ArticleAnnals of work exposures and health2026
Clean with chlorine: peak and short-term occupational exposure to airborne chlorine dioxide during hospital disinfection.
Article in Annals of work exposures and health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
This study assessed occupational exposure to airborne chlorine dioxide (ClO2) during routine hospital disinfection using a rinsing bottle and textile cloth. Sixty-three personal measurements (>108 h) were collected in operating rooms, patient rooms, and a bed-disinfection unit using direct-reading electrochemical sensors. Exposures were summarized as 8-h time-weighted averages (TWA-8h); fractions of time above 0.1 and 0.3 ppm; and 10 s, 60 s, and 15 min moving averages. TWA-8h exposures were generally below the Norwegian OEL-8h of 0.1 ppm. In contrast, short-term peak exposures were frequent and substantial: all tasks had at least one exceedance of 0.1 ppm on 10 s moving averages (Norwegian recommended reference period), and 78% of measured tasks exceeded 0.1 ppm on 60 s moving averages (German reference period). Peaks above 1.09 ppm (the instrument's upper reporting limit) occurred in 59% of tasks. Peaks above 0.3 ppm were typical across all task types, with the highest short-term exposures during disinfection of patient rooms and operating rooms, especially in periods of intensified activity during infectious outbreaks such as COVID-19. Individual work practices contributed to additional variability. The relatively long response time of the electrochemical sensor (t90 up to ∼160 s) likely led to underestimation of true peak magnitudes. Our findings add to emerging evidence that disinfectant use in healthcare is associated with acute respiratory symptoms, and that TWA-8h poorly capture short-term peak exposures. Together, these results underscore the need for revised safety protocols; re-evaluation of exposure limits and the definition of a ceiling value; improved sensor strategies; and clearer operational guidance on how ceiling/STEL metrics (including averaging time) should be applied, to ensure accurate monitoring and assessment for rapidly acting irritants (such as ClO2) in real-world hospital settings.
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