# Occupational Health Effects of Chlorine Spraying in Healthcare Workers: A Systematic Review and Meta-Analysis of Alternative Disinfectants and Application Methods

## TL;DR

This study reviews the health risks of chlorine spraying for healthcare workers and finds it increases respiratory issues, suggesting safer alternatives and better protection.

## Contribution

The paper provides a systematic review and meta-analysis comparing chlorine-based disinfectants and application methods with alternatives in healthcare settings.

## Key findings

- Chlorine-based products significantly increase respiratory condition risk (OR 1.71).
- Spraying is associated with higher respiratory risk compared to other methods (OR 2.25).
- Moderate-certainty evidence supports safer disinfectants and protective measures over banning methods.

## Abstract

Chlorine spraying was widely used during filovirus outbreaks, but concerns about occupational health risks led to a shift toward wiping. This systematic review aimed to evaluate the health risks associated with exposure to disinfectants among healthcare workers (HCWs), with a specific focus on chlorine-based products and spraying compared to alternative disinfectants and general disinfection tasks (GDTs). PubMed, Embase, and Scopus were searched from inception to March 2025. Eligible studies included observational or experimental research on HCWs exposed to chemical disinfectants. Two reviewers independently screened studies, assessed the risk of bias using a validated occupational health tool, and evaluated evidence certainty with the GRADE approach. Meta-analyses used fixed- and random-effects models; heterogeneity was assessed with I2 statistics. Out of 7154 records, 29 studies were included. Most studies were cross-sectional with a high bias risk. Odds ratios (ORs) were calculated using non-exposed groups as reference. Significant associations with respiratory conditions were found for chlorine-based products (OR 1.71), glutaraldehyde (OR 1.44), spraying (OR 2.25), and GDTs (OR 2.20). Exposure to chlorine-based products, glutaraldehyde, spraying, and GDTs likely increases respiratory risk in HCWs, as supported by moderate-certainty evidence. These findings support prioritizing safer disinfectants and strengthening protective measures over banning specific application methods.