Development of a job-task-exposure matrix to assess occupational exposure to disinfectants among US nurses.
Development of a job-task-exposure matrix to assess occupational exposure to disinfectants among US nurses.
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DOI：
10.1136/oemed-2016-103606
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发表时间：
2017-02
影响因子：
4.9
通讯作者：
Le Moual N
中科院分区：
文献类型：
--
作者：
Quinot C;Dumas O;Henneberger PK;Varraso R;Wiley AS;Speizer FE;Goldberg M;Zock JP;Camargo CA Jr;Le Moual N
消毒剂的职业暴露与工作相关性哮喘有关，尤其是在医护人员中。然而，对所涉及的具体产品知之甚少。为了评估消毒剂暴露，我们设计了工作暴露（JEM）和工作任务暴露（JTEM）矩阵，这被认为比自我报告的暴露更不容易出现差异误分类偏倚。然后，我们比较了三种评估方法：自我报告暴露，JEM和JTEM。通过职业问卷对9，073名年龄在49-68岁之间、无哮喘的美国女性注册护士的消毒剂使用情况进行了评估，这些护士来自护士健康研究II。根据8个护理工作中7种消毒剂和喷雾剂的自我报告使用频率（1-3，4-7天/周）创建JEM。然后，我们创建了一个JTEM，将作业和消毒任务结合起来，以进一步减少错误分类。使用产品特定临界值（例如，对于酒精，分别为<30%、30- 49.9%、≥ 50%）;根据每个工作/任务的自我报告暴露分布定义临界值。最常报告的消毒剂是酒精（用途：39%）、漂白剂（22%）和喷雾剂（20%）。更多的护士被归类为高度暴露的JTEM（酒精41%，喷雾剂41%，漂白剂34%）比JEM（分别为21%，30%，26%）。对于大多数消毒剂，JEM和JTEM之间的一致性为公平至中等（kappa：0.3-0.5）。JEM和JTEM暴露估计在大多数护理工作中是异质的，除了急诊室和教育/管理。JTEM可以提供比JEM更准确的估计，特别是对于具有异构任务的护理工作。使用JTEM可能会减少暴露错误分类。
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. Disinfectant use was assessed by an occupational questionnaire in 9,073 U.S. female registered nurses without asthma, aged 49–68 years, drawn from the Nurses’ 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 (e.g., <30%, 30–49.9%, ≥50%, respectively, for alcohol); the cut-offs were defined from the distribution of self-reported exposure per job/task. 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 (kappa: 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. 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.