Are Hospital Cleaning Staff at Risk When Using a One-step Cleaner?

Posted on by Brie M. Hawley, PhD


Workers’ health and safety is an important consideration when choosing cleaning and disinfectant products. In health care settings, disinfection products help minimize healthcare-acquired infections.  In January 2015, the National Institute for Occupational Health (NIOSH), received a request to conduct a health hazard evaluation at a Pennsylvania hospital using a new surface cleaning product consisting of hydrogen peroxide (HP), peroxyacetic acid (PAA), and acetic acid (AA).  The request cited concerns about exposure of hospital environmental services staff to the cleaning product and reported symptoms including burning eyes, nose, and throat; cough; headache; asthma exacerbations; and skin burns.  A summary of the NIOSH evaluation was recently published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

The cleaning product is an EPA-registered non-bleach sporicide (kills spores) advertised as a one-step disinfectant cleaner, virucide (destroys viruses), and deodorizer. According to the manufacturer’s safety data sheet, the product requires no personal protective equipment when it is diluted with water by an automated dispenser before use.

As part of the NIOSH response, researchers interviewed 79 (78%) of 101 current environmental services staff about their health. Full-shift, time-weighted average personal air samples were also collected from a convenience sample of 50 workers for measurement of HP, AA, and PAA. Of the 79 interviewees, 68 (86%) reported using the cleaning product.  Among the 68 employees who worked with the product, the most commonly reported health outcomes were watery eyes (46%), nasal problems (41%), asthma-like symptoms (28%), use of allergy medicine (16%), and shortness of breath (16%). A total of 30 (44%) reported at least one work-related health outcome. Most commonly reported work-related symptoms were watery eyes (29%) and nasal problems (22%). Among 10 respondents with self-reported physician-diagnosed asthma, six reported that something at work brought on or worsened their asthma, and three mentioned the cleaning product specifically by name. All air sampling measurements for HP (ranging from 6 parts per billion (ppb) to 511 ppb) and AA (7 ppb–530 ppb) were below their respective occupational exposure limits of 1,000 ppb and 10,000 ppb (2). PAA measurements ranged from 1 ppb to 48 ppb.  No full-shift exposure limit is established for PAA.

To date, few cross-sectional assessments of worker exposure to HP, AA, and PAA in healthcare settings have been performed, despite the use of this product in more than 500 hospitals nationwide. This evaluation found that hospital cleaning staff using a product containing HP, AA, and PAA frequently reported work-related symptoms despite measured exposures that were below established limits for two of the three chemicals for which full-shift exposure limits are established. However, because both HP and PAA are strong oxidants, it is plausible that the mixture of HP and PAA contributed to the symptoms reported by workers, despite low documented levels of exposure. Furthermore, existing exposure limits might not be protective against asthma-like symptoms. The Association of Occupational and Environmental Clinics recently listed this product as an asthmagen in its Exposure Database (4).

How do we protect workers?

Hospitals should be alert for respiratory, skin, and eye symptoms in environmental services staff. Hospital management can implement a reporting system that would permit employees to report work-related symptoms, with the option for employees who do not wish to be identified to remain anonymous. If environmental services staff do report respiratory, skin, and/or eye symptoms, a combination of engineering and administrative controls might be needed to reduce employee exposures. Additionally, although a one-step disinfectant, virucide, and deodorizer might be considered for widespread use in a hospital, the decision to use disinfectants in specific areas of a health care facility should reflect the level of risk of a health care acquired infection. Finally, physicians should be aware of the potential adverse health effects of occupational exposure to cleaning products and disinfectants when evaluating patients with respiratory and skin complaints.

Have you experienced health effects related to the cleaning products you use at work? Tell us how your workplace addressed the situation in the comment section below.

If you or others in your workplace have experienced symptoms related to use of cleaning products or disinfectants and are interested in a NIOSH evaluation you can request information at the HHE website. A health hazard evaluation can help workers and employers learn whether health hazards are present at their workplace.


Brie M. Hawley, PhD

Dr. Hawley is an industrial hygienist in the NIOSH Respiratory Health Division. 


Since this blog was posted the following related reports and articles were published.

Evaluation of exposure to a hydrogen peroxide, peracetic acid, and acetic acid containing cleaning and disinfection product and symptoms in hospital employees.

Evaluation of exposure to a new cleaning and disinfection product and symptoms in hospital employees.

Eye and airway symptoms in hospital staff exposed to a product containing hydrogen peroxide, peracetic acid, and acetic acid – Blackley – 2023 – American Journal of Industrial Medicine – Wiley Online Library

Respiratory Symptoms in Hospital Cleaning Staff Exposed to a Product Containing Hydrogen Peroxide, Peracetic Acid, and Acetic Acid – PubMed (


Posted on by Brie M. Hawley, PhD

46 comments on “Are Hospital Cleaning Staff at Risk When Using a One-step Cleaner?”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Thanks for posting this. I’ve been receiving many complaints about products with these ingredients from our union members in healthcare across the nation, primarily EVS workers. The switch to these products appears to be driven by hospital infection prevention managers. Manufacturer’s representatives claim the products are green and safe. Unfortunately, occupational health staff are not generally consulted to review worker protections.

    My place of employment uses [product name of the specific sporicidal disinfectant cleaner removed]. and I have experienced the burning eyes, chemical burns in mucous membranes with ulcerations in nose with loss of smell and nose bleeds and asthma like symptoms. I was issued the wrong ppe’s and told to avoid the product, work the night shift( because they do not have to use it on nights) or seek employment elsewhere’s. Every exposure seems to get worse which the hospital dr said could/would happen. Currently seeking employment elsewhere and possible legal advice.

    In February of 2014, the ACGIH Board of Directors approved a Short Term Exposure Limit for peroxyacetic acid (PAA) of 0.4 ppm as a 15-minute time-weighted average, although no Permissible Exposure Limit has been set by OSHA. I believe that PAA is the proximate asthmagen. Thanks, LWR

    Your statement: “No exposure limit is established for PAA.” There is a ACGIH 2013 TLV STEL for PAA (peracetic acid-[79-21-0]) at 0.4 ppm inhalation fraction and vapor (IFV).

    Great point. Because we collected full shift, time-weighted average personal exposures, we could not compare these samples to the ACGIH STEL. This sentence has been modified to include the detail that there currently is no full-shift exposure limit established for PAA. We also added the full-shift PAA measurement results which ranged from 1 ppb to 48 ppb.

    Thanks for the feedback!

    During my time as an industrial hygienist for major University based Hospital there was a switch-over from glutaraldehyde high-level disinfectant to PAA/HP/AA product used for endoscope reprocessing. With this switchover we began receiving complaints from employees in multiple re-processing (automated) areas of nasal burning, eye irritation, respiratory irritation, and exacerbation of asthma symptoms in persons with reported history of asthma. We conducted multiple investigation in several of these locations including air monitoring for PAA, HP, and AA. The air monitoring for HP/PAA was performed using filter and sorbent method developed by a French research group. This method is under review by OSHA SLC lab. All our samples results were below occupational exposure limits, including the ACGIH TLV-STEL (0.4ppm) for PAA. During our literature review we noted that PAA is a very potent irritant at considerable lower concentration than HP and AA. From our work it appears that either the sampling/analytical methodology may not adequately quantifying the PAA levels or the recommended OEL is not protective enough. During this time I received report from our industrial hygienist at other healthcare site of similar complaints.

    Nowdays this kind of acid and chemical products must be baned inhospital and goverment and hospital authority must be take some strong action , so that no one have to bother this all. Few months I have visited (name removed) and its really a very nice hospital and the things that made me wonder that in (name removed) for clearing they using some natural herbal cleaner.

    Glad that workers’ experiences have finally been validated. You and others might be interested in the unique toolkit designed to help employers, procurement staff, health and safety committees, and health and safety activists and specialists choose less toxic cleaning products. (I think that microfibre cloths usually can do the job now done by chemicals.)

    “Tools for informed substitution: How do you find safer chemicals for the workplace?” was prepared for a project in British Columbia. With a little local content (e.g., requirements to substitute carcinogens), it’s useful far beyond BC’s borders.

    ChemDAQ Inc. has developed a portable PAA monitoring system called SafeCide that incorporates a small sensor that can be held, worn or placed to detect PAA vapor levels below the ACGIH TLV-STEL (0.4ppm). The sensor connects to a tablet via BlueTooth and collects accurate, real-time PAA exposure data. See details at [].


    I was affected negatively by the product.I ended up with a PE and I now have RADS. And I’m on inhalers I never was on before for the rest of my life.I worked in the OR I was exposed multiple times doing my shift. Ended up in the ER and then the hospital for 6 days.

    This chemical is use at my job as well at hospital in Silver spring , Maryland and as employee that’s a housekeeper inside the operation rooms it’s harsh ! I have fallen on floor while working with this chemical to burning eyes. I don’t understand how a hospital has no care for the employees for using this on daily basics. I understand that it works for all diseases especially C. Diff but there need to be another way keep not only the patients safe but the housekeepers that have to use this product as well.

    Thanks for sharing good information. Your all blogs are very nice and fantastic. I really like your blog about hospital cleaning staff . Thanks for writing this awesome article. I’m a long time reader but I’ve never been compelled to leave a comment. Brilliant job Thank you.

    Cleaning is very important and when you are working in hospital, it becomes more necessary as the health of patients and other workers around depends very much on that. It is very helpful post you are sharing here with us. The hospital cleaning staff should be more concerned about that.

    I am currently going through the process at my hospital due to respiratory issues with [product names of the specific sporicidal disinfectant cleaners removed] that we have started using. I work in Pharmacy and it is used to clean there. I hope they figure out a solution soon! What about patients who have respiratory issues, how is this affecting them?

    I agree! I work with this product at my job and I was not informed of how harsh this chemical would be on me. I have Asthma and since I’ve been exposed to the horrible chemical, my nose run uncontrollably, my face has broken out in rash, my eyes are irritated, some of the patients ask us not to use it because it make them nauseous. Especially the ones with respiratory issues. Even some of the nurses hate it. I’ve been doing my own research and it is very hazardous to health. I hate using it

    I work as an EVS employee and I have recently been doing some research on this product due to several other employees as well as myself complaining of nose bleeds,headaches,eyes burning,runny nose as well as eyes watering and stomach aches. I truly agree that the hospitals need to be cleaned but not at the expense of causing health issues for its workers. Im currently getting statements from my co workers to send to OSHA as well.

    Please let me know how this works out.
    I am fighting a chemical exposure from dialysis clinic

    I work in a hospital pharmacy that has gone to using [name removed], a one-step cleaner composed of HP, PAA, and AA. There has been many complaints of burning eyes, runny noses, skin irritation from accidental contact, and respiratory issues (it even leaves a taste in the back of your throat that is hard to get rid of). My first direct exposure to this product was doing a terminal clean, which took 71/2 hours to complete. We wore gown, gloves, and booties, with either N95 masks or standard hospital issue masks, but no respiratory protection. I suffered all of these symptoms.

    A few months ago, I was cleaning with this product and became dizzy, lightheaded, and weak. I left the area, but progressed to headache and nausea. Long story short, I was sent to a workman’s comp provider, who gave me the choice of either calling someone to take me to the emergency room or going by ambulance, as my pulmonary function was low. I was diagnosed with an unspecified respiratory condition due to chemicals, gases, fumes, and vapors by the workman’s comp provider, and Toxic effect of other specified substances, accidental (unintentional) by the emergency room physician.

    I have since recovered, but it took weeks before the effects of that exposure abated fully. One exposure. This is not a safe product in any way, shape, or form. I agree that cleaning is important for the health of the patients, but not at the expense of the employees health. This product is too dangerous to be used in this manner.

    Addendum : OSHA will not help you, as they claim there is nothing they can do due to the products MSDS claiming it is safe when used as directed (MSDS’s are created by the products manufacturer, who want to sell their product – could there possibly be a conflict of interest there?). Perhaps we should take note of products such as [name removed], an NSAID said to be safe until it was removed from the market due to increased risk of heart attack and death; or [name removed] and [name removed], recalled for cancer risk, or the antidepressants that require a black box warning for increasing suicidal risk. Clearly manufacturers do not know (or reveal, in some cases) all the risks involved with their products, yet they claim they are safe anyway. I can find no long-term studies on the effects of these products (HP, PAA, and AA formulations), which leaves the general public (or at least the ones being forced to use these products) to be guinea pigs. If enough people have serious consequences as a result of this product, then maybe it will be withdrawn from the market, leaving the people complaining about it to deal with their suffering (or worse). At that point, all they will have left is “I told you so” as they contend with the unnecessarily inflicted health consequences of exposure; including potentially having their lives cut tragically short.

    I had worked in a hospital pharmacy for over 7 years. Once I had COVID, my exposure to Peridox became so bad that I was placed on 3 new inhalers, breathing treatments, anxiety meds, and had to go through 6 months of occupational and speech therapy. I was having asthma attacks 2x A day at work to the point I had to use a nebulizer. I had gone off work for close to 6 months and was not allowed to come back unless it was a Peridox free area, which they knew they couldn’t find. I went through work comp first, they ran test and took me off work, when I came back they said its not work comp and the product was safe and I was put on leave since I filed a report after a code
    was almost called on me for someone using it. I had to find a new job. I now can breathe but feel like something needs to be done. It has cost me a lot of money in medical bills, lost wages (only fmla pay received), and mental health. My PTSD has skyrocked . I’ve thought about a lawsuit against the hospital myself on how they handled the situation.

    [Product name of the specific sporicidal disinfectant cleaner removed]!!! Had no training on proper ppe. Our nose burns ,sore throat ,dizziness, skin itching,and yes , now waiting on results of a skin growth !!! finally read the label on bottle,because nobody addressed the warnings on the label. This stuff is toxic,! Now i realize this could be coincidence ,but a coworker recently died of throat cancer and used it daily

    I had have a current chemical exposure to opp and sopp thru [name removed]
    I have swallowing problems lost 70 pounds had been continuously ill I’m sorry to hear about your friend I hope they will eventually do say about this

    I am getting nausea, bloating, and stomach pain every time I’m at work. I began to notice it would get worse when I sat at my computer to chart. That area is constantly wiped with (name removed). I began to place a towel down at my computer before the beginning of my shift. It made the symptoms 90% better. I did notify my manager after several months of dealing with the discomfort at work. She alerted upper management, and they did NOTHING about it. My manager told upper management my complaints maybe exaggerated. However, others had complained as well about the wipes.

    I have never heard of [Product name of the specific sporicidal disinfectant cleaner removed] until tonight when I went into the employee bathroom at the hospital I work at and came out having the most intensive asthma attack, throat burning that I have ever had. I asked the EV supervisor what he used to clean the bathroom and he said [name removed]. I felt nauseous and now my chest hurts. Are there also carcinogens in this product?

    The Safety Data Sheet (SDS) for the product you reference reports that it is a mixture of hydrogen peroxide, acetic acid, and peroxyacetic acid. NIOSH does not list hydrogen peroxide as an occupational carcinogen ( Likewise, acetic acid is not listed by NIOSH as an occupational carcinogen ( NIOSH is presently evaluating the risks from exposure to peroxyacetic acid, also known as peracetic acid, with respect to its properties as a strong sensory irritant ( NIOSH has conducted health hazard evaluations (HHEs) in hospital settings such as the one you describe. We recommend that management tailor the use of sporicidal disinfectants containing hydrogen peroxide, peracetic acid, and acetic acid to areas of high risk for healthcare-acquired infections and minimize the use of sporicidal products on noncritical surfaces and in non-patient areas.; i.e., not for use in cleaning employee rest rooms (

    My mom is a resident at a nursing home that used [product name of the specific sporicidal disinfectant cleaner removed] for a while and intends to bring it back. She says that simply wiping her bed table with the product takes her breath away and makes her eyes water. The staff is very concerned about I’ll effects and does not want to use the product again.

    I work for a local hospital that just started to use [product name of the specific sporicidal disinfectant cleaner removed],at first using lightly coated “wipes” in a closed top canister. The method was deemed too expensive and soon an open topped (like sieve holes) container with cloth “rags” (old wash cloths) was being used. I started with watery eyes,…then a bit of a runny nose, by the third day of use in cleaning patient rooms I was having extreme headaches. One night after work I awoke unable to catch my breath …I called my doctor the next day and he wrote me an excuse to not use this cleaner. My bosses are now trying to push me into using the chemical again….but at this point if I even get a small exposure, the headache comes back at an extreme level. I am fighting this,…but fear I may have to leave a long-term job in the end.

    Others at my hospital (nurses, patients, and EVS workers)are experiencing some or all of these side-effects….but not many are reporting them.

    I complained they told everyone has issues but it’s the best thing for the hospital at the moment because of the high infection rate. No matter how much it harms the staff. I was healthy before I started working there no breathing issues . Now I can’t be around anything without having a full on attack my life and career is destroyed.I can longer work in Surgery 20+ over.

    Yea my to, I started to use this solution and I had headache, chest pain, cough and cougt to be careful that is acid

    I have had a sever case of contact dermatitis since 1/2019 and we just found out that is due to a reaction to the disinfectant [product name of the specific sporicidal disinfectant cleaners removed]. has anyone else had this issue.

    I’ve worked at a hospital for 2 years now and have nothing but problems with the oxicide cleaner we use. They tell me it’s safe but have had lungs problems like pneumonia and bronchitis that lingers on forever. I clean the daycare there and they pour small amounts of bleach down their sinks at night before I wipe them. Could this be the problem? They tell me no

    I have worked in a hospital for a long time . In 2017 we started using [Product name of the specific sporicidal disinfectant cleaner removed]. Like Linda , I have also experienced mucous membranes issues, burning eyes, migraines, it also causes asthma exacerbation, abdominal pain from breathing this in my nose. I was sick for over 2 months , I have to make sure I have my inhaler at all times. My health is very different when I’m not exposed to the solution and not working in the IV room . I was just recently on 2 antibiotics because of it. In the past I also had to be put on 2 rounds of steroids, azithromycin , robitussin dm with codeine . My manager was already aware I had to asthma attacks while using the solution. I applied for Ada accommodations and got denied by my manger. I’m being forced to look for another job . I’m possibly looking into legal advice . The ingredients in this stuff is not safe even though they claim it to be .
    Hydrogen peroxide, peroxyacetic acid , and other ingredients they do not specify.

    I work as an EVS employee and I have recently been doing some research on this product due to several other employees as well as myself complaining of nose bleeds,headaches,eyes burning,runny nose as well as eyes watering and stomach aches. I truly agree that the hospitals need to be cleaned but not at the expense of causing health issues for its workers. Im currently getting statements from my co workers to send to OSHA as well.

    Is this safe for use in a school? Our district uses it in their special needs building on the changing table between pupils, not allowing it to dry, but wiping it dry due to time constraints with the number of students needing to be changed. It’s also used to clean tables, toys, mats, sensory room items, etc.. I have been bothered by it for years and have complained that it makes me cough and aggravates my asthma. I’m told that it is what is recommended and it is approved by OSHA for use in the school. Now I’m told that they plan to use it more frequently throughout the day with students present due to COVID. They do not often follow the guidelines to spray & let dry and now plan to staff spray it on cloths and wipe tables, mats, and even communication device screens and iPad screens.

    A prior NIOSH Health Hazard Evaluation (HHE) at a hospital using a disinfection product containing hydrogen peroxide, peracetic acid, and acetic acid, recommended that their use be minimized outside of direct patient care areas due to the observed adverse health effects, including asthma, from exposure to vapors from the product. Employees applying products containing peracetic acid should be educated on the documented health risks from exposure to hydrogen peroxide, peracetic acid, and acetic acid. When used, they should only be applied using rags and wipes to apply product to surfaces and should not be used as a spray. Careful consideration should be taken before using sporicidal products containing peracetic acid in non-healthcare settings. To reduce the risk of asthma and other health effects related to disinfecting, school cleaning programs should select disinfectant products on list N ( with asthma-safer ingredients (citric acid or lactic acid) as recommended by the US EPA Design for Environment program. For additional information, review the NIOSH/OSHA Infosheet on protecting workers who use cleaning chemicals. A NIOSH Health Hazard Evaluation ( can assist in the investigation of potential health effects related to worker exposures.

    I have worked in EVS over 40 years. I have gotten chemical burns from using oxicide on a daily basis. Even though my employer has provided me with gloves with an extended cuff, my skin has still been burned because the chemical is left on the bed. It seems the health and safety of the employee is over looked in regards to using this dangerous chemical.

    I began losing my voice at work back in 2015 – it took me until 2017 to relate it to the change from [name of peroxygen cleaning product removed] which never caused any issue to [name of one-step peroxygen cleaning product removed]. It was a struggle to have it removed from my work environment. I had several scans of my larynx which was reported as normal. The encounters continued and I would often go home with headache, hoarse voice that would take days to clear and just an overall feeling like I was getting the Flu. In 2018 a co-worker began using a product that produced the similar symptoms. 6 months later it was determined to be a new formula of [company name removed] laundry detergent that leaves an everlasting odor that still lingers 5-10 min after the person using it leaves. I have had encounters like this with 5 people since then. Forward to April 20, 2021: went in for acute gall bladder surgery-The hospital is filled with [names of one-step peroxygen cleaning product removed] on every corner – no one seems to understand what you mean when you say you are allergic to the stuff. When the anesthetist went to insert his tubes, he found a mangled larynx – 2 anesthetists and 5 attempts finally got the tubes down. He told me after that if this 5th attempt had not been successful, the surgery would have been cancelled (not exactly an real option with the stones in the duct and the pancreas already having been inflamed) or to do a trachea.
    I believe that this product and whatever [company name removed] is putting in some of their new everlasting stinky laundry detergents is causing a great deal of harm. The hospital seems to have no policy – and although I have had it removed from my immediate work place, the COVID thing has really shown that there are no policies in place for someone like me.
    We use [name of peroxygen cleaning product removed] in my immediate workplace – never have a reaction – the kill time is equal to [name of one-step peroxygen cleaning product removed] – the hospital does not understand that if you clean the break room or bathroom the evening before with [names of one-step peroxygen cleaning product removed], that I will still have a reaction the next day. In the ambulance going to the hospital, the wristband was placed indicating allergy: [name of one-step peroxygen cleaning product removed]. But my reaction already had begun the moment I was put in the ambulance because it is cleaned with [name of one-step peroxygen cleaning product removed]. The unit I was on was cleaned with [name of one-step peroxygen cleaning product removed] – the next morning I asked the cleaner to stop cleaning my room with these cleaners. The following day: same story. Finally on day 3 the cleaner came in and when I asked she immediately went and changed the cleaner and by 8 pm that night my pounding headache had lifted. I was told I needed exercise and to walk the unit but on every corner of the unit was a container of [name of one-step peroxygen cleaning product removed]. How do you walk the unit? I asked for an N95 but was told the unit did not have any. I did have one N95 in my purse and used it to try to walk but since I already was in so much pain, my breathing was too shallow to support wearing but for a very short time.
    From what I understand that if I every need surgery again, that the chances are very high that I will need a trachea…… Saddens me that no one seems to care!

    very great blog and also we have to appreciate the cleaners also. thank you for sharing such a nice blog.

    As a pharmacy tech in a oncology clinic, we have to do daily cleaning and monthly with this product. I had to stop helping with Monthly cleaning because every time I did it my eyes would get red and crying and had like a burning sensation in my eyes and face. I used carb on, wear n-95 mask, googles , and a carp, but this items didn’t help. Our facility is still using this product because we are consider hazardous that needs this product to deactivate.

    I brought up my concerns with the sporicidal we use for cleaning once a month. I get eye burning and lung burning. We are a home infusion company with clean room, compounding of IV bags and syringes. I was told it comes with the job. Period

    Thank you for your comment. The recommendations in this blog or in the following Health Hazard Evaluations Reports might be helpful to you.
    Evaluation of exposure to a hydrogen peroxide, peracetic acid, and acetic acid containing cleaning and disinfection product and symptoms in hospital employees.

    Evaluation of exposure to a new cleaning and disinfection product and symptoms in hospital employees.

    We also published two journal articles
    Eye and airway symptoms in hospital staff exposed to a product containing hydrogen peroxide, peracetic acid, and acetic acid – Blackley – 2023 – American Journal of Industrial Medicine – Wiley Online Library

    Respiratory Symptoms in Hospital Cleaning Staff Exposed to a Product Containing Hydrogen Peroxide, Peracetic Acid, and Acetic Acid – PubMed (

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