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April 27, 2008

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Health and safety for cleaning staff

The people who clean our workplaces make our working lives easier and more pleasant but, laments Dr Chris Ide, precious little attention is paid to the many work-related hazards and risks they face.

For a long time, cleaners tended to be typecast as Mrs Mop, whose catchphrase “Can I do you now, sir?’ is probably only familiar now to long-retired readers who can remember the Second World War radio comedy show, ‘ITMA’ (‘It’s That Man Again’) with Tommy Handley! More recently, the work of cleaners has been promoted by the TV programme ‘How clean is your house?’ in which the redoubtable presenters Kim and Aggie visit a householder who has allowed years of grime to build up in their home, and transform it from a filthy hovel into a sparkling palace.

Cleaning is generally regarded as a task carried out by women. The Labour Force Survey (LFS) tells us that, of the 537,000 employed in cleaning, almost 84 per cent are female, and about 70 per cent are part-time. Men sometimes undertake cleaning duties as well, but tend to be employed as window and street-cleaners, or refuse collectors. According to the LFS, the 61,000 involved in these three tasks are exclusively male and almost entirely full-time employees, although there is a substantial proportion of self-employment among window cleaners.1

Another TV programme, ‘A life of grime’, drew attention to some of the rather more unpleasant aspects of the work of environmental health officers, under whose direction street and refuse collectors sometimes work. The health hazards of accumulated dirt are often pointed out, but they tend to relate to the well-being of the householder and family; the hazards presented to the cleaners themselves are rarely, if ever, mentioned.

Over the years I – and many others – have written about the occupational health and safety needs of various groups of workers but, so far, no one has paid much attention to cleaners – although in 2005, Zock wrote a wide-ranging review.2 It may be a case of ‘out of sight, out of mind’, since cleaners often do their work once other employees have gone home.

Ways and means

The purpose of cleaning is not only to ensure that premises are attractive places in which to live and work but also to help maintain buildings, furniture and equipment by removing dirt, etc. and reporting defects. The most common ways of removing dust and grime are dusting, sweeping, and wiping with cloths, brushes and mops. All of this requires quite a high expenditure of energy, although tasks may be mechanised by using such equipment as buffers and vacuum cleaners. Chemical agents can also remove surface contaminants by breaking down deposits of minerals, fats and other complexes and rendering them soluble.

Alternatively, or additionally, cleaning materials may be used to improve the appearance of the surface or object by making it smell more pleasant, disinfecting it, or giving it a shine. The combination of the environment or location that needs to be cleaned, and the chemicals, tools and techniques used to carry this out can present to the cleaning workers involved a wide variety of hazards, which need to be assessed by those who deploy the staff. The cleaners themselves must also receive appropriate training to ensure they understand the nature of these hazards, and the steps they need to take to protect themselves.

Hazards and risks

Physical hazards faced by cleaners may include the need to move bulky furniture to gain access to all areas to be cleaned. Heavy equipment, such as buffing or steam-cleaning machines, may require manual handling, while the machines themselves can expose the workers to noise and vibration hazards, particularly if the equipment is old, or poorly maintained. The plethora of mops, brushes and brooms used by many cleaners can place heavy static loads on their bones and joints, and force them to adopt awkward postures. This, in turn, may give rise to low-back and neck pain and other musculoskeletal disorders, such as work-related upper limb disorders, affecting the shoulders, elbows and wrists, particularly if the task involves lengthy periods of frequent repetitive movements and/or hard gripping, squeezing, or wringing.

The aforementioned chemical agents widely used in cleaning also need to be considered. Any harmful effects will depend on the chemical properties of the substance, and how it is applied. Water is very commonly used and seems innocuous enough but it can make the skin ‘soggy’, something we’ll all have noticed after a long soak in the bath. These effects can be worsened by the use of detergents, which exert a defatting action on the skin. The end result is to reduce the effectiveness of the skin as a barrier, making it easier for the skin to be irritated and/or penetrated by other agents. Many common cleaning chemicals, such as ammonia and bleach, are irritants, while others, which have a very acidic or alkaline pH, are caustic.

Some substances, such as disinfectants, may contain quaternary ammonium compounds and give rise to sensitisation and allergic reactions, although irritant dermatitis, in which the skin becomes reddened, sore and itchy, is more common. Skin problems commonly present in general practice, but it is difficult to determine the extent to which these problems can be attributed to occupation, since many of the substances used are to be found for the same purposes in the home.

However, for some years, the University of Manchester has been running a series of reporting schemes for various occupational diseases and, in 2000, a report was published, which combined the experience of consultant dermatologists with an interest in work-related skin disease, and occupational physicians.

During the six years or so during which data was collected, the annual incidence of contact dermatitis was 12.9 per 100,000 workers. As well as being more common in young women, it also appeared to hit more men as they got older. About 13 per cent were due to soaps and cleaning agents, and 11 per cent to wet work.3 The highest rates in women were found among those employed in catering and laboratory work, hairdressing, and nursing. Meanwhile, a Dutch survey identified wet work as the most likely source of skin problems in cleaners.4

Studies demonstrate that cleaners are more likely to be troubled by runny noses, cough and breathlessness.5 Cleaners often use materials that are sprayed on to the surfaces to be cleaned, using atomiser sprays or aerosols. The fine droplet sprays that these devices produce can generate particles tiny enough to be swept into the depths of the lungs, giving rise to coughs, sneezes, wheezing and runny noses, which can result from irritant effects and sensitisation. Zock and others demonstrated this phenomenon quite convincingly with regard to cleaning in the home environment, showing that the frequency of symptoms rose in parallel with increasing use.6, 7

Even taking into account the effects of smoking, the women who have these symptoms are more likely to be exposed to cleaning agents, particularly bleaches. The most dramatic way in which respiratory harm can arise occurs when chlorine-containing bleaches are mixed with materials containing phosphoric acid and other acid compounds found in toilet cleaners. This could result in the rapid evolution of substantial quantities of gases such as chlorine8 and chloramines,9 which may reach high concentrations in confined spaces and thus give rise to serious persistent lung damage.

Respiratory problems arise from the inhalation of volatile compounds or gases. Alcohols and glycol ethers can evaporate, irritating the eyes and upper airways, and sufficient quantities can be absorbed via the lungs to cause systemic poisoning. While this consequence is most unlikely, at much lower doses glycol ethers may be involved in reduced fertility, possibly through the mechanism of hormone disruption,10 as well as some types of birth defects, such as cleft palate and hare lip. (Note: The authors of these, and other, studies and reviews often urge caution in drawing conclusions from the results because of the small numbers involved and difficulty determining precise exposures.)11, 12

While it is sometimes unpleasant, general cleaning work is unlikely to threaten cleaners with serious infectious disease.

However, cleaners in health-care premises are at risk of needlestick and ‘sharps’ injuries, and thus may be exposed to blood-borne infections, such as hepatitis B, C, and HIV. A course of hepatitis B vaccination, with subsequent checks that immunity has been attained, is essential in this group. Some of these health problems may be reportable under the terms of the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations.

Other issues to consider

To more prosaic matters: if the cleaners are required to work at height, then safe means of access should be provided, such as good step ladders, or ‘kick stools’; they should not have to teeter on chairs, for example. A lot of window cleaners seem to be abandoning ladders for water-filled poles, which enable the worker to remain with their feet on the ground. Others use cherry-pickers, aerial ladder platforms, and scissor lifts to help them meet the requirements of the Working at Height Regulations.

However, technological sophistication comes at a price – the need for proper training, and maintenance of the equipment. This applies just as much to traditional equipment – ladders should not have broken rungs, for example. Appropriate, comfortable clothing is also a ‘must’, particularly for those who are working outdoors in cold and/or wet weather.

One group that might find itself facing particular problems is home helps, usually employed by local authorities. Their duties may include other housekeeping tasks and shopping, as well as cleaning. Furthermore, since they are entering private homes, they may face the hazards of passive smoking. To make things worse, the people for whom these (usually) ladies are working may, with the best intentions, attempt to deodorise their homes with a deodorant aerosol. I have seen at least two cleaners thus afflicted.

Lone-working is also an issue. As previously mentioned, cleaners often go about their work while other employees are at home, i.e. during the night, or early mornings. Thus they often have to work with little or no heating, ventilation, or air conditioning, which is usually turned down or off outside ‘normal’ working hours. In addition, cleaners often work in very small groups or even alone, and so are more vulnerable to harassment.

Since cleaning is regarded as a rather lowly job, which is relatively poorly paid, it often recruits those with low levels of educational attainment. Immigrants also form a large proportion of the cleaning community. Consequently, employers must give particular thought to organising appropriate training, covering such things as safe working techniques. There is the danger that such workers can lull themselves into a false sense of security, since they are working with supplies that may resemble those used in their own homes, only to be put into harm’s way because larger quantities have to be used, or the materials are at “industrial-strength”.

If an organisation employs its cleaners directly, and deploys them exclusively in premises that it controls, then it is much easier for the health and safety practitioner to keep an eye on how the work is being done, and to identify potential shortcomings. The situation becomes more difficult when cleaners are sub-contracted to work in ‘third-party’ premises. Reputable cleaning firms will do their best to adhere to the letter and spirit of the law, and closely liaise with their clients to ensure that the cleaning needs are met while minimising hazards to the domestics. However, this is less likely to happen with firms who recruit via a postcard in a newsagent’s window.

Steps must also be taken to ensure that the cleaners know exactly what they should clean, and leave alone, as well as where they obtain power for their equipment. I suspect that the stories of soaring death rates in Intensive Care Units being attributed to the ‘domestic’ unplugging the life-support machine in order to plug in the vacuum cleaner are more likely the stuff of urban myth, although there may be a grain of truth in them!

This article has concentrated on potential problems affecting a mainly female workforce, whose conditions of employment, etc. may be less than ideal. While it is not the role of the health and safety practitioner to take up cudgels on behalf of these employees’ pay and conditions (at least during working hours), if they apply established skills, then they are likely to improve the quality of working life of another group of workers who make our lives a lot easier and more pleasant than they might otherwise be.


1 Download government statistics

2 Zock, JP (2005): ‘World at work: cleaners’, in Occupational and Environmental Medicine 2005, 62;8:581-84

3 Cherry N, Meyer JD, Adisesh A, Brooke R, Owen-Smith V, Swales C, Beck MH (2000): ‘Surveillance of occupational skin disease: EPIDERM and OPRA’, in Brit J Dermatol 2000, 142;6:1128-34

4 Jungbauer FH, Van der Harst JJ, Schuttelaar ML, Groothoff JW, Coenraads PJ (2004): ‘Characteristics of wet work in the cleaning industry’ in Contact Dermatitis 2004, 51;3:131-34

5 Medina-Ramon M, Zock JP, Kogenvinas M, Sunyer J, Torralba Y, Borrel A, Burgos F, Anton JM (2005): ‘Asthma, chronic bronchitis and exposure to irritant agents in occupational domestic cleaning: a nested case-control study’, in Occup Environ Med 2005, 62;9:598-606

6 Zock P, Plana E, Jarvis D, Anto JM, Kromhout H, Kennedy SM, Kunzli N et al (2007): ‘The use of household cleaning sprays and adult asthma: an international longitudinal study’, in Am J Respir & Critical Care Medicine 2007, 176;8:731-32

7 Jaakkola JJ, Jaakkola MS (2006): ‘Professional cleaning and asthma’, in Curr Opin Allergy Clin Immunol 2006, 6;2:85-90

8 Centres for Disease Control (1991): ‘Chlorine gas toxicity from mixture of bleach with other cleaning products, California’, in JAMA 1991; 226:2529-34

9 Tanen DA, Graeme KA, Raschke R (1999): ‘Severe lung injury after exposure to chloramines gas from household cleaners’, in N Engl J Med 1999; 341:848-9

10 Sallmen M, Lindbohm ML, Kyyronrn P, Nykyri E, Antilla A, Taskinen H, Hemminki K (1995): ‘Reduced fertility among women exposed to organic solvents’, in Am J Ind Med 1995, 27;5:699-713

11 Chevrier C, Dananche B, Bahuau M, Nelva A, Herman C, Francannet C, Robert-Ganancia E, Cordier S (2006): ‘Occupational exposure to organic solvent mixtures during pregnancy and the risk of non-syndromic oral clefts’, in Occup Environ Med 2006, 63;9:617-23

12 Thulstrup AM, Bonde JP (2006): ‘Maternal occupational exposure and birth defects’, in Occup Med 2006, 56;8:532-43

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15 years ago

Cleaning staff- Clean forgotten