Risk assessment and preventive strategies in professional cleaning
Krüger, D.; Louhevaara,V.; Nielsen,J.; Schneider,T.
Professional cleaning is a basic service occupation that is carried out world-wide and often employs ageing women with low occupational and educational status.
With support of the European Commission, a multidisciplinary 3-year project "Prevention of Health and Safety Risks in Professional Cleaning and the Work Environment" was established in 1996by four member states of the European Union (EU). The countries participating in the project are Denmark, Finland, Germany and Italy.
The prevalence of health problems is high among cleaners as compared to the average among wage earners in general. Studies on health, safety and ergonomic aspects of cleaning work have mainly been carried out in the Nordic countries. The results obtained indicate that cleaners have many work-related problems impairing their health and work ability: musculoskeletal complaints, skin problems and some psychosomatic disorders. The numbers of diseases increases rapidly from the age of 45 upwards.
The musculoskeletal complaints are associated with the constrained work positions, heavy lifting, monotonous work and the work pace. The skin problems are linked to the time spent doing wet work and with the use of cleaning agents. The psychosomatic disorders are connected to the work organization, the work pace and irregular working hours.
Since the 1980s professional cleaning work has been under intense rationalization to improve productivity and to save costs, and this trend is still on-going. Less attention has been paid to health and safety issues and ergonomic aspects of cleaning work.
In Finland, for instance, one out of every four female 50-year-old-cleaners proved to have least one cardiorespiratory disease, and almost 60% suffered from some musculoskeletal complaint.
In returns from a Danish questionnaire, more than 75% of cleaners reported some kind of a psychosomatic disorder, over half had musculoskeletal complaints, and a third spoke of skin problems.
A high prevalence of work-related disorders has been found among cleaners in many European countries, so that there is clearly a need for preventive strategies. However, sound scientific knowledge on exposure and acute response, and their causal relation to disorders, must be gathered before any forms of intervention can be implemented.
As was mentioned above, no studies have been carried out to date on the multiple effects on cleaning workers of the various parameters at the workplace, such as different tools, distinct methods, various cleaning agents and types of work organisation.
This lack of knowledge is a result of the research situation on a national level. Only small teams of researchers in certain European countries are committed to ergonomics and occupational medicine with specific reference to professional cleaning work.
This lack of interest in an occupation which is the second or third biggest employer of women in many European countries, has to led to a research deficit in this field.
The proposed project will attempt, within the framework of a European network, to develop a research approach for the kind of comprehensive risk assessment and prevention (cf. figure) that cannot currently be realized on a national level by the institutions concerned because of constraints on available research capacity in the respective countries.
The members of the network have been working on various specific risk factors in cleaning work for years.
The purpose of the EU-project thus is to improve scientific knowledge for risk assessment in cleaning and the work environment, as well as to provide preventive strategies. In order to achieve a comprehensive approach to the increase of health and safety protection for the cleaning workers, it is necessary to identify and to assess all the significant risk factors at the work place and to the environment. This includes research into the connection between risk factors and the etiology of diseases as well as control of risks with respect to preventive strategies.
When promoting health and safety in cleaning work it is necessary to evaluate various cleaning methods, tools, cleaning agents, the work organization, working hours, etiologic histories, medical findings, the quality of cleaning, indoor climate and the environmental impacts. Furthermore the multiple effects of these various dimensions on cleaners, environment and work output also need to be assessed.
The general aim of the first stage of the EU-project was to improve methods to identify and control risk factors in cleaning work.
First of all, review documents were to be prepared in 1996-1997 on various aspects of professional cleaning. Three major topics were considered important:
- Occupational health, individual capacities and work ability
- Ergonomics
- Chemical and physical exposure - quality of cleaning
The purpose of the topic occupational health, individual capacities and work ability was to collect and transfer knowledge by reviewing previous studies, literature and information from public registers, and to make a critical review by combining the information.
The purpose of this review was to contribute to a complete description of the work environment and occupational health and to provide an introduction of appropriate preventive strategies.
A broad spectrum of health problems was selected to describe the occupational health among cleaners:
skin symptoms and skin disorders, airways symptoms and lung disorders, cancer, reproductive failures, allergy, mental health and psychosomatic symptoms, musculoskeletal complaints and disorders. Further anthropometric values (height, weight, body mass index) and physical capacity are described. Literature about these subjects was collected from Medline and supplemented with studies from Germany, Finland, Sweden and Denmark which were known to the members of the concerted action project.
The previous studies based on questionnaires, laboratory examinations and work place studies characterize cleaning as an occupation dominated by heavy and physically hard work, and there are obvious risks of inducing physical and psychological problems. Much information on the occurence of symptoms is obtained through questionnaire studies. The studies often so not include a relevant control group. The one-year-prevalance of low back pain varies from 36-78%, for the neck/upper back from 49-84%, for the shoulder from 27-75%. Sick leave due to musculoskeletal complaints amounts to approximately 30% (Denmark) and even up to 49% (Germany) of all cleaners.
Musculoskeletal disorders are multicausal and previous studies point out that it is necessary to take physical, psychosocial and personal aspects into account as risk factors.
Irritative hand eczema is frequent in cleaning work. The point prevalance of hand eczema varies between 6% and 12% among cleaners. The proportion of irritative hand eczema ranges from 60-90%, whereas allergic hand eczema ranges from 20-30%. The risk factors of hand eczema are wet work, the number of children at home, and genetic factors (atopic dermatitis). Skin symptoms seem to arise relatively quick at the beginning of the employment period and they continue permanently or in sporadically periods.
A second topic of the EU-project deals with the ergonomics of professional cleaning work.
The current design of buildings, facilities and furniture, as well as cleaning tools, machines and methods is poor from the viewpoint of both ergonomics and productive and qualified cleaning. The risks related to psychosocial and physical work and the environment are common. Cleaners have little or no possibilitiy to influence their work and to develop in their occupational career. The cardiorespiratory and musculoskeletal load of cleaning work is high, and it produces a considerable risk of overstrain among women with low physical work capacity. Ergonomics is an essential element for the promotion of cleaners' work ability, health and well-being. Good work ability is also a basic prerequisite for high productivity and quality. Participatory ergonomics seems to be effective and feasible in producing constant improvements in cleaning equipment, methods and organization.
A broad spectrum of cleaning agents has been developed to facilitate removal of dust and dirt, for disinfection and surface maintenance. They are used in large quantities throughout the world. Only few surveys on cleaning agents have been performed, in spite of complex pattern of exposure to them and reported health problems, such as allergies and asthma among cleaning personnel.
So a third research area deals with cleaning agents and the impact of cleaning from the point of view of exposure of the cleaning personnel, occupants in the indoor environment, and quality of cleaning. Cleaning agents are usually grouped in different product categories according to their technical functions and purpose of use, i.e., disinfecting agents and surface care products.
The disinfecting agents are the most hazardous group of cleaning agents, but a new trend has become evident in adapting the composition of cleaning agents towards ecologically friendly ingredients, which meet the requirements of biodegradability and non- or minimum toxicity to aquatic organisms.
Cleaning agents contain evaporative and non-evaporative substances. The major constituent of the former is the volatile organic compounds (VOCs), defined as substances with boiling points in the range from above 0C to ca. 400C. While laboratory emission testing studies have shown a large number of different VOCs with quite different time-concentration profiles, few field studies have been carried out measuring the exposure of cleaning personnel. However, both field studies and emission testing indicate that the use of cleaning agents will result in temporal increase of the overall VOC level. This may occur during the cleaning process and thus enhance the probability of increased short-term exposure of the cleaning personnel, but also afterwards resulting in an overall increased VOCs in the indoor environment and possibly affect the indoor air quality (IAQ) perceived by the occupants. The variety and duration of the emissions depends inter alia on the use of fragrances and high boiling VOCs. Some building materials appear to increase their VOC emission by wet cleaning and thus may affect the IAQ.
Particles and dirt contain a great variety of both volatile and non-volatile substances, including allergens. While the volatile fraction may consist of more than 200 different VOCs including formaldehyde, the non-volatile fraction may contain considerable amounts (> 0.5%) fatty acid salts and tensides (e.g., linear alkyl benzene sulphonates). The level of these substances may be increased immediately after the cleaning process, but few studies are reported. The substances are partly originated from the use of cleaning agents. Both type of substances are suspected to be airway irritants.
Cleaning activities generate dust, mostly by resuspension, but other occupant activities may also resuspend dust and over longer periods of time. Personal sampling of VOCs and airborne dust gives higher results than stationary sampling. International bodies have proposed strategies for air sampling. The large variety of field sampling techniques for VOC and surface particle sampling is listed.
Few cases have been reported resulting in high complaint rates. This is probably due to excessive use of cleaning agents or incorrect dosage of the agent. No direct association between VOC exposure or particle exposure and increased complaint rate has been identified. Both the volatile substances and the non-volatile substances in particles are suspected to impact the perceived IAQ in the form of eye and airway irritation, in addition to skin problems.
Cleaning is a big enterprise involving a large fraction of the workforce worldwide. Cleaning agents comprise a great diversity of chemical substances, many of which are hazardous to human health or to the environment, and may deteriorate the IAQ. Thus it is of great importance to identify ways to improve the working and indoor environments, in addition to the development of methods which can document the quality of cleaning.
In the second stage of the EU-project field studies will be carried out in Denmark, Finland and Germany in collaboration with researchers of the three countries. In the intervention studies preventive strategies have to take the work environment in cleaning into account and must include
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