VOCs in Cleaning/Sanitizing Products and Health
During cleaning and/or sanitizing work, consumers commonly use more than one product. Complex mixtures of VOCs may be created when multiple consumer products are used while cleaning/sanitizing. Consumers also commonly use products with complex formulations – such as combination products that are both cleaners and sanitizers – or they may use products with multiple ingredients formulated for purposes such as dusting or polishing.
A substantial number of scientific studies now have found that chemicals, including VOCs, emitted from cleaning and sanitizing products may have health effects, primarily in those using the products professionally, but also in those doing domestic cleaning in their own homes. Published reviews of the scientific literature have found that cleaning work, including professional use of cleaning or sanitizing products and domestic use of cleaning or sanitizing sprays, is associated with increased risk of new-onset asthma and other respiratory effects [1, 2]. Cleaning sprays, chlorine bleach, and other disinfectants showed strong associations, although the mechanisms are not yet clear, and may include both specific sensitization and irritant effects.
Recent studies in workers have provided additional evidence for this link. Vizcaya et al. [3] found that cleaning work in buildings with high cleaning standards and demands for disinfection were associated with higher risk of asthma symptoms. A study of the development of new asthma related to occupational exposures found increased asthma risk in workers with an acute inhalation event that caused symptoms while mixing cleaning products [4]. Arif et al. [5] found that longer employment in jobs using cleaning agents and disinfectants/sterilants was associated in a dose-related manner to risk of work-related asthma and respiratory symptoms. Several groups of cleaning or sanitizing products were associated with increased risks of respiratory effects, including bleach, cleaners/abrasives, toilet cleaners, detergents, and ammonia; and glutaraldehyde/ortho-phtaldehyde, chloramines, and ethylene oxide. In a study of female hospital workers, exposure to specific cleaning materials were associated with increases in current asthma: decalcifiers, ammonia, and sprays of at least moderate intensity [6]. Lillienberg et al. [7] reported, from a northern European study of occupational asthma, the job category of “cleaners or building caretakers” was associated with among the highest risk of new onset asthma (expressed as “hazard ratios” or HR), with significantly increased HRs for new asthma: 2.6 in men and 1.9 in women, with HRs higher among non-atopics: 3.9 in men and 2.8 in women.
Regarding domestic cleaning, an earlier study had found that a high frequency of using spray products during household cleaning (especially glass-cleaning and furniture sprays and air freshening sprays) was associated with a 40% increase in wheeze, a 50% increase in asthma symptoms or medication use, and approximately a 100% increase in incidence in physician-diagnosed asthma [8]. Recent studies have provided additional evidence on the relationships between domestic cleaning and respiratory health. Le Moual [9] reported that the common use of household cleaning sprays was positively associated with a high asthma symptom score, current asthma, and poorly-controlled asthma in females. Henderson et al. [10] found that higher domestic chemical exposure during pregnancy was associated with persistent wheeze and lung function abnormalities in nonallergic children. This may have resulted from pre-natal effects or irritant effects on the airway after birth. Mehta et al. [11] reported that, especially in older women, long-term frequent use of cleaning sprays, air freshening sprays, and scented products was associated with reduced heart rate variability, suggesting an increased risk of cardiovascular health hazard. This effect was seen mainly in those with preexisting pulmonary conditions such as obstructive lung disease [11]. Bello et al. [12] demonstrated that airborne VOC and ammonia from short-term cleaning can remain in the air for extended periods, resulting in possible exposures to others present soon after.
Chlorine bleach is a common biocide or sanitizing agent. It is not considered a cleaning agent, although it can lighten stains. Because it is not effective in removing soiling or mold, soiled surfaces must be pre-cleaned before chlorine bleach is used as a sanitizer. Chlorine bleach is also commonly found in combination cleaning/sanitizing products which may emit multiple VOCs.
Although use of products containing chlorine bleach has been repeatedly associated with adverse respiratory effects such as increased asthma, limited evidence suggests a possible mixed effect from use of bleach. A study of domestic use of bleach in one’s own household [13] found people who use hypochlorite bleach were less likely to be allergic (with a dose-related decrease in risk of allergic sensitivities) but more likely to have respiratory symptoms, especially with frequent bleach use. The authors documented that the use of bleach was not associated with reduced indoor allergen concentrations. Nickmilder et al. [14] found that children in houses in which bleach products were used at least once per week had a reduced risk of asthma, eczema, or allergies, although their risk of recurrent bronchitis was increased in the presence of parental smoking due to an apparent interaction between the use of bleach and smoking.
Large numbers of adverse respiratory effects from the use of chlorine bleach have been documented (for instance, see the EPA report on Flood-Related Cleaning at http://www.epa.gov/iaq/pdfs/flood-related_cleaning_report.pdf, page 32).
Summary
There is substantial evidence that individuals who do cleaning as their work have an increased risk of adverse respiratory health effects and asthma. There is limited evidence that increased non-occupational (home owner) use of household cleaning sprays increases the risks of the same health effects. Because cleaning activities will often simultaneously increase exposures to VOCs and other pollutants, the links of cleaning work to adverse respiratory health effects are not necessarily a consequence of cleaning-related exposures to VOCs.
7. Lillienberg, L., et al., Occupational exposure and new-onset asthma in a population-based study in Northern Europe (RHINE). Ann Occup Hyg, 2012. 57(4): p. 482-92. DOI: 10.1093/annhyg/mes083