Person wearing gloves and a mask while cleaning elevator buttons

Improving Health: Lessons from the Pandemic

Use of disinfectants increased drastically during the COVID-19 pandemic – in the workplace, at home and in the community.

While disinfectants effectively destroy infectious microorganisms on objects and surfaces, they contain hazardous chemicals that can cause health problems like asthma, skin and eye irritation, and even organ damage. 

Soo-Jeong Lee, PhD, RN, FAAOHN, associate professor, is examining the impact of COVID-19 on the use of disinfectants and associated health effects among hospital cleaning staff – a group on the frontline of workplace disinfectant exposure. 

From how disinfectants affect people’s health to policy changes that made it easier for people with substance use disorders to get treatment, UCSF School of Nursing experts are studying the pandemic’s impact and drawing from the lessons learned in order to improve health.

The Impact of the Pandemic on Disinfectant Use and Workers’ Health

Lee surveyed 256 cleaning staff across the UCSF campus and its medical centers on their disinfectant use in the workplace, at home and in the community, use of protective equipment and health symptoms since the onset of the pandemic. She also collected fecal and urine samples from 43% of respondents – a factor that makes her study unique. 

“Few studies have used biological measures to assess human exposure to quaternary ammonium compounds (QACs) – the most common active ingredients used in disinfectants approved for coronavirus control,” explains Lee. 

She hopes that the biospecimen study findings – for which she collaborates with Libin Xu, PhD, associate professor, University of Washington, for analysis – will address the gap in data about QACs’ impact on human health. 

Soo-Jeong Lee, PhD, RN, FAAOHN
Soo-Jeong Lee, PhD, RN, FAAOHN

“This data will allow us to quantify worker’s exposure and assess health risks so we can design appropriate interventions that will improve employee safety,” explains Lee. Her recommendations include using safer cleaning products and educating employees on the health risks of disinfectants and safe practices. 

Lee is also analyzing data from the California Pesticides Illness Surveillance Program to determine how the pandemic impacted incidence rates of disinfectant-related illnesses in California. 

“The data will provide a more complete picture of the impact of COVID-19 on disinfectant-related illnesses from both occupational and non-occupational exposures,” says Lee.  

Pandemic-Related Work Stressors Tied to Psychological Distress

Oi Saeng Hong, PhD, RN, FAAN, professor, is also studying the impact of COVID-19 on California’s workforce — with a focus on job stress.

In collaboration with colleagues from the University of California, Los Angeles, Hong helped conduct the first study to examine associations of COVID-related work stressors with psychological distress among different racial and ethnic groups in California. 

The study, based on data from the California Health Interview Survey 2020, found that individuals with one or more work stressors – defined as job loss, reduced work hours or working from home which can cause stress due to the lack of social interaction or the need to take care of young children – had higher psychological distress. Further, distress was higher for racial and ethnic minority groups, particularly among Black participants. 

Oi Saeng Hong, PhD, RN, FAAN
Oi Saeng Hong, PhD, RN, FAAN

“Our findings confirmed what we already hypothesized: that the impact of the pandemic is more pronounced for marginalized populations,” says Hong. 

Based on these findings, Hong’s recommendations are two-fold: invest in health care safety net resources like Medi-Cal, free or low-cost health clinics and county hospitals so that all individuals can access care regardless of their ability to pay, and advocate for policy changes to ensure that all California workers receive health coverage. “We must advance policies that reduce health disparities,” she explains.

The project was also a reminder of the value of interdisciplinary collaboration and mentorship, says Hong. The research team, led by Timothy Matthews, PhD candidate, included environmental health scientists, health policy experts and nurse scientists from the National Institute for Occupational Health and Safety’s Southern and Northern California education and research centers

“Collaboration across disciplines is essential to improve the health of those most impacted by COVID-19,” says Hong.  

Pandemic Policy Changes Improve Access to Substance Use Disorder Treatment

Opioid-related overdoses in the United States increased significantly during the pandemic. 

Buprenorphine is a medication that is effective in reducing the risk of opioid overdose. Historically, clinicians were required to obtain a waiver from the Drug Enforcement Administration (DEA) and complete specialized training before they were eligible to prescribe buprenorphine. 

During the pandemic, federal and state regulations were relaxed to make it easier for clinicians to prescribe buprenorphine and combat the opioid crisis. Changes included increased use of telehealth and the ability for clinicians to treat 30 or fewer patients without additional training. 

Joanne Spetz, PhD, FAAN, professor, led a study to examine the number of clinicians with DEA waivers before and during the pandemic. “We were curious about the pandemic-related easing of federal policies for treating opiate use disorder and how that relates to the number of waivers that were obtained before and during the pandemic,” says Matt Tierney, MS, NP, FAAN, professor, who worked with Spetz on the study. 

Their study found that although the number of new clinicians applying for waivers to prescribe buprenorphine slowed during the pandemic, many of the clinicians that already held waivers increased the number of patients they were eligible to treat. Ultimately, treatment became more accessible.  

Matt Tierney, MS, NP, FAAN

With the continued rise in opioid overdoses, the team recommends that pandemic-focused policies like relaxing of training requirements and the expansion of telehealth should be extended to increase access to opioid use disorder treatment. 

And they are not the only ones advocating for policy changes based on lessons from the pandemic. In December 2022, the U.S. passed the Consolidated Appropriations Act which allows clinicians that hold a DEA certificate and are eligible to prescribe controlled substances to also prescribe buprenorphine for substance use disorder. The waiver is no longer required. 

“The pandemic altered health care delivery in the U.S. forever,” says Tierney. “Pandemic-related policy changes led to improved continuity of care. We must continue to build on that progress.” 

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