| By Mohamed Daya, M.D., and David B. Chandler,
PhD. Most commercial cleaning products if used as
directed by the manufacturer's labels should not produce any significant health effects.
However, a number of these products have the potential to produce a variety of adverse
health effects if used improperly (incorrect dilution or application) or if mixed with
other cleaning agents.
One of the most common is bleach. The active
ingredient in most products containing bleach is sodium hypochlorite in concentrations
ranging from 3 percent to 6 percent (with a pH level up to 11.0).
Some bleach solutions may also contain silicate (15
percent to 17 percent) and sodium carbonate (60 percent) and have a pH of 10.5. Bleaching
agents are effective because they react with atmospheric carbon dioxide to produce
hypochlorous acid, which chemically decomposes to produce oxygen free radicals.
Oxygen free radicals are believed to be responsible
for the bleaching and disinfecting activity as well as the toxic effects associated with
these compounds.
Health Effects
Symptoms following exposure to bleach will depend
on the volume, viscosity, pH, concentration, and duration of contact. As an oxidizing
agent, sodium hypochlorite is corrosive to tissue. Solutions containing less than 6
percent sodium hypochlorite will cause significant injury only after prolonged or
extensive exposure.
However, concentrated solutions can produce more
severe tissue injury with less-extensive exposure. Skin or eye exposure produces local
burning and irritation. Inhaling sodium hypochlorite fumes may lead to sore throat, cough,
wheezing, shortness of breath, and pulmonary edema (fluid in the lungs).
Ingesting household bleach can cause oral,
esophageal and gastric burns as well as produce nausea, vomiting, diarrhea and abdominal
pain.
Acid-Containing Products
Toilet bowl cleaners contain various concentrations
of corrosive agents, including such compounds as sulfuric acid (80 percent), hydrochloric
acid (10 percent to 25 percent), oxalic acid (2 percent) or sodium bisulfate (70 percent
to 100 percent).
Other acid-containing products which are corrosive
in nature include drain cleaners (sulfuric acid or sodium hydroxide), metal cleaners and
anti-rust compounds (hydrofluoric, phosphoric, oxalic, hydrochloric, sulfuric or chromic
acids). The cleaning properties associated with these products are thought to stem from
the corrosive nature of these compounds.
Symptoms following exposure to any of them will
depend on the route, concentration and duration of contact. Acids produce their corrosive
effects by directly damaging the surface layers of tissues. Except for hydrofluoric acid,
the surface injury produced by acids prevents further penetration of the skin, limiting
the extent of injury.
Effects to the skin following exposure can range
from reddening and swelling to blister formation and overt skin destruction. Eye exposure
may result in burning, pain, redness and corneal damage.
Inhaling acid fumes can cause sore throat,
coughing, wheezing and shortness of breath. Severe exposure can lead to pulmonary edema,
although this is not likely to occur with most household cleaning products.
Ingestion can lead to severe oral, esophageal
and/or gastric burns, nausea, vomiting and abdominal pain.
Ammoniated Products
Ammonia-based cleaning products are also frequently
used in commercial settings. These products are classified as alkaline (caustic) and
contain from 3 percent to 10 percent ammonium hydroxide.
Other alkaline cleaning products include drain
cleaners (sodium hydroxide), automatic dishwashing detergents (sodium tripolyphosphate,
sodium metasilicate, sodium silicate, sodium carbonate) and oven cleaners (sodium
hydroxide). The caustic nature of these compounds is thought to account for their cleaning
properties.
The clinical effects from exposure to caustic
compounds will depend on the concentration and the amount of contact. Alkaline agents
directly damage tissues.
But unlike acid solutions, alkaline solutions have
the potential for more serious tissue damage because their ability to solubilize skin fats
and proteins lets them penetrate more deeply.
Skin contact with an alkaline solution will produce
a soapy feel and result in severe pain, blister formation, and tissue destruction. Eye
exposure may bring burning, pain, redness and severe corneal injury.
Inhaling ammonia or other alkaline fumes will
produce burning pain in the nose, mouth, throat and chest. More severe exposure can cause
hoarseness, coughing and difficulty in breathing. Ingestion can lead to severe oral,
esophageal and/or gastric burns, nausea, vomiting and abdominal pain.
Mixing Cleaning Products
While casual exposure to any of these products can
be dangerous, exposure to a combination of them can be deadly. In an attempt to make
cleaning products work better and faster, workers have been known to mix multiple cleaning
agents. But indiscriminate mixing of products can lead to the release of toxic gases.
For example, if bleach is mixed with an
acid-containing toilet bowl cleaner, the result will be the release of deadly chlorine
gas. If bleach is mixed with an ammonia-based cleaning agent, harmful chloramine gas --
both monochloramine and dichloramine -- will be generated.
The amount of damage depends on how much was
inhaled -- and for how long. Chlorine gas reacts with water-containing tissues (eyes,
mouth and lungs) to produce hypochlorous acid and oxygen free radicals.
Exposure to low concentrations of chlorine -- 1 to
10 parts per million (ppm) -- may cause burning of the eyes, sore throat and cough. Higher
concentrations (30 to 50 ppm) can lead to more severe coughing, shortness of breath,
wheezing and pulmonary edema. If chlorine vapors become trapped in clothes, they can cause
skin injury.
Anyone exposed to chlorine gas should be moved
quickly to fresh air. This must be done cautiously to avoid exposing to rescuers to the
fumes.
Individuals with significant skin exposure should
have their clothes removed and skin washed thoroughly. In most instances, symptoms will
disappear once the exposure ends. Persistent symptoms need to be further evaluated.
Chloramine Exposure
Similarly, when chloramine gas contacts the mucous
membranes, it forms hypochlorous acid and oxygen free radicals -- potent oxidizing agents
-- that produce direct injury to whatever tissue they contact. Because chloramine cannot
be washed away as easily as chlorine, it can cause more serious damage.
Cleaning in confined spaces such as restrooms in
the presence of chloramine gas can result in cough, sore throat, wheezing and pulmonary
edema. Those exposed to the gas should be removed and treated like victims of chlorine gas
exposure.
Most commercial cleaning products contain low
concentrations of bleach, corrosives or caustic substances and are not likely to be health
hazards if used properly. However, the mixing of bleach with acid- or ammonia-containing
cleaning products can be fatal. Workers should be warned and discouraged from mixing any
cleaning products.
Mohamed Daya, M.D., is medical director and David
B. Chandler, H.D, is director of Chemical and Risk Information System at the Oregon
Health Sciences University in Portland, OR.
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