Calls made to the Poisons Information Centre reveal need for improved risk management of cleaning agents in the workplace

Figures & data

Table 1. Overview of number of cases concerning incidents with cleaning agents and disinfectants during the follow-up period, number that received a request to share contact details for further information about study participation and number of cases for which interviews were conducted.

Caller	Total	Initial request	Interviewed
Public	118	38†	16
Ambulance	3	n/a	n/a
Health care	21	1‡	1

†The number of initial requests/case summary requests may be larger as potentially not all PIC experts logged their requests if denied by the caller. In addition, the PIC experts might have refrained from making/forgotten to make an initial request due to stressful periods in the telephone service, as well as not systematically logged cases for which a request would delay first aid measures.

‡Contact mediated though health care was possible in one case, but was not an intended route for recruitment.

Note: n/a = not applicable; PIC = Poisons Information Centre.

Figure 1. Number of occupational cases and number of cases involving cleaning products, registered by the Swedish Poisons Information Centre for the period 2010–2014.

Table 2. Overview of occupational cases involving cleaning agents and disinfectants recorded by the Swedish PIC for adults during 2010–2014: number of cases and proportion of minor, moderate and risk cases (%).

		Assessed risk†			Exposure route‡					Category of hazardous chemicals^§						Gender^a
Case	Sum	Minor	Mod.	Major	Eye	Skin	Inhal.	Oral	Sev.	Alkali	Acids	Alc. and glycols	Tensides	Hypochlorite	Quat. amm.	F	M
Product group
Professional cleaning agents^b	421	23	187	202	248	80	33	34	26	334	28	–	1	–	–	148	263
Cleaning products	326	64	162	83	186	38	53	38	9	114	24	22	17	–	2	130	192
Dishwasher detergent	249	16	94	136	154	39	13	30	12	223	4	–	–	–	–	128	117
Disinfectant	190	43	99	45	128	25	27	4	6	2	–	50	–	–	63	127	59
Hand sanitizer	148	61	87	0	145	1	–	2	–	–	–	148	–	–	–	128	16
Oven and grill cleaner	141	9	60	71	76	32	15	8	10	121	–	–	–	–	–	70	70
Descaling agent	132	19	72	41	79	6	16	30	1	–	131	–	–	–	–	89	40
Bleach	111	24	62	22	34	13	48	10	6	1	–	–	–	97^c	–	53	54
Caustic soda/drain cleaner	86	9	45	32	14	44	22	4	1	84	–	–	–	–	–	16	67
All purpose cleaner	65	27	35	2	49	–	7	8	1	–	–	–	50	–	1	47	18
Chlorine gas^d	25	3	14	8	–	–	25	–	–	–	–	–	–	–	–	10	15
Laundry detergent	25	4	15	6	19	1	3	1	1	10	–	–	5	–	–	10	15
Dishwashing liquid	24	14	9	1	20	–	1	3	–	–	–	–	24	–	–	15	9
Sanitary cleaner	23	4	8	10	18	–	3	1	1	3	13	–	3	–	–	16	7
Rinse aid	17	4	10	1	16	–	–	1	–	–	5	–	–	–	–	7	10
Sum	1983	324	959	660	1186	279	266	174	74	892	205	220	100	97	66	994	952
Risk
Minor† (%)	16	–	–	–	14	9	27	32	9	5	12	42	47	23	8	20	13
Moderate† (%)	48	–	–	–	43	61	61	48	49	42	51	58	52	57	50	51	46
Major† (%)	33	–	–	–	42	29	9	16	42	52	37	0	1	18	42	27	39

†PIC experts’ judgement based on described exposures and symptoms. Does not include 40 cases logged as ‘undetermined risk’.

‡Excludes four cases where other exposure routes were involved (one nasal, three unknown).

^§Only includes categories with more than 50 cases.

^aExcludes 37 cases for which gender was not recorded.

^bProfessional cleaning agents are logged as such by the PIC and cover floor, kitchen and other surface cleaning products.

^cHypochlorite-containing bleaches are also alkaline (pH 11–12) as sodium hydroxide is used to slow the decomposition of sodium hypochlorite.

^dChlorine gas formed from mixing of hypochlorite and acid cleaning products.

Note: Alc. = alcohols; F = female; Inhal. = inhalation; M = male; Mod. = moderate; PIC = Poisons Information Centre; Quat. amm. = quaternary ammonium compound; Sev. = several.

Figure 2. Relative frequency of risk categories as judged by the Poisons Information Centre expert on calls stacked to 100% for each hour starting with 00:00–00:59 (left axis) and total number of occupational cases involving cleaning agents per hour for the years 2010–2014 (bars, right axis).

Table 3. Overall comparison between the datasets covered in the present study.

Variable	2010–2014 (%)	2016 follow-up (%)	Retrospective vs follow-up (χ^2)†	% of interview cases (number)
Health care callers	22	18	${\chi }_{N=2125,df=1}^2$ = 2.61, p = 0.11	6 (1)‡
Callers from the public recommended to seek health care	53	54	${\chi }_{N=1650,df=1}^2$ = 0.09, p = 0.76	53 (9)
Minor risk cases	16	21	${\chi }_{N=2085,df=2}^2$ = 4.95, p = 0.08	12 (2)
Moderate risk cases	48	53	–	65 (11)
Major risk cases	33	26	–	24 (4)
Eye exposures	60	61	${\chi }_{N=2121,df=4}^2$ = 3.10, p = 0.54	71 (12)
Inhalation exposures	13	9	–	12 (2)
Skin exposures	14	16	–	12 (2)
Oral exposures	9	8	–	6 (1)
Several exposure routes	4	6	–	0 (0)
Male exposed	48	47	${\chi }_{N=2085,df=1}^2$ = 0.03, p = 0.87	59 (10)
Female exposed	50	51	–	41 (7)

†Numbers do not always sum to 100% since not all cases are covered by tabulated categories, e.g., unknown gender or undetermined risk.

‡In one case, request for participation was forwarded to the exposed individual by a health care professional.

Note: Total number of cases: 2010–2014, N = 1983; follow-up period, N = 142; interview cases, n = 17.

Table 4. Overview of interview cases, based on participants’ description of what happened and corresponding records from the Swedish PIC.

Description	Chemical hazard	Route of exposure	Risk†	Workplace‡	Exp. user	Protective equipment	SDS^§	First aid rinse	Health care^a	Lost days^b
Non-intended squirt from spray applicator after use	Alkali	Eye	Mod.	Restaurant	Yes	No	Online	At once	No	0
A hose detached from the mechanical cleaning equipment during use and the exposed forgot to stop the machine before reattaching the hose	Alkali	Eye	Mod.	Dairy	Yes	No	On site	Delayed	Yes^c	1–3
During service of commercial dishwasher, squirt from dosing hose inside machine	Acid	Eye	Mod.	Restaurant	Yes	No	Phone	At once	No	0
Splash while carrying the mixed product up a ladder	Quat.	Eye	Mod.	Constr./main.	Yes	No	Phone	Delayed	Yes	0
Splashed while product was dosed into a tub	Alkali	Eye	Maj.	Restaurant	Yes	No	Label	At once	Yes	0
Descaled commercial dish washer, looked inside to see if programme was finished	Acid	Eye	Min.	Restaurant	Yes	No	Label	At once	No	0
Squirt when demounting spray applicator	Quat.	Eye	Mod.	Restaurant	Yes	No	No	At once	No	0
Dropped measure cup while dosing	Alkali	Eye	Maj.	Cinema	Yes	Gloves	Label	At once	Yes	1–3
Performed above-head spray application	Alkali	Eye	Mod.	Constr./main.	Yes	Glasses	Label	At once	Yes^c	0
Used a wall-mounted bottle of hand sanitizer	Alcohols	Eye	Maj.	Health care	Yes	n/a	n/a	At once	No	0
Dropped canister with concentrated product while dosing	Alkali	Eye and skin	Mod.	Pool	Yes	No	On site	At once	Yes^c	>14
Non-empty canister had been thrown into garbage. When taking the garbage out, product leaked onto hands, followed by eye contamination	Alkali	Eye and skin	Maj.	Restaurant	Yes	Non use	On site	At once	Yes	0
Pump to spray applicator broke and product splashed	Alkali	Eye and skin	Maj.	Restaurant	Yes	No	Label	At once	Yes^c	0
Leaking canister was left out in kitchen (dedicated storage room available). Shoe was soaked	Alkali	Skin	Mod.	Restaurant	Yes	Non use	On site	At once	Yes^c	0
Sprayed large amounts inside a small closed room	Acid	Inhalation	Mod.	Health care	No	n/a	n/a	n/a	No	0
One acidic and one hypochlorite containing cleaning agent mixed in the sewage water forming chlorine gas	Chlorine	Inhalation	Mod.	Dairy	n/a	Non use	On site	n/a	No	0
Product was stored in an unlabelled bottle, was mistaken for water bottle	Gly. eth.	Oral	Mod.	Cleaning	Yes	Non use	Label	n/a	Yes	0

†PIC experts’ judgement based on described exposures and symptoms.

‡Restaurants also include caterers.

^§Interview participants’ answers regarding if and how (e.g., online, over telephone to main office) SDSs or (perceived) corresponding information were available.

^aWhether health care was recommended by the PIC; all participants also followed this recommendation.

^bIn addition to potential lost day/hours on day of acute exposure.

^cOne or more follow-up visits after first visit to health care.

Note: Constr./main. = construction/maintenance; Exp. user = experienced user, Gly. eth. = glycol ether; Label = labelling on package; Maj. = major; Min. = minor; Mod. = moderate; n/a = not applicable/not required; Non use = exposure was not in connection to use of the cleaning agents; PIC = Poisons Information Centre; Quat. = quaternary ammonium compounds; SDS = safety data sheet.