Impact of COVID-19 on disinfectant exposure and associated health effects.

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PROJECT SUMMARY/ABSTRACT Disinfectants are widely used in various products and in various settings to prevent infection and transmission of harmful pathogens. Disinfectants, however, contain hazardous chemicals and are known to cause irritation or allergic symptoms in eyes, skin, respiratory and nervous systems, asthma, and damage to organs with prolonged or repeated exposure. Quaternary ammonium compounds (QACs) are the most common active ingredients used in disinfectants approved for SARS-CoV-2 control. The coronavirus disease 2019 (COVID-19) pandemic led to dramatically increased use of disinfectants in the community and workplaces to prevent SARS-CoV-2 infection and transmission. Such increased use of disinfectants raises substantial concerns regarding the health effects of disinfectants. As for health risk by disinfectants, cleaning workers, particularly in healthcare settings, have been identified as occupational groups most affected by disinfectants. During the COVID-19 pandemic, with the heightened need for infection control in healthcare settings as well as increased use of disinfectants at home/community, these workers may have further increased health risks from disinfectant exposure. The purpose of this study is to assess the impact of the COVID-19 pandemic on disinfectant use and the incidence of disinfectant-related illness and examine the association between disinfectant exposure and health symptoms. We propose a study using three approaches: (1) Analysis of California Pesticide Illness Surveillance Program data (2011-2020) to investigate disinfectant-related illness cases in California. (2) A survey of 300 cleaning staff (predominantly Chinese and Hispanic) in a university health system in Northern California on disinfectant use and chemical-related health symptoms. (3) Measurement of two common QACs (benzalkonium chloride [BAC] and didecyl dimethyl ammonium chloride [DDAC]) in feces and urine in a subset of survey participants (n=100). The study has the following specific aims: (1) Characterize disinfectant-related illness cases in California during 2011-2020 and examine the trend of the annual incidence over time. (2) Characterize disinfectant use during COVID-19 among hospital cleaning staff and examine the relationship of disinfectant use with self-reported health symptoms. (3) Measure QACs (BAC/DDAC) in feces and urine among hospital cleaning staff and examine their associations with self- reported disinfectant use and health symptoms. This study will produce helpful information to assess the public health burden by the widely used disinfectants and the impact of COVID-19 on disinfectant exposure and health problems among the general population as well as the high-risk group of hospital cleaning staff. This study will be one of the first studies that measures and quantifies QACs in human samples to examine health effects. The biological data on QAC exposure among hospital cleaning staff will capture the body burden of disinfectant chemicals from both occupational and non-occupational exposures that increased during the COVID-19 pandemic, and will serve as a valuable foundation for analyses of longer-term health effects.