A57-16 Occupational Health Tradeoffs at the Heart of Hospital Surface Hygiene: Occupational Asthma vs. Occupational Infection and Patient Healthcare-Associated Infections

Rationale

There is > 40 years of evidence demonstrating increased risks of work-related asthma among healthcare workers from exposures to cleaning, disinfection, and sterilization products. As cleaning and disinfection protocols intensify to combat healthcare associated infections, more research is needed to balance occupational health tradeoffs. The study objective was to use behavioral economics to characterize tradeoff choices around cleaning and disinfection among registered nurses (RNs). This approach represents a novel environmental health shift: addressing how competing risks influence risk-based decision-making.

Methods

RNs were recruited from the Nevada State Board of Nursing Listserv in 2025, and recruitment is ongoing. A risk-risk tradeoff survey was developed in which participants are asked to consider hypothetical scenarios related to risks they face for: 1) occupational asthma from cleaning and disinfection, 2) occupational influenza infection for themselves from contaminated surfaces and 3) healthcare-associated influenza infections for their patients from contaminated surfaces. Nurses were presented with two competing risks in a baseline setting and then were asked whether they would prefer to transfer to a healthcare environment where occupational asthma risk increases to a specified level while maintaining the baseline influenza risk or if they would prefer to transfer to a healthcare environment where influenza risk increases to a specified level while maintaining their baseline asthma risk. Additional survey questions included information about respiratory symptoms.

Results

As of November 2025, 368 nurses have been recruited. When presented with the option to increase occupational asthma or occupational infection, 88% of nurses chose to increase their influenza risk to maintain their occupational asthma risk. A similar proportion (84%) preferred to increase influenza infection risk for patients over increasing their occupational asthma risk. Nearly half of the participants reported engaging in cleaning and disinfection on an hourly basis, and 44% reported engaging daily. Over half (58%) reported being near cleaning and disinfection activity on an hourly basis. Twenty percent reported ever having trouble breathing continuously or repeatedly. Of those with this trouble, 30% (22/74) reported that this was brought on by their work environment.

Conclusions

The findings to date indicate that nurses prefer to increase their risk of influenza infection, and even that of patients, to avoid increased occupational asthma risk. Nurses reported frequent exposure to cleaning and disinfection products. This work will inform risk assessments for developing guidance for surface cleanliness that balances infectious disease risks from contaminated surfaces and asthma risks from intensified cleaning and disinfection.

This abstract is funded by: National Heart, Lung and Blood Institute