check to ensure the product is not past its expiration date.  Never mix household bleach with ammonia or any other cleanser.  Unexpired household bleach will be effective against coronaviruses when properly diluted.
      • Prepare a bleach solution by mixing:
        • 5 tablespoons (1/3rd cup) bleach per gallon of water or
        • 4 teaspoons bleach per quart of water
    • Products with EPA-approved emerging viral pathogens claims
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    •  are expected to be effective against COVID-19 based on data for harder to kill viruses.  Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.).
  • For soft (porous) surfaces such as carpeted floor, rugs, and drapes, remove visible contamination if present and clean with appropriate cleaners indicated for use on these surfaces.  After cleaning:
  • Launder items as appropriate in accordance with the manufacturer’s instructions.  If possible, launder items using the warmest appropriate water setting for the items and dry items completely, or
    Use products with the EPA-approved emerging viral pathogens claims (examples at this link
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  • that are suitable for porous surfaces.

 Clothing, towels, linens and other items that go in the laundry

  • Wear disposable gloves when handling dirty laundry from an ill person and then discard after each use.  If using reusable gloves, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be used for other household purposes. Clean hands immediately after gloves are removed.
    • If no gloves are used when handling dirty laundry, be sure to wash hands afterwards.
    • If possible, do not shake dirty laundry.  This will minimize the possibility of dispersing virus through the air.
    • Launder items as appropriate in accordance with the manufacturer’s instructions.  If possible, launder items using the warmest appropriate water setting for the items and dry items completely.  Dirty laundry from an ill person can be washed with other people’s items.
    • Clean and disinfect clothes hampers according to guidance above for surfaces.  If possible, consider placing a bag liner that is either disposable (can be thrown away) or can be laundered.

Hand hygiene and other preventive measures

  • Household members should clean hands often, including immediately after removing gloves and after contact with an ill person, by washing hands with soap and water for 20 seconds.  If soap and water are not available and hands are not visibly dirty, an alcohol-based hand sanitizer that contains at least 60% alcohol may be used.  However, if hands are visibly dirty, always wash hands with soap and water.
  • Household members should follow normal preventive actions while at work and home including recommended hand hygiene and avoiding touching eyes, nose, or mouth with unwashed hands.
    • Additional key times to clean hands include:
      • After blowing one’s nose, coughing, or sneezing
      • After using the restroom
      • Before eating or preparing food
      • After contact with animals or pets
      • Before and after providing routine care for another person who needs assistance (e.g. a child)

Other considerations

Kenneth Rosenman

Kenneth Rosenman, MD, is an expert in the health effects of chemicals (i.e. solvents), metals (i.e. lead) and mineral dusts (i.e. asbestos and silica) both in the workplace and environment.  He has an active research program in occupational and environmental disease with particular interest in pulmonary disease. He has published approximately 205 articles on occupational and environmental disease.  In conjunction with Michigan OSHA and the Michigan Health Department he tracks the occurrence of work-related asthma, acute work-related traumatic fatalities, acute pesticide disease, noise-induced hearing loss, silicosis, blood and urine arsenic, cadmium, lead and mercury levels, serum and red cell cholinesterase levels and asthma deaths in the young.  Under the direction of Dr. Rosenman, the Occupational and Environmental Medicine division's research has resulted in a major impact on patients, communities, and the nation’s regulatory scene.  Notable successes include innovative ways to keep track of occupational / environmental injuries and illnesses, and initiate interventions to prevent these conditions from occurring in others.

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— David Fair is the WEMU News Director and host of Morning Edition on WEMU.  You can contact David at 734.487.3363, on twitter @DavidFairWEMU, or email him at dfair@emich.edu